Advanced Pharmacology discussion post 1

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.


Health care modalities discussion post sample-solution

(Health care modalities)Globally, cardiovascular disease is the leading cause of death. However, among CVD patients, mortality rates have decreased over the past few decades for coronary heart disease and stroke for several reasons. One of them is that survival after an acute heart attack has dramatically improved(Health care modalities discussion post sample). According to Kristofferson et al. (2017), another reason is the growing interest of individuals to improve their health and embrace healthy lifestyle modification as they turn to complementary and alternative medicine both as a self-care and health care option. The National Center for Complementary and Alternative Medicine (NCCAM) describes complementary and alternative medicine as a collection of diverse medical and healthcare systems, practices, and products that are generally not considered part of conventional medicine. Specifically, complementary medicine as the word suggests is used together with conventional medications, whereas alternative medicine is used in conventional medicine (Rabito & Kaye, 2013).(Health care modalities discussion post sample)

Moreover, NCCAM classifies CAM into five domains namely whole medical systems (like homoeopathy, and ayurvedic medicine) mind-body interventions (like yoga and meditation) biologically based therapies (like herbal therapies), manipulative and body-based methods (like chiropractic therapy) and energy-based therapies like Reiki). According to the National Health Interview Survey of 2007, the duo researchers further reported that about 38% of adult Americans and 12% of children reported using CAM in the past year. Despite the increasing interest and acceptance of CAM among the general population, few studies have been done among patients. Experts acknowledge that their use in cardiovascular patients has both benefits and risks. Therefore, this essay aims to examine how the use of CAM healthcare modalities impacts CVS. The selected methods are Ginseng, Hawthorn, L-Arginine and St. John’s Wort within the context of the methods’ effect of the CVS, anticipated benefits, identified risks or potential adverse effects and relative patient education.(Health care modalities discussion post sample)


Panax ginseng as traditional herbal medicine has been used for medicinal purposes for over millennia in Asia, specifically in China, Japan and Korea. Ginseng plant has various species the most commonly used being the Korean ginseng. P.Ginseng and Chinese ginseng (Panax notoginseng and American ginseng Panax quinquefolius). The name Panax translates to all healing and is believed to have stemmed from the belief that the properties of ginseng have the potential to heal all sorts of illnesses that afflict humans. Lee & Kim (2014) note that instead of using whole plants, many studies focus on individual ginsenosides like Rb1, Rg1, Rg3, Re, and Rd. Ginseng and ginsenosides are known to positively affect the nervous system besides possessing anticancer s, anti-inflammatory, anti-oxidative and vasodilation properties.(Health care modalities discussion post sample)

Ginseng Effect on the Cardiovascular System and Its Anticipated Benefits

Due to its vaso-relaxation properties. Ginseng is indicated for CVDs with evidence showing that Koreans have been using its roots and extracts to renew the body and mind. At the same time, cardiac ischemia can lead to the production of reactive oxygen species (ROS), whereby treatment with ginseng improves coronary blood flow and restore it to normal levels.(Health care modalities discussion post sample)

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Studies have also demonstrated that ginsenosides Rg2 and Rh1 decrease oxidation induced damage of the erythrocyte membrane even as energy metabolism and mitochondria shielding by polysaccharides from P.ginseng(Health care modalities discussion post sample). Other benefits expected include the fact that ginsenosides offer protection from myocardial reperfusion damage as the ginsenosides increase 6-keto-prostaglandin F1 alpha production and decrease lipid peroxidation. Due to the limited scope of this essay, the last of the anticipated is that ginsenosides. Re is a potent antioxidant that offers protection to cardiomyocytes against oxidant- mediated damage.(Health care modalities discussion post sample)

Ginseng Identified Risks or Adverse Effects and Patient Education

When administered orally, Panax ginseng is safe when taken up to six months, but researchers believe that its use for more than six months may lead to hormone-like effects like increased heart rate, high or low blood pressure and mod changes( Parlakpinar et al., 2016). In women, other side effects associated with ginseng use for more than six months are menstrual problems and vaginal bleeding. Like any other therapeutic intervention concerning heart disease, the CVD patients should be informed on the benefits, risks, and precautions they should take when using ginseng (Makky et al., 2018). They need to be aware that its use is associated with mild to typical side effects like the herb products stimulatory effect on some people that may cause irritability and insomnia, especially after use for over six months. (Health care modalities discussion post sample)


Hawthorn (Crataegus oxycantha )synonymously known as haw or may bush or white horn is part of plant genus of spiny shrubs and trees commonly found in temperate regions of the Northern Hemisphere be it in America, Europe or Asia. It is one of the natural products used to treat heart failure patients due to its mild positive inotropic effects on myocardial function. Hawthorn contains a wide range of flavonoids and oligomeric procyanidins that have been proven useful in the treatment and management of heart failure.(Health care modalities discussion post sample)

