Osteoporosis Group 12 Case 3A

Pharm Questions:
1. What is the superior form of Calcium for use in the treatment of Osteoporosis?
a) Elemental calcium from calcium carbonate
b) Calcium citrate
c) Elemental calcium from Hydroxyapatite
d) All of the above

2. What is the role of Vitamin K in Osteoporosis?

a) Deficiency causes homocysteinemia, which is correlated with osteoporosis
b) Low Vitamin K is ssociated with enhanced fractue risk
c) Required for metabolism of the bone protein osteocalcin
d) All of the above

3. What is the ideal dosage range of vitamin D for the prevention and treatment of osteoporosis?
a) 200IU twice daily
b) 800-1000 IU daily
c) 1600-1800 IU daily
d) 2200 IU daily

4. What is a good source of vitamin D that helps metabolize calcium levels?

a) ginger
b) garlic
c) avocado
d) caffeine

5. Which of the following drugs may cause mouth ulcers when chewed or sucked on?
a) Raloxifene
b) Teriparatide
c) Digoxin
d) Alendronate

6. SERM’s exercise their effects upon which of the following?

a) Dopamine receptors
b) Serotonin secreting tissues
c) Estrogen receptors
d) Pizza Hut’s delivery time

7. Promensil is based on what natural product, which contains isoflavones?

a. Black Cohosh
b. Black Clover
c. Red Clover
d. White Cohosh

8. Promensil is contraindicated when?

a. Both b and c
b. Pregnancy
c. Lactation
d. During Menstruation

9. Which natural drug below can be used as an alternative to hormone replacement therapy (HRT)?
a. Remifemin
b. Promensil
c. Metroaxte
d. Both a and b
10. Which drug is used for hormone replacement therapy and is based on an active constituent found in Black Cohosh?
a. Remifemin
b. Metroaxte
c. Promensil
d. Both b and c
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RESEARCH QUESTIONS 3B  Schizophrenia
1. Which of the following DOES NOT contribute to the development of schizophrenia?
a) Cerebral allergies,
b) Grapefruit juice
c) Vitamin B-3 and B-6 dependencies
d) Syphilis

2. Which homeopathic remedy would best be indicated for schizophrenia treatment?

a) Hyocaimus
b) Lachesis
c) Nat-mur
d) Arnica

3. Which dosage of fish oils is best recommended for treatment of schizophrenia?

a) 3-9 g/day
b) 0.3 micrograms/day
c) 20 mg/day
d) 3.3-7.3 mg/day

4. Botanicals have been proven quite efficacious for the treatment of schizophrenia. Which list of herbs below would be
utilized best for the treatment of schizophrenia?
a) Vitex, Cimicifuga Racemosa
b) Ipecac, Colchecine
c) Peppermint, Chamomile
d) Hypericum, Ginkgo biloba, Korean Ginseng, Spirulina
5. The ideal diet for a schizophrenic diet:
a) Cereal for breakfast, past for lunch with garlic bread and coffee
b) As much chocolate ice cream and martinis as possible
c) Gluten free, high vegetable and fruit diet
d) Minimal amount of fluid possible since it may interfere with psychological disturbances

6. What is the most common interaction for all Antipsychotics?

a) NSAIDS
b) MAOI
c) CNS depressants
d) Protein pump inhibitors

7. What drug has the highest central antidopaminergic action, it is classified as a “highly potent neuroleptic”?
a) Haloperidol
b) Clozapine
c) Propanolol
d) Aspirin

8. In which drug is the only indication Schizophrenia?

a) Clozapine
b) Haloperidol
c) Risperidone
d) Olanzapine

9. Most Schizophrenic drugs act as an antagonist to which receptor?

a) Muscarinic R
b) Insulin R
c) Nicotinic R
d) Dopaminergic R

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 10. Chlorpromazine is CI with the use of St. John’s wort because?
a) It has synergistic effects and can increase the antipsychotic effects
b) It inhibits the liver enzyme CYP2D6 receptor and increases the effects of Chlorpromazine
c) It causes massive hemorrhaging
d) It is not contraindicated with Chlorpromazine

