CASE STUDY (HERBAL MEDICINE)

1. (Hypertension)
JR is a 55-year-old man who has a 5-year history of refractory hypertension. He asks if
there is anything else he can do about his blood pressure; he currently takes nifedipin,
captopril, and doxasozin,but his blood pressure is regularly in the 150s/90s. He also takes
saw palmetto for benign prostatic hypertrophy (BPH). He comes into your pharmacy and
inquires about stevia. How should you counsel?

2. (Diabetes Mellitus)
UM is a 65-year-old male patient with a 14-year history of type 2 diabetes. Current
diabetes medications include metformin (1000 mg twice daily) and pioglitazone (30 mg
once daily). Average SMBG value is about 200 mg/dl. His most recent HBA1c
measurement was 8,0%, up from 6,8% 6 months ago. His fasting total cholesterol was
240 mg/dl, LDL 166 mg/dl and HDL 35 mg/dl. He does not follow any spesific diet and
does not exercise besides walking his dog. Although height and weight are not available
for UM, visual inspection reveals he is overweight with abdominal obesity and a high
waist circumference. UM was diagnosed with benign prostatic hyperplasia (BPH) 2 years
ago, for which he takes tamsulosin (0,8 mg daily). At the time, he also started taking saw
palmetto. UM states his prostate problem has dramatically improved since starting
tamsulosin and saw palmetto. However since he started using the herb at the same time as
the prescription drug, he is uncertain whether one or both are responsible for the
improvement. He also regularly takes Ginkgo biloba to improve his memory. He
expresses concern about his poor blood sugar control and asks whether there are natural
remedies for type 2 diabetes. How do you advise him?

3. (Anxiety and Insomnia)

Jo is a 45-year old woman complaining of anxiety and insomnia. She has a 4-year history
of mild moderate major depression and is taking 600 mg St.John’s wort daily. She has
never taken prescription antidepressants. She asks you if she should also consult take
more St.John’s wort and if any other herbs can help. How do you counsel?