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

Women's Health Flashcards

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
Q

Medicinal uses of chasteberry

A
  • Amenorrhea
  • Mastalgia
  • Menopause
  • PMS
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26
Q

MOA of chasteberry

A
  • Dopamine agonist

- Decreased gonadotropin, estrogen, progesterone, and prolactin

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27
Q

Safety of chasteberry

A
  • Extract = likely safe when used orally and appropriately

- Extract = possibly unsafe when used during pregnancy and lactation

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28
Q

Efficacy of chasteberry

A
  • Possibly effective for PMS

- Insufficient evidence to mastalgia, dysmenorrhea, and menopause

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29
Q

Drug interactions w/ chasteberry

A

Progestins

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30
Q

Contraindications for chasteberry use

A
  • Pregnancy

- Breastfeeding

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31
Q

Is chasteberry recommended for PMS?

A
  • 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
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32
Q

Is chasteberry recommended for mastalgia, dysmenorrhea, or menopause?

A

Evidence lacking, so probably shouldn’t recommend

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33
Q

What is evening primrose oil?

A
  • Plant native to North and South America

- Oil from seeds is used to make medicine

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34
Q

Active components of evening primrose oil

A
  • Gamma linolenic acid (GLA; omega 6)

- Linoleic acid (omega 6)

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35
Q

Medicinal uses of evening primrose oil

A

Used by women for PMS, mastalgia, and sx of menopause (ex: hot flashes, night sweats)

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36
Q

MOA of evening primrose oil

A

Linoleic acid -> GLA which is involved in regulating inflammation and the immune system

37
Q

Safety of evening primrose oil

A
  • Likely safe up to 6 g daily for 1 year
  • Not safe in pregnancy
  • Possibly safe in lactation
38
Q

Side effects of evening primrose oil

A

Abdominal pain, headache, nausea, diarrhea

39
Q

Efficacy of evening primrose oil

A
  • Insufficient evidence to rate for mastalgia, hot flashes and night sweats due to menopause, and PMS
  • Studies have conflicting evidence
40
Q

Drug interactions with evening primrose oil

A
  • Anticoagulants/ antiplatelets
  • Ritonavir/ lopinavir
  • Phenothiazines
  • Anesthesia
41
Q

Contraindications of evening primrose oil use

A
  • Bleeding disorders
  • Schizophrenia, epilepsy, or other seizure disorders
  • Late pregnancy
42
Q

Should evening primrose oil be recommended?

A

No b/c insufficient evidence

43
Q

Active component of magnesium

A

Elemental magnesium

44
Q

Medicinal uses of magnesium

A
  • Relieve sx of PMS
  • Prevent premenstrual migraines
  • Dysmenorrhea
45
Q

MOA of magnesium

A

Intracellular levels of Mg have been found to be lower in women w/ PMS

46
Q

Safety of magnesium

A
  • 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
Q

Efficacy of magnesium

A
  • 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
Q

Drug interactions w/ magnesium

A
  • Aminoglycosides
  • Antacids
  • Bisphosphonates
  • CCBs
  • Digoxin
  • K+ sparing diuretics
  • Quinolone antibiotics
  • Tetracyclines
49
Q

Contraindications for magnesium use

A
  • Caution in those w/ reduced kidney function

- May increase chance of bleeding in px w/ bleeding disorders

50
Q

Should magnesium be recommended for clinical use?

A

Can be considered beneficial for PMS as long as used in appropriate doses and in px that aren’t contraindicated

51
Q

What is the difference between ALA, EPA, and DHA?

A
  • 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
Q

Active components of omega-3 fatty acids?

A
  • EPA
  • DHA
  • ALA
53
Q

Medicinal uses of omega-3 fatty acids

A
  • Menopause
  • Dysmenorrhea
  • Mastalgia
  • Decrease risk of pre-eclampsia and preterm labour
54
Q

MOA of omega-3 fatty acids

A
  • Metabolism of omega-3 FA produces vasodilatory substances

- Dysmenorrhea and mastalgia pain caused by prostaglandins

55
Q

What is the point of taking omega-3 FA supplements?