Questions for Case 3C

1. Which of the following drug classes is used in the allopathic management of elevated cholesterol?
a) Anabolic Steroids
b) Statins
c) Stimulants
d) Depressants

2. Statins lower cholesterol by inhibiting which enzyme?

a) HMG-CoA reductase
b) Ribonucleases
c) Alcohol dehydrogenase
d) Chymotrypsin

3. Which of the following is true regarding statins?

a) Statins and their metabolites are eliminated mainly by the kidneys
b) Statins and their metabolites are eliminated mainly by biliary excretion (in the feces)
c) Most statins are not transformed by the cytochrome P450 system
d) Most statins are not highly protein bound

4. Which of the following is true regarding statins?

a) Statins are safe to use by pregnant women
b) The most common side effect of statins are sleep disturbances
c) Statins should be avoided by people with hyperlipidemia
d) Statins are contraindicated in patients with active liver disease

5. Which of the following foods interact with statins?

a) Pizza
b) Chocolate
c) Grapefruit juice
d) Seafood

6. Statins work by doing which of the following?

a) Increased clearance of low-density lipoprotein (LDL) from the bloodstream
b) Increased clearance of high-density lipoprotein (HDL) from the bloodstream
c) Decreased clearance of low-density lipoprotein (LDL) from the bloodstream
d) Decreased clearance of high-density lipoprotein (HDL) from the bloodstream

7. Which one of these cold water fish does not provide the long chain fatty acids for lowering cholesterol:
a) Sardines
b) Halibut
c) Makarel
d) Anchovies
e) Salmon

8) Which of these statements is not true of Niacin:

a) Reduces LDL cholesterol
b) Reduces overall mortality
c) Increases HDL cholesterol
d) Increases lipoprotein A levels
e) Reduces fibrinogen levels

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9) Pantethine is the stable form of which B vitamin:
a) B1
b) B2
c) B3
d) B4
e) B5

10) All of these statements about Pantethine are true, except:

a) Plays a role in fat transport to and from cells
b) Important part of coenzyme A
c) Inhibits cholesterol synthesis
d) Without it fats would be metabolized quicker
e) Accelerates the use of fat as an energy source

Pharmacology Case 3D:

1. Which of the following are not oral treatments for eczema?
a) antibiotics
b) anti-histamine
c) diuretic
d) corticosteroids

2. What should the temperature of the water be for those bathing with eczema?
a) scolding hot
b) ice cold
c) luke warm
d) precisely 37.7C

3. What type of soap should be used for eczema?

a) bar soap
b) moisturizing soap
c) liquid cleansers
d) harsh exfoliate

4. Where does eczema typically present?

a) flexure surfaces
b) extensor surfaces
c) the back
d) on the roof of the mouth

5. Which or the following is NOT a typical naturopathic treatment for eczema:

a) Elimination diet
b) Fish oils
c) Anti-inflammatory and soothing botanicals
d) Peat bath

6. What do corticosteroids do to relieve the symptoms of eczema?

a) sedative effect
b) reduce inflammation increase pruritis
c) act as a rubifacent
d) reduce inflammation and decrease pruritis

7. What is the most common dietary cause of eczema?

a) alphatoxin from peanuts
b) exceeding the daily recommended intake of fruits and vegetables
c) dairy products
d) shell fish

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 8. Which of the following is NOT used as a topical treatment of eczema:
a) ACE inhibitor
b) Tar preparations
c) Corticosteroids
d) Botanical anti-inflammatory ointments

9. What strength of corticosteroid should be used for a resistant thick lesion on the palm, soles, and scalp?
a) very potent
b) potent
c) moderately potent
d) weak/mild

10. Eczema most commonly manifests as:

a) thick silvery scales
b) cauliflower-like growths
c) oozing, crusted red rash
d) ‘dew drops on a rose-pedal’ appearance

