Aromatherapy and essential oils

Aromatherapy and essential oils

Aromatherapy

is a form of alternative medicine that uses volatile liquid plant materials, known as essential oils (EOs), and other aromatic compounds from plants for the purpose of affecting a person's
mood or health.

Scientific evidence is growing and preliminary but encouraging for a number of health issues. Essential oils differ in chemical composition from other herbal products because the distillation process only recovers the lighter phytomolecules.

For this reason essential oils are rich in monoterpenes and sesquiterpenes, as well as other VOC substances (esters, aromatic compounds, non-terpenehydrocarbons, some organic sulfides etc.).

Aromatherapy is a generic term that refers to any of the various traditions that make use of essential oils sometimes in combination with other alternative medical practices and spiritual
beliefs.

Popular use of these products include massaging products, medicine, or any topical application that incorporates the use of true, pure essential oils in their products. Medical treatment involving aromatic compounds exist outside of the West, but may or may not be included in the term 'aromatherapy'.

Modes of application



The modes of application of aromatherapy include:

• Aerial diffusion: for environmental fragrancing or aerial
  
• disinfection

• Direct inhalation: for respiratory disinfection, decongestion,
• expectoration as well as psychological effects

• Topical applications: for general massage,
• baths, compresses, therapeutic skin care

• Materials

• Some of the materials employed include:

• Essential oils: Fragrant oils extracted from plants chiefly through steam distillation (e.g. eucalyptus oil) or expression (grapefruit oil). However, the term is also occasionally used to describe fragrant oils extracted from plant material by any solvent extraction
• .
• Absolutes: Fragrant oils extracted primarily from flowers or delicate plant tissues through solvent or supercritical fluid extraction (e.g. rose absolute). The term is also used to describe oils extracted from fragrant butters, concretes, and enfleurage pommades using ethanol.

• Phytoncides: Various volatile organic compounds from plants that kill microbes. Many terpene-based fragrant oils and sulfuric compounds from plants in the genus "Allium" are phytoncides, though the latter are likely less commonly used in aromatherapy due to their disagreeable odors

• .
• Herbal distillates or hydrosols: The aqueous by-products of the distillation process (e.g. rosewater). There are many herbs that make herbal distillates and they have culinary uses, medicinal uses and skin care uses. Common herbal distillates are rose, lemon balm
• and chamomile

• infusion
• Aqueous extracts of various plant material
• (e.g.infusion of chamomile)

• Carrier oils: Typically oily plant base triacylglycerides that dilute essential oils for use on the skin (e.g. sweet almond oil)

Pharmacological effects attributed to essential oils

• Antibacterial: In vitro testing has confirmed antibacterial effects in certain oils including rosemary, clove, lime, cinnamon, and tea tree oil

• .
  
• Antiviral: Supported for tea tree oil, lemongrass, sandalwood,
• peppermint, ginger, thyme, and hyssop in in vitro testing against Herpes

• Antifungal: Supported by in vitro testing for lavender, thyme, clove, juniper, and tea tree oil

• Anti-inflammatory: Reported in in-vitro assays of clove, cinnamon, sage, eucalyptus, black cumin and bay leaf

• Anxiolytic: Reported in animal models using oils of lavender, rose and angelica

• Antispasmotic (spasmolytic): Spasmolytic properties for catnip, lavender and New Zealand tea tree oils have been reported in animal studies.

• Invigorating:

• Antioxidant

Popular uses

• Basilis used in perfumery for its clear, sweet and mildly spicy aroma. In aromatherapy, it is used for sharpening concentration, for its uplifting effect on depression, and to relieve headaches and migraines. Basil oil has many chemotypes and some are known to be emmenagogues and should be avoided during pregnancy.
  
  

• Bergamot is one of the most popular oils in perfumery. It is an excellent insect repellent and may be helpful for both the urinary tract and for the digestive tract. It is useful for skin conditions linked to stress, such as cold sores and chicken pox, especially when combined with eucalyptus oil. Bergamot is a flavoring agent in Earl Grey tea. Cold-pressed Bergamot oil contains bergaptene, a strong photosensitizer when applied to the skin, so only distilled or 'bergaptene-free' types can be topically used.
  
• Black pepper has a sharp and spicy aroma. Common uses include stimulating the circulation and for muscular aches and pains. Skin application is useful for bruises, since it stimulates the circulation.
• Citronella oil, obtained from a relative of lemongrass, is used as an
• insect repellent and in perfumery.
• Clove oil is a topical analgesic, especially useful in dentistry. It is also used an antiseptic, antispasmodic, carminative, and antiemetic.

