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Year 3 - Natural Products > Cancer > Flashcards

Cancer Flashcards

1
Q

Active component of coenzyme Q10

A

Coenzyme Q10 is the active component

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2
Q

Medicinal uses of coenzyme Q10

A
  • Cardiac (CHF, angina, HTN)
  • Neural (bipolar disorder, Parkinson’s, muscular dystrophy)
  • Immune (breast cancer, chemotherapy-related fatigue)
  • Other (diabetes, Lyme disease, aging skin)
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3
Q

MOA of coenzyme Q10

A
  • Antioxidant and immunostimulatory activity

- May protect against doxorubicin cardiotoxicity, possibly through scavenging of free radicals

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4
Q

Safety of coenzyme Q10

A
  • Likely safe when used orally and appropriately
  • Possibly safe in children
  • Possibly safe in pregnancy
  • Insufficient evidence in lactation, so avoid use
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5
Q

Efficacy of coenzyme Q10

A

Insufficient evidence in terms of use for cancer

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6
Q

Drug interactions w/ CoQ10

A
  • Alkylating agents
  • Antihypertensives
  • Warfarin
  • Statins
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7
Q

Contraindications for CoQ10 use

A
  • Hypo/hypertension

- Chemotherapy

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8
Q

Should CoQ10 be recommended for clinical use?

A

Not recommended for cancer prevention of adjunct therapy

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9
Q

What is turmeric?

A

Spice derived from root of turmeric plant, member of ginger family

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10
Q

Active component of turmeric

A

Curcumin

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11
Q

Medicinal uses of turmeric

A
  • Arthritis
  • Crohn’s disease and ulcerative colitis
  • Liver and gall bladder conditions
  • Colorectal and prostate cancer
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12
Q

MOA of turmeric

A

Chemopreventive and growth inhibitory effects thought to occur from effect on gene upregulation, which can cause induction of apoptosis in cancer cells

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13
Q

Safety of turmeric

A
  • Likely safe

- Many studies have shown that it is generally well tolerated, other than GI side effects (N/V, diarrhea, dyspepsia)

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14
Q

Efficacy of turmeric

A
  • Possibly ineffective for reduction of radiation dermatitis
  • Thought to be “ideal chemopreventative agent w/ low toxicity, affordability, and easy accessibility” so high risk px may benefit from it
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15
Q

Drug interactions w/ turmeric

A
  • P-gP inhibition
  • Conflicting evidence of whether is inhibitor or inducer of CYP 1A1 and 1A2
  • Antiplatelets (increase risk of bleeding)
  • Anti-diabetics (increase risk of hypoglycemia)
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16
Q

Contraindications of turmeric

A
  • GERD or gastric ulcer
  • Gallstones or bile duct obstruction
  • Pregnancy
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17
Q

Should turmeric be recommended for clinical use?

A
  • Can be used as a chemopreventative and tx option b/c of potential benefits and minimal risks
  • Shouldn’t replace conventional cancer therapies
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18
Q

What is shark cartilage?

A

Extracted cartilage from freshly caught sharks in Pacific Ocean

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19
Q

Active component of shark cartilage

A

Extracted cartilage which is then processed into gelatin capsules

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20
Q

Medicinal uses of shark cartilage

A

Prevention/ adjunctive tx/ mono-therapeutic tx for cancer

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21
Q

MOA of shark cartilage

A
  • Sharks rarely get cancer b/c are cartilaginous so are avascular and contain vascularization inhibitors
  • Inhibitors of vascularization impede angiogenesis (thought to be effective against tumour cells in humans) and believed that shark cartilage induces apoptosis in tumour cells
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22
Q

Safety of shark cartilage

A
  • Possibly safe when used orally and appropriately
  • Safety demonstrated up to 24 weeks
  • Concern w/ teratogenicity in long-term use
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23
Q

Adverse effects of shark cartilage

A
  • Mild to moderate GI distress

- Taste alteration

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24
Q

Efficacy of shark cartilage

A
  • Likely ineffective

- Randomized, double-blind, placebo-controlled study demonstrated no improvement

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25
Q

Drug interactions w/ shark cartilage

A
  • Immunosuppressants
  • Calcium
  • Thiazide diuretics (risk of hypercalcemia)
  • Fruit juice
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26
Q

Contraindications for shark cartilage use

A
  • Caution in px w/ coronary artery disease and PAD
  • Caution in px w/ renal disease, arrhythmias, or cancer
  • Pregnancy and lactation
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27
Q

Should shark cartilage be recommended for clinical use?

