Herbal Medicine AKAPULKO English name: Acapulco, ringworm bush Scientific name: Cassia alata L.

L. Family: Leguminosae Akapulko or bayabas-bayabasan contains chrysophanic acid, a fungicide used to treat fungal infections, like ringworms, scabies and eczema. Akapulko also contains saponin, a laxative that is useful in expelling intestinal parasites. The extracts from the plant is commonly used as an ingredient for lotions, soaps and shampoos. Uses of Akapulko: Treatment of skin diseases:Tinea infections, insect bites, ringworms, eczema, scabies and itchiness.  Internal: Expectorant for bronchitis and dyspnoea, mouthwash in stomatitis, alleviation of asthma symptoms, used as diuretic and purgative, for cough & fever, as a laxative to expel intestinal parasites and other stomach problems. A strong decoction of the leaves is an abortifacient. Preparation Pound fresh, mature leaves Apply extracted juice on affected area of the skin 1-2 times a day For people sensitive (allergic) to extracted juice, make decoction 1. Boil 1 glass of chopped leaves with 2 glasses of water under low fire for 15 minutes without cover 2. Wash the affected area of skin 1-2 times aday AMPALAYA English name: Bitter gourd, bitter melon Scientific name: Momordica charantia Family Cucurbitaceae DESCRIPTION Vine, with flower and fruit bearing Vegetables family, the leaves and fruit can be eaten Contains a mixture of flavanoids and alkaloids make the Pancreas produce more insulin that controls the blood sugar in diabetics. Good source of vitamins A, B and C, iron, folic acid, phosphorous and calcium. Uses of Ampalaya: Good for rheumatism and gout And diseases of the spleen and liver Aids in lowering blood sugar levels Helps in lowering blood pressure Relives headaches Disinfects and heals wounds & burns Can be used as a cough & fever remedy Treatment of intestinal worms, diarrhea Helps prevent some types of cancer 

Enhances immune system to fight infection Is an antioxidant, parasiticide, antibacterial & antipyretic PREPARATION Wash the leaves and cut into small pieces Boil 2 glasses of chopped leaves, add 4 glasses of water, let it boil for 15 mins. in low fire without cover Set aside to cool then strain Drink 1/3 glass of decoction 30 mins. Before meal 3 x a day Sprouted leaves can be eaten, steamed or cooked on top of boiled rice, glass 2x a day BAWANG English name: Garlic Scientific name: Allium sativum Family: Liliaceae DESECRIPTION Cloves used as spice Elongated leaves with flower Uses of Bawang: Good for the heart Helps lower bad cholesterol levels (LDL) Aids in lowering blood pressure Remedy for arteriosclerosis May help prevent certain types of cancer Boosts immune system to fight infection With antioxidant properties Cough and cold remedy Relives sore throat, toothache Aids in the treatment of tuberculosis With anticoagulant properties PREPARATION Fry in a small amount or without oil Broil the cloves Soak in vinegar for 30 minutes Blanch in boiling water for 5 minutes Eat 2-3 cloves 3 x a day after meal BAYABAS English Name: Guava Scientific name: Psidium guajava Family: Myrtaceae DESCRIPTION Bayabas or guava is a small tree, 3 5 meters tall with greenish-brownish smooth bark. The round globular bayabas fruit starts as a flower and is usually harvested and eaten while still green. The fruit turns yellowish-green and soft when ripe. The bark and leaves can be used as astringent. The use of the leaves is for cleaning and disinfecting wounds by rinsing the afflicted area with a decoction of the leaves. The fruit, aside form being delicious, contains a very high concentration of vitamin C.

DESCRIPTION Bayabas or guava is a small tree, 3 5 meters tall with greenish-brownish smooth bark. The round globular bayabas fruit starts as a flower and is usually harvested and eaten while still green. The fruit turns yellowish-green and soft when ripe. The bark and leaves can be used as astringent. The use of the leaves is for cleaning and disinfecting wounds by rinsing the afflicted area with a decoction of the leaves. The fruit, aside form being delicious, contains a very high concentration of vitamin C. Uses of Bayabas: Antiseptic, astringent & anthelminthic Kills bacteria and fungi Treat diarrhea in children Hypertension, diabetes and Asthma Promotes menstruation Toothache PREPARATION Wash the leaves and chop into pieces Boil 2 glasses of chopped leaves with 4 glasses of water Boil for 15 minutes in low fire without cover Set aside to cool then strain Wound treatment: Wash the wound 2x a day Mouth wash: Luke warm decoction LAGUNDI English Name: Chaste tree Scientific name: Vitex negundo L. Family: Verbenaceae DESCRIPTION Shrub, 5 meters high It is one of the ten herbal medicines endorsed by the Philippine DOH as an effective herbal medicine with proven therapeutic value. Uses of Lagundi Relief of asthma & pharyngitis Relief of rheumatism, dyspepsia, boils, diarrhea Treatment of cough, colds, fever and flu and other bronchopulmonary disorders Alleviate symptoms of Chicken Pox Removal of worms, and boils PREPARATION Wash the leaves and chop or cut into pieces Measure 2 glasses of water and 1 glass of chopped fresh leaves Boil under low fire for 15 minutes without cover Set aside to cool then strain Cough and Asthma: 1/3 glass 3 x a day Fever: 1/3 glass every 4 hours SAMBONG English Name: Blumea camphora Scientific name: Blumea balsamifera

