DOCSLIB.ORG

Complementary and Alternative Medicine Use for Menopausal Complaints 11

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Complementary and Alternative Medicine Use for Menopausal Complaints 11 COMPLEMENTARY AND ALTERNATIVE MEDICINE USE AND THE MENOPAUSAL TRANSITION: THE EFFECT OF A CHINESE HERBAL FORMULA ON VASOMOTOR SYMPTOMS AND BONE TURNOVER Corinne Patching van der Sluijs, B.Sc, B.Hlth Sc, Dip Ed This thesis is submitted for the degree of Doctor of Philosophy, University of Western Sydney Centre for Complementary Medicine Research November 2007 © C. van der Sluijs 2007 ii CERTIFICATION The work presented in this thesis is, to the best of my knowledge and belief, original except as acknowledged in the text. I hereby declare that I have not submitted this material, either in full or in part, for a degree at this or any other institution. Corinne Patching van der Sluijs iii DEDICATION To Byron Edward Patching Without your loving support and patience, this work would not have been possible And To our two beautiful young children who entered the world during this time Micah Robert (1st January 2005) Grace Elisabeth (23rd June 2006) iv ACKNOWLEDGEMENTS I wish to take this opportunity to express my sincere thanks to the many people who supported and assisted me during this research project; without whose help this thesis would not have eventuated. I am grateful to the many survey respondents and clinical trial participants who graciously gave their time to take part in this research. Thank you to the general practice clinics, the menopause clinics, the New South Wales Government and the University of Western Sydney who gave permission to allow for the distribution of the questionnaire. To my principal supervisor Professor Alan Bensoussan, I am extremely grateful for your guidance, expertise, patience and understanding throughout this journey; and to my co- supervisors Drs Smita Shah and Liwan Liyanage who encouraged and supported me during this time. I am grateful for the assistance and support of Dr Rod Baber and staff at the Royal North Shore Menopause Clinic, Professors Felix Wong and Markus Seibel. In addition, I wish to acknowledge the support of Professor Seibel and the ANZAC Research Centre for providing the bone marker assay kits and for testing the samples. Sungwon Chang, I am grateful for your statistical guidance and assistance. Your support has been invaluable. I wish to also sincerely thank practitioners Nadine Licht, Christine Guirguis and Tuyet Tran for your considerable help in consulting trial participants. I am grateful for financial support and the PhD scholarship granted to me by the University of Western Sydney. I also wish to thank staff at CompleMED for their ongoing support for this project. Finally, I would like to express my sincere gratitude for the financial and technical assistance received from Global Therapeutics for the clinical trial. v ABSTRACT Although Hormone Therapy (HT) is the most effective treatment for alleviating menopausal vasomotor symptoms and reducing bone loss, many women are reluctant to take this treatment due to side effects and concerns about safety. Epidemiological studies suggest that a significant proportion of women use Complementary and Alternative Medicine (CAM) therapies to alleviate vasomotor symptoms and improve quality of life. Anecdotal and clinical evidence indicate a number of CAM therapies, such as herbal medicine, may be effective in alleviating symptoms and modulating bone metabolism. Hence, in the context of concerns over the safety of HT and the extensive history of the clinical use of herbal medicine, this thesis investigated issues pertinent to CAM use and the menopausal transition. The aims of this thesis were to: • Examine the nature and extent of CAM use by women transitioning through menopause • Evaluate the effectiveness of a herbal formula containing Chinese herbs and Cimicifuga racemosa for alleviating vasomotor symptoms, improving quality of life and modulating bone turnover markers. From July 2003 until July 2004 the Women’s Health during Midlife Survey recruited 1,296 women aged 45-65 who were symptomatic when transitioning through menopause or asymptomatic but taking menopause specific treatments. A validated 19-item survey instrument assessed the use of CAM modalities and menopause vi specific products. The instrument was completed voluntarily and anonymously by women recruited from three strata; menopause clinics, clinics of general practice and government agencies. Approximately 54% of respondents had visited a CAM practitioner and/or used a CAM product during the previous 12 months. The most popular practitioners were the naturopath (7.2%) and acupuncturist (4.8%), while soy (25.4%) and evening primrose oil (EPO, 18.4%) were the most popular products. Massage and chiropractic were considered the most effective therapies, while phytoestrogen tablets and EPO were the most efficacious