• Eucalyptus oil is often used in combination with peppermint to provide relief for the airways in case of cold or flu.
• Geranium oil is used as an astringent, antiseptic and diuretic.

• Jasmine is used as an aphrodisiac.

• Lavender oil is used as an antiseptic, to soothe minor cuts and burns, to calm and relax, for insomnia and to soothe headaches and migraines.

• Lemon oil is uplifting and anti-stress/anti-depressant. In a Japanese study, lemon essential oil in vapour form has been found to reduce stress in mice.
• Lemon oil aroma may enhance one's mood, and help with relaxation.
• Rose is used as an aphrodisiac.

• Sandalwood oil is used as an aphrodisiac.

• Tea tree oil and many other essential oils have topical (external) antimicrobial (i.e. antibacterial, antifungal, antiviral, or antiparasitic) activity and are used as antiseptics, disinfectants,and in mouthrinses.

• Yarrow oil is used to reduce jointinflammation and relieve cold and
• influenza symptoms.
• Ylang-ylang oil is used as an aphrodisiac

Gastrointestinal Tract Problems

Gastrointestinal Tract Problems

 

 

Mouth ulcers

Mouth ulcers are extremely common, affecting as many as one in five
of the population and they are a recurrent problem in some people.
They are classified as aphthous (minor or major) or herpetiform
ulcers. Most cases (more than three quarters) are minor aphthous
ulcers, which are self-limiting. Ulcers may be due to a variety of causes
including infection, trauma and drug allergy. However, occasionally
mouth ulcers appear as a symptom of serious disease such as carcinoma.
The pharmacist should be aware of the signs and characteristics

that indicate more serious conditions.

Patients may describe a history of recurrent ulceration, which began in
childhood and has continued ever since. Minor aphthous ulcers are
more common in women and occur most often between the ages of 10 and 40

Nature of the ulcers

Minor aphthous ulcers usually occur in crops of one to five. The
lesions may be up to 5mm in diameter and appear as a white or
yellowish centre with an inflamed red outer edge. Common sites are
the tongue margin and inside the lips and cheeks. The ulcers tend to last from 5 to 14 days

Other types of recurrent mouth ulcer include major aphthous and
herpetiform. Major aphthous ulcers are uncommon, severe variants of
the minor ones. The ulcers, which may be as large as 30mm in
diameter, can occur in crops of up to ten. Sites involved are the lips,
cheeks, tongue, pharynx and palate. They are more common in sufferers
of ulcerative colitis.
Herpetiform ulcers are more numerous, smaller and, in addition to
the sites involved with aphthous ulcers, may affect the floor of the
mouth and the gums. Table 1 summarises the features of the three
main types of aphthous ulcers.
Systemic conditions such as Behc¸et’s syndrome and erythema
multiforme may produce mouth ulcers, but other symptoms would
generally be present

Duration

Minor aphthous ulcers usually heal in less than 1 week; major
aphthous ulcers take longer (10–30 days). Where herpetiform ulcers
occur, fresh crops of ulcers tend to appear before the original crop
has healed, which may lead patients to think that the ulceration is
continuous.

Oral cancer

Any mouth ulcer that has persisted for longer than 3 weeks
requires immediate referral to the dentist or doctor because an ulcer

of such long duration may indicate serious pathology such as

carcinoma. Most oral cancers are squamous cell carcinomas, of which
one in three affects the lip and one in four affects the tongue. The
development of a cancer may be preceded by a premalignant lesion,
including erythroplasia (red) and leucoplakia (white), or a speckled
leucoplakia. Squamous cell carcinoma may present as a single ulcer
with a raised and indurated (firm or hardened) border. Common
locations include the lateral border of the tongue, lips, floor of the
mouth and gingiva. The key point to raise suspicion would be a lesion
that had lasted for several weeks or longer. Oral cancer is more common in smokers than non-smokers

Medication

The pharmacist should establish the identity of any current medication,
since mouth ulcers may be produced as a side-effect of drug
therapy. Drugs that have been reported to cause the problem include

aspirin

and other NSAIDs, cytotoxic drugs and sulfasalazine (sulphasalazine).
Radiotherapy may also induce mouth ulcers. It is worth
asking about herbal medicines because feverfew (used for migraine)
can cause mouth ulcers.
It would also be useful to ask the patient about any treatments tried
either previously or on this occasion and the degree of relief obtained.
The pharmacist can then recommend an alternative product where
appropriate.

