Home Books Katzung & Trevor's Pharmacology: Examination & Board Review, 12e

Chapter 60: Dietary Supplements & Herbal Medications

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

(A) Echinacea

(B) Ginkgo

(C) Melatonin

(D) Milk thistle

(E) Saw palmetto

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

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 available as a supplement 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?

(A) Coenzyme Q10

(B) Glucosamine

(C) Melatonin

(D) Tyrosine

(E) Vitamin E

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.

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?

(A) Alprazolam

(B) Fluoxetine

(C) Levodopa

(D) Methylphenidate

(E) Morphine

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.

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?

(A) Echinacea

(B) Ephedra

(C) Ginseng

(D) Milk thistle

(E) Saw palmetto

Saw palmetto, a complex extract from the berries of Serenoa repens or Sabal serrulata, is widely purported to improve the symptoms of BPH. The answer is E.

Which of the following is a derivative of serotonin that may have value in managing symptoms of jet lag?

(A) Ephedra

(B) Garlic

(C) Ginseng

(D) Glucosamine

(E) Melatonin

Garlic might get you a row of seats to yourself, but the compound that will help in jet lag is melatonin. The answer is E.

Which compound enhances immune function in vitro and is used to decrease the symptoms of the common cold?

(A) Echinacea

(B) Ginkgo

(C) Garlic

(D) Melatonin

(E) Milk thistle

The freshly pressed juice of the aerial parts of Echinacea purpurea is purported to reduce the symptoms of the common cold and the time of recovery if ingested within 24 h of onset. The answer is A.

Rejection of heart transplants has occurred in patients being treated with standard doses of cyclosporine when they also used which of the following dietary supplements?

(A) Echinacea

(B) Ginkgo

(C) Milk thistle

(D) St. John’s wort

(E) Saw palmetto

St. John’s wort induces the formation of hepatic enzymes that metabolize cyclosporine, and its use can decrease the effectiveness of the immunosuppressant drug in organ and tissue transplantation. The answer is D.

In 2003, a study published in the Annals of Internal Medicine found that this botanical substance accounted for more than 60% of adverse events associated with dietary supplements used in the United States. The “herbal” in question, which is used to aid weight loss and promote sports performance, is which of the following?

(A) Echinacea

(B) Ephedra

(C) Ginkgo

(D) Ginseng

(E) Saw palmetto

Concern about the risks of using products containing ephedra during heavy workouts or in diet programs that stress the cardiovascular system has led to a ban on such nutritional supplements in the United States. The answer is B.

Which of the following is a popular supplement whose purported efficacy in osteoarthritis is believed to be due to its role as a precursor to the glycosaminoglycans that form joint cartilage?

(A) Coenzyme Q10

(B) Dehydroepiandrosterone (DHEA)

(C) Glucosamine

(D) Nicotinic acid

(E) Melatonin

The amino sugar glucosamine, a building block for glycosaminoglycans, has become popular among people with osteoarthritis of the knee. The answer is C.

Couples who are attempting to conceive a child should avoid chronic use of which of the following?

(A) Echinacea

(B) Ephedra

(C) Ginkgo

(D) Ginseng

(E) Melatonin

Chronic use of melatonin appears to suppress LH secretion in women and to decrease sperm quality in men. The answer is E.

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Chapter 60: Dietary Supplements & Herbal Medications

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