A
  • 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
Q

Safety of omega-3 FA

A

Generally safe when used at doses less than 3 g/day

57
Q

Adverse effects of omega-3 FA

A
  • Nausea
  • Loose stools
  • Dyspepsia
  • Increased risk of bleeding (when taken > 3 g/day)
58
Q

Efficacy of omega-3 FA for dysmenorrhea

A

Effective in reducing sx of primary dysmenorrhea

59
Q

Efficacy of omega-3 FA for mastalgia and menopause

A

Likely ineffective

60
Q

Efficacy of omega-3 FA for pre-eclampsia and pre-term labour

A
  • No evidence on preventing pre-eclampsia

- Possibly effective for preventing premature delivery when given during pregnancy

61
Q

Drug interactions w/ omega-3 FA

A
  • Anticoagulants and antiplatelets (increased risk of bleeding)
  • Antihypertensives (increased risk of hypotension)
62
Q

Should omega-3 FA be recommended for clinical use?

A
  • 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
Q

What is the difference between soy and isoflavones?

A
  • Soy is a primary source of phytoestrogens called isoflavones
  • Isoflavones are structurally similar to estrogen in the body
64
Q

Active components of soy

A
  • Phytoestrogens (isoflavones and lignans)

- Phytosterols

65
Q

Medicinal uses of soy

A
  • Menopausal sx
  • Osteoporosis
  • PMS
  • Preventing and/or treating breast cancer and endometrial cancer
66
Q

MOA of isoflavones

A
  • 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
Q

Safety of isoflavones

A
  • 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
Q

Efficacy of isoflavones

A
  • Possibly effective for post-menopausal sx

- Insufficient reliable evidence for mastalgia, PMS, and dysmenorrhea

69
Q

Drug interactions w/ isoflavones

A
  • MAO inhibitors (major)

- Moderate = antibiotics, anti-diabetic drugs, antihypertensives, diuretics, estrogens, progesterone, warfarin

70
Q

Contraindications for isoflavones

A
  • Soy allergy

- Precaution w/ kidney problems, thyroid problems, asthma, cystic fibrosis, cancer, infection, depression, diabetes

71
Q

Should isoflavones be recommended for clinical use?

A
  • 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
Q

What is vitamin B6?

A
  • 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
Q

Medicinal uses of vitamin B6

A
  • PMS
  • Dysmenorrhea
  • Pregnancy-induced nausea and vomiting
74
Q

MOA of vitamin B6

A
  • 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
Q

Safety of vit B6

A
  • 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
Q

Adverse effects of vit B6

A
  • N/V
  • Abdominal pain
  • Heartburn
  • Headache
  • Somnolence
77
Q

Efficacy of vitamin B6

A
  • Possibly effective for PMS

- Insufficient evidence for dysmenorrhea

78
Q

Drug interactions w/ vit B6

A
  • Antihypertensives (increased risk of hypotension)
  • Amiodarone
  • Phenobarbital
  • Phenytoin
  • Levodopa
79
Q

Should vitamin B6 be recommended for clinical use?

A
  • Can be recommended for PMS if taken w/in recommended dose
  • Monitor for side effects
  • Not recommended for dysmenorrhea b/c insufficient evidence
80
Q

What is vitamin E?

A

Fat-soluble vitamin naturally occurring in many foods (grains, meats, fruits, vegetables)

81
Q

Active components of vitamin E

A

8 chemical forms (4 tocopherols and 4 tocotrienols)

82
Q

Medicinal uses of vitamin E

A
  • PMS
  • Dysmenorrhea
  • Menopausal sx
  • Chronic cystic mastitis
83
Q

MOA of vitamin E

A
  • Prevents oxidation of vitamin A and C
  • Protects PUFAs in membranes from attack by free radicals
  • Protects RBCs against hemolysis
84
Q

Safety of vitamin E

A
  • 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
Q

Side effects of vitamin E

A
  • Nausea
  • Diarrhea
  • Intestinal cramps
  • Fatigue
86
Q

UL of vitamin E

A

1000 mg/day

87
Q

Efficacy of vitamin E

A
  • Possibly effective for PMS and dysmenorrhea

- Cochrane study declared not effective for perimenopause/ menopause

88
Q

Drug interactions w/ vitamin E

A
  • Antiplatelets
  • Cyclosporine
  • Orlistat
  • Tipranavir
89
Q

Should vitamin E be recommended for clinical use?

A
  • 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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