__________ is an herbal constituent which is not an anticoagulant but rather a venotonic; __________ is a naturally occurring compound which is a strong anticoagulant; __________ is an anticoagulant drug based on a naturally occurring compound.
a. coumadin, phenprocoumon, warfarin
b. dicoumarol, coumarin, warfarin
c. coumarin, dicoumarol, phenprocoumon
d. coumarol, dicoumarol, phencoumarol

c. coumarin, dicoumarol, phenprocoumon

A transplant patient was receiving anti-rejection therapy with the immunosuppressant drug cyclosporin, and began taking a botanical substance. A routine examination later indicated that acute rejection of the new organ was beginning to take place. Which substance was implicated in this effect?
a. Echinacea
b. Milk Thistle
c. Grapefruit juice
d. St. John’s Wort

d. St. John’s Wort

According to our text, the major source of substances which present a risk of adverse interactions with drugs is:
a. mood-altering herbs
b. herbs that induce MDR-1
c. compounds found in foods and beverages
d. herbs that inhibit or induce CYP enzymes

c. compounds found in foods and beverages

Amprenavir, indinavir, nelfinavir, saquinavir, and ritonavir are __________ which should not be taken with __________ because the latter has been found to disturb plasma levels of the drugs.
a. antidepressants; Panax ginseng
b. hypoglycemics; Gymnema sylvestre
c. antihypertensives; Ephedra sinica
d. antivirals; Hypericum perforatum

d. antivirals; Hypericum perforatum

An herb which __________ an enzyme will tend to enhance the metabolism and/or clearance of a drug which is processed by that enzyme; and herb which __________ an enzyme will diminish the metabolism and/or clearance of a drug which is processed by that enzyme.
a. induces, suppresses
b. induces, inhibits
c. inhibits, induces
d. activates, induces

b. induces, inhibits

An inaccurate analysis has stated that compounds in Feverfew have been shown to inhibit platelet activity, and thus it should not be taken with anticoagulant herbs. What is wrong with this statement?
a. the compounds do not actually interact with anticoagulants
b. the compounds were misidentified and do not really occur in Feverfew
c. it is impossible to achieve the doses necessary for this effect with oral use
d. it is based solely on rat and mouse studies

c. it is impossible to achieve the doses necessary for this effect with oral use

Caution must be exercised when prescribing herbs for users of digoxin, warfarin, phenytoin, phenobarbital, and immunosuppressive (for transplants) or HIV antiviral drugs, because:
a. drugs have narrow therapeutic windows
b. the drugs are metabolized by the cytochrome P450 enzyme system
c. interactions with these drugs can lead to liver damage
d. interactions with various herbs are common

a. drugs have narrow therapeutic windows

Concurrent use of __________ and drugs affecting the central nervous system may be contraindicated or should be carefully monitored because the herb can potentiate sedative effects or disturb dopamine metabolism.
a. Panax ginseng
b. Piper methysticum
c. Pausinystalia yohimbe
d. Valeriana officinalis

b. Piper methysticum

Large doses of __________ should not be taken with digoxin or digitoxin because:
a. Licorice; it inhibits the enzyme that metabolizes digoxin, leading to excessive levels in the blood
b. St. John’s Wort; it induces CYP3A4 and lowers plasma levels of the drug
c. St. John’s Wort; it induces MDR-1 activity which may result in subtherapeutic concentrations of the drug in the body
d. Lycium barbarum; it induces the P-glycoprotein efflux transporter and interferes with metabolism of the drug

c. St. John’s Wort; it induces MDR-1 activity which may result in subtherapeutic concentrations of the drug in the body

Long term use of large doses of __________ should be avoided when using __________ drugs because the herb can disturb the electrolyte balance of the blood by inhibiting the renin-angiotensin system and can counteract the effects of the drugs.
a. Garlic; anticoagulant
b. Licorice; antihypertensive
c. Ginseng; corticosteroid
d. Kava; diuretic

b. Licorice; antihypertensive

Psyllium, Marshmallow, and Slippery Elm are examples of herbs which contain __________ and should not be taken simultaneously with various drugs and nutrients because they __________.
a. tannins; bind and precipitate the substances
b. alkaloids; are known to have caused several adverse interactions
c. enzyme inducers; facilitate metabolism and clearance of the substances
d. fiber; inhibit absorption of the substances

d. fiber; inhibit absorption of the substances

Recent research has found the levels of __________ are correlated with the intensity of interactions between St. John’s Wort and several drugs which are metabolized by CYP3A4, CYP2C19 and/or P-glycoprotein.
a. silymarin
b. catechins
c. hypericin
d. hyperforin

d. hyperforin

St. John’s Wort, Dong Quai, and large doses of Garlic and Ginger are contraindicated with __________ because they can:
a. MAO inhibitors; inhibit the P-glycoprotein efflux pump and raise neurotransmitter levels
b. anticoagulants; disrupt the INR
c. cardiac glycosides; up-regulate metabolism and clearance of the drugs
d. antihypertensives; increase blood pressure

b. anticoagulants; disrupt the INR

Which of the following compounds is NOT considered to be a xenobiotic in reference to the human system?
a. cyclosporin
b. dioxin
c. glucosinolates
d. glucose

d. glucose

Which of the following compounds or classes of compounds is most commonly involved in herb – drug interactions?
a. MDR-1
b. monoamine oxidase
c. CYP3A4
d. conjugation enzyme

c. CYP3A4