If there is no improvement after 1 week, the patient should see the doctor

Symptomatic treatment of minor aphthous ulcers can be recommended
by the pharmacist, and can relieve pain and reduce healing
time. Active ingredients include antiseptics, corticosteroids and local
anaesthetics. There is evidence from clinical trials to support use of
topical corticosteroids and

chlorhexidine mouthwash. Gels and
liquids may be more accurately applied using a cotton bud or cotton
wool, providing the ulcer is readily accessible. Mouthwashes can be
useful where ulcers are difficult to reach.

Chlorhexidine gluconate mouthwash

There is some evidence that

chlorhexidine mouthwash reduces duration
and severity of ulceration. The rationale for the use of antibacterial
agents in the treatment of mouth ulcers is that secondary
bacterial infection frequently occurs. Such infection can increase discomfort
and delay healing. Chlorhexidine helps to prevent secondary
bacterial infection but it does not prevent recurrence. It has a bitter
taste and is available in peppermint as well as standard flavour.
Regular use can stain teeth brown – an effect that is not usually
permanent. Advising the patient to brush the teeth before using the
mouthwash can reduce staining. The mouth should then be well rinsed
with water as chlorhexidine can be inactivated by some toothpaste
ingredients. The mouthwash should be used twice a day, rinsing 10 ml
in the mouth for 1 minute.

Topical corticosteroids

Hydrocortisone

and triamcinolone act locally on the ulcer to reduce
inflammation and pain, and to shorten healing time. The former is
available as pellets, the latter in a protective paste. To exert its effect, a
pellet must be held in close proximity to the ulcer until dissolved. This
can be difficult when the ulcer is in an inaccessible spot. One pellet is
used four times a day. The pharmacist should explain that the pellets
should not be sucked, but dissolved in contact with the ulcer. These
treatments are best used as early as possible. Before an ulcer appears,
the affected area feels sensitive and tingling – the prodromal phase –
and treatment should start then. They should be applied 3–4 times
daily. They have no effect on recurrence but should be restarted at the

first signs of a new outbreak.

Local analgesics

Benzydamine mouthwash

or spray and choline salicylate dental gel

are short-acting but can be useful in very painful major ulcers. The
mouthwash is used by rinsing 15 ml in the mouth three times a day.
Numbness, tingling and stinging can occur with

benzydamine.
Diluting the mouthwash with the same amount of water before use
can reduce stinging. The mouthwash is not licensed for use in children
under 12. Benzydamine spray is used as four sprays onto the affected
area three times a day. Although aspirin is no longer recommended for
children under 16 years because of possible links with Reye’s syndrome,

choline salicylate dental gel

produces low levels of salicylate
and can therefore be used in children.

Carbenoxolone

Available as gel and mouthwash,

carbenoxolone was shown in one
small study to relieve pain and reduce healing time.

Local anaesthetics (e.g. lidocaine (lignocaine), benzocaine)

Local anaesthetic gels are often requested by patients. Although they
are effective in producing temporary pain relief, maintenance of gels
and liquids in contact with the ulcer surface is difficult. Reapplication
of the preparation may be done when necessary. Tablets and pastilles
can be kept in contact with the ulcer by the tongue and can be of value
when just one or two ulcers are present. Any preparation containing a
local anaesthetic becomes difficult to use when the lesions are located
in inaccessible parts of the mouth.
Both

lidocaine and benzocaine have been reported to produce sensitisation,
but cross-sensitivity seems to be rare, probably because the
two agents are from different chemical groupings. Thus, if a patient
has experienced a reaction to one agent in the past, the alternative

 

treatment and prophylaxis of swine flu

In the wake of the recent development and the upgrade of the swine flu to the pandamic status, let us review the medications that is used to treat it.
Will start by the Tamiflu






Treatment of Influenza


TAMIFLU (oseltamivir phosphate) is indicated for:

• The treatment of uncomplicated acute illness due to influenza infection in adults and adolescents (>13 years) who have been symptomatic for no more than 2 days.
  
  The treatment indication is based on two Phase III clinical studies of naturally occurring influenza in adults in which the predominant infection was influenza A (95%) and a limited number with influenza B (3%) and influenza of unknown type (2%), reflecting the distribution of these strains in the community. The indication is also supported by influenza A and B challenge studies. No data are available to support the safety and efficacy of TAMIFLU in adult patients who commenced treatment after 40 hours of onset of symptoms.
• The treatment of uncomplicated acute illness due to influenza in pediatric patients 1 year and older who have been symptomatic for no more than 2 days.
  
