Alternative therapy

If you want to see what your body will look like tomorrow, look at your thoughts today. 

The following are the chief alternative therapies that will be covered in this chapter  

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Adapted from Fontaine, K. L. (2000). Healing practices Alternative therapies for... 

McNicholas L, Howell EF Buprenorphine Clinical Practice Guidelines, Field Review Draft November 17, 2000. Rockville, MD, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, Office of Pharmacologic and Alternative Therapies, 2000... 

The readers of this book can help to reverse these problems, improve outcomes of care both clinically and economically, and enable drug use to meet stated goals and objectives. This text provides a thorough analysis and summary of treatment options for commonly occurring diseases and the medications or alternative therapies used to successfully treat these conditions. 

Assuming KK continues to take the prescription and over-the-counter medications listed in her medication history obtained during her hospitalization, should any of these medications be discontinued or changed If changed, what alternative therapy would you recommend ... 

Cromolyn and nedocromil are inhaled anti-inflammatory agents that block both the early- and late-phase response. Both agents are considered alternative therapies to inhaled corticosteroids for the treatment of mild persistent asthma however, both are less effective than low doses of inhaled corticosteroids.2,30 The exact mechanism of action of these agents is not understood, but they appear to inhibit mast cell mediator release as well as modulate other inflammatory responses.3... 

Many medications can precipitate an attack of acute pancreatitis. If a medication is determined to be the cause of acute pancreatitis, it should be discontinued and alternative therapy considered.13,14... 

Obtain a thorough history of non-prescription and prescription drug use and complementary and alternative therapies utilized, as well as identifying medication allergies. 

Develop a plan for monitoring therapeutic outcomes, focusing on the individual symptom profile and level of function of each patient. Include a plan for dosage adjustments or alternate therapy if the patient fails to respond adequately. Include serum drug concentration monitoring as appropriate. 

HRT is indicated primarily for the relief of moderate to severe vasomotor symptoms. It remains the most effective treatment for vasomotor symptoms and should be considered only in women experiencing those symptoms. Women with mild vasomotor symptoms may benefit from nonpharmacologic therapy alone however, many women will seek medical treatment for these symptoms. The benefits of HRT outweigh the risks in women who do not have CHD or CHD and breast cancer risk factors however, careful consideration should be given to alternative therapies for the relief of menopausal symptoms in women with these risks. Women should be involved in the decision and may choose to use HRT despite having some risk factors owing to the severity of their symptoms. Regardless of the situation, HRT should be prescribed at the lowest dose that relieves or reduces menopausal symptoms and should be recommended only for short-term use. Women should be reassessed every 6 to 12 months, and discontinuation of therapy should be considered. 

BMD will increase and the risk of fractures will decrease in women taking HRT. However, when therapy is discontinued, a decline in BMD will resume at the same rate as in women not on HRT. Therefore, therapy for osteoporosis prevention should be considered long term. Since HRT should be maintained only for the short term, alternative therapies such as bisphosphonates or raloxifene should be considered as first-line therapy for the prevention of postmenopausal osteoporosis, in addition to appropriate doses of calcium and vitamin D. Because of the risks associated with HRT, it should not be prescribed solely for the prevention of osteoporosis. 

The results of these trials demonstrate that ERT or HRT should not be prescribed for the prevention of CHD or in patients with preexisting CHD. For women suffering from vasomotor symptoms with a history of CHD, including CHD risk factors, alternative therapies should be considered. Additionally, lifestyle modifications should be implemented, and therapies to treat risk factors such as hypertension and hyperlipidemia should be prescribed. It is important to note that the average age of women included in the HERS and the WHI trials was 67 and 63 years, respectively. Therefore, these trials were unable to assess the true risk in younger, potentially healthier women with fewer cardiovascular risk factors. 

