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292 Cards in this Set

  • Front
  • Back

According to the articles on regulatory issues, all of the following except one are good arguments in favor of stricter regulation of botanical medicines? Which one is not a good argument?


CORRECT: Excessive prices for commercial herbal products


INCORRECT:


  • Interactions between herbs and drugs
  • Adulteration of some preparations with drugs Lack of routine reporting of adverse events


  • Lack of standardization among herbal preparations

*List examples of expectorant herbs and describe their function.

Increase ciliary activity, reduce mucus viscosity; liquefy pulmonary secretions




EX: Eucalyptus, thyme

* List examples of mucilaginous herbs and describe their function.

Form protective coating




EX: Mullein, Marshmallow, Plantain

* What condition(s) are the tannin-containing herbs helpful in addressing?

Acute diarrhea

* What herbs were formerly FDA-approved over-the-counter laxatives, but have since been disapproved due to modern efficacy and safety research?

Cascara & Aloe

* What constituent of licorice can raise BP, so is removed in some preparations?

Glycyrrhizin

* What does a carminative do in the digestive system?

Carminative: relieve bloating and fullness

* What does a cholagogue do in the digestive system?

Cholagogue: promote bile production

* What does a bitter do in the digestive system?

Bitter: stimulate gastric secretions

* Which botanicals have caffeine as a significant constituent?

Guarana, mate, black and green tea

* What are the pharmaceutical medications with which St. John’s wort is most likely to interact in a significant way?

SSRIs, protease and reverse transcriptase inhibitors, anticoagulants, immunosuppressants

* What is the relationship between alliin, alliinase, and allicin in the pharmacokinetics of garlic?

Allianase acts on alliin to produce allicin

* What does it mean for an herbal to “potentiate” a pharmaceutical medication? What precautions need to be taken in cases like this? What herbals are most known for potentiating anticoagulant medications?


  • The herb increases the power or effect of the medication
  • Contraindications should be noted; taken with care
  • Bromelain, St John’s Wort

* Discuss the history and evolution of the German Commission E and the development of its monographs on botanical therapeutics

The commission E was appointed by a government agency to review phytotherapeutic agents for efficacy and safety

* What is a “declared content” on a botanical label and why is it important with potentially toxic herbals?

Name of each ingredient and what it contains

* Describe current supplement labeling regulations regarding health claims and structure/function properties of herbs.

In the U.S., the label can describe an effect on the structure or function of the body if supported by a reasonable amount of scientific evidence Therapeutic claims cannot be made on the label or in the package insert

* What is an enteric coated capsule? In what ways can they be helpful and at what point should they be used in relation to a meal?


  • Allow for controlled or delayed release of active ingredients
  • Improves ease of swallowing
  • Extends shelf life
  • Masks any unpleasant tastes of active ingredients
  • Taken at least one hour before a meal
  • Coating protects the medicinal core

* What is standardization about and what are its main purposes?

Standardization guarantees the content of one or more active constituents and marker compounds

Tincture

common preparation using alcohol or alcohol+water to produce extracts of a wide variety of herbs and herb combinations

Syrups

especially useful for giving botanical medicines to children

Medicinal Oils

alcohol-free preparation that would be expected to contain only lipid-soluble components

Medicinal Spirits

a solution of a volatile substance in alcohol of alcohol+water

Plant Juices

made from fresh plant parts and contain water-soluble components

Infusion

water poured boiling over herb and covered, steeped 10 minutes, then strain

Decoction

covered with water, boiled, simmer 10 minutes, strained

Maceration

covered with room temperature water, stands 6 hours, strained

* Know the major pharmaceuticals drugs derived from herbs as covered in class and what the originating herbal is.


  • -digoxin: foxglove leaf
  • -codeine: opium poppy
  • -aspirin: willow bark
  • -quinine: chinchona bark

* What are the key arguments AGAINST increasing regulation of botanical medicines in the United States?

-difficult to reach the proof for medical efficacy

* What are the key arguments FOR increasing regulation of botanical medicines in the United States?

-many herbal products contain undisclosed prescription or over-the-counter drugs and heavy metals


-standardizing herbal preparations promotes batch-to-batch consistency


-more responsibility on the manufacturers of dietary supplements (evidence of good manufacturing practices)


-ensuring what’s on the label is what’s inside


-lack of routine reporting of adverse events


-interactions between herbs and drugs

According to the articles on regulatory issues, all of the following except one are good arguments in favor of stricter regulation of botanical medicines? Which one is not a good argument?

