Post on 21-Jan-2016
description
Pharmanex Medical Division
Drug-Nutrient Depletion
Dr. James LaValle
The PMD Opportunity
• Majority of American adults are using supplements– Physicians are the most trusted source of information– Patients see a pharmacist 7 or 8 times more often than a doctor
• HCPs are a trusted source for information – 95% of Americans trust their physicians– 56% of Americans use them as a source of information– 84% of the time people are taking their pharmacists advice
The PMD Opportunity
• Many HCPs stock-and-dispense supplements– There are over 100,000 alternative
practitioners in the U.S.– 60-70% stock-and-dispense product
The PMD Opportunity
• HCPs who stock-and-dispense supplements have potential to move a lot of volume– Many are generating significant monthly revenues.
Pharmanex Medical Representatives can be the sole providers of scientific information to HCPs and pharmacists in the dietary
supplement category
The PMD Opportunity
1. Provide scientific materials for HCPs to benefit their practice2. Provide a unique opportunity that each HCP can be involved in
• Advocate• Rebating• Retailing (Alopathic MDs, Alternative Practicioners, Chiropractors)
3. Provide unparalleled products and service to patients who become Pharmanex consumers
• Effective, safe products recommended by their physician
The PMD Mission
• Focused efforts on the education of pharmacists, doctors, and other HCPs in the following areas:– Drug-Induced Nutrient Depletions– Drug-Herb Interactions– Herb-Herb Interactions
• Increased awareness of monetary compensation through this knowledge
The Future of PMD
• Drugs can inhibit nutrient absorption,synthesis, transport, storage, metabolism, or excretion
• Multi-factorial problem• Tremendous opportunity for HCPs outcomes of
patients and increase sales of nutritional supplements
Drug Induced Nutrient Depletions
Drug Induced Nutrient Depletions
Oral contraceptives: deplete folic acid, B6, B1,B2, B3, B12, C, Mg, Se, Zn, tyrosine
Estrogen replacementtherapy (ERT & HRT): deplete B6, Mg
Female Hormone Medications
F. Ahmed, et al., Am J Clin Nutr 28 (6) (Jun 1975): 606-15.
Effect of Oral Contraceptive Agents on Vitamin Nutrition Status
• Women using low-dose OCs for 6 to 12 months excretion on kynurenic and xanthurenic acid EGOT activity with B6 challenge in erythrocyte folate levels in erythrocyte riboflavin conc. and fall in erythrocyte
glutathione reductase activity
Folic Acid Depletion with Oral Contraceptive Use
• Anemia: weakness, low energy• Birth defects• Cervical dysplasia• Elevated homocysteine• Depression breast and colorectal cancer
P. Bermond, Acta Vitaminol Enzymol 1982; 4(1-2): 45-54
Vitamin B-6 Depletion with Oral Contraceptive Use
• Reduced synthesis of serotonin and melatonin; elevated homocysteine
• Symptoms: depression, anxiety, decreased libido, impaired glucose tolerance
• Therapy: 40 mg B6/day restores biochemical values and relieves clinical symptoms
Hydralazine: B6, CoQ10Loop: Ca, Mg, K, Zn, B1, B6, CThiazides: Mg, K, Zn, CoQ10Potassium-sparing: Ca, Zn, FABeta-blockers: CoQ10, melatoninClonidine/Methyldopa: CoQ10ACE: ZnChlorthalidone: Zn
Blood Pressure Regulators
Magnesium
• Muscle relaxant-Ca channel blocker platelet aggregation (like aspirin)• Thins the blood (like Coumadin)• Blocks Ca uptake (like Procardia)• Relaxes blood vessels (ACE inhibitors)• Improves cardiac contractibility which oxygenation of the heart