Family: Compositae DESCRIPTION Shrub, 3 meters high Uses of Sambong Diuretic agent Effective in the dissolving kidney stones For hypertension & rheumatism Treatment of colds & fever Anti-diarrheic & Anti-gastralgic properties Helps remove worms, boils Treats dysentery, sore throat PREPARATION Wash the leaves and chop or cut in small pieces Measure 2 glasses of water and 1 glass chopped leaves Boil under low fire for 15 mins. Without cover Set aside to cool then strain 1/3 glass 3x a day TSAANG-GUBAT English Name: Wild tea Scientific name: Ehretia microphylla Lam. Family: Boraginaceae DESCRIPTION: Shrub, 5 meters high Has small and shiny leaves Uses of Tsaang-Gubat Stomach pains Gastroenteritis Intestinal motility Dysentery Diarrhoea or LBM Mouth gargle Body cleanser/wash PREPARATION Wash the leaves and chop or cut in small pieces Measure 2 glasses of water and 1 glass chopped leaves Boil under low fire for 15 mins. Without cover Set aside to cool then strain 1/2 glass every 4 hours ULASIMANG BATO English Name: Peperomia Scientific name: Peperomia pellucida Linn. Family: Piperaceae DESCRIPTION A variety of grass with heart-shaped leaves Use of Pansit-pansitan Arthritis Gout Skin boils, abscesses, pimples Headache Abdominal pains kidney problems

PREPARATION Wash 1 glass fresh mature leaves Add pinch of salt and pepper to taste Divide into 3 parts and consume in the morning, at noon and at night DECOCTION Wash the leaves and cut into small pieces Boil 2 glasses of chopped leaves with 4 glasses of water, let it boil for 15 mins. Under low fire without cover Cool then strain Drink 1/3 glass 3x a day after meal YERBA BUENA English Name: Peppermint Scientific name: Mentha cordifolia  Family: Labiatae DESCRIPTION Vine with mint aroma Green four-sided leaves Uses of Yerba Buena : Arthritis Head aches Tooth aches Mouth wash Relief of intestinal gas Stomach aches Indigestion Drink as tea for general good health PREPARATION Wash the leaves and chop or cut in small pieces Measure 2 glasses of water and 1 glass chopped leaves Boil under low fire for 15 mins. Without cover Set aside to cool then strain Body pain/ache: 1/3 glass 3x a day Pounded fresh leaves can be applied directly on the location of the pain NIYUG-NIYOGAN English Name: Chinese honey suckle, Burma Creeper, Liane Vermifuge, Rangoon Scientific name: Quisqualis indica L. Family: Combretaceae DESCRIPTION Vine, up to 8 meters high Has red, rose and white flowers Nuts (fruit) bearing Seeds that taste like coconut Uses of Niyug-Niyogan Antihelminthic: Dried seeds preferable for deworming Diarrhea and fever: Roasted seeds Skin diseases: Pounded leaves externally Dysuria: Decoction of boiled leaves PREPARATION Used only matured seeds, dried and newly cracked nut

Consume seeds 2 hours after meal If the first dose has no effect, repeat the same dose after one week Nutrition and Diet  Science that deals with the process by which components of food are made available for an organism for meeting energy requirements, building and maintaining and in more general terms, for maintaining the organism in an optimum function state.  Two Groups of FoodsMicronutrients include vitamins and some elements. These are consumed in small amounts and are absorbed unchanged.  Macronutrients include carbohydrates, fats and proteins, which on digestion are converted to glucose, fatty acids, glycerol, peptides and amino acids I. CARBOHYDRATES  prime importance in the diet  Food sources: Starches (Plain cooked rice, maize, bihon, puto); root crops (camote, cassava, gabi, potato);fruits; sugar; vegetable (upo, beets, carrots, patani, batao)  providing the major source of energy intake (40-80% of total energy intake in different country and total energy intake for Filipinos) for work and development because of the following reasons. Reasons 1. Carbohydrates are readily available being widely distributed in a variety of easily grown plants such as grains, vegetables and fruits 2. The cost in the total food budget is relatively small 3. Provides quick and sustained body fuel from rapid oxidation of starches and sugars yielding the needed body heat and energy with CO2 and water as end products Carbohydrates  RDA: 55-70% of TCA  Energy yield: 4kcal/g II. FATS Food Source:  Saturated fatty acids animal source like meat, eggs, milk fat  Unsaturated fatty acids plant source like vegetable oil (olive oil, peanuts, almonds, avocado oil) A. Functions  Containing source of fuel for the body to store and burn as needed for energy  Like carbohydrates, fat spares protein from being used for energy  Dietary vehicle for vitamins A, D, E and K  Controls body temperature  Protections against injury  RDA: 20-30%  Energy yield: 9 kcal/g III. PROTEINS D. Food source:  Animal foods: fish, meat, poultry, and other internal organs, seafoods (crabs, shrimps, shellfish)

Plant foods: dried beans, mongo, soybean, garbanzos, peanuts, beans, nuts, rice and bread  From the Greek word proteius meaning of primary importance  Are large complex molecules that made up 20% of our body weight muscles, bone, cartilage, skin, and other tissues TYPES OF PROTEINS 1. Antibodies 2. Contractile proteins 3. Enzymes 4. Hormonal proteins 5. Structural Proteins 6. Storage Proteins and Transport proteins Functions of Proteins:  Contributing to enzymes activity that promotes chemical reactions in the body  Transporting substances around the body  Keeping fluids and pH balance in the body  Serving as building blocks for hormone production  Helping blood clot  Promoting antibody activity that controls immune and allergy functions IV. VITAMINS  They are classified as fat-soluble (ADEK) and water-soluble (Vitamins B and C)  Needed by the only in small amount Signs and symptoms in adult patients Sign and Symptoms General: Wasted, skinny (especially temporal muscles) Abdomen Distension and Hepatomegaly Extremities: Edema Decubitus ulcer, poor wound healing Bone tenderness Bone ache, joint pain Muscle wasting and weakness Muscle tenderness, muscle pain Possible Nutrient Deficiency Protein calorie

Flaking dermatitis, scaling

Protein, Calories, Niacin, Riboflavin, Zinc, Vitamin A Vitamin C, K, Fatty acids Niacin, protein-calorie

Bruising purpura Pigmentation changes, desquamation of semi exposed areas Signs and symptoms in infant patients Sign and Symptoms