products. Although 26.4% of respondents indicated their doctor asked about CAM use, 71% of CAM users said they informed their physician about using CAM. Of the 60% of women using pharmaceutical medicines, 62.5% reported using a CAM product during the preceding 12 months. The survey results confirm the continued popularity of CAM use amongst women transitioning through menopause. A number of treatments were perceived to be effective in relieving symptoms. However, communication between medical practitioners and patients about CAM use is inadequate, and given the high use of pharmaceutical medicines this oversight may unnecessarily expose women to drug- herb interactions. A randomised, double-blind, placebo controlled clinical trial was conducted to evaluate the effectiveness of a herbal formula derived from two traditional Chinese herbal formulae with the addition of Cimicifuga in alleviating vasomotor symptoms. The trial recruited 93 healthy women who reported at least six vasomotor symptoms vii per day. After a four week baseline period, women were randomly allocated to receive either herbal treatment or identical looking placebo tablets for 16 weeks. During the trial women recorded the number and severity of their flushes on a Daily Flush Diary, and at each monthly consultation two quality of life scales were completed. Forty nine eligible trial women were entered into a pilot study to assess the effect of the formula on bone turnover markers; bone specific alkaline phosphatase and deoxypyridinoline (corrected for creatinine). The herbal formula was found to be no more effective than placebo in reducing the frequency of flushing and the composite hot flush score or in improving quality of life. The pilot study found the formula had no effect on bone turnover markers after 16 weeks of treatment. Therefore, this formula cannot be recommended as a treatment for vasomotor symptoms and is unlikely to have any long term effect on bone. The use of CAM during the menopausal transition is very popular. Although this thesis found the current herbal formula to be an ineffective treatment, the scientific evaluation of potential CAM therapies is imperative so that health care professionals and consumers can make informed decisions concerning treatment options for the alleviation of symptoms. viii TABLE OF CONTENTS CERTIFICATION II DEDICATION III ACKNOWLEDGEMENTS IV ABSTRACT V TABLE OF CONTENTS VIII LIST OF FIGURES XIII LIST OF TABLES XIV LIST OF ABREVIATIONS XVI LIST OF APPENDICES XVIII CHAPTER 1 INTRODUCTION 1 1.1 General Background to the Study 1 1.2 Aim and Scope 5 1.3 Significance of the Study 8 1.4 Thesis Overview 9 SECTION ONE COMPLEMENTARY AND ALTERNATIVE MEDICINE USE FOR MENOPAUSAL COMPLAINTS 11 CHAPTER 2 CAM AND THE MENOPAUSAL TRANSITION 12 2.1 Introduction 12 2.2 Defining CAM 13 2.3 Economic Impact of CAM 15 2.4 The CAM Consumer 19 2.5 CAM Use and the Menopausal Transition 23 ix 2.6 CAM Use by Middle Aged Women 32 2.7 Summary and Conclusions 42 CHAPTER 3 SURVEY: RESEARCH DESIGN 44 3.1 Introduction 44 3.2 Study Objectives 45 3.3 Participants and Setting 46 3.4 Survey Instrument 49 3.5 Statistical Analyses 53 3.6 Summary 54 CHAPTER 4 SURVEY: RESULTS 56 4.1 Introduction 56 4.2 Survey Instrument Reliability 57 4.3 Demographics and Health Characteristics 57 4.4 Use of CAM 62 4.5 Use of Pharmaceuticals 69 4.6 Determinants of CAM Use 71 4.7 Discussion 72 CHAPTER 5 SURVEY: DISCUSSION AND CONCLUSIONS 75 5.1 Introduction 75 5.2 CAM Use by Women Aged 45-65 75 5.3 CAM and Pharmaceutical Use 80 5.4 Determinants of CAM Use 81 5.5 Methodological Considerations 83 5.6 Conclusions 86 x SECTION TWO THE EFFECT OF FF-01 ON VASOMOTOR SYMPTOMS AND BONE TURNOVER 87 CHAPTER 6 MENOPAUSE AND VASOMOTOR SYMPTOMS 88 6.1 Introduction 88 6.2 A Definition of the Menopause 89 6.3 Epidemiology of the Menopause 92 6.4 Changes during the Menopausal Transition 94 6.5 Symptoms of the Menopause 99 6.6 Pharmacological Treatments for Vasomotor Symptoms 116 6.7 Summary and Conclusion 124 CHAPTER 7 CHINESE HERBAL MEDICINE FOR VASOMOTOR SYMPTOMS 126 7.1 Introduction 126 7.2 TCM and Menopause 127 7.3 Systematic Review on CHM for Vasomotor Symptoms 131 7.4 Discussion and Conclusions 153 CHAPTER 8 TRIAL FORMULA: FF-01 155 8.1 Introduction 155 8.2 FF-01: the Clinical Trial Formula 156 8.3 Constituent Herbs of the Formula 158 8.4 CHM Pharmacological Research 189 8.5 Summary and Conclusions 191 CHAPTER 9 MENOPAUSE AND BONE METABOLISM 193 9.1 Introduction 193 9.2 Definition of Osteoporosis 194 xi 9.3 Risk Factors for Osteoporosis 195 9.4 Burden of Osteoporotic Fractures 196 9.5 Skeletal Changes Associated with Menopause 198 9.6 Biochemical Markers of Bone Turnover 199 9.7 Pharmacological Treatments for Osteoporosis 203 9.8 The Effect of Herbs on Bone Metabolism 217 9.9 Summary and Conclusions 222 CHAPTER
Load more

Recommended publications
  • Dr. Duke's Phytochemical and Ethnobotanical Databases List of Chemicals for Lyme Disease (Chronic)
    Dr.
