AP Pharmacology & Medication Management 2 — Questions and Answers
Question 1: A patient taking warfarin asks about using danshen (Salvia miltiorrhiza). What is the primary concern?
- Danshen inhibits warfarin absorption in the gut
- Danshen potentiates warfarin's anticoagulant effect, increasing bleeding risk (Correct answer)
- Danshen accelerates warfarin metabolism via CYP induction
- Danshen has no significant interaction with warfarin
Correct answer: Danshen potentiates warfarin's anticoagulant effect, increasing bleeding risk
Danshen inhibits warfarin metabolism and has its own anticoagulant properties, significantly increasing bleeding risk.
Question 2: Which herb is most associated with causing hypertensive crisis when combined with MAO inhibitors?
- Ginger (Zingiber officinale)
- Ephedra (Ma Huang) (Correct answer)
- Astragalus (Huang Qi)
- Licorice (Gan Cao)
Correct answer: Ephedra (Ma Huang)
Ephedra contains ephedrine, which combined with MAO inhibitors can cause dangerous hypertensive crisis due to increased sympathomimetic activity.
Question 3: A patient on metformin reports using bitter melon (Momordica charantia) daily. The acupuncture physician should monitor for:
- Hyperglycemia
- Hypoglycemia (Correct answer)
- Hypertension
- Nephrotoxicity
Correct answer: Hypoglycemia
Bitter melon has hypoglycemic properties that can potentiate metformin's blood glucose-lowering effect, risking hypoglycemia.
Question 4: Which of the following best describes the mechanism by which St. John's Wort reduces effectiveness of many medications?
- It chelates drug molecules in the GI tract
- It induces CYP3A4 and P-glycoprotein, increasing drug metabolism and efflux (Correct answer)
- It inhibits CYP2D6, slowing drug breakdown
- It raises gastric pH, reducing drug absorption
Correct answer: It induces CYP3A4 and P-glycoprotein, increasing drug metabolism and efflux
St. John's Wort is a potent inducer of CYP3A4 and P-glycoprotein, leading to reduced plasma levels of many drugs including cyclosporine, antiretrovirals, and oral contraceptives.
Question 5: A patient using fish oil supplements at high doses (>3g EPA/DHA daily) is scheduled for surgery. The AP should:
- Encourage continued use as fish oil prevents post-surgical inflammation
- Advise discontinuation 1-2 weeks prior to surgery due to antiplatelet effects (Correct answer)
- Advise switching to flaxseed oil instead
- No action is needed as fish oil has no surgical risk
Correct answer: Advise discontinuation 1-2 weeks prior to surgery due to antiplatelet effects
High-dose fish oil has significant antiplatelet effects and should be discontinued 1-2 weeks before surgery to reduce bleeding risk.
Question 6: Glycyrrhizin, the active compound in high-dose licorice (Gan Cao), is most likely to cause which adverse effect?
- Hypoglycemia and weight loss
- Pseudoaldosteronism with hypertension and hypokalemia (Correct answer)
- Hepatotoxicity and jaundice
- Peripheral neuropathy
Correct answer: Pseudoaldosteronism with hypertension and hypokalemia
Glycyrrhizin inhibits 11-beta-hydroxysteroid dehydrogenase, causing sodium retention, potassium loss, and hypertension (pseudoaldosteronism).
Question 7: A patient on levothyroxine reports taking kelp supplements daily. What is the main clinical concern?
- Kelp's iodine content can interfere with thyroid hormone regulation (Correct answer)
- Kelp chelates levothyroxine, reducing its absorption
- Kelp induces hepatic enzymes that metabolize levothyroxine
- Kelp has no meaningful interaction with thyroid medications
Correct answer: Kelp's iodine content can interfere with thyroid hormone regulation
Kelp is high in iodine, which can disrupt thyroid function and interfere with levothyroxine therapy, causing either hypo- or hyperthyroid states.
AP Pharmacology & Medication Management 2
A patient taking warfarin asks about using danshen (Salvia miltiorrhiza).
What is the primary concern?