Possible Nutrient Deficiency

Stunting, washing, lethargy, poor appetite, weight loss

Energy, protein, folic acid, Vitamin B12, Vitamin C, Vitamin D, Zinc, Calcium, Iron Vitamin A, Vitamin C, Zinc

Poor wound healing, impaired resistance to infection Anemia

Vitamin A, Folic acid, Vitamin B12, Iron Carbohydrates

Hypoglycemia, ketosis

Xerophthalmia

Vitamin A

Rickets

Vitamin D, Calcium

Brain damage, mental retardation, hypothyroidism Protein calorie Hyperparathyroidism Protein, thiamine Sensitivity to cold, changes to finger-nails, hair or tongue

Iodine

Calcium

Iron

Protein, Vitamin C, Zinc Vitamin D Vitamin C Protein , calorie, Vitamin D Thiamine

Table of Vitamins Vitamins Source Function Deficienc y, Overdosa ge and Toxicity level Night blindness Headache , skin disease 10 mg RD A

Sign and Symptoms Skin Pallor Follicular hyperkeratosis Perifollicular petechiae (especially after raised venous pressure)

Possible Nutrient Deficiency Folate, iron, vitamin B12 Vitamin A (Retinol) Liver, eggs, milk, crab, fat, cheese, dilis, malunggay, kamote tops, Healthy skin, bone and teeth developm ent, healthy

Vitamins A and C Vitamin C

500 0 I.U.

kangkong, saluyot, carrots, squash Vitamin D (Calciferol) Manufacture d by the body through direct sunlight or UV rays. Liver fish oils, egg yolk

hair, good vision and reproducti on Bone growth and developm ent; helps in the absorption of calcium and phosphoru s Rickets, muscle spasm Loss of appetite, nausea, vomiting, excessive thirst, increased urination, nervousn ess and hypertens ion RBC hemolysis , bleeding problems, eye problems, difficulty in walking, nervous system disorders, double vision, muscles weakness 1g Hemorrha ge Kernicteru s 500 mg Vitamin B12 (Cyanocobala min) Helps in the nervous system function. May also help in the release of energy Pernicious anemia, beriberi 1.5 mg 400 I.U. Vitamin B2 (Riboflavin)

egg s yolk

from absorbed carbohydr ates For protein metabolis m. Helps the body release energy from food Chapped lips, cracked mucous membran es at the side of the mouth 1.7 mg

Dried mushrooms, malunggay, seaweed, powdered milk, liver, heart, kidney, lean meat, shellfish, quail eggs Peanuts, peanut butter, rice polishing, whole wheat bread, mushrooms, dried Saffron flowers(kasu bha), sesame seeds, powdered coffee and tea Dried yeast, liver, organ meats, whole grain cereals, fish, legumes

Vitamin B3 (NIACIN)

Vitamin E (Tocopherol)

Vegetable oils, egg yolks, whole grain cereals, wheat germ, green vegetables, nuts, and seeds, margarine

An antioxidan ts. Helps form red blood cells

30 I.U.

For nervous and digestive system functions; helps release energy from food; controls blood cholestero l Helps in nitrogen metabolis m

Pellagra characteri zed by dermatitis , diarrhea and inflammat ion of the mucous membran e 100 mg

20 mg

Vitamin B6 (pyridoxine)

Vitamin K

Leafy vegetables, alfalfa leaves, spinach, carrot tops, tomatoes, pork, liver vegetable oils Whole grain, cereals and dried beans, lean pork and beef, liver, heart, kidney, fish and shellfish and duck

Formation of clotting factors

Convulsio n among infants, anemia, skin diseases, nerve problems Nerve problems 500 mg Pernicious anemia

2 mg

Vitamin B1 (Thiamine)

Meats, liver, whole grain cereals, corn, soybeans, peanuts and green leafy vegetables

Helps from red blood cells, metabolize d nutrients and function of nervous system Helps form red blood cells

6 ug

Folic acid (folate)

Green leafy vegetables, root vegetables,

Blood disorders

400 ug

lean beef, liver, kidney, dairy products and yeast Vitamin C (ascorbic acid) Citrus fruits, tomatoes, potatoes, cabbage, green peppers Helps promote growth, bone and teeth developm ent. Also help in the repair of tissues and increase resistance to infection Scurvy 60 mg

certain type of anemia Copper Banana, peas, whole wheat, prunes, oysters, shellfish Assists the body in iron utilization; helps built hemoglobin in the blood; takes part in ascorbic acid metabolism and aids use of fatty acid Helps regulate the rate of energy production and body weight and promotes proper growth. It also promotes healthy hair, nails, skin and teeth Helps form red blood cells and transport of oxygen in the blood and muscles

emaciation (thinness) Anemia, anorexia, edema and retarded growth 10 mg 1-2 mg

Iodine

Onions, seafood, meat, eggs

Hypothyroidis m, goiter, and related growth 2000 mcg

120 150 ug

Table of Minerals Vitamins Source Function Deficiency, Overdosage and Toxicity level Hypocalcemia , muscle spasm Hypercalcemi a, kidney problems, difficulty in urination 2000 mg RD A

Calcium

Dairy products, milk and milk products, fish, meat, eggs, cereal products, beans, fruits, leafy vegetable s Yeast, nuts, mushroo ms, asparagus , meat, chicken, Meat, kidney, liver, milk, oysters, clams

Helps in the bone and teeth formation. Helps in muscles contraction and blood clotting

100 0 mg Iron Red meat, liver, kidney, beans, peas and lentils, dried apricots and figs, cocoa, bread and cereal products Dried figs, dried apricots, lemon, almonds, corn, nuts, seeds, vegetable s, fruits

Anemia, decreased mental alertness

18 mg

Chromium

Takes part in glucose metabolism and helps in carbohydrat e and fat utilization Essential components of cobalamin that helps treat a