MC 3E Questions:
1) What is a common cause of Parkinson’s disease?
a) vitamin C deficiency
b) oxidative stress
c) frequent head trauma
d) excess electrical activity in the brain

2) What dosage of Coenzyme Q10 is appropriate to start with for parkinson’s treatment?
a) 1200-1400 mg
b) 2-6 mg
c) 4000-6000 mg
d) 100-200 mg

3) 5-HTP should be used only in combination with which drug?

a) Levopdopa/carbidopa combination
b) entacapone
c) Selegiline
d)Amantadine

4) What would be a good non-pharmaceutical/non-supplement approach in the treatment of parkinson’s?

a) focus on detoxification and diet
b) washing your body in rainwater
c) eat large amounts of farmed fish
d) get your reflexes checked regularly

5) What two botanicals are indicated in the treatment of parkinson’s disease?

a) angelica sinensis and allium sativum
b) allium sativum and ginkgo biloba
c) Camillia sinensis and ginkgo biloba
d) juglans nigra and angelica sinensis

6) Levodopa/Carbidopa is used to relieve the symptoms of Parkinson’s disease. They work through the following
mechanism:
a) Levodopa/Carbidopa crosses the blood-brain barrier and acts to relieve symptoms directly
b) Levodopa/Carbidopa is a precursor to dopamine, which crosses the blood-brain barrier and is converted to
dopamine in the basal ganglia
c) Levodopa/Carbidopa is a precursor to dopamine, which crosses the blood- brain barrier and is converted to dopamine in
the substantia nigra.
d) Levodopa/Carbidopa is a precursor to serotonin, which crosses the blood-brain barrier and is converted to serotonin in the
basal ganglia.
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 7) Selegiline is used in the treatment of idiopathic parkinson’s disease. What class is it in?
a) Selective Irreversible monoamine oxidase (MAO) B inhibitor
b) SSRI
c) Prolactin inhbitor
d) COMT inhibitor

8) Which of the following systems is NOT used in the elimination of antiparkinsons agents?
a) KI/urine
b) LIV/detoxification
c) GI/ feces
d) LU/ acid & base homeostasis

9) Why is Carbidopa used with Levodopa in the treatment of Parkinson’s?

a) Carbidopa inhibits the carboxylation of levodopa, which results in 99% bioavailability.
b) Carbidopa promotes the carboxylation of levodopa, which results in 99% bioavailability
c) Carbidopa inhibits the decarboxylation of levodopa, which results in 99% bioavailability.
d) Carbidopa promotes the decarboxylation of levodopa, which results in 99% bioavailability

10) What is the most common treatment for Parkinsons disease?

a) Amantadine
b) Selegiline
c) Entacapone
d) Levodopa/Carbidopa

Group 4A
1. What is the mechanism of action by which Beta-lactams work:
a. Inhibit bacterial protein synthesis.
b. Inhibit bacterial cell wall synthesis**
c. Interferes with bacterial replication
d. Interferes with bacterial attachment to host cells

2. What are the different sub-groups of Beta-lactams?

a. Tetracyclines, Erythromycins, Beta-lactamase inhibitors
b. Penicillins, Erythromycins, Tetracyclines
c. Aminoglycosides, Beta-lactamase inhibitors, Tetracyclines
d. Penicillins, Cephalosporins, Beta-lactamase inhibitors.**

3. Which is the most common route by which beta-lactams are given?

a. Orally
b. Sub-lingual
c. Parenterally**
d. Transdermally

4. Amoxicillan is in which class of Penicillins?

a. Narrow-spectrum penicillins.
b. Extended-spectrum penicillins.**
c. Penicillinase-resistant penicillins.
d. Enterococci specific penicillins.