    [Show full text]
  • Supporting Materials for Reappointment of Rong Di for 2004
    CURRICULUM VITAE Rong Di Associate Research Professor Department of Plant Biology School of Environmental and Biological Sciences Rutgers University 222B Foran Hall, 59 Dudley Rd., New Brunswick, NJ 08901 Ph. (848)-932-6350, Fax (732)-932-9377 [email protected] http://plantbiology.rutgers.edu/faculty/di/Rong_Di.html July 2017 Appointments 2017-Present Associate Research Professor, Department of Plant Biology, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ 2011-2017 Assistant Research Professor, Department of Plant Biology and Pathology, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ 2014-Present Adjunct Professor, Hainan University, Hainan, China 2003-2011 Assistant Research Professor, Biotechnology Center for Agriculture and the Environment, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ 1997- 2002 Research Associate, Biotechnology Center for Agriculture and the Environment, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ 1992-1996 Postdoctoral Scholar, Dept. of Plant Pathology, and Dept. of Agronomy, University of Kentucky, Lexington, KY 1986-1992 Graduate Research Assistant, Dept. of Plant Pathology, Iowa State University, Ames, IA 1983-1985 Assistant Lecturer, Dept. of Plant Protection, South China College of Tropical Crops (SCCTC), Hainan, P. R. China Education Ph.D. 1992 Plant Virology, Iowa State University, Iowa (Advisor: W Allen Miller) M.S. 1989 Plant Virology, Iowa State University, Iowa (Advisor: John Hill) B.S. 1983 Plant Protection, South China College of Tropical Crops, Hainan, P.R. China Honors and Awards 1985 Selected as the only one among 45 graduates in the Dept. of Plant Protection from SCCTC China to study abroad.
    [Show full text]
  • Selective Estrogen Receptor Modulators for BPH: New Factors on the Ground
    Prostate Cancer and Prostatic Disease (2013) 16, 226–232 & 2013 Macmillan Publishers Limited All rights reserved 1365-7852/13 www.nature.com/pcan REVIEW Selective estrogen receptor modulators for BPH: new factors on the ground M Garg1, D Dalela1, D Dalela1, A Goel1, M Kumar1, G Gupta2 and SN Sankhwar1 As the current management of BPH/lower urinary tract symptoms by traditionally involved pharmacological agents such as 5alpha- reductase inhibitors and a1-adrenoceptor antagonists is suboptimal, there is definite need of new therapeutic strategies. There is ample evidence in literature that suggests the role of estrogens in BPH development and management through the different tissue and cell-specific receptors. This article reviews the beneficial actions of selective estrogen receptor modulator (SERM) and ERb- selective ligands, which have been demonstrated through in vitro studies using human prostate cell lines and in vivo animal studies. SERMs have anti-proliferative, anti-inflammatory and pro-apoptotic mechanisms in BPH, and also act by inhibiting various growth factors, and thus represent a unique and novel approach in BPH management directed at estrogen receptors or estrogen metabolism. Prostate Cancer and Prostatic Disease (2013) 16, 226–232; doi:10.1038/pcan.2013.17; published online 18 June 2013 Keywords: selective estrogen receptors modulators; BPH; estradiol; estrogen receptor b INTRODUCTION relevant articles were selected for the discussion of role of SERMs in BPH in BPH is a common urological problem of aging males. It occurs in this review. about 10% of men below the age of 40 and increases to about 80% by 80 years of age.1 Clinical BPH is a benign enlargement of the prostate, which ESTROGENS AND ITS RECEPTORS: ROLE IN BPH results in voiding urinary difficulties that may, sometimes, Though BPH typically manifests in later stage of life when 2 significantly impair the quality of life in older patients.