Impaired action of insulin and low blood glucose level

50200 ug Magnesiu m

Cobalt

Poor growth and appetite, listlessness (lack of energy) and progressive

8 ug

Aids in regulation of body processes like normal heart rhythm and in normal functioning of body enzymes

Irritability, abnormal heart rhythm, emotional tension, depression, and muscular weakness

270 320 mg

Manganes e

Nuts, leafy vegetable s, beets, peas, whole grain cereals, egg yolks, tea

Essential constituent of bone structure; vital in reproductio n and normal functioning of the nervous system Active role in enzymatic actions of the body

Skeletal abnormality

2.57 mg

Selenium

Wheat germ, tomatoes, onions, broccoli, garlic, eggs, seafood, liver, kidney

Molybden um

Green leafy vegetable s, lentils, milk, whole grains, potatoes, peas, liver Milk, cheese, meat, poultry, fish, cereals, nut, legumes

Poor growth and slowing down of body activities

150 500 mg

Phosphoru s

Helps in the proper developmen t of bones and teeth. Facilitates quick release of energy for muscle contraction. Transports fatty acids. Prevents rickets Vital for muscle contraction, nerve impulses and proper functioning of heart and kidneys. Helps regulate blood pressure and water balance in cells

Stunted growth and defective structure of teeth and bones in young children Impaired of iron and calcium utilization and bone erosion

800 mg Sodium Shellfish, meats, eggs, table salt

Pert of certain enzymes that act as antioxidants which help fight cell damage; helps prevent particular type of protein calories malnutrition ; enhances proper immune response; and aids proper functioning of heart muscle Necessary for maintaining fluid balance. Transports nutrients across cell membranes Helps the body use protein and carbohydrat es; vital for growth and developmen t; synthesis of cell protein (DNA and RNA formation); and proper functioning of the immune system

Selenium deficiency is rare in human

785 ug

14 g

950 266 0 mg

Zinc

Potassium

Abundant in all foods, fresh fruits and vegetable s, including potatoes, meat, wholemeal flour, cereals, milk, coffee, tea

Muscular weakness, increase in nervous irritability, mental disorientation , and cardiac irregularities Heart block 18g

950 266 0 mg

Wheat germ, yeast, pumpkin seeds, lentils, corn, eggs, dry milk, nuts, oysters, steak, lamb chops

Growth failure, impaired wound healing, impaired sense of taste and smell, and sexual infantilism in teenagers 150 mg

1216 mg

V. Minerals  Needed by the body to function properly

Some minerals are needed in large doses ( calcium, iron, etc.) while others may be taken in small amounts (copper, magnesium, manganese, phosphorus, selenium, iodine, sodium, potassium, zinc, etc.) VI. WATER  Makes up about 60% of an adult s body weight. Requirements for water are met in many ways. Most fruits are more than 90% water  Takes an active part in many chemical reactions and is needed to carry other nutrients, to regulate body temperature, and to help eliminates wastes Factors affecting BMR  Body size  Sex  Body temperature  Growth  Age  Pregnancy and lactation  Specific Dynamic Action or thermal effect of food  Body composition  State of Nutrition  Climate  Hormone secretions  Sleep  Physical or muscular activity ADULTS Body Mass Index (BMI)  It is the number that shows body weight adjusted for height.  BMI can be calculated with simple math using inches and pounds, or meters and kilograms.  For adults aged 20 years or older, BMI fall into one of these categories: underweight, normal, overweight, or obese For adults aged 20 years or older, BMI fall into one of these categories:  Underweight  Normal  Overweight  obese BMI

40 or more

Morbidly Obese

DESIRABLE BODY WEIGHT (DBW) DETERMINATION  The DBW, and not the actual weight of the individual is used as the basis in the calculation of TER or TCA.  It can be determined by:   a. Height-weight tables of FNRI b. Modified Tannhausers method in the absence of heightweight tables DBW(kg) = (height in cm - 100) - (10%[ht in cm 100])

c. NADP Formula  Males 5ft 112 lbs 4 lbs for every inches above (below) 5ft  Female 5ft 106 lbs 4 lbs for every inches above (below) 5ft Interpretation  Obese if body weight is more than 20% above the desirable weight  Overweight if the weight is >10%-20% above the desirable weight  Normal if the weight is 10% of the desirable body weight  Underweight if the weight is >10% below the desirable weight An underweight  Physical Signs a. adipose tissue lacking b. muscles are flabby c. skin and bones  Possible complications a. Kwashiorkor b. Marasmus Overweight  Hazards/Concerns  Changes in normal body functions  Risk of developing diseases  Increases risk during surgeries  Lowers general fitness of a person  Physical, Social and Economical implications DETERMINATION OF TOTAL ENERGY REQUIRMENT (TER) OR TOTAL CALORIC ALLOWANCE (TCA)  Factorial Method TCA or TER = BMR + PA + SDA Basal Metabolic Rate (BMR)  Minimum amount of energy needed to maintain the vital process of life under basal condition  1 kcal/kg of body weight/hour  Correction for sleep: deduct 0.5 kcal/kg BW/hr  BMR = 1 kcal/kg x DBW x 24 hrs Physical Activity (PA)  Hospital patient - 10%  Sedentary - 30%

Interpretation BMI Below 15 15 - 18.5 18.5 - 24.9 25.0 - 29.9 30.0 - 39.9

Weight status Emaciated Underweight Normal Overweight Obese

Light - clerks, typist (50%) Moderate - housewives,shoemaker,jeepney drivers,students, fishermen (75%)  Heavy construction workers (100%) PA = BMR x % physical activity classification

 

NADP b. NADP method TCA/TER= DBW x 40= 50 x 40= 2226 Special Considerations

Thermogenic effect of blood (Specific Dynamic Action or SDA)  The energy required for digestion, absorption, transport, and utilization of food  SDA = (BMR + PA) x 0.6 adult ( 12 y/o)  0.15 child (<12 y/o)

