Medchem 525: 3

In the 2012 meta-analysis evaluating the effect of zinc in the treatment of the common cold, the use of zinc significantly reduced the duration of symptoms by how long?

3.65 days
2.65 days
0.65 days
1.65 days

1.65 days

In the meta-analysis evaluating the effect of zinc on the treatment of the common cold, zinc appears to be equally effective in children as in adults.

True
False

False

Which of the following is a true statement regarding the available zinc products?

Zinc gluconate appears to be more effective than zinc sulfate.
Zinc gluconate has been associated with damage to the nasal tissues.
The zinc gluconate formulations have a higher percentage of elemental zinc per dose compared to zinc sulfate formulations.
All of the above are correct

Zinc gluconate has been associated with damage to the nasal tissues.

What is the minimal daily dose of Zinc acetate needed to decrease the duration of the common cold based on the Hemiliä review?

200 mg
75 mg
150 mg
50 mg

75 mg

The area under the concentration-time curve (AUC) of silymarin, the active ingredient in milk thistle is decreased in patients with liver disease compared to normal subjects which may limit its efficacy.

True
False

False

A systemic, comprehensive review of the literature on hepatitis and the use of milk thistle (Rambaldi et al) concluded that milk thistle treatment

was associated with significant renal toxicity
reduced alcoholic liver mortality in all trials but not in high quality trials
reduced liver-related death in the high quality studies
was unworthy of future research efforts

reduced alcoholic liver mortality in all trials but not in high quality trials

In addition to the potential use in the treatment of cirrhosis, an additional proposed use of milk thistle is in the treatment of

Irritable bowel disease
Amanita philloides mushroom posioning
Gall bladder disease
All of the above

Amanita philloides mushroom posioning

A large double blind placebo controlled clinical study evaluated the effects of silymarin in the treatment of chronic hepatitis in patient unsuccessfully treated with interferon therapy found that

Both doses of silymarin significantly decreased ALT levels
Neither dose of silymarin significantly decreased ALT levels.
Only the higher dose of silymarin decreased serum aminotransferase (ALT) levels.

Neither dose of silymarin significantly decreased ALT levels.

Which of the following is the proposed mechanism for glucosamine in the treatment of osteoarthritis?

Glucosamine inhibits the induction of IL-1beta, a pro-inflammatory cytokine
Glucosamine inhibits NF-kappa-B activity
Glucosamine is a building block for the glycosaminoglycahns that are part of the structure of cartilage
All of the above

All of the above

It has been hypothesized that glucosamine sulfate is more effective than glucosamine HCl. What is a true statement regarding glucosamine sulfate?

Glucosamine sulfate has been evaluated in more clinical studies than glucosaminde hydrochloride.
Glucosamine serum concentrations are higher when glucosamine is administered as glucosamine sulfate
The sulfate salt produces sulfate concentrations high enough to stimulate chondroitin sulfate synthesis.
All of the above

Glucosamine sulfate has been evaluated in more clinical studies than glucosaminde hydrochloride.

The GAIT study evaluated glucosamine HCl and chondroitin alone and in combination on knee pain in patients with osteoarthritis. Which of the following describes the results of this large clinical study?

Chondroitin concentrations increased above baseline concentrations in the chondrotin treated patients.
Glucosamine HCl and chondrotin in combination was more effective than either treatment alone overall.
Glucosamine HCl and chondrotin in combination was more effective than placebo in the subgroup of patients with moderate to severe knee pain.
All of the above

Glucosamine HCl and chondrotin in combination was more effective than placebo in the subgroup of patients with moderate to severe knee pain.

Although the meta-analysis by Wandel et al and the large GAIT study found that chondroitin and glucosamine were not efficacious, the Natural Standards evaluation gave chrondoitin and glucosamine sulfate Grade A. Why?

The GAIT study used glucosamine HCl instead of glucosamine sulfate.
Many smaller, studies have demonstrated clinically significant effects.
Other meta-analysis have demonstrated efficacy.
All of the above

All of the above

Evening primrose oil is used primarily for conditions involving pain and inflammation. The rational for this use is

GLA is converted to the omega-3 fatty acids, EPA and DHA.
GLA is converted to prostaglandin E1 which reduces inflammation.
The oil contains salicylates.
The oil is used as a topical lubricant for the knee in osteoarthritis.

