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Chapter 60: Dietary Supplements & Herbal Medications

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A patient has accidentally ingested mushrooms identified as Amanita phalloides. Which herbal substance is claimed to protect against hepatic dysfunction?

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(A) Echinacea

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(B) Ginkgo

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(C) Melatonin

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(D) Milk thistle

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(E) Saw palmetto

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Milk thistle contains compounds that may have cytoprotective actions against liver toxins, including those present in Amanita mushrooms. The answer is D.

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Your patient, a 45-year-old male, requires atorvastatin. He enjoys lifting weights and is worried about statin-induced muscle pain. He asks you if he can take anything to prevent that. You tell him there is an endogenous antioxidant that may help. Some clinical trials suggest that patients with statin-associated myopathy had reduced muscle pain after receiving this supplement. The supplement is which of the following?

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(A) Coenzyme Q10

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(B) Glucosamine

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(C) Melatonin

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(D) Tyrosine

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(E) Vitamin E

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HMG-CoA reductase, the enzyme required for coenzyme Q10 synthesis, is inhibited by statins (see Chapter 35). This inhibition may contribute to statin-associated myopathy. A small double-blind clinical trial found a significant reduction in muscle pain in patients with statin-associated myopathy who were treated with coenzyme Q10. The answer is A.

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Which drug has a biochemical effect that most closely resembles the proposed mechanism of action of the psychoactive constituent(s) of St. John’s wort?

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(A) Alprazolam

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(B) Fluoxetine

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(C) Levodopa

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(D) Methylphenidate

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(E) Morphine

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Extracts of the flowers of St. John’s wort contain chemicals with possible antidepressant activity. In vitro studies have shown that these chemicals interfere with the neuronal reuptake of amine neurotransmitters in a fashion similar to the proposed mechanism of antidepressant actions of tricyclic antidepressants and SSRIs such as fluoxetine. The answer is B.

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A 67-year-old male reports difficulty starting a urine stream and feeling an urge to urinate again soon after urinating. Examination confirms benign prostatic hyperplasia (BPH). He prefers not to take prescription medications. Which of the following is an alternative medicine that is commonly used to treat the urinary symptoms associated with BPH?

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(A) Echinacea

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(B) Ephedra

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