CORRECT: Excessive prices for commercial herbal products


INCORRECT:


- Interactions between herbs and drugs


- Adulteration of some preparations with drugs - Lack of routine reporting of adverse events


Lack of standardization among herbal preparations

Which one of the following is not a difference between the US and European countries such as Germany regarding the status of herbal medicines?

CORRECT: The U.S. has always led the way worldwide in the development and testing of botanical medicine products


INCORRECT:


- Herbal medicines are subjected to more regulation in European countries such as Germany.


- Herbal products are regulated as dietary supplements in the US.


- Herbal medicines have higher stature in medical education and clinical practice in European countries such as Germany.

Digoxin is isolated from...

Foxglove leaf

Codeine is isolated from...

Opium poppy

Aspirin is isolated from...

Willow bark

Quinine is isolated from...

Chinchona bark

A typical botanical extract can be expected to concentrate active substances from the dried herb by how much in terms of an herb-to-extract ratio?

5:1

What is the volatile oil content of typical herbs that contain such oils?

1-2%

Which of the following, if any, is not one of the factors that can affect the content of active constituents of medicinal herbs.

All of these factors affect the content of active constituents of medicinal herbs:



  • Cultivation
  • Climate
  • Soil quality
  • Plant genetics

True or False: Standardization of botanical preparations is simply a process of adjusting chemistry to produce the desired content.

False

Choose the correct statement about the use of solvents for preparing botanical extracts.

Correct Answer: Aqueous extracts are high in polar compounds while alcohol extracts are high in lipophilic constituents


INCORRECT:


  • Aqueous and alcohol extracts are both high in polar compounds
  • Aqueous and alcohol extracts are both high in lipophilic constituents
  • Aqueous extracts are high in lipophilic constituents while alcohol extracts are high in polar compounds

T or F: Using marker compounds to adjust the quality of botanical extracts can always be expected to guarantee consistent therapeutic potency of the product

False

Which of the following, if any, is not true regarding fingerprint chromatograms?

ALL ARE TRUE:



  • Can characterize the presence and relative amounts of several herb components
  • Can be used to compare batches of the same product for quality control
  • Can confirm product identity by comparing products to standard reference samples
  • Utilizes high-performance liquid chromatography

Which of the following, if any, is not an advantage of coated tablets over uncoated tablets?

CORRECT:


Reduces the cost of the product


INCORRECT:


- Masks any unpleasant tastes of active ingredients
- Allows for controlled or delayed release of active ingredients
- Extends shelf life Improves ease of swallowing

When should enteric-coated tablets or capsules be taken?

At least 1 hour before a meal

State TWO alternate terms for lozenges?


  • Pastilles
  • Troches

Botanical product labels in the US are allowed to describe the purpose of the product according to which one of the following rules?

Can describe an effect on the structure or function of the body if supported by a reasonable amount of scientific evidence.

Indicate all of the correct statements below regarding the German Commission E.

CORRECT:


The Commission E was appointed by a government agency to review phytotherapeutic agents for efficacy and safety


INCORRECT:


- Commission E monographs only review single herbs and preparations made from them


- The Commission E continues to gather and review monographs today - - The Commission E monographs are only available in German language editions

The European Union relies on which agency to update critical information about phytomedicines?

European Scientific Cooperative on Phytotherapy

T or F: The authors of our text present data showing that the placebo effect does not account for much of the therapeutic effect of treating disorders such as widespread pain, insomnia, gastric symptoms, and depression.

False

When a study reports only the change in outcome within each group, this is called a __________ comparison, and is a common error that may fail to detect a __________.

When a study reports only the change in outcome within each group, this is called a before & after comparison, and is a common error that may fail to detect a large placebo effect.

According to the Natural Standard Evidence-Based Validated Grading Rationale described in the file Important Terms in Botanical Medicine Research, what evidence grade would be given if any one of these criteria were met: 1) Evidence of benefit only from 1 small randomized controlled trial (RCT) of inadequate size and quality of design, or 2) Conflicting evidence of benefit from multiple RCTs with no clear benefit from the better designed trials, or 3) Evidence of benefit only from observational studies and non-randomized trials with no basic science supporting evidence, or 4) Support only from basic science evidence or theory.

C (Unclear or conflicting scientific evidence)

What is the latin binomial for garlic?

Allium sativa

What is the latin binomial for red yeast?

