Term
| When referring to the economics of herbals, what does CAM stand for? |
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Definition
| Complementary and Alternative Medicine |
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Term
| In 2005, how much money was spent on herbals in the US? |
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Definition
$250 million
-this continued to grow after 2007, when $33.9 billion was spent on out of pocket visits to CAM practitioners and CAM products |
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Term
| List the medications derived from plants. |
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Definition
atropine
digoxin
colchicine
quinine
codeine
vincristine
ipecac
taxol
physostigmine
senna
ephedrine
cocaine
salicylin
capsaicin
scopolamine
respirine |
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Term
| What does the 1994 Dietary Supplement and Health Education Act say? |
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Definition
| -the dietary supplement/ ingredient manufacturer is responsible for ensuring the supplement or ingredient is safe before it is marketed |
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Term
| Are dietary supplement/ ingredient menufacturers regulated by the FDA? |
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Definition
no
-no safety or efficacy data is needed
-no claims for diagnosis, tx, cure or prevention of dz may be made |
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Term
| Who is responsible for taking action against any unsafe supplement product AFTER it reaches the market? |
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Definition
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Term
| What are 4 herbal safety issues? |
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Definition
lack of standardization
questionable good manufacturing practices
adulterated/ mislabeled products
adverse reaction reports (high, 184 deaths from 1993-1998) |
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Term
| In 2007, what did the FDA publish? |
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Definition
comprehensive regulations for Current Good Manufacturing Practices
-for those who manufacture, package or hold dietary supplement products
*meaning, products must be properly labeled
*must be free of adulterants
*must be manufactured according to specific standards |
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Term
| Is there a maximum set for heavy metals with dietary supplements? |
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Definition
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Term
| What are the top selling herbs? |
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Definition
Garlic
Echinacea
Saw palmetto
Ginkgo biloba
Cranberry
Soy
Ginseng
Black cohosh
St. John’s Wort
Milk thistle
Green tea
Evening primrose
Valerian
Grape seed extract
Horny Goat Weed
Kava
Bilberry
Red clover
Bilberry
Ginger
Horse chestnut seed
Grape seed extract
Valerian
Grape seed extract
Horny Goat Weed
Kava
Bilberry
Red clover
Bilberry
Ginger
Horse chestnut seed
Grape seed extract |
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Term
| Of the top selling herbs, which ones have reactions to them? |
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Definition
echinacea
saw palmetto
ginkgo bilboa
ginseng
St. John's Wort
Horny Goat Weed
Kava |
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Term
| What are the uses of glucosamine and chondroitin? |
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Definition
tx for osteoarthritis and other joint disorder
-used as primary tx in Portugal, Spain and Italy
typically used in combination: most common forms are glucosamine sulfate and chondroitin sulfate |
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Term
| Do physicians in the field actually recommend glucosamine/ chondroitin before going directly to surgery? |
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Definition
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Term
| What are some adverse effects of glucosamine/ chondroitin? |
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Definition
| constipation, diarrhea, drowsiness, stomach upset, headache, nausea, rash |
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Term
| What drug should you worry about interacting with glucosamine? |
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Definition
|
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Term
| What drug should you worry about interacting with chondroitin? |
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Definition
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Term
| Who should you be cautious with when recommending glucosamine/ chondroitin? |
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Definition
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Term
| How did a study in Belgium show that glucosamine works? |
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Definition
| showed no joint space loss and an improvement in symptoms compared to progressive joint space narrowing and worsening symptoms with placebo (Lancet 1/2001) |
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Term
| What do older studies suggest about glucosamine/chondroitin? |
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Definition
| support a reduction in joint pain and improved ROM |
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Term
| What is saw palmetto typically used for? |
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Definition
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Term
| How long does saw palmetto maintain effectiveness with BPH? When are benefits usually seen? |
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Definition
at least 3 yrs
within 4-6 wks. |
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Term
| Approximately what percentage of men with BPH report improvement saw palmetto? |
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Definition
|
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Term
| What is the dose of saw palmetto? |
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Definition
| 160 mg twice daily or 320 mg daily |
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Term
| What are some side effects of saw palmetto? |
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Definition
abdominal pain
back pain
constipation
diarrhea
headache
increased blood pressure
nausea |
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Term
| Are there any known drug interactions with saw palmetto? |
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Definition
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Term
| What is the therapeutic application of ginger? |
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Definition
nausea
motion sickness
hyperemesis graviarum
control arthritis symptoms |
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Term
| What are the contraindications of ginger? |
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Definition
in pregnancy and in those with gallstones
if someone has always had GI issues |
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Term
| Are there any known adverse reactions with ginger? |
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Definition
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Term
| What are the 3 available sources of ginseng? |
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Definition
Panax ginseng- korean or asian
Panax quinquefolius- American
Eleutherococcus senticosus- Siberian (not actually ginseng, but has similar properties) |
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Term
| What are the uses of ginseng? |
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Definition
sedative
aphrodisiac
diuretic
antidepressant
stamina
concentration
stress
improved "well being" |
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Term
| How should ginseng be dosed? |
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Definition
depending on version...
