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Chapter 74. Herbal and Nonherbal Dietary Supplements

Which product affects circadian rhythm and also functions as a hormone to aid in ovulation and sexual maturity?

a. Saw palmetto

b. St. John's wort

c. Black cohosh

d. Melatonin

Answer d is correct. Due to this effect on the body, melatonin is commonly used for insomnia and is not recommended for use in adolescents.

Answer a is incorrect. Saw palmetto inhibits 5-α-reductase, dihydrotestosterone receptors, and has some anti-inflammatory activity.

Answer b is incorrect. St. John's wort works in neural synapses to influence reuptake of neurotransmitters and also has some gamma-aminobutyric acid (GABA) antagonism.

Answer c is incorrect. Black cohosh affects the vasovagal system and may have some estrogenic effects.

A 51-year-old female patient has been diagnosed with perimenopause and she is beginning to have occasional hot flushes, which are fairly mild. She is on no regular medications, has no medical conditions other than borderline high cholesterol, which she is reducing through diet and lifestyle changes. She states she isn't ready to start estrogen therapy yet, but would like to try a natural alternative to reduce the flushes. Which of the following is the most appropriate product?

a. Saw palmetto

b. Kava

c. Black cohosh

d. Red yeast rice

Answer c is correct. Black cohosh is used for menopausal symptoms and likely works by affecting the vasovagal and thermoregulatory systems.

Answer a is incorrect. Saw palmetto is primarily used for benign prostatic hyperplasia (BPH).

Answer b is incorrect. Kava is primarily utilized for anxiety and insomnia.

Answer d is incorrect. Red yeast rice can be used for hyperlipidemia.

A 42-year-old woman visits your pharmacy with complaints of increased sensitivity to the sun after starting a new natural product. Which of the following is most likely to cause this side effect?

a. Garlic

b. Kava

c. Echinacea

d. Chondroitin

e. St. John's wort

Answer e is correct. Increased photosensitivity is a well-documented effect; patients should be educated to wear sunscreen.

Answers a, b, c, and d are incorrect. These products are not associated with sun sensitivity as a side effect.

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