Lanoxin
• Calcium, magnesium, phosphorus via increased urinary excretion
• Magnesium deficiencies increase likelihood of cardiac dysrhythmias and atrial fibrillation
HMG-CoA ReductaseInhibitors “Statins” : deplete CoQ10
The “fibrates” : depletes B12, E, Cu, Zn
Gemfibrozil: depletes CoQ10, E
Bile Acid sequest: depletes A, D, E, K, Ca B12, Mg, P, Zn, Fe, Folic Acid, fat, beta-carotene
Cholesterol Lowering Drugs
• Sulfonylureas– depletes CoQ10
• Biguanides– depletes CoQ10, B12, FA
Anti-diabetic Drugs
Phenothiazines: depletes B2 & CoQ10, melatonin
Tricyclic antidepressants: deplete B2 & CoQ10
Phelezine (MAOI): depletes vitamin B6Haloperidol: depletes CoQ10, vitamin E,
melatonin
Lithium: depletes inositol
Psychotherapeutic Drugs
Corticosteroids: Vit A, C, D, B6, B12, FA, Ca, Cr, Mg, K, Se, ZnColchicine: Vit B12, Ca, Na, K, P, B-caroteneSulfasalazine: Folic acidIndomethacin: Folic acid, ironNSAIDS: Folic acidAspirin/salicylates: Vit C, FA, B5, Ca, Fe, Na, K
Anti-inflammatory Drugs
Both drugs deplete melatonin:• Insomnia• Greater cancer risk• Increased free radical aging damage
Anti-Anxiety AgentsDiazepam (Valium) and Alprazolam (Xanax)
• Beneficial bacteria manufacture B vitamins and vitamin K in the GI tract
• Beneficial bacteria produce proteases, lipases, and lactase that aid in digestion of nutrients
• Bifidobacteria produce SCFAs that provide from 5-10% of our daily energy supply
• Dysbiosis further disrupts digestion and absorption of nutrients
Antibiotics
Carnitine: abnormal lipids, liver function, glucose
Copper: anemia, cardio & connective tissue problems
Zinc: immunity, wound healing, taste & smell
Vitamin B12: anemia, CVD risk, depression
Antiviral AgentsZidovudine and Related HIV/AIDS Drugs
• Most nutrients are depleted• Cytotoxic drugs can cause:
– damage to gastric & GI mucosa/malabsorption– inflamed GI tract/painful, decreased appetite– nausea and vomiting– dysbiosis
Chemotherapy Drugs
• Vitamin B12 depletion• Slow release of KC1 salts alters intestinal pH, which
decreases B12 absorption• Anemia, elevated homocysteine, depression,
neurological problems
Timed Release KC1 Drugs
• Theophylline: depletes vitamin B6-inhibits synthesis of the enzyme pyridoxal kinase which is necessary to convert B6 to pyridoxal-5-phosphate
• Beta2 adrenergic agonists: deplete potassium
Bronchodilators
• Vitamin K depletion
• Interferes with the enzyme responsible for the synthesis of vitamin K
Coumadin
Vitamin C: drug most likely to deplete innormal individuals
Iron: due to blood loss in GI tract
Potassium: increased urinary loss
Folic acid folate: displaces bound serum
Aspirin
• Mineral Oil absorption of vitamins A, D, E, K, and beta-carotene, calcium &
phosphorus
• Bisacodyl– depletes potassium– Intense peristalsis and rapid bowel emptying can cause hypokalemia
• Sodium phosphate enema– depletes Ca & Mg
Laxatives
• Mg/Al antacids– deplete calcium, phosphorus and
folic acid (protein)
• Sodium bicarbonate– deplete potassium and folic acid
(protein)
Antacids
• Pharmanex Medical Representatives have the opportunity to increase sales and increase their income by utilizing Drug-Nutrient Depletions in conjunction with their Health Care Professionals.
• Many Representatives are currently achieving increased success through the Medical Divison.