  The pediatric indication is based on one Phase III clinical study of naturally occurring influenza in pediatric patients aged 1 to 12 years in which 67% of influenza infected patients were infected with influenza A and 33% with influenza B.
  
  TAMIFLU, when taken as recommended for the treatment of influenza, alleviates the symptoms and reduces their duration.

Prevention/Prophylaxis of Influenza


The decision to administer TAMIFLU for prophylaxis to close contacts should be based on the knowledge that influenza is circulating in the area and the index case demonstrates characteristic symptoms of influenza. TAMIFLU is not effective in providing prophylaxis for respiratory infections other than influenza therefore a proper diagnosis of the index case is important.

TAMIFLU is not a substitute for influenza vaccination. Vaccination is the preferred method of prophylactic prevention against influenza.
The use of antivirals for the treatment and prevention of influenza should be determined on the basis of official recommendations taking into consideration variability of epidemiology and the impact of the disease in different geographical areas and patient populations.


TAMIFLU is indicated for:

• The prevention of influenza illness in adults and adolescents 13 years and older following close contact with an infected individual (the index case).
  
  The prevention indication is based on a phase III clinical study programme consisting of 4 Phase III clinical trials.
• The prevention of influenza illness in pediatric patients 1 year and older following close contact with an infected individual (the index case).
  
  This indication is based on a substudy of pediatric patients in a Phase III clinical trial.

Contraindications

• TAMIFLU (oseltamivir phosphate) is contraindicated in patients with known hypersensitivity to any of the components of the product. For a complete listing, see Dosage Forms, Composition and Packaging.
• Use of TAMIFLU in children under 1 year of age is contraindicated. TAMIFLU may be safely administered only once the blood-brain barrier is fully developed.

Nanotechnology in your kitchen

Nanotechnology

Scientists are exploring everything in both directions.i.e. moving from the macro molecules and particles to the smaller ones e.g. micro-scale and nano-scale till they reached the atom and its smaller protons , neutrons and electrons. Others are moving in the direction of bigger and bigger ones till they reached the study of the universe and its galaxies.
Our concern here is the nano-scale .Simply it means particles of nano-size. It has many applications and we are keen about its pharmaceutical applications.From the first sight it seems to be a complicated science but actually it is not.For examples , we know that the more surface area available for reaction the more the solubility of the compound or material. With soluble drugs we can increase its solubility by increasing its available surface area either by grinding or micronisation.The same concept is used in case of insoluble drugs but the ordinary methods of particle size reduction are not sufficient to reach that degree with which we can bring the insoluble drug into solution. The old fashioned method to achieve the needed solubility is to use surfactants but actually this is not real solubility , it is just suspending the small particles in the liquid phase. With the application of nano-technology principles they succeeded to achieve that without using surfactants by the conversion of the particles to the nano-size.What makes nanotechnology a complicated science is just its sophisticated and required devices from microscopes to the devices which can undergo that particle size reduction to be within the nano-scale.Nano-size particles can be achieved using sonication i.e. the use of ultra-sonic waves to strike bigger particles. As the particles reach the nano-scale size , it would be an easy method to bring them to the solvated state.I`m not going to go in details . I just want to give you and easy method that you can apply to make nano-particles in you kitchen and make a product that is said to have some anti-bacterial activity.Bye for now. See you later with that product.

Ginko , الجنكو

Ginko 

الجنكو

Ginkgo (Ginkgo biloba; in Chinese and Japanese , pinyin  romanization: yín xìng, Hepburn romanization: ichō or ginnan), also spelled gingko, also known as the Maidenhair Tree after Adiantum, is a unique species of tree with no close living relatives. The ginkgo is classified in its own division, the Ginkgophyta, comprising the single class Ginkgoopsida, order Ginkgoales, family Ginkgoaceae, genus Ginkgo  and is the only extant species within this group. It is one of the best-known examples of a living fossil, because Ginkgoales other than G. biloba are not known from the fossil record after the Pliocene.

For centuries it was thought to be extinct in the wild, but is now known to grow in at least two small areas in Zhejiang province in Eastern China, in the Tian Mu Shan Reserve. However, recent studies indicate high genetic uniformity among ginkgo trees from these areas, arguing against a natural origin of these populations and suggesting that the ginkgo trees in these areas may have been planted and preserved by Chinese monks over a period of about 1000 years. Whether native ginkgo populations still exist has not been demonstrated unequivocally.