NADP method (National Asso. Of Developmental Pediatrics) TCA = DBW x 40  To lose in 1-2 (lbs)/week, subtract 500 kcal daily from the calculated TCA respectively and conversely add same amount of kcal to gain 1-2 lb/week NADP Recommendation  NADP Recommendation for overweight/obese adult 1. Compute allowance base on DBW and subtract 500kcal/day 2. If only moderately overweight, recommend exercise and avoidance of fats and sugar Example EXAMPLE COMPUTATION FOR DBW, TCA AND DISTRIBUTION of the TCA into CARBOHYDRATES, PROTEINS AND FATS  Filipino female, moderately active adult, 5 ft 1 inch (155cm) weighing 130 lbs (59kg) classify the nutritional status of your patient.  Compute for the dietary intake needed to loose or gain 2 lbs/week if adjusted intake for carbohydrates is 60%, proteins is 10% and fats is 30%.  1. DBW a. Modified Tannhauser Method DBW (kg) = (height in cm -100) (10%[height in cm-100]) = (155-100) (55 x 0.1) = 50 kg NADP Method b. NADP method Female 5 ft 106 lbs 1 inch 4 lbs 110 lbs (50 kg) Actual weight DBW x 100 Actual weight 59kg 50kg x 100 = 15% 59 kg ***59 kg is between 10-20% above the DBW of kg = overweight TCA/TER = BMR +PA+SDA a. Factorial method BMR = 1 kcal/kg x DBW x 24 hrs = 1 x 50 x 24 = 1200 kcal PA = BMR x % activity = 1200 x 0.75 = 900 kcal SDA = (BMR + PA) x 0.06 = 2100 x 0.06 =126 kcal 2226 kcal

PEDIATRICS 1. Waterlow Classification for Wasting  Computation: Actual weight Ideal weight for actual length or height x 100 =___%  Classification: Normal >90% Mild 80-90% Moderate 70-80% Severe <70% 2. Waterlow Classification for Stunting Computation: Actual height or length Ideal height or length for age x 100 =___% Classification: Normal Mild Moderate Severe 90-95% 80-90 <80% >95%

PROTEIN-ENERGY MALNUTRITION MARASMUS *Balanced starvation *Very low in both protein and calories *Caused by insufficient KWASHIORKOR *Very low in protein, but one in which contains calories in the form of carbohydrates

intake of milk

A. Usual age B. Essential features 1. Edema 2. Wasting

0-2 y/o

1-3 y/o

None Gross loss all skin and bones Obvious Obvious Usually apathetic, quiet

Lower legs, sometimes face or generalized Sometimes hidden; sometimes fat Sometimes hidden Sometimes hidden Usually irritable, moaning, also apathetic

3. Muscle wasting 4. Growth retardation 5. Mental changes C. Variable features 1. Appetite 2. Diarrhea 3. Skin changes 4. Hair changes

Usually good Often (past or present) Seldom

Usually poor Often (past or present) Occasional flaky paint or enamel dermatosis Often sparse, straight, silky, dyspigmentation; gray or reddish Often Always

Seldom

5. Moonface 6. Hepatic enlargement

Seldom Seldom

PHARMACOTHERAPY  application of drugs in the prevention, treatment or diagnosis of disease and their use in purposeful alteration of normal functions  division of Pharmacy which correlates pharmacodynamics with the pathologic physiology or microbiologic or biochemical aspect of disease  Pharmacokinetics- The study of the absorption, distribution, metabolism, and excretion of drugs by living organisms.  Pharmacodynamics- The study of the biochemical and physiologic mechanisms of drug action. Drugs  chemical substances that have an effect on living organisms.  Therapeutic drugs often called medicines, are those drugs used in the prevention or treatment of diseases. Up until a

few decades ago, dried plants were the greatest source of medicines; thus the word drug was applied to the Drug vs Medicine  Drug any substance that alters physiologic function w/potential for affecting health  Medicine drug administered for therapeutic effects All medications are drugs Not all drugs are medications Sources of Drugs  Drugs are obtained from many sources.  Many inorganic materials, such as metals, are chemotherapeutic; hormones, alkaloids, vaccines, and antibiotics come from living organisms;  Other drugs are synthetic or semisynthetic.  Synthetics are often more effective and less toxic than the naturally obtained substances and are easier to prepare in standardized units.  Plants - digitalis and opium  Animals - insulin and thyroid  Minerals or mineral products - potassium, chloride, and lithium carbonate  Synthetic chemical compounds - barbiturates, sulfonamides, and aspirin.  Biotechnology - genetically engineered pharmaceutical products Drug Nomenclature  Drugs used as therapeutic agents may be conveniently divided into two main groups: (1) nonprescription drugs (2) prescription drugs Drug Names: Chemical Name  exactly the chemical constitution of the drug and the exact placing of its atoms or molecular groupings.  chemical name composition of the drug by its molecular structure  Example: acetylsalicylic acid Generic Name (Nonproprietary Name)  provided by the United States Adopted Names (USAN) Council  Is equivalent to the same drug with a brand name, but is less expensive  Example: Aspirin Drug Name: Official Name  name under which the drug is listed by the U.S. Food and Drug Administration (FDA).  FDA- empowered by Federal Law to name drugs for human use in the U.S. Trademark (Brand Name)  followed by the symbol . This indicates that the name is registered and that its use is restricted to the owner of the drug, who is usually the manufacturer of the product.  Consistent bioavailability, more easily recognized by appearance.  Example: Bayer