    [Show full text]
  • Medicinal Properties of Selected Asparagus Species: a Review Polo-Ma-Abiele Hildah Mfengwana and Samson Sitheni Mashele
    Chapter Medicinal Properties of Selected Asparagus Species: A Review Polo-Ma-Abiele Hildah Mfengwana and Samson Sitheni Mashele Abstract Asparagus species are naturally distributed along Asia, Africa, and Europe and are known to have numerous biological properties. This review article was aimed to provide an organized summary of current studies on the traditional uses, phy- tochemistry, and pharmacological and toxicological studies of Asparagus laricinus Burch., Asparagus africanus Lam., Asparagus officinalis L., Asparagus racemosus Willd., and Asparagus densiflorus (Kunth) Jessop to attain and establish new insights for further researches. Information used in this review was obtained from electronic database including PubMed central, Google scholars, Science direct, Scopus, and Sabinet. Based on the present findings, the existing literature still presents some breaches about the mechanism of action of various constituents of these plants, and their relation to other plant compounds in poly-herbal formulations, as well as their long-term use and safety. More in-depth studies are still needed for active compounds and biological activities of Asparagus laricinus, Asparagus africanus, and Asparagus densiflorus. Therefore, innumerable opportunities and possibilities for investigation are still available in novel areas of these plants for future research stud¬ies. It can be concluded that all selected Asparagus species have tremendous potential to improve human health and the pharmacological activities of these plants can be attributed to bioactive phytochemicals they possess. Keywords: Asparagaceae, Asparagus africanus lam., Asparagus densiflorus (kunth) Jessop, Asparagus laricinus Burch., Asparagus officinalis L., Asparagus racemosus Willd., pharmacological actions, phytochemistry 1. Introduction Historically, plants were used for numerous purposes for mankind in general, inter alia, feeding and catering, culinary spices, medicine, various forms of cosmetics, symbols in worship and for a variety of ornamental goods.
    [Show full text]
  • Study of Some Pharmacological Actions of Berberine*
    July 1971 Ind. J. Physiol, & Pharmac, aration, properties and molecular thesaponin of Achyranthes aspera, STUDY OF SOME PHARMACOLOGICAL ACTIONS OF BERBERINE* M. SABIR AND N. K. BHIDE neon the phosphorylase activity of Department of Pharmacology, All-India Institute of Medical Sciences, New Delhi-16 Summary: Berberine produced reversible and dose-dependant hypotension in the anaesthe- tized dog, cat, rat and frog. The hypotension was studied in details in the dog. It was not due to the release of tissue histamine and was not blocked by atropine, rnepyramine, phenoxyben- zamine, propranolol, pentolinium, bilateral vagotomy and ablation of brain. Propranolol- pentoliniurn combination, however, blocked this effect in some animals and, for a short period, reversed it to hypertension in the others. Berberine did not alter the actions of carbachol, histamine, bradykinin, isoprenaline, adrenaline and nor-adrenaline on the blood pressure. It increased the volume of spleen and hind limb. Berberine appears to induce hypotension by directly acting on the blood vessels. Berberine stimulated the ill si/It dog heart and produced tachycardia which outlasted hypotension. In smaller doses, it stimulated the isolated heart of the rabbit and the frog. It temporarily reversed the depression of the frog heart perfused with low calcium Ringer. In the dog and frog, myocardial depression is not likely to contribute to the berberine-iriduced hypotension. The respiratory stimulant action was parrallel to, and could be a reflex phenomenon provoked by hypotension. In mice, berberine lowered the rectal temperature, reduced the spontaneous motor activity and prolonged the hexobarbitone sleeping time. It increased the incidence of death but not the severity of tremors in the tremorine-treated mice.