The relationship of Ginkgo to other plant groups remains uncertain. It has been placed loosely in the divisions Spermatophyta and Pinophyta, but no consensus has been reached. Since Ginkgo seeds are not protected by an ovary wall, it can morphologically be considered a gymnosperm. The apricot-like structures produced by female ginkgo trees are technically not fruits, but are seeds that have a shell that consists of a soft and fleshy section (the sarcotesta), and a hard section (the sclerotesta).

Overview:

Ginkgo (Ginkgo biloba) is one of the oldest living tree species and its leaves are among the most extensively studied botanicals in use today. In Europe and the United States, ginkgo supplements are among the best-selling herbal medications. It consistently ranks as a top medicine prescribed in France and Germany.

Ginkgo has been used in traditional medicine to treat circulatory disorders and enhance memory. Scientific studies throughout the years have found evidence to support these uses. Although not all studies agree, ginkgo may be especially effective in treating dementia (including Alzheimer's disease) and intermittent claudication (poor circulation in the legs). It also shows promise for enhancing memory in older adults. Laboratory studies have shown that ginkgo improves blood circulation by dilating blood vessels and reducing the stickiness of blood platelets.

Ginkgo leaves contain two types of chemicals (flavonoids and terpenoids) believed to have potent antioxidant properties. Antioxidants are substances that scavenge free radicals -- compounds in the body that damage cell membranes, tamper with DNA, and even cause cell death. Free radicals occur naturally in the body and grow in number as we age. But environmental toxins (including ultraviolet light, radiation, cigarette smoking, and air pollution) can also increase the number of free radicals. Free radicals are believed to contribute to health problems including heart disease and cancer as well as Alzheimer's disease and other forms of dementia. Antioxidants such as those found in ginkgo can help neutralize free radicals and may reduce or even help prevent some of the damage they cause.

Plant Description:

Ginkgo biloba is the oldest living tree species. A single tree can live as long as 1,000 years and grow to a height of 120 feet. It has short branches with fan-shaped leaves and inedible fruits that produce a strong odor. The fruit contains an inner seed, and there has been a report of a human poisoning from ingesting the seed. Ginkgos are tough, hardy trees and are sometimes planted along urban streets in the United States.

Although Chinese herbal medicine has used both the ginkgo leaf and seed for thousands of years, modern research has focused on the standardized Ginkgo biloba extract (GBE), which is prepared from the dried green leaves. This standardized extract is highly concentrated and seems to be clinically more effective in treating health problems (particularly circulatory ailments) than the non-standardized leaf alone.

What's It Made Of?:

More than 40 components isolated from the ginkgo tree have been identified, but only two are believed to be responsible for the herb's medicinal effects: flavonoids and terpenoids. Flavonoids are plant-based antioxidants. Laboratory and animal studies have shown that flavonoids protect the nerves, heart muscle, blood vessels, and retina from damage. Terpenoids (such as ginkgolides) improve blood flow by dilating blood vessels and reducing the stickiness of platelets.

Medicinal Uses and Indications:

Based on studies conducted in laboratories, animals, and humans, gingko is used for the following:

Dementia and Alzheimer's disease

Ginkgo is widely used in Europe for treating dementia. It was used originally because it improves blood flow to the brain. Now further study suggests it may work directly to protect nerve cells that are damaged in Alzheimer's disease. A number of studies have found that gingko has a positive effect on memory and thinking in people with Alzheimer's or vascular dementia.

Clinical studies suggest that ginkgo may provide the following benefits for people with Alzheimer's disease:

• Improvement in thinking, learning, and memory (cognitive function)
• Improvement in activities of daily living
• Improvement in social behavior
• Fewer feelings of depression

Several studies have found that ginkgo may be as effective as prescription Alzheimer's medications in delaying the symptoms of dementia.

However, one of the longest and best-designed studies found ginkgo was no better than placebo in reducing Alzheimer's symptoms. In a 2008 study, 176 people in the United Kingdom with Alzheimer's took either ginkgo or placebo for 6 months. At the end of the study there was no difference in cognitive function or quality of life between the groups.

Ginkgo is sometimes suggested to prevent Alzheimer's and dementia, as well, and some studies have suggested it might be helpful. But in 2008, a well-designed study (the GEM study) with more than 3,000 elderly participants found the ginkgo was no better than placebo in preventing dementia or Alzheimer's.