Drug Classifications  Drugs may be classified according to the body system they affect May be classified by their therapeutic use or clinical indications Ex. Antacids, Antibiotics, Antihypertensive, Diuretics, Laxatives May be classified using the physiologic or chemical action May be classified as prescription or non-prescription drugs Drug Classification Indicates  Effect on a body system  Symptoms relieved  Desired effect Classification of Drugs  Antineoplastic Agents  Cardiac Muscle Drugs  Diuretics  Antihistamines  Anti-Infective Agents Antifungal Antibiotics  Anti-Inflammatory Agents -Steroids -Non-steroidal Agents  Joint Drugs  Blood Coagulants  Anticoagulants  Hemorrheologic Agents  Dental Agents  Ears, Eyes and Nose Vasoconstrictors  GI Enzyme and Acid Agents  Gastrointestinal Muscle Movement Agents  Genitourinary Muscle Relaxants  Glaucoma Agents  Adrenal agents  Glucocorticoids  Mineralocorticoids  Pituitary Agents  Reproductive Agents  Thyroid Agents  Nervous System Adrenergic Agents (Sympathomimetic)  Nervous System Anticonvulsants, Sedatives & Hypnotics  Tranquilizers  Nervous System Cholinergic and Anticholinergic Agents  Nervous System Skeletal Muscle Relaxants  Nervous System Stimulants  Pain Agents -also known as Analgesics  Respiratory Antitussives, Expectorants, and Mucolytics  Respiratory Smooth Muscle Relaxants  Serums, Toxoids, & Vaccines  Skin & Mucous Membrane Agents and Enzymes

 Vitamins and Caloric Agents Non-Prescription Drugs  over the counter medications (OTC) which can be purchased by anyone.  No Rx needed  Examples: Tylenol, Maalox, Tums Illegal Drugs  Illegal drugs- recreational drugs  Drugs and chemical substances used for non-therapeutic purposes  Obtained illegally or have not received approval for use by the FDA Sources of Drug Standards  United States Pharmacopoeia USP verifies the identity, strength, purity, and quality of dietary supplement finished products, dietary supplement ingredients, and pharmaceutical ingredients. A National Formulary  a manual containing a list of medicines that are approved for prescription throughout the country, indicating which products are interchangeable. USP Dictionary of USAN and International Drug Names  database contains more established drug name listings than any other comparable resource. Drug Standards Ensure  Strength or potency  Purity  Efficacy  Safety  Bio-availability Standards of Practice  Information for Administering Medications Generic Name/Trade Name/Classification Clinical Uses/Safe Dosage Mechanism of Action Side Effects/Adverse Effects Contraindications/Precautions Significant Drug Interactions Monitoring Needs/Patient Education Evaluation of Effectiveness Pharmaceutical Dosage Forms  Drug substances are seldom administered alone, but rather as a part of a formulation in combination with one or more no medical agents that serve varied and specialized pharmaceutical functions. Types of Dosage Forms  Syrups  Elixirs  Suspensions  Emulsions  Capsules  Tablets  Creams  Ointments  Suppositories  Aerosols

 Parenteral Introduction to Drug Dosage Prescription  comes from the Latin "praescriptus" compounded from "prae", before + scribere, to write = to write before.  Historically, a prescription was written before the drug was prepared and administered. Parts of a prescription  The superscription (or heading) with the symbol R or Rx which stands for the word Recipe, meaning (in Latin) to take;

biochemical physiological mechanisms by which the chemical produces a response in living organisms Three Phases of Action

The inscription which contains the names and quantities of the ingredients;  The subscription or directions for compounding the drug  The signature which is often preceded by the sign s. standing for signa, mark, giving the directions to be marked on the container. Administration of Medications Route of administration  the path by which a drug, fluid, poison or other substance is brought into contact with the body.  Mode of drug administration affects the rate at which onset of action occurs and may affect the therapeutic response that results  crucial in determining the suitability of a drug  Enteral - drug administered along any portion of GI tract  Sublingual, Oral, Buccal, Rectal, Nasogastric  Parenteral - any med route other than alimentary canal  IV, IM, ID, SQ, Instillation, Inhalation, Topical, Transdermal, Drug Action

The Rx 

First Pass Effect  Drugs given orally and absorbed from GI tract  Carried to the liver  Extensively metabolized  Only part of the dose reaches systemic circulation for distribution  Bioavailability -%of drug that reaches systemic circulation  First pass/hepatic first pass  Enter liver first  Coumadin  Morphine  Lidocaine  Some NTGs Drug Effects  Therapeutic effects (primary)  Side effects (secondary)  Adverse effects (secondary)  Toxic effects (secondary)  Desired effect  Therapeutic effect-example  Adverse effect / Side effect  Harmful, undesirable response  Mild reactions to debilitating disease that can become chronic  Dose related or patient sensitivity  Drug allergy - patient s immune system identifies a drug as dangerous to the body .must be destroyed or neutralized-mild itching to life threatening Adverse drug reactions  any noxious unintended and undesired effects of a drug that occur at doses used for prevention, diagnosis or treatment. ADR  Type A reactions  AUGMENTED  Predictable, common and related to pharmacological action of the drug ex. Side effects, secondary effects, drug interaction  Type B reactions  BIZAARE  Unpredictable, uncommon, usually not related to the pharmacological actions of the drug. ex. Idiosyncratic reaction, pseudoallergenic, hypersensitivity  Type C reactions  CONTINUOUS  associated with long-term drug therapy e.g. Benzodiazepine dependence and Analgesic nephropathy.  are well known and can be anticipated.