    [Show full text]
  • Modulation of Major Human Liver Microsomal Cytochromes P450 by Component Alkaloids Of
    DMD Fast Forward. Published on June 26, 2020 as DOI: 10.1124/dmd.120.091041 This article has not been copyedited and formatted. The final version may differ from this version. DMD # 91041 Modulation of Major Human Liver Microsomal Cytochromes P450 by Component Alkaloids of Goldenseal: Time-Dependent Inhibition and Allosteric Effects Matthew G. McDonald, Dan-Dan Tian1, Kenneth E. Thummel, Mary F. Paine, Allan E. Rettie Departments of Medicinal Chemistry (MGM, AER) and Pharmaceutics (KET), School of Pharmacy, Downloaded from University of Washington, Seattle, WA, 98195; Department of Pharmaceutical Sciences (DDT, MFP), College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA, 99202; Center of Excellence for Natural Product Drug Interaction Research (KET, MFP, AER) dmd.aspetjournals.org at ASPET Journals on September 26, 2021 1 DMD Fast Forward. Published on June 26, 2020 as DOI: 10.1124/dmd.120.091041 This article has not been copyedited and formatted. The final version may differ from this version. DMD # 91041 Running Title: Complex Effects of Goldenseal Alkaloids on CYPs Corresponding author: Matthew G. McDonald, Ph.D. Department of Medicinal Chemistry University of Washington, Box 357610 1959 NE Pacific, Seattle WA 98195 Telephone: (206) 384-3386 Downloaded from Fax: (206) 685-3252 Email: [email protected] dmd.aspetjournals.org Number of: Text pages: 44 Tables: 6 Figures: 6 at ASPET Journals on September 26, 2021 References: 39 Words in Abstract: 250 Words in Introduction: 734 Words in Discussion: 1701 Abbreviations: AUC, area under the plasma concentration versus time curve; CYP, cytochrome P450; fu,HLM, fraction unbound in human liver microsomes; fu,p, fraction unbound in plasma; GSE, goldenseal extract; HLMs, human liver microsomes; Imax,u, maximum unbound plasma concentration; KPi, potassium phosphate; MDZ, midazolam; MI, metabolic intermediate; NP, natural product; PBPK, physiologically- based pharmacokinetic; TDI, time-dependent inhibition 2 DMD Fast Forward.
    [Show full text]
  • Regulation of Specific Target Genes and Biological Responses by Estrogen Receptor Subtype Agonists Leitman Et Al
    COPHAR-861; NO. OF PAGES 8 Available online at www.sciencedirect.com Regulation of specific target genes and biological responses by estrogen receptor subtype agonists Dale C Leitman1, Sreenivasan Paruthiyil2, Omar I Vivar1, Elise F Saunier2, Candice B Herber1, Isaac Cohen2, Mary Tagliaferri2 and Terence P Speed3,4 Estrogenic effects are mediated through two estrogen receptor adverse effects. The most troublesome side-effect of (ER) subtypes, ERa and ERb. Estrogens are the most estrogens is the increased risk of breast and endometrial commonly prescribed drugs to treat menopausal conditions, cancer [1,2]. Estrogens also increase blood clotting that but by non-selectively triggering both ERa and ERb pathways can lead to venous thromboembolisms, and possibly in different tissues they can cause serious adverse effects. The strokes and heart disease, particularly in older women different sizes of the binding pockets and sequences of their [1]. activation function domains indicate that ERa and ERb should have different specificities for ligands and biological responses Estrogens in hormone therapy (HT) were formulated that can be exploited for designing safer and more selective long before there was a significant understanding of estrogens. ERa and ERb regulate different genes by binding to the mechanism of action of estrogens. The identification different regulatory elements and recruiting different of ERa and ERb (Figure 1) and the crystal structures of transcription and chromatin remodeling factors that are their ligand binding domain (LBD), the discovery of a expressed in a cell-specific manner. ERa-selective and ERb- variety of coregulatory proteins involved in the genomic selective agonists have been identified that demonstrate that pathway and the demonstration of the nongenomic the two ERs produce distinct biological effects.