Intermittent Claudication

Because ginkgo improves blood flow, it has been studied in people with intermittent claudication (pain caused by reduced blood flow to the legs). People with intermittent claudication have a hard time walking without feeling extreme pain. An analysis of eight published studies revealed that people taking ginkgo tend to walk roughly 34 meters farther than those taking placebo. In fact, ginkgo has been shown to be as effective as a prescription medication in improving pain-free walking distance. However, regular walking exercises are more beneficial than ginkgo in improving walking distance.

Glaucoma

One small study found that people with glaucoma who took 120 mg of ginkgo daily for 8 weeks had improvements in their vision.

Memory Enhancement

Ginkgo is widely touted as a "brain herb." It has been studied to see whether it can improve memory in people with dementia, and some studies found it did help. It's less clear whether ginkgo helps improve memory in healthy people who experience normal memory loss that comes with age. Some studies have found slight benefits, while other studies have found no effect on memory. The most effective dose seems to be greater than or equal to 240 mg per day. Ginkgo is commonly added to nutrition bars, soft drinks, and fruit smoothies to boost memory and enhance cognitive performance, although it's doubtful that such small amounts of gingko would be effective.

Macular Degeneration

The flavonoids found in ginkgo may help stop or lessen some retinal problems (problems with the back part of the eye). Macular degeneration (often called age-related macular degeneration or ARMD) is an eye disease that affects the retina. It is a progressive, degenerative eye disease that tends to affect older adults and is the number one cause of blindness in the United States. Some studies suggest that gingko may help preserve vision in those with ARMD.

Tinnitus

Nerve damage and certain blood vessel disorders can lead to tinnitus (ringing, hissing, or other sound in the ears or head when no external sound is present). Because ginkgo improves circulation, it has been studied to see whether it can treat tinnitus. A few poorly designed studies found it might moderately relieve the loudness of the tinnitus sound. However, a well-designed study including 1,121 people with tinnitus found that ginkgo (taken 3 times daily for 3 months) was no more effective than placebo in relieving symptoms of tinnitus. In general, tinnitus is a very difficult problem to treat.

Other

A standardized ginkgo extract was reported to significantly improve functional measures (such as coordination, energy level, strength, mental performance, mood, and sensation) in 22 people with multiple sclerosis (MS).

Available Forms:

• Standardized extracts containing 24 - 32% flavonoids (also known as flavone glycosides or heterosides) and 6 - 12% terpenoids (triterpene lactones)
• Capsules
• Tablets
• Liquid extracts (tinctures, fluid extracts, glycerites)
• Dried leaf for teas

How to Take It:

Pediatric

Ginkgo is not generally used in children.

Adult

Initial results often take 4 - 6 weeks, but should grow stronger beyond that period.

Memory impairment and cardiovascular function: Generally, 120 mg daily in divided doses, standardized to contain 24 - 32% flavone glycosides (flavonoids or heterosides) and 6 - 12% triterpene lactones (terpenoids). If more serious dementia or Alzheimer's disease is present, up to 240 mg daily, in 2 or 3 divided doses, may be necessary.

Intermittent claudication: 120 - 240 mg per day

Precautions:

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain components that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider qualified in the field of botanical medicine.

GBE is generally considered to be safe, and side effects are rare. In a few cases, gastrointestinal upset, headaches, skin reactions, and dizziness were reported.

There have been a number of reports of internal bleeding in people who take ginkgo. However, it is not clear whether ginkgo was responsible or whether there was another cause (whether a combination of ginkgo and blood-thinning drugs caused the bleeding, for example). One human study found that ginkgo significantly prolonged bleeding time when given along with cilostazol (Pletal), a commonly used blood-thinner. However, other studies found that gingko combined with warfarin (Coumadin) did not prolong bleeding time. Because of the uncertainty, you should ask your doctor before taking gingko if you also take blood-thinning drugs.

If you take gingko, you should stop taking it at least 36 hours prior to surgery or dental procedures due to the risk of bleeding complications. Tell your doctor or dentist that you take gingko.

People who have epilepsy should not take gingko, because there is concern that it might cause seizures.

Pregnant and breastfeeding women should not take gingko.

Do not eat Ginkgo biloba fruit or seed.

Possible Interactions:

Ginkgo may alter the metabolism and effectiveness of some prescription and non-prescription medications. If you are being treated with any of the following medications, you should not use ginkgo without first talking to your health care provider:

Anticonvulsant medications -- High doses of ginkgo could make drugs to control seizures, such as carbamazepine (Tegretol) or valproic acid (Depakote), less effective.