Monascus purpureus

What specific part of Allium sativa is used in botanical medicine?

bulb

What specific part of Ginkgo biloba is used in botanical medicine?

leaf

Which two botanicals have been shown to increase walking distance in subjects with peripheral arterial disease?

Allium sativa


Ginkgo biloba

Which of the following is true about the relationship of alliin, alliinase, and allicin?

Allianase acts on alliin to produce allicin

Match the garlic preparation with the correct description: garlic powder

used in most clinical trials

Match the garlic preparation with the correct description: garlic oil

steam distillation product subject to enzymatic & thermal breakdown of active constituents

Match the garlic preparation with the correct description: aged garlic

fermentation product subject to degradation of active constituents

Which of the following, if any, is NOT a therapeutic effect of garlic demonstrated in at least some clinical studies?

All of the following are therapeutic effects demonstrated in some studies:





  • Inhibits progression of atherosclerosis
  • Lowers blood triglycerides
  • Lowers total blood cholesterol
  • Lowers blood pressure

T or F: According to human research, garlic can reduce platelet aggregation after a few days of treatment.

False

What is the daily intake of alliin associated with successful lipid-lowering in most clinical studies using garlic powder?

About 6 -10 mg

Which two adverse effects should be monitored in patients taking garlic?


  • Excessive bleeding tendency
  • Hypotension

What is the most likely mechanism for the effects of red yeast rice on blood cholesterol?

Inhibition of cholesterol synthesis

What is the most likely mechanism for the effects of garlic on blood cholesterol?

Inhibition of cholesterol synthesis

Which of the following is the family of active constituents associated with red yeast rice?

Monacolins

Which two adverse effects should be monitored in patients taking red yeast rice?


  • Elevated liver enzymes
  • Muscle pain, tenderness, and weakness

According to the National Institutes of Health article, garlic has been found to interfere with the effectiveness of what type of drug?

an HIV drug

Which of the following is the most accurate list of possible side effects of ginkgo biloba?

Correct: headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skin reactions


INCORRECT:



  • headache, itchy eyes, gastrointestinal issues, asthma, fatigue, and drowsiness
  • anxiety, difficulty urinating, dry mouth, headache, heart damage, high blood pressure, irregular heart rhythms
  • breath and body odor, heartburn, upset stomach, and allergic reactions

Large amounts of a dangerous toxin are found in which ginkgo preparation?

roasted seeds

What is the latin binomial for witch hazel?

Hamamelis virginiana

What is the latin binomial for German chamomile?

Matricaria recutita

What is the latin binomial for evening primrose?

Oenotherae biennis

What is the latin binomial for pineapple (bromelain)?

Ananas comosus

What is the latin binomial for comfrey?

Symphytum officinale

What is the latin binomial for tea tree oil?

Melaleuca alternifolia

Which specific part is used in botanical medicine?


Calendulas

flower

Which specific part is used in botanical medicine?


Arnica

flower

Which specific part is used in botanical medicine?


Camomile

flower

Which specific part is used in botanical medicine?


Evening primrose

seed oil

Which specific part is used in botanical medicine?


Witch hazel

leaves, twigs, & bark

Which specific part is used in botanical medicine?


Comfrey

leaves & root

Name the active constituent:


Evening primrose oil

gamma-linolenic acid

Name the active constituent:


Witch hazel

tannins

Name the active constituent:


Camomile

apigenin

Name the active constituent:


Tea tree oil

(+)-terpinen-4-ol

Name the active constituent:


Camomile

alpha-bisabolol

Name the active constituent:


Arnica

helenalin

The health condition for which it has promising or good evidence as a therapeutic intervention:


Bromelain

post-operative or post-traumatic swelling, especially of the nose & paranasal sinuses

The health condition for which it has promising or good evidence as a therapeutic intervention:


Aloe vera

Psoriasis & genital herpes

The health condition for which it has promising or good evidence as a therapeutic intervention:


Tea tree oil

cutaneous fungal infections

The health condition for which it has promising or good evidence as a therapeutic intervention:


Witch hazel

hemorrhoidal disease

The health condition for which it has promising or good evidence as a therapeutic intervention:


Evening primrose oil

atopic eczema

Comfrey products should have declared content of what potentially-toxic constituent?

unsaturated pyrrolizidine alkaloids

Which botanical medicine may potentiate the effects of anticoagulant and platelet-inhibiting medications?

Bromelain

A German product containing which herb has shown positive results in the treatment of several types of skin disorders, including decubitus ulcers?