    [Show full text]
  • Anticancer Activity of <Emphasis Type="Italic">Asparagus
    J. Korean Soc. Appl. Biol. Chem. 54(2), 188-193 (2011) Article Anticancer Activity of Asparagus cochinchinensis Extract and Fractions in HepG2 Cells Mikyung Park1†, Myeong Sook Cheon2†, Seong Hwan Kim1, Jin Mi Chun2, A Yeong Lee2, Byeong Cheol Moon2, Taesook Yoon2, Byung Kil Choo3, and Ho Kyoung Kim2* 1Laboratory of Chemical Genomics, Pharmacology Research Center, Korea Research Institute of Chemical Technology, P.O.Box 107, Yuseong-gu, Daejeon 305-600, Republic of Korea 2Center of Herbal Resources Research, Korea Institute of Oriental Medicine, 483 Exporo, Daejeon 305-811, Republic of Korea 3Department of Crop Agriculture & Life Science, College of Agriculture & Life Science, Chonbuk National University, Jeonju 561-756, Republic of Korea Received October 18, 2010; Accepted January 4, 2010 Asparagus cochinchinensis Merrill (Liliaceae) has been traditionally used for the treatment of cancer in Korea and China, but its anticancer activity and underlying mechanism remain to be defined. Anticancer activities were investigated on fractions obtained from A. cochinchinensis 70% ethanol extract (ACE-EtOH) in human hepatocellular carcinoma HepG2 cells. Ethylacetate fraction from A. cochinchinensis extract (ACE-EA), more effective than other fractions, induced apoptosis of HepG2 (IC50=72.33±0.34 μg/mL), as revealed by apoptotic feature observation, increased capase-3 activity and Poly ADP ribose polymerase cleavage, and decreased expression of X-linked inhibitor of apoptosis protein in a dose-dependent manner. Protein levels of autophagy- related molecules, microtubule-associated protein 1 light chain 3 α and beclin 1, appeared to be induced by ACE-EA, suggesting ACE-EA exhibits anti-cancer activity with induction via both apoptosis and autophagy signaling pathways in HepG2 cells.
    [Show full text]
  • Pharmaceutical and Veterinary Compounds and Metabolites
    PHARMACEUTICAL AND VETERINARY COMPOUNDS AND METABOLITES High quality reference materials for analytical testing of pharmaceutical and veterinary compounds and metabolites. lgcstandards.com/drehrenstorfer [email protected] LGC Quality | ISO 17034 | ISO/IEC 17025 | ISO 9001 PHARMACEUTICAL AND VETERINARY COMPOUNDS AND METABOLITES What you need to know Pharmaceutical and veterinary medicines are essential for To facilitate the fair trade of food, and to ensure a consistent human and animal welfare, but their use can leave residues and evidence-based approach to consumer protection across in both the food chain and the environment. In a 2019 survey the globe, the Codex Alimentarius Commission (“Codex”) was of EU member states, the European Food Safety Authority established in 1963. Codex is a joint agency of the FAO (Food (EFSA) found that the number one food safety concern was and Agriculture Office of the United Nations) and the WHO the misuse of antibiotics, hormones and steroids in farm (World Health Organisation). It is responsible for producing animals. This is, in part, related to the issue of growing antibiotic and maintaining the Codex Alimentarius: a compendium of resistance in humans as a result of their potential overuse in standards, guidelines and codes of practice relating to food animals. This level of concern and increasing awareness of safety. The legal framework for the authorisation, distribution the risks associated with veterinary residues entering the food and control of Veterinary Medicinal Products (VMPs) varies chain has led to many regulatory bodies increasing surveillance from country to country, but certain common principles activities for pharmaceutical and veterinary residues in food and apply which are described in the Codex guidelines.
    [Show full text]
  • Guideline for Preoperative Medication Management
    Guideline: Preoperative Medication Management Guideline for Preoperative Medication Management Purpose of Guideline: To provide guidance to physicians, advanced practice providers (APPs), pharmacists, and nurses regarding medication management in the preoperative setting. Background: Appropriate perioperative medication management is essential to ensure positive surgical outcomes and prevent medication misadventures.1 Results from a prospective analysis of 1,025 patients admitted to a general surgical unit concluded that patients on at least one medication for a chronic disease are 2.7 times more likely to experience surgical complications compared with those not taking any medications. As the aging population requires more medication use and the availability of various nonprescription medications continues to increase, so does the risk of polypharmacy and the need for perioperative medication guidance.2 There are no well-designed trials to support evidence-based recommendations for perioperative medication management; however, general principles and best practice approaches are available. General considerations for perioperative medication management include a thorough medication history, understanding of the medication pharmacokinetics and potential for withdrawal symptoms, understanding the risks associated with the surgical procedure and the risks of medication discontinuation based on the intended indication. Clinical judgement must be exercised, especially if medication pharmacokinetics are not predictable or there are significant risks associated with inappropriate medication withdrawal (eg, tolerance) or continuation (eg, postsurgical infection).2 Clinical Assessment: Prior to instructing the patient on preoperative medication management, completion of a thorough medication history is recommended – including all information on prescription medications, over-the-counter medications, “as needed” medications, vitamins, supplements, and herbal medications. Allergies should also be verified and documented.