5. What is the most common adverse effect of penicllins and cephalosporins?

a. Nausea, vomiting, and diarrhea
b. Hematological toxicities such as neutropenia and thrombocytopenia.
c. Disruption of the natural GI flora leading to superinfections
d. Type 1-Hypersensitivity disorders mediated by IgE. **

6. With regards to cephalosporins which of the following are true:

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 a. 1st generation are most effective against gram positive and 2nd generation are most
effective against gram negative. **
b. 1st generation are most effective against gram negative and 2nd generation are most
effective against gram positive.
c. Both 1st and 2nd generation are most effective against gram positive.
d. Both 1st and 2nd generation are most effective against gram negative.

7. Which of the following drugs is given in combination with clavulanate to treat otitis media?
a. Pencillin G
b. Cephalexin
c. Cefepime
d. Amoxicillin**

8. Cephalosporins and Penicillins share common methods of resistance, the most common of which
is:
a. Inactivation of the drug by beta-lactamase enzymes.**
b. Ribosome protection – bacteria produces proteins that prevent drug binding
c. Bacteria shows decreased permeability to the drug
d. Upregulate ways of metabolizing the drug so it is not longer effective.

9. Which of the following common cooking herbs has antimicrobial effects in addition to tasting
great.
a. Cinnamon
b. Rosemary
c. Garlic
d. All of the Above**

10. Which of the following antimicrobial properties is not found in Oregano?

a. Eugenol
b. Thymol
c. Cavacrol**
d. Both b and c

4B MCQs:
1. What is the primary oral hypoglycemic drug of choice for type II diabetes?
A. Insulin
B. Biguanide (Metformin)
C. Sulfonylureas
D. Thiazolindinediones

2. Which of the following is NOT a naturopathic treatment for type II diabetes?

A. Exercise
B. Cinnamon
C. Fish oil
D. Caffeine

3. Which of the following herbs may potentiate hypoglycemic effects of sulfonylurea therapy?
A. blueberry, cranberry, and blue cohosh
B. St John’s Wort, Comfrey, and Blue Cohosh
C. Chapparal. Comfrey, and Blue Cohosh
D. Bittermelon, prickly pear, and gingko
4. Which of the following is true with regards to sulfonylurea therapy?
A. Sulfonylurea therapy is the first drug of choice for type II diabetes mellitus.
B. Sulfonylurea therapy should be avoided in patients with hepatic or renal failure.
C. Sulfonylurea therapy is considered safe and is a replacement for diet and exercise.
D. Sulfonylurea therapy is not highly plasma protein bound.
5. A horrendously obese 75 YOA patient has just been diagnosed with Type II diabetes and is wondering what they can do to
reduce the symptoms and complications. Which of the following is the most appropriate advice?

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 A. Exercise is key to reducing the symptoms and complications of type two diabetes. She should join a spin class or
some other aggressive and vigorous exercise program 2 hours a day until resting heart rate is below 60 BPM then
back it down to 1 hour a day.
B. Diet is key here and she should stop eating any CHOs in any form and replace them with protein to avoid
postprandial spikes.
C. In a gentle and compassionate way let her know the she is “pooched”. The best thing now is to live it up, spend her
savings, and go on that round the world cruise right away.
D. Recommend light exercise up to 20 minutes per day and modify her diet so that CHOs are reduced, fiber is increased
and educate her on her condition how to monitor it and how to use the glycemic index scale when preparing her
meals.