Hawthorn Effect on the Cardiovascular System and Anticipated Benefits

           Cardiac remodelling resulting from pressure overload consists of changes in the heart structure that include alterations in extracellular matrix volume, cell number, cardiac wall thickness and chamber size all of which have a bearing on heart function. The overarching goal of heart function is to maintain adequate blood delivery to all body cells while normalizing wall pressure. Dood et al. (2013) note that hawthorn extracts increase heart contractility and myocardial oxygen utilization, lowering the heart rate.(Health care modalities discussion post sample)

Some of the benefits of hawthorn used in cardiovascular patients are that congestive heart failure patients benefit in relieving symptoms and physiologic outcomes emanating from hawthorn extract use have demonstrated its efficacy as adjunctive therapy CHF (Wang et al., 2013). Additionally, the antioxidant, positive inotropic, anti- cardiac remodelling and anti-inflammatory effects have been found in various in vivo and in vitro experiments.(Health care modalities discussion post sample)

Hawthorn Identified Risks or Adverse Effects and Patient Education

Despite the benefits of Hawthorn in CVD patients, some of its pharmacological properties, specific mechanisms remain unclear and pose some risks that are likely to cause adverse effects (Rababah et al., 2020). Studies indicate that oral hawthorn is well-tolerated since it is a slow-acting herb that should be used for 4 to 8 weeks for optimal benefits to be realized. With the most effective dosage still unknown to date, the recommended dosage ranges from 160 to 1800 mg per day in two or three divided days. Therefore, there is a need for patient education on how to cope with some of the known side effects like dizziness, headache, migraine, palpitation and gastrointestinal complaints (Wang et al., 2013)(Health care modalities discussion post sample)


Schultze discovered an essential endogenous amino acid known as L- arginine in 1886. It has a vital metabolic role as an ammonia detoxification product, is a urea cycle metabolite and is involved in the formation of active enzymes. In this paper’s context, the L-Arginine amino acid is of interest due to its close connection to a vital signal molecule nitric acid oxide since it is the sole substrate in the production of NO. (Health care modalities discussion post sample)

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L-Arginine Effect on the Cardiovascular System and Anticipated Benefits

Casanato et al. (2019) observed that L- Arginine supplementation increases the plasma levels of NO metabolites leading to an improvement in the duration and magnitude of post-exercise hypotension by causing a significant decrease in systolic blood pressure. One of the benefits of L- Arginine supplementation in hypertensive individuals is that it leads to BP reduction(Health care modalities discussion post sample). Another benefit is that supplementation does not enhance femoral artery vasodilation and alterations in the autonomic nervous system. Therefore as Speer et al. (2020) conclude in their research, healthcare researchers should seriously consider offering a beverage that provides the ergogenic benefits of L-Arginine supplementation in a sports drink. There should also be additional research that captures the full benefits AA on endurance performance to be used before, during and after an event whether this e I athletics, recreational sport or for the general population.(Health care modalities discussion post sample)

L-Arginine Use in CVD Patients Identified Risks or Adverse Effects and Patient Education

In their study, Bahadoran et al. (2016) note that while it is safe for most people to take L- Arginine by mouth on a short term basis, it has been known to cause side effects like low blood pressure, abdominal pain, bloating and also diarrhoea. Therefore, patient education is required so that the patient is aware that several administration methods exist like inhalation, through the skin and injection. The patient should also have information with regard to special considerations like during pregnancy and breastfeeding and its use in children. The patient should also be informed on contraindications as drug-drug interactions can make other comorbidities like Herpes, cirrhosis and asthma worse.(Health care modalities discussion post sample)

St. John’s Wort (SJW)

St John Wort (Hypericum perforatum) is a plant that bears yellow star-shaped flowers 

whose products and extracts are used to treat and manage various health issues like depression, mood disorders and menopause symptoms, although there is no good scientific evidence to support these uses. Studies have like St. Joh Wort to cardiovascular health uses. Belwal et al. (2019) note that H. Perforatum. However, a native of Europe is widely distributed in Asia, North Africa, North and South America, and all the world’s temperate regions.(Health care modalities discussion post sample)

St John Wort Effect on the Cardiovascular System and Anticipated Benefits

Traditionally, St John Wort is known for its potential to ward off depression, but in the contemporary world, it is gaining ground in the field of cardiology (Nicollusi et al., 2020). This is because patients with pre-existing conductive heart dysfunction or high patients above 65 years have found it safer in the context of their cardiac function compared to tricyclic anti-depressants like Elavil or Amtitrytiline. Contemporary healthcare professionals opine that SJW may be indicated as first-line therapy for heart disease patients diagnosed with depression. (Maher et al., 2016). Some of the anticipated benefits of SJW are that it enhances blood capillaries’ functions and improves heart function.(Health care modalities discussion post sample)