Overall, non-hormonal therapies are less effective in treating vasomotor symptoms than HRT but do offer an important option for women experiencing menopausal symptoms who cannot or are unwilling to take HRT. The antidepressants gabapentin and clonidine have the best evidence for efficacy of all the non-hormonal options and should be considered first as an alternative to HRT. The most important considerations in choosing an alternative therapy are the patient s comorbidities and the efficacy and safety of the medication. 

Compared with postmenopausal osteoporosis, few clinical trials have been conducted evaluating therapies in men. Although alendronate and calcitonin have both been studied, only alendronate reduces fracture rates in men. Teriparatide also has been studied, but no data are available yet on fracture rates. At this time, alendronate and teriparatide are approved by the FDA for the treatment of osteoporosis in men. Owing to proven benefit in reducing fractures and relative safety, alendronate should be considered first-line treatment for primary osteoporosis in men. Teriparatide should be reserved as alternate therapy in this population. 

Perform a thorough medication history, including prescription, over-the-counter, and alternative therapies. 

Complementary and alternative medicine therapies, such as acupuncture, biofeedback, chiropractic manipulation, dietary supplements, herbal therapy, and homeopathic preparations, are used by individuals with allergic rhinitis.29,30 Use of bromelain, gingko, ginseng, licorice, quercetin, and Urtica dioica has been reported, but large-scale studies documenting efficacy are lacking.31,32 Caregivers should inquire routinely about patients use of alternative therapies and counsel patients about the lack of validated data to support such practices.12... 

Alternative Therapies Ceftriaxone 2 g IV every 12 hours or Ceftriaxone only LFT elevation, ... 

Penicillin MIC 0.1-1 mg/L Standard Therapy Ceftriaxone or cefotaxime Alternative Therapies Moxifloxacin 400 mg IV every Nausea/vomiting/diarrhea, dizziness, ... 

Penicillin MIC 0.1 mg/L Penicillin G or ampicillin Alternative Therapies Ceftriaxone or cefotaxime or ... 

Streptococcus gentamicin (5 mg/kg per day, dosing based on serum levels) Alternative Therapies Trimethoprim-sulfamethoxazole (TMP-SMX) 10-20 mg/kgTMP IV per day in divided doses every 6-8 hours or meropenem Standard Therapy TMP-SMX Rash, Stevens-Johnson syndrome, bone marrow suppression, nausea/vomiting, hepatotoxicity 14-21... 

Ceftriaxone or cefotaxime Alternative Therapies Aztreonam 2 g IV every 6-8 hours Phlebitis, fever, rash, headache, confusion, duration may be required for neonates)... 

Herpes simplex PO or IV daily if shunt involved Alternative Therapies Linezolid Standard Therapy if shunt involved) 14-21 (21 for... 

Acyclovir 20 mg/kg IV every 8 hours (neonates) Alternative Therapy Foscarnet 120-200 mg/kg IV per day in divided doses every 8-12 hours neurotoxicity, phlebitis Nephrotoxicity, electrolyte imbalances, nausea/ vomiting, headache, penile ulceration, thrombophlebitis, seizures ... 

Tapeworm infections (T. saginata and T. solium) are treated with praziquantel 5 to 10 mg/kg as a single dose (use the same dose for adults and pediatric patients).3 The treatment for cysticercosis and neurocysticercosis may include surgery, anticonvulsants (neurocysticercosis can cause seizures), and anthelmintic therapy. The anthelmintic therapy of choice is albendazole 400 mg twice daily for 8 to 30 days. The pediatric dose of albendazole is 15 mg/kg (maximum 800 mg) in two divided doses for 8 to 30 days. The doses for both adults and pediatric subjects can be repeated if necessary. Praziquantel is an alternative therapy.3... 

Due to the variable appearance of genital warts, treatment maybe based on the size, site, and morphology of the lesions. Additionally, switching to alternate therapy is appropriate if there has been no response after three treatment cycles. 

Finally, trials can follow parallel or crossover study designs. In a parallel trial, patients are assigned to a therapy that they remain on, and they are compared with patients in alternate therapy groups. In a crossover trial, patients switch or change therapy assignments during the course of the trial. 

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