6. A horrificly obese 75 YOA patient waddles into your office on your first day as a licensed ND. She has been recently
diagnosed as a type II diabetic and is terrified and doesn’t want to use any allopathic meds. She has made the adjustments
to exercise and her meal plan is appropriate. Her fasting blood glucose 6.5 mmol/l (normal is>4.0 <6.0) She wants to be
normal and she is begging and pleading for your help. You dig deep, you go back to year 2 at CCNM you see Kim, Ian,
Mel, Tara and Toby giving a wonderful presentation on diabetes the day before the final Pharm exam. This is what you
remember…
A. 6.5 mmol/l, no worries! That is only prediabetic lets just wait until it is above 7.0mmol/l and then do something.
B. I remember nothing but I think a little counseling would be fitting here.
C. OK. If she has 2tbsps of cinnamon each morning and uses a little more ginger and garlic, 2 tbls olive oil, 2-4g fish
oil and garlic with her meals we may see a difference that might bring her into a normal glucose range. Thanks Kim,
Ian, Mel, Tara and Toby wherever you are!
D. They said something about stimulants didn’t they? You recommend coffee, smoking or chewing tobacco and, if she
can get it, something a little stronger.
7. The proper management of hypoglycemia in patients with Diabetes Mellitus includes all of the following EXCEPT:
A. Addressing food consumption, quality, meal spacing, snacks and glycemic index of foods.
B. Psychological assessment of patients as the development of diabetes is linked with stress, visceral adipocity and
glucose insensitivity.
C. Recommending the patient take aspirin to avoid tension headaches associated with hypoglycemia.
D. Educating patient on hypoglycemic symptoms, in order to avoid ‘hypoglycemic unawareness’ so they know when to
ingest glucose.
8. Risk factors of hypoglycemic state include all of the following EXCEPT:
A. excessive urination
B. Warfarin
C. Taking too much diabetes medication (e.g., insulin)
D. Elderly, debilitated, or malnourished patients
9. Which of the following is NOT a sign of hypoglycemia?
A) Hunger
B) Nervousness
C) Dizziness
D) Constipation
10. Which of the following is a quick fix food to treat hypoglycemia?
A) Water
B) 1/2 cup fruit juice
C) Diet Soda
D) 1 teaspoon of Baking soda

Group 4C
1) What may be a clinical picture of a patient with Polycystic Ovarian Syndrome?
a) Male, hypertensive, & erectile dysfunction
b) Female 20, irregular vaginal bleeding, hirsutism
c) Female 60, difficulty losing weight, dry skin & hair, fatigue
d) Female 30, fatigued, thirsty, increased urination and high fasting glucose levels
2) What elevated hormone contributes to the abnormal hair growth found in women with PCOS?
a) Insulin
b) Estrogen
c) Testosterone
d) Melatonin

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3) Which of the following is not indicated for treatment of PCOS?
a. Plantago ovata
b. Glycyrrhiza glabra
c. Dehydroepiandrosterone
d. Astragalus membranaceus

4) Which of the following is not true regarding weight reduction and PCOS?

a. decreases serum LH levels

b. increases serum insulin levels
c. decreases serum androgen levels
d. decreases lipid levels

5) Which of the following is the most likely presentation of someone with hypothyroidism?
a) muscle cramps, constipation and restless legs
b) irritability, depression and cardiac tamponade
c) irritability, depression and high blood pressure
d) muscle cramps, constipation and difficulty losing weight

6) Which laboratory results might indicate PCOS?

a) high TSH, high prolactin and low estrogen
b) high TSH, low prolactin and high estrogen/progesterone
c) low TSH, high prolactin and high testosterone
d) low TSH, low estrogen and high testosterone

7) antihyperglycemics and regular exercise as combined treatment for PCOS can produce which of the following adverse
reactions?

a) increased risk for cardiovascular disease

b) gastrointestinal upset

c)increased risk of type II diabetes

d) hypoglycemia

8) Progestin-only oral contraceptives adverse effects and PCOS have in common which symptoms?

a) weight gain, acne, hirsutism

b)increased risk of cardiovascular diease

c) a and b

d) none of the above

9) Which of the below drugs is used in the treatment of PCOS to decrease the risk of endometrial cancer?

a) Oral antihyperglycemic agent - Metformin

b) Progestin-only oral contraceptive – Norethindrone

D) c) Anti-Androgen – Spironolacton
E) d) Low-dose oral contraceptive pills
F) e) Both b & d

10) If the patient has trouble conceiving later on in life due to her PCOS what options are available to her?

a) Conception is not a typical issue with PCOS, in fact a patient with this condition is more prone to multiple births.
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 b) If the patient is diligent with her Anti-Androgen therapy, becoming pregnant should not be an issue.

c) The drugs Clomiphene citrate, or Follicle-stimulating hormone: follitropin-alpha, may be used induced
ovulation and increase the likelihood of conception.

d) Because the birth control pill is the primary treatment for PCOS, pregnancy is not an option.

