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Year 3 - Natural Products > Women's Health > Flashcards

Women's Health Flashcards

(89 cards)

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1
Q

What is black cohosh?

A

Wildflower native to eastern North America

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2
Q

Active components of black cohosh?

A

Main component used to standardize = remifemin 27-deoxyactein (triterpene glycoside

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3
Q

Medicinal uses of black cohosh

A
  • Relieve menopause sx
  • Induce labour
  • Prevent breast cancer, osteoporosis, CV disease
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4
Q

MOA of black cohosh

A

May have central opioid receptor activity as a mu-opioid receptor agonist, decreasing frequency between LH pulses in postmenopausal women and alleviating menopausal symptoms.

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5
Q

Safety of black cohosh

A

Possibly safe when used orally and appropriately

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6
Q

Common side effects of black cohosh

A
  • GI
  • Musculoskeletal
  • Connective tissue complaints
  • May cause liver damage (so monitor liver while taking black cohosh)
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7
Q

Safety of black cohosh in pregnancy

A
  • Possibly unsafe
  • May have hormonal effects and menstrual/ uterine stimulant effects
  • Avoid using in pregnancy
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8
Q

Safety of black cohosh in lactation

A
  • Possibly unsafe
  • May adversely effect nursing child
  • Avoid using if breastfeeding
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9
Q

Efficacy of black cohosh

A
  • Possibly effective

- Cochrane database say insufficient evidence to support use for menopausal sx

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10
Q

Drug interactions w/ black cohosh

A
  • Atorvastatin
  • Cisplatin (avoid concurrent use)
  • CYP 2D6 substrates
  • Hepatotoxic drugs
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11
Q

Contraindications for black cohosh use

A
  • Pregnancy and lactation

- Elderly, adolescents, children

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12
Q

Is black cohosh recommended for clinical use?

A

Has potential effectiveness in reducing hot flashes, but no guarantee for other conditions

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13
Q

How is calcium formulated as an NHP?

A

As a salt form, ex: calcium carbonate

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14
Q

Active component of calcium

A

Elemental calcium

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15
Q

Medicinal uses for calcium carbonate

A
  • Antacid
  • Supplementation to reduce risk of developing osteoporosis
  • NHP to reduce risk of colorectal cancer, stroke, and CV disease
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16
Q

MOA of calcium

A

Supplementation adds back the calcium that is reduced by estrogen

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17
Q

Safety of calcium

A
  • Likely safe when used orally or IV appropriately in safe doses
  • UL = 2500 mg for 19-50 y/o; 2000 mg for < 50 y/o
  • Possibly unsafe when used in excessive doses
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18
Q

Calcium should be taken with _____

A

Vitamin D

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19
Q

Efficacy of calcium

A
  • Likely effective in PMS and for decreasing bone loss in post-menopausal women
  • Insufficient evidence to rate in dysmenorrhea
  • Ineffective in mastalgia (breast tenderness)
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20
Q

Drug interactions w/ calcium

A

Thiazide diuretics, androgens, antiestrogens, lithium, progestins (can cause hypercalcemia)

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21
Q

Contraindications for calcium use

A
  • Severe cardiac disease
  • Hypercalcemia
  • Hypercalciuria
  • V fib
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22
Q

Should calcium be recommended for clinical use?

A
  • Relatively safe when used in appropriate doses

- Best evidence for PMS and prevention of bone loss

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23
Q

What is chasteberry?

A
  • Fruit of the chaste tree

- Dried, ripe fruit or extract are used

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24
Q

Active components of chasteberry?