Summary
Pharmanex Medical Division E-HEALTH CARE
PREVENTIVE MEDICAL MODEL FOR THE
HEALTHCARE PROFESSIONAL
Michael Jason, MD, FACP, FACC, FCCPClinical Asst Professor Medicine&Cardiology
Cornell University Medical College/NYU
• Medical Model– DX, RX
• Preventive Model– Clinical solutions– Natural diagnosis– History (survey)– Non invasive screening
APPROACH HCP
Please take the time to fill out the questionnaire below: Name: _____________________________________ (1) Do you have heart disease and/or cancer in your family history? Yes / No (2) Do you have Cholesterol concerns? Yes / No (3) Do you smoke? Yes / No (4) Do you have a consistent energy level? Yes / No
(A) Do you feel you lack energy? Yes / No (5) Do you have a regular exercise program? Yes / No (6) Do you have inconsistency in your mood? Yes / No
(A) Do you suffer from depression? Yes / No (7) Do you find memory and concentration a problem? Yes / No (8) Do you currently take supplements? Yes / No
(A) Vitamins/ antioxidants? Yes / No
Kinds, dosage, purpose? (B) Herbals? Yes / No
Kinds, dosage, purpose? (C) Would you like your pharmacist to give direction and
guidelines in these areas? Yes / No Thank you for participating in our survey. Our goal is to provide you with a total health care program by making good health our business. Please use the coupon below toward any Pharmanex purchase.
PATIENT QUESTIONAIRE
Non Invasive Screening
LIPID HYPERLIPIDEMIA GLUCOSE DIABETES% BODY FAT OBESITYBONE DENSITY OSTEOPOROSISPFT ASTHMA/COPDSURVEY SEDPSYCHOMETRICS DEMENTIA/ADDSURVEY DEPRESSIONFAM/PERS HX CANCER
Educating patients (and healthcare professionals) about nutrition, exercise and targeted, safe and effective, rational nutritional and herbal supplementation enables a patient to become increasingly more informed about preventable determinants of chronic illness and disease and, therefore, more empowered and in charge of the powerful aspects of their own health care. (eg. chronically ill, oncology patients)
Why Introduce Herbal & Nutritional Supplements to Patients in a Clinical Practice?
There is a new emphasison nutrition and lifestyle interventionthat is now taking center stage in the overall wellness programsrecommended by many health careprofessionals.
Why are so many HCP’s interested inNutrition and Lifestyle Intervention?
Times are changing in the rapidly emerging world of health care and managed care. There is a resurgence of interest in natural approaches to health.
Why are Natural Medicines ImportantIn a Modern Clinical Setting?
The modern clinical “Renaissance” is making Natural Medicines the most rapidly growing and popular segment of OTC products in Pharmacies, Health Food Stores, and ultimately recommended by Physicians , Alternative Practitioners and other Health Care Professionals, as part of a more preventive and comprehensive, preventive program integrated with routine clinical care.
NATURAL MEDICINE RENAISSANCE
Healthcare Professionals (Physicians, Pharmacists and Alternative Practitioners) are being approached more and more often by their patients and other health care professionals about the 1) proper usage, 2) side effects, 3) contraindications, 4) drug-herb and herb-herb interactions and 5) correct dosage of natural medicines, and how these products should be incorporated into the clinical management of patients with multiple pre-existing illnesses and coadministered drugs.
INCREASED CONSUMER DEMAND
Complimentary Care = Integrative Medicine
Key Clinical Concept There is a need for complimentary medicine practices to be incorporated into today’s
modern medicine, and it needs to be done judiciously, with clinical results presented in a scientific manner, focused on evidence based medicine with clinical proof that certain complimentary interventions work before suggesting them to our patients.
Why is Complimentary Medical Care so Important in Today’s Modern Medicine
From a professional standpoint, there is an educational and experiential deficit that is seeking more information, looking for help and answers and easier access to information because of a great need and desire to be educated.
Why are modern HCP’s so eager to learn more about Natural Remedies?