Type D reactions DELAYED refer to carcinogenic and teratogenic effects. are delayed in onset and are very rare since extensive mutagenicity and carcinogenicity studies are done before drug is licensed.  Type E reactions  ENDING OF USE  Withdrawal syndromes  Alcohol (delirium tremens)  Barbiturates (restlessness, mental confusion, convulsions  Opioids (narcotic withdrawal)  Type F reactions  FAILURE OF EFFICACY  Result of imperfect or counterfeit manufacture of the product.  Examples of failed efficacy:  Failure to control infection  Uncontrolled HPN  Intractable pain  Idiosyncratic response Something out of the ordinary Sensitivity related adverse reactions . Specific to the individual patient Sometimes has genetic cause They don t know Idiosyncratic Reactions vs. Allergic Reactions     idiosyncratic reaction--an uncharacteristic, nonimmunological response to a drug that is not related to its pharmacological actions  allergic or hypersensitivity reaction --immunologically mediated Toxic Reactions --Occur in response to high dose or long-term use but may occur with normal doses if drug elimination is impaired. --May cause organ dysfunction, blood disorders (physiological toxicity) or behavioral changes (behavioral toxicity). Toxicity vs. Carcinogenicity  Toxicity--something that will make you sick, either right away or later.  Carcinogencity--will cause cancer, which maybe the results of being exposed to something toxic. Allergic Reactions vs. Non-allergic drug reactions  In a drug allergy, your immune system mistakes a medication for a disease-causing agent.  Nonallergic drug reactions have a wide variety of causes, including the drug's intended mechanism of action. Allergic Reactions  Indicated by skin reactions ranging from mild rashes to flaming red patches of hives.  More severe reactions cause facial swelling, shortness of breath or dizziness. 

Anaphylaxis (rare)--an extremely severe allergic reaction in which blood pressure may fall rapidly and the throat may rapidly swell shut, cutting off the airway. Hypersensitivity  allergic response to a drug after it has been used more than once  May cause rash, swelling, fever, or, in the worst cases, anaphylactic shock (hypotension, bronchospasm, blocking or airways). Carcinogencity  study to determine the propensity of a drug to produce or exacerbate tumors or cancer cells in humans or animals Teratogenicity  study to determine whether a drug can cause physical defects in a developing embryo. Common or Serious Side Effects  CNS effects  Gastrointestinal effects  Hematological effects  Hepatotoxicity  Nephrotoxicity  Allergic or hypersensitivity reaction  Drug fever  Idiosyncratic reaction  Carcinogenicity  Teratogenicity  Drug dependence  Drug tolerance Sources of Drug Information  Pharmacology textbook  Pharmacists  Internet sources  Journal articles  Drug reference books TRADITIONAL AND ALTERNATIVE MEDICINE Traditional medicine/TM y refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being. y The term describes medical knowledge systems, which developed over centuries within various societies before the era of modern medicine y Traditional medicines: y Herbal medicine y Ayurvedic medicine y Unani medicine y Acupuncture y Traditional Chinese medicine Herbal Medicine y folk and traditional medicinal practice based on the use of plants and plant extracts. Traditional Medicine y A SHAMAN decorates himself and performs a special dance to cast out the evil spirits that make people ill

General Overview of Herbal Medicine y History y The practice has existed since prehistoric times and flourishes today as the primary form of medicine for perhaps as much as 80% of the world's population. y Types y Herbal teas y Herbal tinctures y Fluid extracts y Solid extracts y Powdered herbs and tablets y Herbal ointments y Essential oils y Herbal supplements y Filipino Practice of Herbal Medicine y The curative effects of the herbs were tested by traditional healers on their patient on try-anderror basis. y The rural folks and the poor continued to rely on herbal medicines available in abundance, locally. Ayurveda y Ayurvedic medicine is a practice in use primarily in the Indian subcontinent, which advocates argue assists with health and healing. A person is seen as a unique individual made up of 5 primary elements y Air, fire, water, ether, and earth y Ether and air = Vata dosha y Fire and water = Pitta dosha y Water and earth = Kapha dosha y The word "Ayurveda" is a tatpurusha compound of yus "long life" and veda "knowledge", and roughly translates as the "Science of a long life" Unani y They considered something to be fire, water, earth and air in the human body y Unani medicine is very close to Ayurveda. y The base used in Unani medicine is often honey. Background of Unani Medicine y According to followers of Unani medicine, these elements (fire, water, earth, air) are present in different fluids and their balance leads to health and their imbalance leads to illness. Acupuncture y is a technique of inserting and manipulating needles into "acupuncture points" on the body. Background Of Acupuncture y (from Lat. acus, "needle" (noun), and pungere, "prick" (verb) y According to acupunctural teachings this will restore health and well-being, and is particularly good at treating pain. Chinese Medicine y a form of Oriental medicine, which includes other traditional East Asian medical systems such as traditional Japanese and Korean medicine.

These practices include herbal medicine, acupuncture, and massage Advantage of traditional medicine it s affordable it s abundant easier to prepare recovery process beyond the management of emotional and cognitive impairment by also enhancing social interaction, spirituality, and self-functioning easy access or handy Disadvantage of traditional medicine the amount of medication is not accurate there are other substance present in the medication which you don t need there is more adverse/side effect they work more slowly than the more aggressive pharmaceutical and surgical medicine there is undesirable taste can cause allergies some can cause infection can be the cause of instant death WHO efforts in promoting safe, effective and affordable traditional medicine World Health Organization WHO defines Traditional Medicine as "the medicine that refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being". World Health Organization launched its first ever comprehensive traditional medicine strategy in 2002 The strategy is designed to assist countries to: y Develop national policies on the evaluation and regulation of TM/CAM practices. y Create a stronger evidence base on the safety, efficacy and quality of the TAM/CAM products and practices; y Ensure availability and affordability of TM/CAM including essential herbal medicines; y Promote therapeutically sound use of TM/CAM by providers and consumers. y Document traditional medicines and remedies. Standards and quality control y The legal status of herbal ingredients varies by country. For example, Ayurvedic herbal products may contain levels of heavy metals that are considered unsafe in the U.S.,but heavy metals are considered therapeutic in Ayurvedic medicine. What is Alternative Medicine? y Alternative medicine is a broad term that refers to any type of treatment that is not yet accepted as customary. y Alternative medicine practices are used instead of standard medical treatments. y Alternative medicine broadly describes methods and practices used in place of conventional medical treatments. y

