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

Men's Health Flashcards

1
Q

What is phytosterol/ beta-sitosterol?

A
  • Plant sterol (steroid alcohol)

- Found in variety of plants like vegetable oil, nuts, and avocados

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2
Q

Active component of phytosterol?

A

Beta-sitosterol/ phytosterol

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3
Q

Medicinal uses of phytosterol

A

BPH tx

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4
Q

Mechanism of action of phytosterol for BPH

A

May involve inhibition of 5-alpha-reductase activity, which converts testosterone to dihydrotestosterone

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5
Q

Safety of phytosterol

A
  • Considered “likely safe” when used orally and appropriately
  • Shown to be safe for 18 months of tx
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6
Q

Efficacy of phytosterol

A
  • “Likely effective” for treating BPH
  • Shown to significantly improve urinary sx, increase urine flow, and decrease postvoid residual urine volume
  • Doesn’t affect prostate size
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7
Q

Drug interactions w/ phytosterol

A
  • Ezetimibe - inhibits intestinal absorption of beta-sitosterol
  • Pravastatin - decreases beta-sitosterol blood levels (don’t know if occurs w/ other statins; doesn’t occur w/ simvastatin)
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8
Q

Contraindications to phytosterol use

A

Px w/ sitosterolemia (rare inherited lipid storage disease) - can increase absorption and decrease clearance of beta-sitosterol

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9
Q

Is phytosterol recommended for clinical use?

A

Well-tolerated w/ few adverse effects and contraindications, and shown to improve urinary sx so can be recommended

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10
Q

What does saw palmetto come from?

A
  • Palm tree in North America w/ saw-toothed edges

- Berries are dried for medicinal use; purified lipid-soluble extract of the berry contains the active ingredients

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11
Q

What is the difference between the preparation of saw palmetto for clinical studies compared to commercial products?

A
  • Clinical studies use extracts prepared w/ lipophilic, non-polar solvents containing 80-90% fatty acids
  • Commercial products don’t have the same lipophilic content, so may not have same efficacy
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12
Q

Saw palmetto is composed of ____. Which component is most active?

A
  • Free fatty acids
  • Phytosterols
  • Long-chain alcohols
  • Unknown which is most active
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13
Q

What is thought to provide the benefit of saw palmetto?

A
  • Sitosterol

- One of the steroidal compounds found in the plant that has anti-androgenic and oestrogenic activity

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14
Q

Medicinal uses of saw palmetto

A
  • BPH tx

- Tx of prostatitis, chronic pelvic pain syndrome, and prostate cancer (along w/ other herbs)

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15
Q

Proposed anti-androgenic MOA for saw palmetto

A
  • Non-competitive inhibitor of 5-alpha-reductase to prevent conversion of testosterone to dihydrotestosterone
  • This may reduce prostate growth
  • Saw palmetto not proven to reduce levels of 5-alpha-reductase
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16
Q

Proposed anti-proliferative MOA for saw palmetto

A

May inhibit fibroblast growth factor & epidermal growth factor to slow prostate cell proliferation, skin inner prostatic epithelia, and facilitate apoptosis

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17
Q

Proposed anti-inflammatory MOA for saw palmetto

A

Inhibition of lipoxygenase and cyclooxygenase which induce anti-inflammatory effects

18
Q

How can saw palmetto be prepared?

A
  • Dried
  • Powder
  • Non-standardized extracts (dry extract, fluid extract, decoction, infusion)
19
Q

Safety of saw palmetto

A
  • “Likely safe” when used in oral preparations up to 3 years

- Long-term use of rectal preparations isn’t well studied and safety is unknown

20
Q

Effectiveness of saw palmetto

A
  • Use and efficacy is poorly understood
  • Lacks clinical evidence to demonstrate effective use
  • Cochrane review showed saw palmetto is no more effective than placebo in relieving urinary sx or increasing urinary flow
21
Q

Drug interactions w/ saw palmetto

A
  • Hormonal activity of saw palmetto could interact w/ oral contraceptives and hormone therapy
  • May increase bleeding w/ antiplatelets and anticoagulants
22
Q

Contraindications to saw palmetto use

A

Advise to d/c saw palmetto 2 weeks prior to surgery

23
Q

Is saw palmetto recommended for clinical use?

A

Not recommended b/c not proven to be superior to placebo

24
Q

What is pygeum?

A

Bark extracted from African Plum tree (native to Africa)

25
Q

Active components of pygeum

A

Most pharmacologically active molecules are found in lipophilic portions of the bark
- Includes triterpenes and ferulic acid esters

26
Q

Medicinal uses of pygeum

A

BPH tx

27
Q

MOA of pygeum

A
  • Anti-inflammatory – blocks production of certain metabolite and leukotrienes
  • Anti-androgenic - blocks and inactivates androgen receptors
  • Anti-cancer - interferes w/ cell growth and induces apoptosis
28
Q

Safety of pygeum

A

Likely safe when used orally and appropriately

29
Q

Possible adverse reactions w/ pygeum

A
  • Headache

- GI irritation

30
Q

Effectiveness of pygeum

A
  • Shown to improve sx of BPH in most clinical trials

- Men taking pygeum were 2x as likely as men taking placebo to report an improvement in sx

31
Q

Drug interactions w/ pygeum

A

No known interactions

32
Q

Contraindications w/ pygeum

A

No known contraindications

33
Q

Should you recommend pygeum for clinical use?

A

Can be recommended for sx management since shown to be effective and has no substantial adverse effects or interactions

34
Q

Active components of pumpkin seed

A
  • Triterpenoids
  • Carotenoids
  • Curcumosin
  • Phytosterols
35
Q

Medicinal uses of pumpkin seed

A
  • BPH
  • Androgenic alopecia
  • Cancer and CV effects
  • Anxiety, insomnia
  • Diabetes
36
Q

Effectiveness of pumpkin seed for BPH

A
  • Considered possibly effective
  • One trial found improvement in sx associated w/ BPH, but no changes in objective measures
  • Other trials didn’t find improvement in various BPH parameters compared to placebo
37
Q

MOA of pumpkin seed for BPH

A

Inhibition of 5-alpha-reductase for BPH tx

38
Q

Safety of pumpkin seed

A
  • Likely safe when used in amounts commonly found in foods

- Possibly safe when used in medicinal amounts for up to 1 year

39
Q

Adverse reactions w/ pumpkin seed

A
  • Well tolerated

- Rare mild stomach discomfort

40
Q

Drug interactions w/ pumpkin seed

A
  • Lithium - pumpkin may decrease excretion and increase lithium levels
  • Warfarin - possible INR increase and anticoagulant effect increase
  • Captopril/ felodipine
41
Q

Contraindications for pumpkin seed?

A

Use of amounts greater than those found in food

42
Q

Recommend pumpkin seed for clinical use?

A

International consultation for urological diseases guidelines (and other associations) don’t recommend any phytotherapies for BPH Tx

Year 3 - Natural Products (6 decks)

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