A

Not recommended for prevention, tx, or adjunctive therapy b/c no clinical evidence

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28
Q

What is another name for Panax ginseng?

A

Asian ginseng

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29
Q

Medicinal uses of panax ginseng

A
  • Cancer
  • Cancer-related fatigue
  • Alzheimer’s disease
  • Immune stimulation
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30
Q

Active components of panax ginseng

A

Ginsenosides main component for cancer uses

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31
Q

MOA of panax ginseng

A
  • Decrease production of tumor necrosis factor
  • Diminish DNA strand breakage
  • Inhibit formation of induced skin tumors
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32
Q

Contraindications for panax ginseng use

A
  • Hemorrhagic or thrombotic disorders

- Diabetes, autoimmune disorders and cardiac conditions

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33
Q

Drug interactions w/ panax ginseng

A
  • Anticoagulants
  • Is a CYP 2D6 inhibitor, 3A4 inducer, and interacts w/ 2C19; px on any anti-cancer drugs metabolized by these enzymes should avoid use
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34
Q

Efficacy of panax ginseng

A

Insufficient evidence likely due to lack of standardization and in vivo studies on Ginseng

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35
Q

Safety of panax ginseng

A
  • Safe when used orally for less than 6 months

- Unsafe in children, pregnancy, and long term oral use

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36
Q

Should panax ginseng be recommended for clinical use?

A
  • Lack of clinical evidence, so not recommended over traditional remedies
  • No in vivo studies proving efficacy
  • Can take w/ caution as long as no drug interactions or contraindications
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37
Q

What is red clover?

A

Legume w/ phytoestrogens (plant-based compounds structurally similar to estradiol) that are capable of binding to estrogen receptors as agonists or antagonists

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38
Q

Active component of red clover

A

Isoflavones

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39
Q

Medicinal uses of red clover

A

Prevention of breast and endometrial cancer

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40
Q

Safety of red clover

A
  • Likely safe when used orally in amounts commonly found in foods
  • Possibly safe when used orally or topically in medicinal amounts
  • Pregnancy and lactation - likely safe when used in amounts commonly used in foods; likely unsafe when used orally in medicinal amounts b/c of estrogenic activity
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41
Q

Adverse effects of red clover

A
  • Nausea
  • Headache
  • Myalgia, weight gain
  • Increased duration of menstrual cycles
42
Q

Efficacy of red clover

A

Insufficient evidence

43
Q

Drug interactions w/ red clover

A
  • Anticoagulants/ antiplatelets
  • Contraceptives/ estrogens
  • Tamoxifen
44
Q

Contraindications for red clover use

A
  • Hormone sensitive cancers and conditions

- Coagulation disorders

45
Q

MOA of red clover

A
  • Estrogen receptor agonist and antagonist
  • Metabolites have high affinity for beta-estrogen receptors
  • Anti-neoplastic effects may be attributed to effects on cell cycle and apoptosis
46
Q

Should red clover be recommended for clinical use?

A
  • Don’t recommend
  • Very little reliable evidence to prevent endometrial and breast cancer
  • Not enough evidence to determine a recommended dose
47
Q

What is mistletoe?

A

Common name for many species of hemiparasitic plants that grow on pine, oak, and variety of other trees

48
Q

Active components of mistletoe

A

Lectins and viscotoxins which are proteins shown to have cytotoxic and immunomodulatory actions

49
Q

Medicinal uses of mistletoe

A

Injections of mistletoe extract used to treat cancer

50
Q

MOA of mistletoe

A
  • Definite pathway has yet to be identified
  • Proposed mechanisms include direct cytotoxic action or immunomodulation (enhancing natural killer cell-mediated tumor cell lysis; downregulating key genes involved in tumor progression, malignancy, and cell migration and invasion)
51
Q

Safety of mistletoe

A

Mistletoe and its berries are considered toxic as a whole, as are its active ingredients

52
Q

Effects of mistletoe toxicity

A
  • Gastroenteritis
  • Hallucinations
  • Seizures
  • Anaphylaxis
53
Q

Efficacy of mistletoe

A
  • Evidence to support use of mistletoe as cancer tx is weak

- Some evidence suggests mistletoe may be used as adjunct to breast cancer therapy, but more research needed

54
Q

Drug interactions w/ mistletoe

A
  • No well documented interactions

- Caution w/ immunosuppressants, hepatotoxic drugs, antihypertensives

55
Q

Contraindications for mistletoe use

A

Pregnancy and lactation

56
Q

Should mistletoe be recommended for clinical use?

