McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach,
11th Edition
Chapter 05: Complementary and Alternative Therapies
Key Points
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Complementary and alternative medicine (CAM) is used by 40% of adults to either
augment or replace traditional medical therapies.
CAM practices include, but are not limited to, botanicals, nutritional products, and herbal
supplements. It is critical for nurses to know about alternative medicine and to note its
use in their assessment.
Botanicals are additive substances that come from plants; an herb is “any plant that is
used for culinary or medicinal purposes.”
The therapeutic value of plants is the basis of phytomedicine.
Many Americans use botanical dietary supplements for therapeutic or preventive reasons,
and herbal therapy has surged in popularity.
Health care providers and consumers are asking questions about herbal therapy’s
effectiveness, potential toxicity, and reactions with conventional medications.
Herbs can be useful, but they can also be ineffectual or even dangerous.
National Center for Complementary and Integrative Health (NCCIH) lists current clinical
trials with herbal products on their website.
Dietary Supplement Health and Education Act (DSHEA) defines dietary supplements as
the following:
o Intended to supplement the diet
o Contains one or more dietary ingredients (including vitamins, minerals, herbs or
other botanicals, amino acids, and certain other substances) or their constituents
o Intended to be taken by mouth, in forms such as tablet, capsule, powder, softgel,
gelcap, or liquid
o Labeled as being a dietary supplement
Manufacturers are required to ensure that their products are safe and that the label
information is truthful and not misleading; however, they are not required to demonstrate
product safety before the product is sold.
Packaging of all dietary supplements must bear the wording “This statement has not been
evaluated by the U.S. Food and Drug Administration (FDA). This product is not intended
to diagnose, treat, cure, or prevent any disease.”
Manufacturers of dietary supplements are allowed to make three types of claims: (1)
health claims, (2) structure and function claims, and (3) nutrient content claims. To make
these claims, manufacturers must have supporting data.
The physiologic effects of the product can be noted, but no claims can be made about
preventing or curing specific conditions.
Consumers are reminded that premarket testing for safety and efficacy is not required,
and manufacturing is not standardized.
Copyright © 2023, Elsevier Inc. All Rights Reserved.
Key Points
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5-2
The Current Good Manufacturing Practices (CGMPs) standards are multifaceted and
require that package labels give the quality and strength of all contents and that products
be free of contaminants and impurities.
A seal of approval is awarded to products that meet criteria similar to that of the CGMPs
by four organizations; however, the seal of approval is no indication of the product’s
safety or efficacy.
The most commonly used herbs include Astragalus, chamomile, cinnamon, Echinacea,
garlic, ginger, Ginkgo, ginseng, green tea, hawthorn, licorice root, kava kava, milk thistle,
peppermint, saw palmetto, St. John’s wort, turmeric, and valerian.
Consumers and health care providers must be alert to potential hazards with herbal
therapy; although herbs are natural substances, natural does not mean safe.
It is essential that health care providers obtain a complete listing of all of the herbal
preparations the patient takes in all forms—teas, infusions, tinctures, tablets, and dried
herbs—the reason they are taken, and their perceived effectiveness to ensure that they do
not interfere with the use and actions of prescribed medications.
Some herbal products can also directly affect laboratory test results.
Not all herbal products are safe via all routes.
Many products have significance for patients facing surgery because they may interfere
with the absorption, breakdown, and excretion of anesthetics, anticoagulants, and other
surgery-related medications.
It is the responsibility of consumers to educate themselves about herbs before use and to
purchase products only from reputable dealers.
Many herbal resources are available on the Internet and from print sources, and the reader
must evaluate each independently and decide whether the information is credible and
appropriate.
Copyright © 2023, Elsevier Inc. All Rights Reserved.