Chamomile

Which preparation of aloe vera is suitable for topical treatment of skin conditions?

gel

An anti-inflammatory product called Phlogenzym (marketed in North America as Wobenzym PS) contains several ingredients, one of which is ___________.

bromelain

Which botanical is used both topically as an extract in tinctures, ointments, and oils as well as orally in homeopathic dilutions?

arnica

Which botanical agent may increase the potency of certain antibiotics?

bromelain

What is the latin binomial name?


Devil's claw

Harpagophytum procumbens

What is the latin binomial name?


Frankincense

Boswellia serrata

What is the latin binomial name?


Feverfew

Tanacetum perthenium

What is the latin binomial name?


Butterbur

Petasites hybridus

What is the specific part used for pain in botanical medicine?


Devil's claw

tuber

What is the specific part used for pain in botanical medicine?


Boswellin

gum resin

What is the specific part used for pain in botanical medicine?


Willow

bark

What is the specific part used for pain in botanical medicine?


Peppermint

essential oil from leaf

What is the specific part used for pain in botanical medicine?


Feverfew

leaf

What is the specific part used for pain in botanical medicine?


Butterbur

rhizome

What is the proposed active constituent or licensed standardized extract?


Feverfew



parthenolide

What is the proposed active constituent or licensed standardized extract?


Cayenne

capsaicinoids

What is the proposed active constituent or licensed standardized extract?


Willow bark

salacin

What is the proposed active constituent or licensed standardized extract?


Devil's claw

iridoid glycosides

What is the proposed active constituent or licensed standardized extract?


Butterbur

Petadolex

In clinical trials using Harpagophytum extracts with standardized active principle content, what is the minimum amount of harpagoside prescribed per day?

50 mg

T or F: Given the pharmacokinetics of harpagoside, both of the following statements are true: 1) a single morning dose could be expected to reduce symptoms within half an hour, and 2) relief should persist for the entire day.

False

Persons allergic to members of the daisy family should be cautious consuming which TWO herbs?

Feverfew & Butterbur

Persons sensitive to aspirin should not use which herb?

Willow bark

Which TWO botanicals have been shown effective against some types of pain when used topically?

Capsaicin & Peppermint

Which botanical has been shown clinically effective specifically against tension headache?

Peppermint

For which TWO painful conditions have Devil's claw preparations been studied in controlled trials?

Osteoarthritis & Chronic back pain

Capsaicin preparations have been studied in controlled trials for treating all of the following painful conditions except one. Which one has NOT been studied?

Migraine headache

Which botanical has been found more effective as the whole dried herb than as an ethanolic extract?

Feverfew

For which botanical extract is it important to have a guarantee that it is free of pyrrolizidine alkaloids?

Butterbur

Interrupting which herb after taking it for a long time may result in difficulty sleeping, headaches, joint pain, nervousness, and stiff muscles?

Feverfew

T or F: The traditional use of ginkgo biloba is based on medicinal use in Asia, not in Europe.

True

Which part of the plant is used?


Ginkgo biloba

leaf only

Which part of the plant is used?


St. John's wort

leaf & flowers

Clinically-proven preparations are 4-7:1 concentrates:


St. John's wort, Gingko biloba, or BOTH

St. John's wort

Clinically-proven preparations are 35-67:1 concentrates


St. John's wort, Gingko biloba, or BOTH

Gingko biloba

Clinically-proven preparations are acetone-water extracts:


St. John's wort, Gingko biloba, or BOTH

Gingko biloba

Clinically-proven preparations are alcohol-water extracts:


St. John's wort, Gingko biloba, or BOTH

St. John's wort

Extracts contain phytochemicals from the flavonoid family:


St. John's wort, Gingko biloba, or BOTH

BOTH

Which constituent of ginkgo must be remove because it has been shown to incite allergic responses and other toxic reactions?

ginkgolic acids

On which two families of constituents are medicinal ginkgo extracts standardized?

flavonoid glycosides & terpene lactones

T or F: Since no pharmacokinetic studies of ginkgo extracts have been done, the amount absorbed and bioavailable is unknown.