    [Show full text]
  • Berberine Exerts a Protective Effect on Rats with Polycystic Ovary Syndrome
    Shen et al. Reproductive Biology and Endocrinology (2021) 19:3 https://doi.org/10.1186/s12958-020-00684-y RESEARCH Open Access Berberine exerts a protective effect on rats with polycystic ovary syndrome by inhibiting the inflammatory response and cell apoptosis Hao-Ran Shen1†, Xiao Xu1† and Xue-Lian Li1,2* Abstract Background: Polycystic ovary syndrome (PCOS) is a common endocrine disease of the female reproductive system that seriously affects women’s health. Berberine (BBR) has many pharmacological properties and is used as an insulin sensitizer. This study aimed to investigate the effect of BBR on PCOS and explore its related mechanisms. Methods: Forty-two rats were randomly divided into the following six groups (n = 7 per group): control, control + BBR, PCOS-normal diet (ND), PCOS-ND + BBR, PCOS-high-fat diet (HFD), and PCOS-HFD + BBR. The PCOS rat models were established by injecting rats with dehydroepiandrosterone. Further, the rats were gavaged with BBR (150 mg/ kg/d) for 6 weeks. Then, the body weight, HOMA-IR, and testosterone levels of all rats were determined. Cell apoptosis of ovary granulosa cells was determined by a TUNEL assay kit. Real-time quantification PCR (RT-qPCR) and western blotting were utilized to evaluate the expression of TLR4, LYN, PI3K, Akt, NF-kB, TNF-α, IL-1, IL-6,andcaspase-3. Results: BBR reduced the levels of insulin resistance and testosterone in PCOS rats. Additionally, the cell apoptosis rate increased significantly in PCOS rats (P < 0.05) and decreased after BBR treatment (P < 0.05). The results of RT-qPCR and western blotting showed that the expression levels of TLR4, LYN, PI3K, Akt, NF-kB, TNF-α, IL-1, IL-6,andcaspase-3 significantly increased in PCOS rats, while BBR suppressed their expression levels.
    [Show full text]
  • Dietary Supplements Compendium Volume 1
    2015 Dietary Supplements Compendium DSC Volume 1 General Notices and Requirements USP–NF General Chapters USP–NF Dietary Supplement Monographs USP–NF Excipient Monographs FCC General Provisions FCC Monographs FCC Identity Standards FCC Appendices Reagents, Indicators, and Solutions Reference Tables DSC217M_DSCVol1_Title_2015-01_V3.indd 1 2/2/15 12:18 PM 2 Notice and Warning Concerning U.S. Patent or Trademark Rights The inclusion in the USP Dietary Supplements Compendium of a monograph on any dietary supplement in respect to which patent or trademark rights may exist shall not be deemed, and is not intended as, a grant of, or authority to exercise, any right or privilege protected by such patent or trademark. All such rights and privileges are vested in the patent or trademark owner, and no other person may exercise the same without express permission, authority, or license secured from such patent or trademark owner. Concerning Use of the USP Dietary Supplements Compendium Attention is called to the fact that USP Dietary Supplements Compendium text is fully copyrighted. Authors and others wishing to use portions of the text should request permission to do so from the Legal Department of the United States Pharmacopeial Convention. Copyright © 2015 The United States Pharmacopeial Convention ISBN: 978-1-936424-41-2 12601 Twinbrook Parkway, Rockville, MD 20852 All rights reserved. DSC Contents iii Contents USP Dietary Supplements Compendium Volume 1 Volume 2 Members . v. Preface . v Mission and Preface . 1 Dietary Supplements Admission Evaluations . 1. General Notices and Requirements . 9 USP Dietary Supplement Verification Program . .205 USP–NF General Chapters . 25 Dietary Supplements Regulatory USP–NF Dietary Supplement Monographs .
    [Show full text]