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DISCUSSION POST # 1 Reply to Nozomi

The 25-year-old woman stated that her 4-year-old child has been coughing and sounds congested. She wants to know if echinacea might help her child.

 Q6. Is it safe for this mother to give her child echinacea? 

Answer #6: Although echinacea is generally well-tolerated, it has many possible adverse effects, such as angioedema, bronchospasm, abdominal discomfort, headache, dizziness, drowsiness, and altered fertility (Williams, 2021). Additionally, some studies have shown that echinacea is associated with liver injury and toxicity (LiverTox, 2019). Nevertheless, several studies have shown the benefit of Echinacea for children, especially because approximately 30% of upper respiratory infections in children develop into bacterial complications associated with pneumonia, sinusitis, or otitis media (Ogal et al., 2021). In their study, Ogal et al. (2021) found that compared to the control group who received only Vitamin C, the subjects who used Echinacea showed significant prevention of cold days and URIs by up to 32.5%. Additionally, respiratory tract complications were reduced by 65%, and antibiotic prescriptions were reduced by 76.3% (Ogal et al., 2021). In another study by Awad (2020), the researcher found that the concomitant use of azithromycin with Echinacea resulted in decreased severity of tonsillitis compared to children who received only azithromycin. However, Ogal et al. (2021) discussed the possible variability in effectiveness depending on the products and the way they are prepared. Interestingly, lipophilic preparations, which are freshly harvested 
Echinacea purpurea, have been shown to be more effective than hydrophilic preparations, such as pressed juices (Ogal et al., 2021). Both of these studies suggested that Echinacea has a high safety profile, even in the pediatric population. Thus, for this patient, it is probably safe to give Echinacea to her child, but it is also crucial to obtain a thorough history and carry out a physical examination to make sure that he or she does not have other factors which may lead to adverse effects of Echinacea. Furthermore, Ogal et al. (2021) suggest that research on Echinacea is still ongoing, and it does not replace antibiotics or other conventional treatments, especially in severe cases of URIs. 

DISCUSSION POST # 2 Reply to Elaine

Q4. A 25-year-old woman comes to your office asking for oral contraceptive refills. She stated that she was feeling depressed and heard about St. John’s wort used in depression which she started taking a week ago. 

 Answer Q4. St. Johns Wort acts as a serotonin reuptake inhibitor thereby increasing the amount of serotonin in the synaptic cleft (Peterson & Nguyen, 2022). It also has similar effects on dopamine and norepinephrine. As such, any additional medications that also act to increase serotonin levels or inhibit monoamine oxidase such as the antidepressants SSRIs and SNRIs, tricyclic antidepressants, some antipsychotics, and MAOIs can lead to serotonin syndrome.  

It is also an inducer of cytochrome P450 and can increase the drug metabolism of any medications that are metabolized by the liver isoenzymatic system. Specifically, drugs metabolized by the CYP3A4 isoenzyme are affected such as HIV medications, warfarin, tacrolimus, oxycodone, and digoxin. This interaction can possibly lead to treatment failure and significant adverse effects. In this case study, the patient is at risk for breakthrough bleeding or unintended pregnancy due to the induction of cytochrome P450 and the increased metabolism of oral contraceptives (Rosenthal & Burchum, 2021).

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