False

Inhibits synaptic reuptake of neurotransmitters:


Hypericum perforatum or Gingko biloba

Hypericum perforatum

Upregulates 5-hydroxytryptamine receptors:


Hypericum perforatum or Gingko biloba

Hypericum perforatum

Increases tolerance of brain tissue to hypoxia:


Hypericum perforatum or Gingko biloba

Gingko biloba

Inhibits platelet activation factor (PAF):


Hypericum perforatum or Gingko biloba

Gingko biloba

Reduces "behavioral despair" in animal models:


Hypericum perforatum or Gingko biloba

Hypericum perforatum

Increases skin reponse to the effects of UV radiation:


Hypericum perforatum or Gingko biloba

Hypericum perforatum

Inhibits age-related decline of choline and alpha-adrenergic receptors:


Hypericum perforatum or Gingko biloba

Gingko biloba

Affects brain waves evaluated by computer-analyzed EEG:


Hypericum perforatum or Gingko biloba

Gingko biloba

T or F: While ginkgo has been demonstrated to have value in the treatment of dementia, it has never been found helpful for improving cognitive function in non-demented subjects.

False

According to the German Committee for Proprietary Medicinal Products, modern research on the efficacy of gingko biloba should assess all but one of the following categories of outcomes in patients with dementia. Which category is not a required outcome to assess?

Subjective self-assessment of patient's mood state

The German Commission E determined that ginkgo extracts were indicated for all of the following except _____________.

prevention of stroke

T or F: Only St. John's wort extracts with moderate to high hyperforin content have been found effective in clinical trials

False



When assessing the response to antidepressant therapies using instruments such as the Hamiliton Depression Rating Scale, what percentage score improvement is considered good evidence of a meaningful response?

50%

T or F: The placebo effect probaby accounts for at least 50% of the beneficial effects of St. John's wort on depression

True

T orF: Lower cost and fewer adverse effects are two distinct advantages of either ginkgo or hypericum extracts over pharmaceutical medicines typically prescribed for dementia or depression, respectively.

True

T orF: Marked improvement in depressive symptoms can be expected to occur withing one to two weeks of therapy with hypericum extracts.

False

St. John's wort may interact significantly with which of the following types of drugs? (choose all of the correct answers)


  • Immunosuppressants
  • Protease and reverse transcriptase inhibitors
  • Selective serotonin reuptake inhibitors (SSRIs)


INCORRECT:

Anticoagulants



What is the Latin binomial name of Kava?

Piper methysticum

What is the Latin binomial name of Hops?

Humulus lupulus

What is the plant part primarily used in Kava?

rhizome

What is the plant part primarily used in Valerian?

root

What is the plant part primarily used in Lavender?

flowers only, any gender

What is the plant part primarily used in Hops?

stobiles (female flowers)

What is the active constituent of Valerian?

sesquiterpenes

What is the active constituent of Lavender?

linalyl acetate and cineol

What is the active constituent of Kava?

pyrones

What is the active constituent of Hops?

humulone and lupulone

Which medicinal herb has been studied primarily as aromatherapy?

Lavender

Human clinical studies of kava have tested extracts with varying amounts of active constituents; what is the highest percentage content of actives tested?

70%

Which potential adverse reaction to kava has led to a product recall in Europe and a public warning issued by the US FDA?

Liver damage

T orF: Aqueous and ethanol extracts of valerian root are equivalent in the quality of their actions.

False

Which subspecies of Valerian is recommended for use in valerian preparations?

officinalis

Valerian products with a high content of which constituent should not be used due to potential toxicity?

Valepotriates

Upon which neurotransmitter does valerian appear to exert its pharmacological effects?

Gamma-aminobutyric acid (GABA)

T or F: Kuhlmann (1999) demonstrated that valerian extract had no adverse effects on the reaction time, alertness, or concentration

True

T or F: Patients with sleep disturbances can expect to achieve improvement after only a few days of valerian use.

False

According to our text, which two additional herbal calmatives have been tested in combination with valerian in clinical studies?

Hops & Lemon balm

All of the following measures except one were affected in human studies of the effects of lavender. Which measure was not assessed?

NOT ASSESSED:


Reductions in blood markers of the stress response


ASSESSED:


  • Self-rated sedation
  • More relaxed and less depressed self-rated mood
  • Increased "happiness" based on autonomic nervous system responses
  • Decline in EEG potentials that correlate with vigilance and alertness

What are the reported side effects of Kava?


  • Dystonia
  • Interaction with drugs used for Parkinson's disease

What is the reported side effect of Lavender (oral use)?

Headache, appetite changes, constipation

What is the reported side effect of Lavender (topical use)?

Breast growth in young boys

What is the Latin binomial name of Hawthorne?

Crataegus monogyna

What is the Latin binomial name of Horse chestnuts?