use for 2-3 weeks followed by a 1-2 week break |
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Term
| What are the adverse affects of ginseng? |
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Definition
chest pain
diarrhea
headache
impotence
increased BP
nausea
vomiting
nervousness |
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Term
| What are the precautions of ginseng? (2 types of pathologies) |
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Definition
|
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Term
| What are the drug interactions with ginseng? |
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Definition
phenelzine
digoxin
warfarin
stimulants (ginseng abuse syndrome) |
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Term
| What are the uses of ginkgo? |
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Definition
dementia
age-related memory loss
peripheral vascular insufficiency |
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Term
| What is the dose of ginkgo? How long does it take to see full affects? |
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Definition
120-240 mg/day, divided 3 x daily
6-12 wks to see full effects |
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Term
| What are the adverse effects of ginkgo? |
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Definition
diarrhea
flatulence
headache
nausea
vomiting
bleeding
seizures
rash when come in contact with the fruit. |
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Term
| What are the drug interactions with gingko? |
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Definition
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Term
| What are the uses of St. John's Wort? (Hypericum perforatum) |
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Definition
mild to moderate depression
dysthmia- chronic but mild depression |
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Term
| What is the dose of St. John's Wort? |
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Definition
300 mg TID
-900 mg/day total |
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Term
| How do you convert from prescription antidepressant to St. John's Wort??? |
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Definition
no definitive answer, but could:
cut dose of original agent in half and add St. John's
-After 1-2 wks: d/c original medication |
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Term
| What are the side effects of St. John's Wort? |
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Definition
rarely seen:
mild stomach upset, constipation, allergic rxns (rash), tiredness, dizziness, restless ness, headache, dry mouth
severe phototoxicity seen in animals--> increased risk of cataracts |
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Term
| Why is St. John's Wort often found in combination with kava? |
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Definition
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Term
| Why is St. John's Wort often found in combination with kava and valerian? |
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Definition
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Term
| What are some St. John's Wort drug interactions? |
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Definition
DIGOXIN, WARFARIN and OCPs
protease inhibitors
cyclosporine
theophylline
olanzapine
clozapine
etoposide
teniposide
mitoxantrone
doxorubicin
SSRIs
sumatriptan
tramadol
photosensitizing agents |
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Term
| What has St. John's Wort been tested against by the NCCAM and NIH? |
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Definition
sertraline
-most of these studies contain the flaw that the doses of the prescription antidepressant is inadequate |
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Term
| For what is echinacea used? |
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Definition
wound healing agent
nonspecific immunostimulant- prevention of infection |
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Term
| What are the doses of echinacea? |
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Definition
varies:
caps: 900 mg to 1 g TID
Should not be used for > 8 wks. |
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Term
|
Definition
kava-kava social drinking
seizures, anxiety, depression, insomnia, pain, rheumatism, muscle spasms |
|
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Term
| What are the adverse effects of kava? |
|
Definition
visual disturbances (red eyes)
slow reflexes
decrease blood counts
dry skin
yellow skin discoloration
mild GI disturbances
SOB
dependence |
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Term
| What are the drug interactions with kava? |
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Definition
alcohol: increases kava side effects
benxodiazepines (Valium): additive side effect
Xanax: coma
Levodopa: increased Parkinson's symptoms. |
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Term
| What are the indications for the use of garlic? |
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Definition
treating hyperlipidemia and HTN
may be used in bacteria, fungal and viral infections |
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Term
| What are the contraindications to using garlic? |
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Definition