GLA is converted to prostaglandin E1 which reduces inflammation.

A recent, large, widely publicized study in patients with major depression found that

St. John’s wort was more efficacious than placebo and sertraline (Zolof)
St. John’s wort and sertraline were both superior to placebo
St. John’s wort was as efficacious as sertraline and placebo
St. John’s wort was less efficacious than sertraline and placebo

St. John’s wort was as efficacious as sertraline and placebo

Even though there are more than 10 active components of St. John’s wort, the one component that maybe responsible for the majority of the antidepressant activity is

Rutin
Hypericin
Seratonin
Hyperforin

Hyperforin

The meta-analysis by Rahimi et al and the comparative analysis of Kasper et al comparing Hypericum perforatum (St. Johns’ wort) to the selective serotonin reuptake inhibitors (SSRI) and the tricyclic antidepressants (TCAs) found

St John’s wort was as efficacious and had a lower incidence of adverse events than the SSRIs and TCAs.
St John’s wort was not as efficacious as the SSRIs and TCAs; however the lower incidence of adverse events and improvement in compliance is a major advantage of using St. John’s wort.
St. John’s wort, SSRI and TCAs were equally efficacious and had similar incidence of adverse events.

St John’s wort was as efficacious and had a lower incidence of adverse events than the SSRIs and TCAs.

The use of St. John’s wort is primarily limited due to

Photosensitivity
Hypersensitivity
Drug interactions
All of the above

Drug interactions

According to Kasper et al, one of the major explanations for the variability in the results of clinical trials of St. John’s wort in depression is

The difference in the time of harvesting of the flowers and buds
The use of root extract
The differences in preparation of the extract
All of the above

The differences in preparation of the extract

St. John’s wort has been shown to be an effective antidepressant in patients with mild, moderate and severe depression.

True
False

False

EGb 761 is the extract preparation that has been most studied of which herbal product?

St. John’s wort
Ginseng panax
Ginkgo biloba
Milk Thistle

Ginkgo biloba

It is more difficult to determine a statistically significant treatment effect in clinical studies of depression because the placebo response has been progressively

increasing
decreasing
There is no effect of a change in the placebo response in determining a treatment effect

Increasing

Which of the following is not associated with the proposed pharmacologic effect of St. John’s wort?

Increases dopamine activity in pre-frontal cortext
Modules the L-glutamate pathway
Vasodilation of cerebral vessels
Inhibits the uptake of norepinephrine, serotonin and GABA in CNS synapses

Vasodilation of cerebral vessels

Which of the following is not associated with the pharmacologic effect of Ginkgo Biloba?

Antioxidant
Antiinflammatory
Anticholinergic
Antiplatelet activation factor

Anticholinergic

A potential risk of self-therapy with ginkgo is

blood clots
drug interactions with anti-platelet drugs
myocardial infarction
ischemic stroke

drug interactions with anti-platelet drugs

The results of the GEM study evaluating ginkgo biloba in prevention of dementia was

negative in subjects with normal cognition.
negative in both subjects with normal cognition and in those elderly subjects with mild impairment.
negative in subjects with normal cognition but positive in patients mild impairment.

negative in both subjects with normal cognition and in those elderly subjects with mild impairment.

Prior to the GEM study, there were a large number of double blind, placebo controlled trials that had found ginkgo to be more efficacious in improving cognition than placebo in patients with dementia.

True
False

True

Chondritin

contains neural tissue and maybe a risk for bovine spongiform encephalopathy
is too large a molecule to be absorbed
is a glycosaminoglycan obtained from bovine cartilage
is a glycosaminoglycan obtained from bovine milk

is a glycosaminoglycan obtained from bovine cartilage

There is good evidence of efficacy of petasites in the treatment of

hiccups
hepatitis
irritable bowel disease
seasonal rhinitis

seasonal rhinitis

The major safety issue with petasite products is that raw and unprocessed butterbur extracts contain pyrrolizidine alkaloids which can results in

asthma
liver toxicity
excessive bleeding
All of the above

liver toxicity

Methylsulfonylmethane (MSM)

is commonly take with glucosamine.
it may provide radical scavenging activity.
has been graded by Natural standards as Grade C, unclear or conflicting evidence in the treatment of osteoarthritis.
All of the above

All of the above

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