Aesculus hippocastanum

Which plant part is used with the herb Hawthorne?

leaves & flowers

Which plant part is used with the herb Rosemary?

leaves only

Which plant part is used with the herb Horse chestnut?

seed

What is the active constituent of Hawthorne?

flavonoids or oligomeric procyanidins

What is the active constituent of Coffee & black tea?

Methylxanthines

What is the active constituent of Hoser chestnut?

aescin

A combination of hawthorne extract and what essential oil was found effective for raising blood pressure in subjects with orthostatic hypotension?

camphor oil

T or F: A single dose of hawthorn extract has discernible effects on subjective complaints related to cardiac insufficiency

False

Indicate all of the pharmacological effects of hawthorn extracts demonstrated in preclinical research in vitro or in animal models.

ALL:



  • Increase in coronary blood flow
  • Increased amplitude of myocardial contractions
  • Cardioprotective effects during recovery from cardiac ischemia, indicated by reduced release of lactate dehydrogenase
  • Increase in cardiac stroke volume


How does hawthorne extract differ pharmacologically from cardiac glycosides such as digitalis?

Hawthorne is positively inotropic yet antiarrhythmic

All but one of the following herbs is a source of digitaloids that are not recommended for phytotherapeutic use due to their pharmacokinetic and other shortcomings. Which one?

Foxglove

What is the correct description of the extraction method used to produce WS 1442, the hawthorne extract used in many clinical studies of heart failure?

Water and alcohol extraction

Which two botanicals owe their circulatory effects to the presence of caffeine and related substances?

Guarana & Mate'

According to our text, what outcomes have been demonstrated in human studies of horse chestnut extract? Choose all answers that are correct.

ALL:


- Significantly reduced foot and ankle edema after a long distance airplane flight


- Significantly reduced symptomatic complaints in patients with chronic venous insufficiency


- Equivalence between horse chestnut extract and compression stocking therapy for reducing edema in patients with chronic venous insufficiency - Significantly reduced leg volume in patients with chronic venous insufficiency

Esculin is a toxin that must be processed out of ___________, and is one reason why the raw or unprocessed herb should not be used.

Horse chestnut

What is the Latin binomial forArtichoke?

Cynarum scolymus

What is the Latin binomial forTurmeric?

Curcuma longa

What is the Latin binomial forDandelion?

Taraxacum officinalis

What is the Latin binomial for Licorice?

Glycyrrhyza glabra

Which plant part is used for Ginger?

Rhizome only

Which plant part is used for Chamomile?

Flowers

What is the active constituent of Peppermint?

Menthol

What is the active constituent of Turmeric?

Curcumin

What is the active constituent of Artichoke?

Cynarin

Which mechanism of action is associated with this in the treatment of digestive tract dysfunction? Bitter

Stimulate gastric secretionsd

Which mechanism of action is associated with this in the treatment of digestive tract dysfunction? Cholegogue

Promote bile production & emptying of the gallbladder

Which mechanism of action is associated with this in the treatment of digestive tract dysfunction? Carminative

Relieve bloating & fullness by facilitating gas expulsion

Match the herb with the digestive condition best proven to respond to its use: Artichoke

Complaints in the upper abdomen aggravated by fat intake

Match the herb with the digestive condition best proven to respond to its use: Peppermint oil
Irritable bowel syndrome

Match the herb with the digestive condition best proven to respond to its use: Licorice

Peptic ulcer

Which TWO alcoholic beverages use wormwood as an ingredient?

Vermouth & absinthe

As treatment or prevention of nausea and vomiting, the effectiveness of ginger is least convincing when which of the following is the cause?
LEAST: Postoperative



OTHER CHOICES:



  • Chemotherapy
  • Morning sickness
  • Sea sickness

T or F: In the treatment of gastrointestinal disorders, peppermint oil given in delayed-release (enteric-coated) formulations has more clinical evidence than conventional formulations, and may be less likely to cause side effects of nausea, heartburn, and abdominal discomfort.

False

Which component of licorice has mineralocorticoid-like action, and is removed in some formulations to prevent side effects of blood pressure elevation and potassium loss?

Glycyrrhizin

Which herb is recommended NOT to be used in large amounts during pregnancy, based on research suggesting increased risk of preterm labor?

Licorice

What is the Latin binomial for Bilberry?

Vaccinium myrtillus

What is the Latin binomial forPsyllium?

Plantago species

What is the Latin binomial forMilk thistle?