It may also be described as "diagnosis, treatment, or therapy which can be provided legally by persons who are not licensed to diagnose and treat illness" Contemporary uses of alternative medicines. y acupuncture, y aromatherapy, y Ayurveda (Ayurvedic medicine), y biofeedback, y chiropractic medicine, y herbalism y holistic nursing, y homeopathy, y hypnosis, y massage therapy, y meditation, y naturopathy, y osteopathic manipulative therapy (OMT), y reflexology, y Reiki, y spiritual healing, y Tai Chi, y traditional Chinese Medicine (TCM), and y yoga. Aromatherapy y Essential oils form the basis of aromatherapy y Extracted by means of steam distillation, cold expression, or fixed oil or alcohol extraction y Oils can be inhaled, massaged onto the body, added to the bath or shower, or sprayed in the room. y Most of the oils have antiseptic, antiviral, antiinflammatory, pain relieving, anti-depressant and expectorant property Chiropractic y The word chiropractic came from the Greek word Cheiro (hand) and prakrikos (done by hand). y The chiropractor manipulates the backbone with his hands to bring back into alignment the vertebrae that are misaligned or misplaced Homeopathy y Is based on the principle that substances that are poisonous in large doses can be very beneficial in small doses y The name homeopathy comes from the Greek word homios which means like and the word pathos meaning suffering y Examples: bee sting, snake venoms, arsenic, gold and silica Message Therapy y Is one of the oldest, simplest forms of therapy and is a system of stroking, pressing and kneading different areas of the body to relieve pain, relax, stimulate, and tone the body. Osteopathy y An osteopath treats a patient s head and neck using gentle twisting and turning movements Naturopathy y

Is based on the belief that the body is self-healing. The body will repair itself and recover from illness spontaneously if it is a healthy environment. y Naturopaths treat illnesses and ailments with special diets, fasting, hydrotherapy, and vitamins and herbs. y They advocate the ounce of prevention way of life. Reflexology y Is based on the principle that there are reflexes in the feet and hands which correspond to every part of the body. y By stimulating or applying pressure to the feet or hands, circulation is increased and specific bodily and muscular function are promoted. Shiatsu y Is a Japanese word made up of two written characters meaning finger (shi) and pressure (atsu). y The application of pressure is the underlying principle of shiatsu. y The practitioners use fingers and thumb for applying pressure precisely at localized points y Shiatsu also involves gentle stretch and manipulation techniques y Is a Japanese word for finger pressure, although shiatsu therapist also use their feet, elbows, and knees to apply pressure Yoga y Is a set of physical practices that include stretches, breathing practices, and progressive deep relaxation y The main concern is the interaction of body and mind. y Yoga therapy employs asanas (posture), pranayama (breathing exercise) and meditation and /or visualization Herbal Medicines y Is a complementary therapy that uses plants or plant extracts to treat illness. y Herbal practitioners believe that delicate chemicals balance of the whole herb is needed for greater effect and to reduce potential side effects. y Different parts of plants can have very different actions. Healing y works by positive energy instead of positive thinking y This is called the laying on of hands or touching, to channel energy into the patient Hypnotherapy y Works on the level of the subconscious, where humans hold many thoughts of which they are not aware y Is widely used to treat people with emotional problems y 10 Medicinal Plants DOH y SAMBONG Scientific name : Blumea balsamifera (L.) DC Family: Compositae Indication: Edema, Diuretic Anti-urolithiasis y AKAPULKO Scientific name: Cassia alata L. Family: Leguminosae

Indication: Ringworm and other fungal infections of the skin y NIYUG-NIYOGAN Scientific name : Quisqualis indica L. Family: Combretaceae Indication: Intestinal worms (Ascaris and Trichina) y TSAANG-GUBAT Scientific name: Ehretia microphylla Lam. Family: Boraginaceae Indication: Intestinal motility y AMPALAYA Scientific name : Momordica charantia Family: Cucurbitaceae Indication: Diabetes mellitus (mild non-insulin dependent) y LAGUNDI Scientific name: Vitex negundo L. Family: Verbenaceae Indication: Anti-cough Anti-asthma y ULASIMANG BATO Scientific name : Peperomia pellucida Family: Piperaceae Indication: Anti-hyperuricemia (Arthritis and Gout) y BAYABAS Scientific name: Psidium guajava L. Family: Myrtaceae Indication: Antiseptic for wounds Mouthwash (for infection due to swollen gums and tooth decay) y BAWANG Scientific name : Allium sativum Family: Liliaceae Indication: Reduces blood cholesterol y YERBA BUENA Scientific name: Mentha x cordifolia Family: Labiatae Indication: Body pain/ache Complementary medicine y describes practices used in conjunction and cooperation with conventional medicine, to assist the existing process.

Complementary and alternative medicine (CAM) y umbrella term for both branches. CAM includes practices that incorporate spiritual, metaphysical, or religious underpinnings; non-European medical traditions, or newly developed approaches to healing. Support for alternative medicine y Advocates of alternative medicine hold that alternative therapies often provide the public with services not available from conventional medicine. This argument covers a range of areas: y Patient Empowerment y Methods of Pain Management y Tretment that supports the Biopsychosocial Model of health, y Stress reduction services y Palliative Care DIFFERENCES BETWEEN TRADITIONAL AND ALTERNATIVE MEDICINE TO WESTERN MEDICINE TRADITIONAL MEDICINE plant, animal, and mineral based medicine spiritual therapy, manual techniques and exercises has scientific evidence safer and more effective patient- healer relationship allopathic or Western Medicine ALTERNATVE MEDICINE Temporary aids mind, body, and spirit of the human being as composing one single system physiological and psychological lack of proper testing less research less safe and less effective dangerous side effects DIFFERENCES BETWEEN TRADITIONAL & ALTERNATIVE MEDICINE TO WESTERN MEDICINE WESTERN MEDICINE Modern medicine Symptom-based medicine Technology-based (drug and surgery oriented) usually used when someone is in life threatening accident formal system to deliver its services patient-doctor relationship