16 - Gender-Specific Health Issues Flashcards Preview

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Flashcards in 16 - Gender-Specific Health Issues Deck (103):
1

Who are the highest users of NHPs?

women with higher education

2

Why are women with higher education among the highest users of NHPs?

-Frustration over adverse effects of mainstay pharmacological therapies
-Concern over long-term safety of hormonal agents (Women's Health Initiative)
-Misconception that NHPs are safer

3

What are concerns that people may have?

-Drug interactions
-Safety
-Allergies

4

What women's health issues are a part of this lecture?

-Premenstrual Syndrome
-Mastalgia
-Dysmenorrhea
-Perimenopause/Menopause

5

What is PMS?

-Both physical and behavioural symptoms occurring repetitively in 2nd half of the menstrual cycle & interfere with aspects of the woman's life

6

Etiology of PMS?

Unknown; women who suffer ate ++ sensitive to normal hormonal fluctuations associated with menstrual cycle

7

What are some affective symptoms of PMS?

-depression
-irritability
-anxiety
-nervousness
-decreased concentration

8

What are some somatic symptoms of PMS?

-breast pain
-bloating and swelling
-headache
-tiredness
-body aches

9

What are some treatment approaches to PMS?

-Exercise, relaxation techniques (mild, moderate and severe) EFFECTIVE ?
-SNRIs, SSRIs (mod-severe)
-Cyclic OC use (drospirenone) or continuous OC use (any progestin)
-Role of NHPs ?

10

What is Mastalgia?

-Breath tenderness or pain: Dull ache, heaviness, tightness, burning sensation
-Cyclic vs non-cyclic nostalgia; can be variable depending on hormonal fluctuations
-New onset must always be evaluated by MD; rule out pathology (breast cancer)

11

Describe Cyclic Mastalgia

-70% of women experience some mild pain/swelling cyclically, before menstruation (approx 1 week); 11% of affected experience mod-severe pain
-Usually presents initially between ages of 20-40 yo
-Generally bilateral; can radiate to axilla area
-Caused by hormonal changes related to ovulation that stimulate the proliferation of normal glandular breast tissue = pain!

12

Calcium can be used to treat ____

PMS

13

Forms of calcium ?

-Calcium carbonate
-Calcium citrate

14

Natural sources of calcium ?

-dairy products
-fortified orange juice
-soy milk
-fish canned with it's bones
-dark green vegetables
-nuts, seeds, tofu

15

Is Calcium safe ?

Likely safe when taken orally, within tolerate upper intake levels (2000-2500 mg per day) - must consider all intake sources

16

SE of calcium ?

GI upset, constipation

17

Is Calcium effective for PMS?

Likely effective - approx 1000mg daily improves mood, water-retention and pain of PMS

18

Mechanism of Calcium for PMS?

Variations in estrogen levels during premenstrual period may limit calcium absorption and metabolism >> lower Ca2+ levels, may contribute to mood & other symptoms associated with PMS

Ca2+ involved in production of serotonin

19

Vitamin B6 is used for ?

PMS and mastalgia

20

Natural sources of Vitamin B6?

-cereal grains
-legumes
-vegetables
-liver
-meat
-eggs

21

Is Vitamin B6 safe?

possibly safe when taken orally, exceeding RDA (recommended dietary allowance)

22

SE of Vitamin B6

-n&v
-heartburn
-loss of appetite
-headache

Sensory neuropathy @ high dose (>1000mg daily)

23

Is Vitamin B6 effective?

Possibly effective:
-50-100mg may improve nostalgia and possibly PMS-related depression (limited evidence); more evidence as combo with Mg2+

24

Mechanism of Vitamin B6?

Unclear; may possess some anti-inflammatory properties. Some theories suggest minor Vitamin B6 deficiency

25

What can Chasteberry be used for?

PMS and mastalgia

26

Active components of Chasteberry?

Berry "fruit": iridoid glycosides, flavonoids, linoleic acid, progestins

27

Is Chasteberry safe?

Likely safe - when taken orally & appropriately; safe use in studies up to 1.5 years

28

SE of Chasteberry?

mild, GI reactions, itching, rash, headache, fatigue, acne & menstrual disturbances

29

Effectiveness of Chasteberry?

Possibly effective:
-20-40mg daily (typical dose) may improve nostalgia and PMS-related symptoms

30

Mechanism of Chasteberry?

Some women with PMS and nostalgia have elevated prolactin levels; components of chaste berry inhibit prolactin release through dopamine receptor agonism (D2)

31

Magnesium food sources

Legumes, whole grains, vegetables (especially broccoli, squash, green leafy vegetables), seeds and nuts (almonds)

32

Is magnesium safe?

likely safe when taken orally, below UL (UL = 350 mg daily)

33

SE of magnesium ?

diarrhea

34

Is magnesium effective?