Antidepressants -- Taking ginkgo along with selective serotonin reuptake inhibitor (SSRIs) antidepressants may increase the risk of serotonin syndrome, a potentially fatal condition. Ginkgo may enhance the effects (both good and bad) of antidepressant medications known as MAOIs, such as phenelzine (Nardil). SSRIs include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)
• Sertraline (Zoloft)

Antihypertensive (blood pressure) medications -- Ginkgo may lower blood pressure. For that reason, if you take medication to lower your blood pressure you should ask your doctor before taking gingko. There has been a report of an interaction between ginkgo and nifedipine (Procardia), a calcium channel blocker used for blood pressure and arrhythmias.

Blood-thinning medications -- Ginkgo has blood-thinning properties and should not be used if you are taking anticoagulant (blood-thinning) medications. There has been bleeding in the brain reported when using a ginkgo product and ibuprofen (Advil), a non-steroidal anti-inflammatory drug (NSAID). Blood-thinners include:

• Aspirin
• Clopidogrel (Plavix)
• Heparin
• Warfarin (Coumadin)

Medications to lower blood sugar -- Ginkgo may increase insulin levels in healthy subjects and decrease insulin levels in people with diabetes. If you have diabetes, you should not use gingko without first talking to your doctor.

Cylosporine -- Ginkgo biloba may help protect the cells of the body during treatment with the drug cyclosporine, which suppresses the immune system.

Thiazide diuretics(water pills) -- There is one report of a person who took a thiazide diuretic and gingko experiencing high blood pressure. If you take thiazide diuretics, ask your doctor before taking gingko.

Trazodone -- There is one report of an elderly Alzheimer's patient going into a coma after taking ginkgo and trazodone (Desyrel), an antidepressant medication.

Alternative Names:

Fossil tree; Kew tree; Maiden hair tree

• Reviewed last on: 3/26/2009
• Steven D. Ehrlich, NMD, private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

Supporting Research

Adams LL, Gatchel RJ, Gentry C. Complementary and alternative medicine: applications and implications for cognitive functioning in elderly populations. Altern Ther HealthMed. 2001;7(2):52-61.
Aruna D, Naidu MU.Pharmacodynamic interaction studies of Ginkgo biloba with cilostazol and clopidogrel in healthy human subjects. Br J Clin Pharmacol. 2006 Sep 29; [Epub ahead of print].
Ashton, A. K., Ahrens, K., Gupta, S., and Masand, P. S. Antidepressant-induced sexual dysfunction and Ginkgo Biloba. Am J Psychiatry. 2000;157(5):836-837.
Benjamin J, Muir T, Briggs K, Pentland B. A case of cerebral haemorrhage-can Ginkgo biloba be implicated? Postgrad Med J. 2001;77(904):112-113.
Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD003120. Review.
Bridi, R., Crossetti, F. P., Steffen, V. M., and Henriques, A. T. The antioxidant activity of standardized extract of Ginkgo biloba (EGb 761) in rats. Phytother Res 2001;15(5):449-451.
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Development of Pharmacy Practice from 1940's up till Now

Development of Pharmacy Practice from 1940's up till Now

Author:
Dr. Mohamed Ahmed A. Moustafa
Professor of Medicinal Chemistry
mmoustafa50@hotmail.com

In the beginning, I am very pleased to start sharing in the activities of this important site aiming to help in creating bright future for Pharmacists and Pharmacy Practice.

Pharmacy practice has faced several changes in responsibilities and developments along the period started from the end of the Second World War up till now. In fact, these evolutions in the responsibilities of Pharmacists were necessary to meet development in industry, technology, and the impact of the societies needs to improve health care system. Unfortunately, I should emphasize that pharmacy practice in most of the Arabic countries does not cope with international development in this field.

1940s and 50s
Pharmacists compounded drugs used to treat patients. Pharmacy lab was very rich in raw materials of available drugs, chemicals and extracts and it was the primary source of simple and compound medicines. Pharmacists were able to prepare powdered drugs in the form of packages, cachets and pills. Syrups, solutions and elixirs beside creams and ointments were currently dispensed in the pharmacy.


" كان يقال ان الحنفية فى اجزاخانة الدكتور موافى ، اللة يرحمة، فى ميدان المحطة بالمنصورة بتنزل ماء دّهب"


1960s and 1970s

Rapid growth of Pharmaceutical industries that began to take over the role of drug production.