should not be used by breast feeding mothers
flatulence, heartburn or dermatitis |
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Term
| What are the adverse rxns of garlic? |
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Definition
reduces clotting time
increases blood levels of HIV meds |
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Term
| For what is valerian used? |
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Definition
sedative for insomnia/restlessness
antispasmodic |
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Term
| What are the adverse effects of Valerian? |
|
Definition
blurred vision
headache
nausea
allergic rxns
liver toxicity* |
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Term
| What are some drug interactions with Valerian? |
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Definition
| alcohol, pain meds, Valium (causes increased sedation) |
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Term
| What are some medications with high interaction potential with herbs? |
|
Definition
Coumadin® (warfarin)
Dilantin® (phenytoin)
Lanoxin® (digoxin)
Neoral® (cyclosporine)
-Prevents organ rejection episodes with transplants
Tagamet® (cimetidine)
-For reflux
TheoDur® (theophylline) |
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Term
| Which herbs have a rxn with wafarin? |
|
Definition
Angelica root
Arnica flower
Anise
Asafoetida
Bogbean
Borage seed oil
Bromelain
Capsicum
Celery
Chamomile
Clove
CoEnzyme Q10**
Danshen
Devil’s claw
Don Quai**
Fenugreek
Feverfew
Garlic**
Ginger
Ginkgo**
Ginseng*
Green tea*
Horse chestnut
Licorice root
Lovage root
Meadowsweet
Onion
Parsley
Papain
Papaya extract
Passionflower Herb
Poplar
Quassia
Red clover
Rue
St. John’s Wort**
Sweet clover
Turmeric
Willow bark
Vitamin E** |
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Term
Herbs can potentially cause an increase in morbidity/ mortality in the perioperative period.
What 8 herbs have the greatest impact in pts undergoing surgery? (when interviewing someone about to have surgery, these should raise some red flags) |
|
Definition
Echinacea
Ephedra
Garlic
Ginkgo
Ginseng
Kava
St. John's Wort
Valerian |
|
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Term
| When monitoring a CBC for surgery, what should you remember if a pt is taking chondroitin? |
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Definition
| it is a heparin like structure |
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Term
| When monitoring a CBC for surgery, what should you remember if a pt is taking garlic? |
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Definition
| it inhibits platelet aggregation |
|
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Term
| When monitoring a CBC for surgery, what should you remember if a pt is taking kava? |
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Definition
| decreased platelet and lymphocyte count |
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Term
| When monitoring a CBC for surgery, what should you remember if a pt is taking mayapple? |
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Definition
| causes leukopenia and thrombocytopenia |
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Term
| You may need to look at the coag studies for a pt about to undergo surgery if they are on what herbs? |
|
Definition
angelica (dong quai)
black haw
cat’s claw
fenugreek
feverfew
ginger
horse chestnut
kelp and kelpware
lungwort
pau d’arco
poplar
red clover
tonka bean
turmeric
willow |
|
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Term
| When monitoring a CBC for surgery, what should you remember if a pt is taking licorice? |
|
Definition
| increases BP, liver and kidney toxicity |
|
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Term
| When monitoring a CBC for surgery, what should you remember if a pt is taking Goldenseal? |
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Definition
| worsens edema and increases BP |
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Term
| What resources can be used to verify the quality of an herb? |
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Definition
consumerlab.com
national Natural Foods Association
Thorne Research
Quality statements from the manufacturer |
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Term
| What might a quality statements from the manufacturer of an herbal supplement yield? |
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Definition
FDA approved or not
Follows code of federal regulations or not
inspection of incoming ingredients |
|
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Term
| When should a pt reconsider and talk to their doctor regarding herbs? (5) |
|
Definition
pregnant
child
plant/ pollen allergies
multiple medical problems
multiple medications |
|
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Term
| Is it smart to select herbs with the manufacturer's name, address and contact number? |
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Definition
|
|
Term
| Should you avoid products without lot numbers or expiration dates? |
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Definition
|
|
Term
| Should you ever take more than the recommended amt of herbs? |
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Definition
|
|
Term
| Does natural always mean safe? |
|
Definition
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