Peer Responses:
    Length: A minimum of 150 words per post, not including references
    Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
    Citations need to be within 5 (Five)  years
    Context: Nursing in the USA
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T7 W8 PD1 R1

1.    Your patient is peri-menopausal and would like to use an herbal product, what do you recommend?
According to Burchum & Rosenthal, Black Cohosh (Cimicifuga racemosa) is listed by the U.S. Pharmacopeia as an official drug to treat symptoms of menopause including hot flashes, vaginal dryness, depression, palpitations, irritability and sleep complications. This herbal product has been known to develop rash, headache and dizziness. It should be used with caution with patients who have a compromised liver or are already taking medications which can cause further liver damage. Reconciliation of medication should be conducted due to black cohosh causing hypotensive effects on those taking antihypertensives and hypoglycemic effects on those taking insulin.
2.    Which natural product helps to prevent bacteria from adhering to the urinary tract and bladder wall?
Cranberry Juice is used to prevent urinary tract infections and can decrease urine odor with patients with urinary incontinence. The juice prevents proanthocyanidins from adhering to the bladder wall however cannot be used as treatment to remove bacteria that is already attached (Burchum & Rosenthal, 2019). Cranberry juice is only effective for older adult women, teens, and those in their twenties.
3.    Which herbal product is used in OTC cold prevention preparations?
Echinacea also known as coneflower plant, stimulates the immune system by suppressing inflammation, treating viral infection as influenza and the common cold (Burchum & Rosenthal, 2019). Due to its stimulation of the immune system, this product should be avoided for patients with chronic infections as lupus, rheumatoid arthritis, HIV, immunocompromised and those with tuberculosis.
4.    Which herbal product can be effective in treating depression and why?
St. Johns wort is used to treat mild to moderate major depression. Hyperforin and hypericin are extracted from the plant and decrease the reuptake of serotonin, norepinephrine and dopamine similar to the mechanism of action of tricyclic antidepressants (Burchum & Rosenthal, 2019). Although well tolerated there are CNS effects, GI discomfort and in high doses risk for phototoxicity. St. Johns wort has numerous drug interactions and can accelerate the metabolism of many drugs causing a decrease in the effects. If taken with other serotonin enhancing medications, it can intensify serotonin causing potentially fatal serotonin syndrome.
5.    Your patient is taking a megadose of Vitamin A, why is this dangerous?
Vitamin A is a fat-soluble vitamin and essential for normal vision, organ function, immune system and reproduction. Its labeled as a pregnancy risk factor X due to its teratogenic effects on craniofacial nerve defects and abnormalities with CNS, cardiac and thymus. Its toxic symptoms can also cause loss of bone density, impede growth, liver damage and headache (Mayo Clinic, 2017). Drug interactions include anticoagulants, hepatotoxic drugs, retinoids, orlistat for weight loss and topical cancer drugs.
6.    Your patient asks which vaccine will be given at birth, what is your response?
The first Hepatitis B vaccine, which protects against 14 potentially serious diseases, is given within the first 12 hours after birth (CDC, 2020). It is also one of the safest vaccines given into the babys thigh (Burchum & Rosenthal, 2019).  and will require two additional doses at month one and month six.

References
Burchum, J. R., & Rosenthal, L. D. (2019). Lehnes pharmacology for nursing care (10th ed.). Elsevier.
Center for Disease Control and Prevention. 2020. Vaccines shortly after birth. Retreived June 24, 2020 from https://www.cdc.gov/vaccines/parents/by-age/birth.html
Mayo Clinic. 2017. Vitamin A. Retrieved June 24, 2020 from https://www.mayoclinic.org/drugs-supplements-vitamin-a/art-20365945