A
  • Not recommended as single entity for cancer tx b/c low level of evidence
  • May be used as adjunct to conventional cancer tx as long as consult medical professional and use commercially licensed products
57
Q

What is melatonin?

A
  • Hormone produced in pineal gland of brain from amino acid tryptophan
  • Synthesis and release stimulated by darkness and suppressed by light
58
Q

Active component of melatonin

A

Melatonin

59
Q

Medicinal uses of melatonin

A
  • Jet lag, insomnia, shift-work disorder

- Breast, lung, prostate, brain, head, neck, and GI cancer

60
Q

MOA of melatonin

A
  • Increases binding of GABA to its receptor
  • Responsible for regulation of the body’s circadian rhythm, endocrine secretions, and sleep patterns
  • For cancer, appears to protect against formation of tumours, by inhibiting proliferation and causing apoptosis in cancer cells
61
Q

Safety of melatonin

A
  • Likely safe when used short term or as a single dose

- Possibly safe when used long term

62
Q

Efficacy of melatonin

A
  • Possibly effective for solid tumours
  • Some evidence suggests that taking combined high dose melatonin w/ conventional chemotherapy or IL-2 may improve tumour regression rate
  • Also seems to help in decreasing chemotherapy toxicities
  • Possibly effective in improving thrombocytopenia associated w/ cancer, cancer tx or other disorders from chemotherapy or IL-2
63
Q

Common adverse effects of melatonin

A
  • Overall well tolerated
  • Headache, dizziness, drowsiness
  • Nausea
64
Q

Drug interactions w/ melatonin

A
  • Anticoagulant/antiplatelets
  • Anticonvulsants, antihypertensives
  • Antidiabetic agents
  • Immunosuppressants
  • Contraceptives
  • For all these drugs, monitor combination for possible adverse effects
65
Q

Contraindications for melatonin use

A
  • Autoimmune disease
  • Lactose intolerance
  • Renal impairment
66
Q

Should melatonin be recommended for clinical use?

A
  • Can be used as add-on therapy for cancer as long as no contraindications or drug interactions
  • Possibly effective in solid tumours and reducing chemo toxicities
  • Likely safe
67
Q

What is laetrile?

A

Purified form of amygdalin, which is found in pits of many fruits

68
Q

Active component of laetrile

A

R-amygdalin

69
Q

Medicinal uses of laetrile

A

Reduce incidence of colon, lung, prostate, and rectal cancer

70
Q

MOA of laetrile

A
  • Amygdalin decomposes into hydrocyanic acid (cyanide), which is though to induce apoptosis of cancer cells, inhibit proliferation of cancer cells, and inhibit expression of cancer cell genes
71
Q

Safety of laetrile

A

Likely unsafe when taken orally or IV since apricot kernel is source of cyanide

72
Q

Efficacy of laetrile

A

Possibly ineffective for cancer by Natural Medicines Database

73
Q

Drug interactions w/ laetrile

A

High dose vitamin C (increases risk of cyanide poisoning)

74
Q

Contraindications for laetrile use

A
  • Pregnancy and lactation (theoretical risk of teratogenesis)
  • Allergy to almonds or fruit pits
  • Vegetarians w/ B12 deficiency (increased risk of cyanide poisoning)
75
Q

How has laetrile been studied?

A

Mainly studied alone as alternative tx to cancer, or as adjunctive therapy w/ other non-conventional tx

76
Q

Should laetrile be recommended for clinical use?