Possibly effective:
-200mg elemental Mg2+ (common dose) may improve PMS-related symptoms (mood, fluid retention), often combined with B6 (50mg) to help with PMS-related anxiety symptoms (nervous tension, mood swings, irritability)

35

What is magnesium used for?

PMS

36

Mechanism of magnesium for PMS

intracellular levels of Mg2+ found to be lower in women with PMS

37

What is Ginkgo biloba used for?

PMS and mastalgia

38

Is ginkgo biloba safe?

Likely safe:
When used orally and appropriately (trial data up to 6 years), BUT some concern over carcinogenic effects in animals (high doses; hepatic, thyroid, gastric & nasal CA observed)

39

SE of ginkgo biloba

mild GI upset, headache, dizziness, palpitations, constipation & allergic skin reactions

40

Is Ginkgo biloba safe?

Possibly effective
-may reduce breast tenderness and other physical/psychological PMS symptoms (start on Day 16 of cycle and continue until Day 5)

41

Mechanism of Ginkgo biloba?

unclear - possibly due to anti-inflammatory properties

42

What is primary dysmenorrhea?

-refers to the presence of recurrent, cramps, lower abdominal pain that occurs during menses in the absence of demonstrable disease that could account for these symptoms
-pain begins at onset of menses and improves over 12-72 hours; nausea, diarrhea, fatigue, headache often accompany pain

43

What is the general treatment approach for dysmenorrhea ?

-Heat, exercise, yoga, sexual activity, diet ?
-Acupuncture
-NSAIDs, oral contraceptives, IUDs, injectable contraception (Depo-Provera)

44

List 4 NHPs that can be used for dysmenorrhea

-omega 3
-vitamin E
-vitamin B1
-magnesium

45

Active components of omega 3 fatty acid

EPA, ALA, DHA

46

Natural sources of omega 3 fatty acid

fish oil, flax, nuts, eggs, soy beverage, edamame

47

Is Omega 3 fatty acid safe?

Likely safe when used orally and appropriately (fish oil doses < 3 grams daily) at higher doses, concerns regarding anticoagulant effect and bleed risk

48

SE of omega 3 fatty acids?

halitosis, fish burps, heartburn, loose stool

49

Are omega 3 fatty acids effective for dysmenorrhea?

Possibly effective:
-Taking fish oil seems to decrease pain, NSAID consumption, and interference with daily activities in women with dysmenorrhea

50

Mechanism of omega 3 fatty acids?

Unclear - possibly due to anti-inflammatory properties (blockade of inflammatory cytokines)

51

Natural sources of Vitamin E?

wheat germ oil, vegetable oils, cereal grains, animal fats, meat, poultry, eggs, fruits and vegetables

52

Is Vitamin E safe?

Likely safe at standard doses
-in unhealthy patients, recommend 400IU or less

53

SE of vitamin E?

nausea, diarrhea, intestinal cramps, fatigue, weakness, headache, bleed risk at elevated doses

54

Is Vitamin E effective?

Possibly effective:
-200 IU BID or 500 IU daily starting 2 days before menstruation, continuing through the first 3 days of bleeding, decreased pain severity/duration and blood loss

55

Mechanism of action of vitamin E

unclear - may block prostaglandin release

56

_______ is likely safe and possible effective for dysmenorrhea

Vitamin B1

57

Is there evidence for using Magnesium for dysmenorrhea

-not indicated

58

Mechanism of magnesium for dysmenorrhea

-Unclear; some resources cite possible Mg2+ deficiency as root cause
-Calcium agonist effect of Mg2+ ion on smooth muscle? Used in prevention of preterm birth (IV) to inhibit uterine contractions - possibly via similar mechanism for dysmenorrhea

59

What is menopause?

Permanent cessation of menstrual periods..after a woman has experienced 12 months of amenorrhea without any other obvious pathological or physiological cause .. medium age of 51.4 years

60

What is perimenopause (PM) ?

Menopausal transition starting - 4 years before cessation of menstruation. Includes a number of physiologic changes: irregular menstrual cycles, marked hormonal fluctuations, hot flashes, sleep disturbances, mood symptoms and vaginal dryness

61

Long-term effects of menopause?

-bone loss and osteoporosis
-increased CV disease risk

62

What is PM a chance for?

to implement some preventative medicine

63

What is the treatment strategy for menopause?

-Treat symptoms
-Prevention plan for post-menopausal complications

64

List 4 NHPs that can help with perimenopause/menopause ?

-Black cohosh
-Evening Primrose Oil
-Soy/isoflavones
-Calcium

65

Active component in black cohosh ?

Rhizomes

66

Is black cohosh safe ?

Possibly safe:
-When used orally and appropriately
-Some concern regarding liver toxicity - case reports of liver failure, acute hepatitis, monitor liver function

67

Is black cohosh effective for menopause ?

Possibly effective:
-Evidence is very conflicting depending;
-Modest benefit on decreasing hot flashes;
-Conclude very weak evidence for menopausal symptoms

68

Mechanism of black cohosh for menopause?