SJW Identified Risks or Adverse Effects and Patient Education

Evidence abounds that demonstrate that SJW, when administered orally, can be safely used for up to three months with some studies indicating safe use for 12 months(Health care modalities discussion post sample). However, when taking in large doses, (exceeding 300 mg 3 times a day) SJW has been known to cause side effects like nervousness, irritability and skin rash amongst other adverse events. Patient education should focus on drug-drug interaction since SJW is known to interact with many drugs. The healthcare professional should see to it that the patient’s medications are reviewed to see any problems. The patients should also be equipped with information regarding other administration methods and special considerations if pregnant or breastfeeding. If found to cause sleeplessness, the patient should be advised to be taking their fair dose in the morning. Other safety considerations education should incorporate SJW dosage in children and comorbidities like Alzheimer disease, bipolar disorder and depression, to mention but a few(Health care modalities discussion post sample)


In conclusion, this essay has established that CAM use among patients diagnosed with various CVDs is a common occurrence. The current review has highlighted the need for more rigorous studies to determine the specific physiologic impacts and the long-term benefits of cardiovascular morbidity and mortality where CAM is being utilized. Both the patient and the professional should know whether Ginseng, Hawthorn- L- Arginine or SJW, each has its benefits and potential risks. Suffice it to say that open communication lines should be nurtured through patient and practitioner education on CAM use, focusing on the side effects management, avoidance and safety considerations the CVD patient should consider. Only by so doing is CAM use in CVD patients have optimal benefits when taken as a treatment option.(Health care modalities discussion post sample)

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(Health care modalities discussion post sample)
Advanced Pharmacology discussion post 1 1


Bahadoran, Z., Mirmiran, P., Tahmasebinejad, Z., & Azizi, F. (2016). Dietary L-arginine intake and the incidence of coronary heart disease: Tehran lipid and glucose study. Nutrition & metabolism13(1), 1-9.

Belwal, T., Devkota, H. P., Singh, M. K., Sharma, R., Upadhayay, S., Joshi, C., … & Pande, V. (2019). St. John’s wort (Hypericum perforatum). In Nonvitamin and Nonmineral Nutritional Supplements (pp. 415-432). Academic Press.

Casonatto, J., Zago, D. M., Enokida, D. M., Grandolfi, K., & Aguiar, A. F. (2019). L-arginine supplementation improves post-exercise hypotension in elderly women. Revista Brasileira de Medicina do Esporte25(4), 333-337.

Dood, K. P., Frey, A. D., & Geisbuhler, T. P. (2013). The effect of hawthorn extract on coronary flow. Journal of Evidence-Based Complementary & Alternative Medicine18(4), 257-267.(Health care modalities discussion post sample)

Kristoffersen, A. E., Sirois, F. M., Stub, T., & Hansen, A. H. (2017). Prevalence and predictors of complementary and alternative medicine use among people with coronary heart disease or at risk for this in the sixth Tromsø study: a comparative analysis using protection motivation theory. BMC complementary and alternative medicine17(1), 1-9

Lee, C. H., & Kim, J. H. (2014). A review on the medicinal potentials of ginseng and ginsenosides on cardiovascular diseases. Journal of ginseng research38(3), 161-166..

Makky, E. A. (2018). Korean Red Ginseng: Benefits Versus Precautions. INNOSC Theranostics and Pharmacological Sciences1(1), 10-13.

Pahlavani, N., Jafari, M., Sadeghi, O., Rezaei, M., Rasad, H., Rahdar, H. A., & Entezari, M. H. (2014). L-arginine supplementation and risk factors of cardiovascular diseases in healthy men: a double-blind randomized clinical trial. F1000Research3.(Health care modalities discussion post sample)

Parlakpınar, H., Özhan, O., Ermiş, N., & Acet, A. (2016). Cardiovascular effects of panax ginseng.(Health care modalities discussion post sample)

Rababa’h, A. M., Al Yacoub, O. N., El-Elimat, T., Altarabsheh, S., Deo, S., Al-Azayzih, A., … & Alzoubi, K. H. (2020). The effect of hawthorn flower and leaf extract (Crataegus Spp.) on cardiac hemostasis and oxidative parameters in Sprague Dawley rats. Heliyon6(8), e04617.

Speer, H., D’Cunha, N. M., Davies, M. J., McKune, A. J., & Naumovski, N. (2020). The Physiological Effects of Amino Acids Arginine and Citrulline: Is There a Basis for Development of a Beverage to Promote Endurance Performance? A Narrative Review of Orally Administered Supplements. Beverages6(1), 11.(Health care modalities discussion post sample)

Wang, J., Xiong, X., & Feng, B. (2013). Effect of crataegus usage in cardiovascular disease prevention: an evidence-based approach. Evidence-Based Complementary and Alternative Medicine2013.

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