A
  • Don’t recommend
  • No anti-cancer activity in human clinical trials
  • Product is banned by the FDA
  • No sound data and risk of cyanide poisoning
77
Q

Safety of garlic

A
  • Likely safe if used orally and appropriately; and in pregnancy when used in amounts commonly found in food
  • Possibly safe if used topically (may cause severe skin infection); and in children
  • Possibly unsafe if using raw garlic topically; and in pregnancy and lactation when used orally in medicinal amounts
78
Q

Common adverse effects of garlic

A
  • Malodorous breath/ body odour
  • N/V
  • Flatulence
  • Increased risk of bleeding w/ oral garlic
79
Q

Efficacy of garlic

A
  • Inconsistent findings, but possibly effective in decreasing risk of developing prostate cancer in 50% of Chinese men
  • Possibly ineffective in reducing risk of developing breast and lung cancer
80
Q

Drug interactions w/ garlic

A
  • Isoniazid

- Moderate interaction = anticoagulants, antidiabetics, antihypertensives, protease inhibitors, and CYP 3A4 substrates

81
Q

Contraindications to garlic use

A
  • Bleeding disorders

- Surgery (d/c 1-2 weeks prior to surgery)

82
Q

MOA of garlic

A
  • Stimulate T-cell proliferation
  • Restore suppressed antibody responses
  • Radical scavenging activity
  • Induced apoptosis in human leukemia cells by ajoene
83
Q

Medicinal uses of garlic

A
  • Prevention of prostate, colorectal, gastric, and esophageal cancer
  • Adjunctive therapy to chemo or radiation
84
Q

Should garlic be recommended for clinical use?

A
  • Not recommended
  • Most studies done on prevention of cancer
  • Don’t use in place of conventional chemotherapy and doesn’t improve QOL through management of side effects
85
Q

What is the difference between essiac and sorrel?

A
  • Essiac = NHP made up of 4 botanicals (burdock root, sheep sorrel, slippery elm, rhubarb)
  • Sorrel = anticancer agent in essiac (active component)
86
Q

Medicinal uses of essiac

A

Tx of cancer

87
Q

MOA of essiac

A

In vitro research shows high concentrations of essiac have inhibitory effects on different human cancer cell lines

88
Q

Administration of sorrel

A

Essiac commonly used orally as herbal tea, but also available as capsules, powder, and liquid extract

89
Q

Safety of sorrel

A
  • Possibly safe when used orally in Essiac
  • Possibly unsafe when used orally in large amounts (possibility of oxalate poisoning)
  • Possibly unsafe in children, pregnancy, and lactation
90
Q

Efficacy of sorrel

A

Insufficient evidence for breast cancer

91
Q

Drug interactions w/ sorrel

A
  • No known drug interactions w/ sorrel

- Decreases absorption of calcium, iron, and zinc

92
Q

Contraindications for essiac use

A

Children, pregnancy, and lactation

93
Q

Should essiac be recommended for clinical use?

A
  • Not recommended for treating cancer

- Considered possibly safe but insufficient evidence to rate efficacy

94
Q

What is astragalus?

A

Genus of flowers first used in medicine in TCM

95
Q

Active components of astragalus

A
  • Efficacy due to variety of polysaccharides and saponins present
  • No single chemical responsible for effectiveness
96
Q

Medicinal uses of astragalus

A
  • Chemotherapy toxicity
  • Chemotherapy-related fatigue
  • Prevention of chemo-related immune suppression
  • Used in addition to conventional chemotherapy to stimulate immune cells
97
Q

MOA of astragalus

A
  • Boosts immune system by promoting killer T cells
  • Increases antioxidant levels in body
  • Anti-inflammatory effects by lowering TH2 hormones, which can reduce rate of tumour growth
98
Q

Safety of astragalus

A
  • Possibly safe

- Caution should be used in consumption of different species besides membranaceus or mongholicus

99
Q

Efficacy of astragalus

A
  • Insufficient evidence for chemotherapy toxicity and chemo-related fatigue
  • Possibly effective in stimulating immune system and mitigating adverse effects related to chemo
100
Q

Drug interactions w/ astragalus

A
  • Cyclophosphamide
  • Immunosuppressants
  • Lithium
101
Q

Contraindications for astragalus use

A

None identified yet

102
Q

Should astragalus be recommended for clinical use?

A
  • Potentially promising adjunct to chemotherapy to increase tolerability
  • Should be considered if no major interactions

Year 3 - Natural Products (6 decks)

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