Pharmacist role is becoming more technical:

n Pharmacist as dispenser
n Focus on product
n Ethics prohibit Pharmacist from discussing drug effect or Rx with patient.
"للاسف هذا هو الحال بالنسبة للصيادلة فى معظم الوطن العربى حتى الان"

Hospital Pharmacy

In the 1960s, hospital pharmacists implemented unit-dose drug distribution systems to reduce medication, dispensing and administration errors. Hospital pharmacists assumed responsibility for compounding parenteral admixtures in the 1960s and 70s.
In the 1970s pharmacists began maintaining medication profiles to review patient medications for drug related problems. Computerized systems for automatically reviewing prescriptions for allergies, drug interactions, appropriateness of the dosage, and other common drug related problems have since evolved.






• Drug information centers were created in hospitals to provide drug information to physicians and other health care providers.
• The role of pharmacists as drug information providers led to decentralization of pharmacists to provide drug information.


"من هنا بدات علاقة حقيقية بين الاطباء والصيادلة من اجل تقديم خدمة افضل للمرضى"



1970s and 1980s
Clinical Pharmacy
Most hospitals in USA began to develop clinical pharmacy services. Pharmacists were decentralized to patient care units to provide clinical services.
Ambulatory clinical services also began in clinics and a few community pharmacies.
In the 1980s most states required pharmacists to provide patient medication counseling to outpatients on new prescriptions. Verbal, written and computerized printed education materials to supplement verbal patient counseling have since evolved.

Clinical Pharmacy rules could be summarized in the following points:
n Scientific knowledge brought bedside
n Drug use control (social role)
n Drug therapy experts
n Consulted and extension with physicians in hospital setting
n Most communication with physicians and nurses
n Little communication with patient

1990s to Now
Pharmaceutical Care and Pharmacotherapy (Pharmacist as Patient Care Provider)
Pharmacist became part of the health care system. It has real relation with patient. Now, Pharmacy practice trends are:
v Increased emphasis on patient care services as well as drug distribution.
v Increased emphasis on continuity of care (home-office practice-hospital-long term care, etc.)
v Increased emphasis on preventive care (use of OTCs, alternative medicines, self-diagnostic kits, diet, screening procedures, immunizations, etc.)
v Increased use of automation for pharmacy dispensing.

v Increased use of information technology.
v Increased evidenced based use of alternative and complimentary medicines
v Increased collaborative practices with other health professionals.
v Better documentation of the value of pharmaceutical care
v Greater use of pharmacist reimbursement methods tied to patient care services and patient outcomes.
Pharmacists are becoming key players in developing systems of care (automated treatment protocols) and employed by the pharmaceutical industry, pharmaceutical benefits managers, third party payers and the government to develop systems of care.

In Primary care services, pharmacists take responsibility for the primary care of patients. Pharmacists will not likely become independent prescribers and primary care providers but may be delegated significant responsibilities using collaborative practice agreements. Organized ambulatory care, collaborative practices in community pharmacies.

Physicians and nurses continue to refer to pharmacists as clinical pharmacists. They think of clinical pharmacists being pharmacists who focus on how to optimize the use of drugs in patient care as opposed to drug dispensers. This overlap of terms

really makes no difference which term is used as long as pharmacists are focused on improving patient care as well as assuring safe drug distribution and administration.

It is important to point out that the reshaping of pharmacy practice had begun with the reshaping of pharmacy education.






Bachelor Degree of Science in Pharmacy (5 year program)
is replaced by Pharm D. program which provide Doctor in Pharmacy Degree. Pharm. D. program is six years educational program of which 5 years of pharmaceutical and medical courses are covered followed by one year of at least clinical rotations in different medical areas. Post graduate residency training to develop knowledge and skills are very important.



Pharmaceutical educationin in the Pharm. D. program is focused on preparing pharmacists as patient care providers (emphasis on pharmacotherapy role)
Importance of Education and Training for Pharmacists to Prepare for Roles Today and in the Future relies on
• Intensive courses in pathophysilogy and Therapeutics
• Clinical professional skills
• Professional experience program

"There is no future in counting pills. The future for pharmacists is in providing optimal value services to society"


Finally, Pharmacists now can act as health care provider in Wards, Clinics, Hospital Pharmacy, Satellite Pharmacy, and Community Pharmacy.

Thank You


Dr. Mohamed A. Moustafa
03.09.2006