Silybum marianum

What is the mechanism of action:


Psyllium husk

Bulk forming laxative

What is the mechanism of action:


Senna pods and leaves

Anthranoid stimulation of intestinal mucosa

What is the mechanism of action:


Aloe latex

Anthranoid stimulation of intestinal mucosa

Tannin-containing herbs can play an important role in the control of which health condition?

Acute diarrhea

Which type of botanical remedy for constipation is most likely to produce adverse effects of loose stools and colicky abdominal pain.

Anthranoid-containing herbs

Which of the following is an FDA-approved non-prescription drug?

Senna

Which TWO laxative herbs are no longer FDA-approved for use in over-the-counter medications due to lack of modern clinical and safety data?

Cascara & aloe

Senna may be contraindicated in people taking either diuretics, horsetail, or licorice, due to concerns about altered blood levels of ___________.

Potassium

T or F: While human trials of patients with cirrhosis of the liver have found silymarin treatment provides supportive benefits, improved survival rates have never been demonstrated.

False

What part of the milk thistle plant is the typical source from which silymarin is extracted?

Seed

The 2008 Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) study found that hepatitis C patients who used silymarin had which TWO of the following positive results?


  • milder symptoms of liver disease
  • better quality of life

Allergic reactions to milk thistle are more common among people allergic to all of the following except one. Which one?

Wheat

What is the Latin binomial for Saw palmetto?

Serenoa repens

What is the Latin binomial forNettle?

Urtica dioica

What is the Latin binomial forPygeum?

Prunus africana

What is the Latin binomial forChasteberry?

Vitex agnus-castus

What is the Latin binomial forBlack cohosh?

Cimicifuga racemosa

Which plant part is used in Saw palmetto?

Fruit

Which plant part is used in Chasteberry?

Fruit

Which plant part is used in Nettle?

Root and/or rhizome

Which plant part is used in Black cohosh?

Root and/or rhizome

Which plant part is used in Pygeum?

Bark

What are the active constituents of Saw palmetto?

Fatty acids & sterols

What are the active constituents of Pygeum?

Phytosterols, pentacyclic terpenes, & ferulic acid esters

What are the active constituents of Black cohosh?

Triterpene glycosides

What is the extraction features of clinically-studied preparations of Saw palmetto?

Fat soluble extract prepared with hexane or liquid carbon dioxide

What is the extraction features of clinically-studied preparations of Nettle?

10:1 herb to extract ratio prepared with methanol-water solvent

All of the following mechanisms, except one, have been demonstrated for saw palmetto extracts. Which one has NOT been demonstrated for saw palmetto extracts?
Inhibit prostatic aromatase
All of the following mechanisms, except one, have been identified for nettle extracts. Which one is NOT a mechanism for nettle extracts?
Reduce blood prolactin levels


THESE ARE MECHANISMS:


  • Anti-inflammatory effects
  • Inhibition of 5-alpha reductase enzyme
  • Inhibit prostatic aromatase

Two of the following mechanisms have been demonstrated for pygeum extracts, one has not. Which one has NOT been demonstrated for pygeum extracts?

Correct: Interactions with sex-hormone-binding globulin (SHBG)


OTHER CHOICES:


  • Inhibition of 5-alpha reductase enzyme
  • Inhibition of aromatase enzyme activity
The clinical effects of chasteberry probably depend on modifying the activity of which hormone?

Prolactin

A case of necrotizing hepatitis has been associated with use of which herb?

Black cohosh

Which of the following is TRUE?
Correct: People taking dopamine-related medications, such as certain antipsychotic drugs and Parkinson's disease medications, should avoid using chasteberry.

INCORRECT:


  • Blue cohosh is an acceptable substitute for black cohosh
  • Saw palmetto appears to affect readings of prostate-specific antigen (PSA) levels
Which of the following best describes the assumption regarding the anti-stress function of herbs such as the ginsengs?
Correct: Expands the adaptation phase while delaying or preventing the exhaustion phase of the stress response.


OTHER CHOICES:


  • Expands both the adaptation phase and the exhaustion phase of the stress response.
  • Delays or prevents both the adaptation phase and the exhaustion phase of the stress response.
  • Expands the exhaustion phase while delaying or preventing the adaptation phase of the stress response.

What is the Latin binomial forSiberian ginseng?

Eleutherococcus senticosus

What is the Latin binomial forAmerican ginseng ?

Panax quinquefolius

What is the Latin binomial forGotu kola?

Centella asiatica

Which plant part is used inGinseng and Eleuthero?

Root

What are the active constituents inAsian ginseng?

Glycosidal saponins

What are the active constituents inEleuthero?