Estrogen-like effects, mechanism unknown

69

What is some risk information with black cohosh ?

-Use with caution during hormone therapy
-Not to be confused with BLUE cohosh which is CARDIOTOXIC
-Products may not always contain the proper herb

70

Active components in evening primrose oil?

gamma-linolenic acid, linoleic acid

71

Is evening primrose oil safe?

Likely safe when used orally and appropriately. Evening primrose has been used safely in doses up to 6 grams daily for up to 1 year

72

SE of evening primrose oil

mild, transient GI SE's

73

Is evening primrose oil effective for treating menopause symptoms?

Possibly ineffective
-Research has shown it does not help menopausal symptoms

74

Mechanism of action behind evening primrose oil?

Gamma linolenic acid (GLA) has anti-inflammatory properties

75

natural source of soy ?

soy beans

76

Is Soy safe for treating menopausal symptoms?

likely safe

77

SE of soy

minor GI reactions, allergic response

78

Is Soy effective for treating menopausal symptoms?

Possibly effective:
Consuming soy protein 20-60 grams providing 34-100 mg of isoflavones daily seems to modestly decrease the frequency and severity of hot flashes in some menopausal women. Also shown to increase bone mineral density (important for osteoporosis related to menopause)

79

Mechanism for soy for treating menopausal symptoms?

weak estrogenic activity, may act as SERMs

80

What is BPH

Benign Prostatic Hyperplasia:
-enlargement of prostate gland that occurs more frequently as age advances, can be asymptomatic initially but often results in symptoms and bladder, urinary tract and kidney complications

81

What is the typical presentation of BPH

Storage symptoms: Increased daytime frequency, nocturne, urgency, and urinary incontinence

Voiding symptoms:
Slow urinary stream, splitting or spraying of the urinary stream, intermittent urinary stream, hesitancy, straining to void, and terminal dribbling - increases risk for UTI

82

Complications of BPH

untreated BPH can cause acute urinary retention, recurrent UTIs, hydronephrosis & renal failure

83

What are some Rx options for BPH

-Alpha 1 adrenergic antagonists
-5 alpha reductase inhibitors
-Anticholinergic agents
-Phosphodiesterase-5 inhibitors

84

What are some NHP for BPH

-saw palmetto
-pygeum
-phytosterol/beta-sitosterol
-pumpkin seed

85

Natural sources of saw palmetto

soybeans

86

Is Saw palmetto safe for BPH

likely safe, when used orally and appropriately, studies of up to 3 years duration

87

Is saw palmetto effective for BPH?

-Study results are highly contradictory
-Overall it appears that saw palmetto does not offer significant benefit for symptoms of BPH. Any benefits are modest at best.

88

Mechanism behind saw palmetto?

Reduces prostate specific antigen (PSA); mechanism unclear

89

Active component in Pygeum?

bark

90

Is Pygeum safe for BPH?

likely safe when used orally and appropriate up to 12 months, 75-200mg capsules of standardized pygeum extract taken daily

91

Is Pygeum effective for BPH

Likely effective
-Taking pygeum orally reduces the functional symptoms of BPH. Pygeum decreases nocturne by 19%, increases peak urine flow by 23% and reduces residual urine volume by 24% in men with BPH

92

Mechanism behind Pygem for BPH ?

Appears to inhibit prostatic 5-alpha reductase (not as good as finasteride tho). Reduction of urethral obstruction and improvement of bladder function have been observed

93

What are phytosterols/beta-sitosterol ?

found in plants, similar to human cholesterol, beta-sitosterol is most common dietary phystosterol

94

Natural sources of phytosterols/beta-sitosterol ?

fruits, vegetables, soybeans, breads, peanuts, plant oils

95

Are phytosterols/beta-sitosterol safe for BPH?

Likely safe when used orally and appropriately up to 18 months

96

SE of phytosterols/beta-sitosterol ?

nausea, indigestion, gas, diarrhea, constipation, reduced appetite

97

Is phytosterols/beta-sitosterol effective ?

Likely effective
-Taking beta-sitosterol 60-130 mg orally in 2-3 divided doses daily significantly improves urinary symptoms, increases maximum urinary flow .. it does not affect prostate size

**only helping with symptom management, not treating the underlying problem

98

Mechanism of phytosterols/beta-sitosterol ?

animal studies: might inhibit 5 alpha reductase activity

finasteride is more potent tho

99

Pumpkin seed used in combo with ?

saw palmetto

100

Is pumpkin seed safe ?

possibly safe when used orally and appropriately

101

SE of pumpkin seed

nausea, indigestion, gas, diarrhea, constipation, reduced appetite

102

Is pumpkin seed effective for BPH?

possibly effective:
-480mg orally in 2-3 divided doses daily (with or without saw palmetto)
-may help BPH symptoms, limited evidence

103

Mechanism of pumpkin seed?

Possibly diuretic effect, relieve bladder discomfort, causing the perception of reduced prostate gland swelling without reducing the gland size