A
  • Flavonoids
  • Iridoid glycosides
  • Essential oils
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25
Medicinal uses of chasteberry
- Amenorrhea - Mastalgia - Menopause - PMS
26
MOA of chasteberry
- Dopamine agonist | - Decreased gonadotropin, estrogen, progesterone, and prolactin
27
Safety of chasteberry
- Extract = likely safe when used orally and appropriately | - Extract = possibly unsafe when used during pregnancy and lactation
28
Efficacy of chasteberry
- Possibly effective for PMS | - Insufficient evidence to mastalgia, dysmenorrhea, and menopause
29
Drug interactions w/ chasteberry
Progestins
30
Contraindications for chasteberry use
- Pregnancy | - Breastfeeding
31
Is chasteberry recommended for PMS?
- One RCT showed extract can control PMS-associated mood swings when taken 6 days prior to onset of menses for 6 consecutive months - Fewer adverse effects than other therapies but evidence lacking
32
Is chasteberry recommended for mastalgia, dysmenorrhea, or menopause?
Evidence lacking, so probably shouldn't recommend
33
What is evening primrose oil?
- Plant native to North and South America | - Oil from seeds is used to make medicine
34
Active components of evening primrose oil
- Gamma linolenic acid (GLA; omega 6) | - Linoleic acid (omega 6)
35
Medicinal uses of evening primrose oil
Used by women for PMS, mastalgia, and sx of menopause (ex: hot flashes, night sweats)
36
MOA of evening primrose oil
Linoleic acid -> GLA which is involved in regulating inflammation and the immune system
37
Safety of evening primrose oil
- Likely safe up to 6 g daily for 1 year - Not safe in pregnancy - Possibly safe in lactation
38
Side effects of evening primrose oil
Abdominal pain, headache, nausea, diarrhea
39
Efficacy of evening primrose oil
- Insufficient evidence to rate for mastalgia, hot flashes and night sweats due to menopause, and PMS - Studies have conflicting evidence
40
Drug interactions with evening primrose oil
- Anticoagulants/ antiplatelets - Ritonavir/ lopinavir - Phenothiazines - Anesthesia
41
Contraindications of evening primrose oil use
- Bleeding disorders - Schizophrenia, epilepsy, or other seizure disorders - Late pregnancy
42
Should evening primrose oil be recommended?
No b/c insufficient evidence
43
Active component of magnesium
Elemental magnesium
44
Medicinal uses of magnesium
- Relieve sx of PMS - Prevent premenstrual migraines - Dysmenorrhea
45
MOA of magnesium
Intracellular levels of Mg have been found to be lower in women w/ PMS
46
Safety of magnesium
- Likely safe in women and in those pregnant and breastfeeding when used in oral doses under the UL (350 mg daily) - Considered possibly safe when given IM and IV - Possibly unsafe orally or IV in excessive doses (can lead to diarrhea)
47
Efficacy of magnesium
- Possibly effective to relieve sx of PMS (some evidence that it improves mood changes and fluid retention in px w/ PMS) - Possibly effective for reducing bone loss in postmenopausal osteoporosis - Possibly effective for sx of dysmenorrhea
48
Drug interactions w/ magnesium
- Aminoglycosides - Antacids - Bisphosphonates - CCBs - Digoxin - K+ sparing diuretics - Quinolone antibiotics - Tetracyclines
49
Contraindications for magnesium use
- Caution in those w/ reduced kidney function | - May increase chance of bleeding in px w/ bleeding disorders
50
Should magnesium be recommended for clinical use?
Can be considered beneficial for PMS as long as used in appropriate doses and in px that aren't contraindicated
51
What is the difference between ALA, EPA, and DHA?
- ALA (alpha linolenic acid) is an essential fatty acids, so we must get it through our diets - Body converts ALA to EPA and DHA
52
Active components of omega-3 fatty acids?
- EPA - DHA - ALA
53
Medicinal uses of omega-3 fatty acids
- Menopause - Dysmenorrhea - Mastalgia - Decrease risk of pre-eclampsia and preterm labour
54
MOA of omega-3 fatty acids
- Metabolism of omega-3 FA produces vasodilatory substances | - Dysmenorrhea and mastalgia pain caused by prostaglandins
55
What is the point of taking omega-3 FA supplements?
- Omega-6 FA metabolized into arachidonic acid, which is a precursor for prostaglandins and vasoconstrictive substances - Most people have more omega-6 than omega-3, so supplementation of omega-3 will help lower levels of prostaglandins and vasoconstrictive substances and increase levels of vasodilatory substances
56
Safety of omega-3 FA
Generally safe when used at doses less than 3 g/day
57
Adverse effects of omega-3 FA
- Nausea - Loose stools - Dyspepsia - Increased risk of bleeding (when taken > 3 g/day)
58
Efficacy of omega-3 FA for dysmenorrhea
Effective in reducing sx of primary dysmenorrhea
59
Efficacy of omega-3 FA for mastalgia and menopause
Likely ineffective
60
Efficacy of omega-3 FA for pre-eclampsia and pre-term labour
- No evidence on preventing pre-eclampsia | - Possibly effective for preventing premature delivery when given during pregnancy