Lignan glycosides

What are the active constituents inGrape seed?

Procyanidins

Clinical studies of Asian ginseng before 1990, while not always meeting current standards of research methodology, suggested most of the following effects in humans. Which one of the following was NOT suggested by early clinical studies?

CORRECT: Improved resistance to infection


OTHER CHOICES:


  • Improved intellectual performance
  • Improved mood
  • Improved physical performance

According to our text, what is the likely reason that western ginseng trials have not produced results as promising as Asian tradition and research has suggested?

Western trials used dosages that were too low

According to the German Commission E monograph, all of the following uses for ginseng except one are recommended. Which one is not recommended in the monograph?

To improve mood

Which of the following is not a source of "polyphenolic oligomers of the flavonoid type"?

CORRECT: Cordyseps




OTHER CHOICES:



  • Pine bark
  • Green tea
  • Grape seed

Which two preparations of Echinacea were approved by German Commission E?


  • Expressed juices of the aerial parts of E. purpurea
  • Alcohol extracts of the root of E. pallida

Which constituent is apparently not present in expressed juice echinacea products?

cicoric acid

T or F: Studies such as Dorn (1989), showing that echinacea can shorten the duration of a cold, typically give larger amounts of the preparation when symptoms first appear, followed by a smaller dosage for the remainder of treatment.

True

According to our text, why may liquid echinacea preparations be more effective than solid forms that are swallowed?

Liquid preparations may act locally on lymphoid tissues in the oropharynx

All of the following side effects have been reported for ginseng. According to NCCAM, which group may have been due to another herb or drug in the ginseng product?

CORRECT: Breast tenderness, menstrual irregularities, and high blood pressure




OTHER CHOICES:



  • Lower levels of blood sugar in diabetics
  • Allergic reactions
  • Headaches and sleep and gastrointestinal problems

People are more likely to experience allergic reactions to echinacea if they are allergic to which of the following groups of plants?

Ragweed, chrysanthemums, marigolds, and daisies

In an English study that randomized subjects with respiratory infections to treatment with antibiotics or no treatment, what determining factor predicted which patients recovered faster?

Whether they were satisfied with their interaction with the doctor

What is the physiological action of a Diaphoretic ?

Induces perspiration

What is the physiological action of anExpectorant?

Increase ciliary activity, reduce mucus viscosity, liquefy pulmonary secretions

What is the physiological action of an Anti-tussive?

Reduce irritability & stimulation of cough receptors above & below the pharynx

What is the physiological action of a Mucilaginous?

Form protective coating over pharyngeal mucosa

What is the Latin binomial of Ivy?

Hedera helix

What is the Latin binomial of Butterbur?

Petasides hybridus

Which plant part is used in Ivy?

Leaf

Which plant part is used inEucalyptus?

Leaf

What is the active constituent of Eucalyptus ?

Cineol

What is the active constituent of Ivy?

Saponins

What is the active constituent ofEphedra?

Alkaloids

T or F: Research on the pain-relieving efficacy of willow bark proves that virtually all of the effect is due to the salicylate content of the herb.

False

Which one of the following herbs is NOT used as a source of essential oils in cough remedies and expectorants?

Correct: Butterbur



OTHER CHOICES:



  • Pine
  • Eucalyptus
  • Thyme

T or F: According to our text, strong preparations of essential oils are contraindicated for use in the facial region of infants and children under 2 years of age

True

Prospan is the brand name of the herbal product containing which botanical species?

Hedera helix

Which plant part(s) of petasides hybridus was first used for an extract called Ze 339, developed to treat allergic rhinitis?

leaf

Which herb has potential adverse effects including palpitations, elevated blood pressure, and sleeplessness?

Ephedra

Which one of the following has NOT been traditionally used as a mucilaginous herb?

Correct: Ivy




OTHER CHOICES:



  • Marshmallow
  • Plantain
  • Mullein

Indicate which one of the clinical conditions listed that has NOT responded to treatment with ivy extract in controlled trials, according to our text.

Correct: Respiratory infections in children INCORRECT:


  • Chronic obstructive bronchitis in children
  • Bronchial asthma in children
  • Chronic obstructive bronchitis in adults

***The respiratory infection study was observational, so there was no control group
Which two of the following botanicals can contain potentially toxic pyrrolizidines?
Coltsfoot & Butterbur
People are more likely to experience allergic reactions to butturbur if they are allergic to which of the following groups of plants?
Ragweed, chrysanthemums, marigolds, and daisies