61
Drug interactions w/ omega-3 FA
- Anticoagulants and antiplatelets (increased risk of bleeding) - Antihypertensives (increased risk of hypotension)
62
Should omega-3 FA be recommended for clinical use?
- Not recommended for mastalgia, menopause, or pre-eclampsia b/c no evidence - Some evidence for pre-term labour, so can recommend under supervision of physician - Strong evidence for dysmenorrhea, so can recommend as long as using < 3 g/day
63
What is the difference between soy and isoflavones?
- Soy is a primary source of phytoestrogens called isoflavones - Isoflavones are structurally similar to estrogen in the body
64
Active components of soy
- Phytoestrogens (isoflavones and lignans) | - Phytosterols
65
Medicinal uses of soy
- Menopausal sx - Osteoporosis - PMS - Preventing and/or treating breast cancer and endometrial cancer
66
MOA of isoflavones
- Bind to alpha and beta estrogen receptors, w/ higher affinity for beta receptor - In postmenopausal women w/ less estrogen, isoflavones have weak estrogenic effect, shown to improve hot flashes - Also have antioxidant activity, thought to be beneficial in preventing breast cancer
67
Safety of isoflavones
- Likely safe when used orally and appropriately (60 g of soy protein daily up to 16 weeks) - Possibly safe when used short term (< 60 g of soy protein daily for up to 6 months) - Possibly unsafe when used in high doses
68
Efficacy of isoflavones
- Possibly effective for post-menopausal sx | - Insufficient reliable evidence for mastalgia, PMS, and dysmenorrhea
69
Drug interactions w/ isoflavones
- MAO inhibitors (major) | - Moderate = antibiotics, anti-diabetic drugs, antihypertensives, diuretics, estrogens, progesterone, warfarin
70
Contraindications for isoflavones
- Soy allergy | - Precaution w/ kidney problems, thyroid problems, asthma, cystic fibrosis, cancer, infection, depression, diabetes
71
Should isoflavones be recommended for clinical use?
- No - Only safe when used for up to 16 weeks - Possibly effective for post-menopausal sx, but these sx would likely last longer than 16 weeks so not an effective tx
72
What is vitamin B6?
- Water soluble B vitamin found in many foods (legumes, vegetables, meat, eggs) - Required in amino acid metabolism and involved in carb and lipid metabolism
73
Medicinal uses of vitamin B6
- PMS - Dysmenorrhea - Pregnancy-induced nausea and vomiting
74
MOA of vitamin B6
- Vit B6 converted to pyridoxal phosphate which is important in many metabolic reactions - Some reactions include synthesis of GABA in CNS and metabolism of serotonin, NE, and dopamine which may relieve pain and help w/ depression sx
75
Safety of vit B6
- Likely safe when used appropriately w/in recommended dietary allowances (1.3 mg for females > 50; 1.5 mg for females < 50) - Likely safe in pregnancy and lactation when used w/in recommended dietary allowances (1.9 mg in pregnancy and 2 mg in lactation); should be used short term unless closely monitored by physician
76
Adverse effects of vit B6
- N/V - Abdominal pain - Heartburn - Headache - Somnolence
77
Efficacy of vitamin B6
- Possibly effective for PMS | - Insufficient evidence for dysmenorrhea
78
Drug interactions w/ vit B6
- Antihypertensives (increased risk of hypotension) - Amiodarone - Phenobarbital - Phenytoin - Levodopa
79
Should vitamin B6 be recommended for clinical use?
- Can be recommended for PMS if taken w/in recommended dose - Monitor for side effects - Not recommended for dysmenorrhea b/c insufficient evidence
80
What is vitamin E?
Fat-soluble vitamin naturally occurring in many foods (grains, meats, fruits, vegetables)
81
Active components of vitamin E
8 chemical forms (4 tocopherols and 4 tocotrienols)
82
Medicinal uses of vitamin E
- PMS - Dysmenorrhea - Menopausal sx - Chronic cystic mastitis
83
MOA of vitamin E
- Prevents oxidation of vitamin A and C - Protects PUFAs in membranes from attack by free radicals - Protects RBCs against hemolysis
84
Safety of vitamin E
- Safe and generally well tolerated when taken at recommended doses (no more than 15 mg from food and supplements) - Possibly safe in pregnancy when used orally/appropriately - Likely safe in lactation
85
Side effects of vitamin E
- Nausea - Diarrhea - Intestinal cramps - Fatigue
86
UL of vitamin E
1000 mg/day
87
Efficacy of vitamin E
- Possibly effective for PMS and dysmenorrhea | - Cochrane study declared not effective for perimenopause/ menopause
88
Drug interactions w/ vitamin E
- Antiplatelets - Cyclosporine - Orlistat - Tipranavir
89
Should vitamin E be recommended for clinical use?
- Can be recommended for dysmenorrhea, but only slightly more beneficial than placebo - Not recommended for perimenopause/ menopause b/c conflicting evidence - Can be recommended for severe PMS - Can help reduce severity of mastalgia in those deficient in vitamin E

Year 3 - Natural Products (6 decks)

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