Pharmacology Case #4D Multiple Choice Questions

1. Which of the following herbs fights microorganisms by using terpinene-4-ol (oil) to interfere with its metabolism?
a. Artemisia annua
b. Melaleuca alternifolia
c. Tabebuia avellanedae
d. Lomatium dissectum

2. How does Tabebuia avellanedae fight off parasites?

a. Uses flavonoid quercetin to prevent e.coli from binding to bladder walls
b. Uses sesquiterpene artemisinin to stop transmission of information through plasmids
c. Uses anthraquinones to degrade cell membranes
d. Uses flavonoid quercetin to inhibit the electron transport chain

3. All of the following are especially good for respiratory infections except:
a. Cinchona spp
b. Ligusticum porteri
c. Lomatium dissectum
d. Baptisia tinctoria

4. This class of synthetic chemical substances derived from para-aminobenzenesulfonamide inhibit the growth and
multiplication of certain bacteria (but do not kill them) by interfering with the synthesis of folic acid:
a. Fluoroquinolones
b. Quinolones
c. Sulfonamide
d. Stimulant

5. When DNA-gyrase is inhibited by quinolones, a ________ in the supercoiling occurs with a consequent disruption of the
spatial arrangement of DNA:
a. Increase
b. Reduction
c. Null effect
d. Massive increase

6. Which of the following drugs mode of action depends upon blocking bacterial DNA replication by binding itself to an
enzyme called DNA gyrase, thereby causing double-stranded breaks in the bacterial choromosome.:
a. Metformin
b. Amoxicillin
c. Ciprofloxacin
d. Ceprotin

7. Which of the drugs when overdosed, will most likely elicit seizures and unusual sluggishness:
a. Nalidixic Acid
b. Lisinopril
c. Methotrexate
d. Trimethoprim

8. Crystalluria is a common side effect of which group of drugs:

a. Stimulants
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 b. Fluoroquinolones
c. Sulfonamides
d. Laxatives

9. PABA’s have been found to have a drug-drug interaction with which of the following drugs:
a. Ciprofloxacin
b. Norfloxacin
c. Nalidixic Acid
d. Sulfadiazine

10. Which of the following drugs have been shown to slightly increase Theophylline (Bronchodilator) levels when taking
together:
a. Ciprofloxacin
b. Norfloxacin
c. Trimethoprim
d. Both a) and b)

Group 4E
Multiple Choice

1) Which of the following is not a sub-class of protein synthesis inhibitors?

A) Tetracyclines
B) Aminoglycosides
C) Floroquinolones **
D) Erythromycins

2) Which of the following drugs is not a Tetracylines?

A) Doxycycline
B) Demeclocycline
C) Methacycline
D) Tobramycin**

3) Azithromax is an example of a
A) Erythromycin**
B) Tetracycline
C) Aminoglycoside
D) Loop diuretic

4) Which of the following does NOT exhibit broad spectrum antimicrobial activity?
A) Allicin sativa
B) Glychrrhiza glabra
C) Hypericum perforatum
D) Hydrastis Canadensis

5) Why is Hypericum Perforatum so well indicated as an herb addressing infective organisms?

A) Works within the immune system stimulating Antigen presenting cells
B) Works as a immunostimulatory in its affect against bacteria
C) It’s antimicrobial activity works against both gram negative and gram positive bacteria
D) It’s shown to induce interferon leading to antiviral activity

6) ________ is to Hydrastis Canadensis as Hypericin is to ___________?

A) Berberine, Glychrrhiza Glabra
B) Berberine, Hypericum Perforatum
C) Sesqueterpines, Hypericum Perforatum
D) Sesqueterpines, Glychrrhiza Glabra

7) Which of the following bacterial protein synthesis inhibitor families has the toxic effect of irreversible vestibular damage,
hearing loss and tinnitus?
A) Tetracyclins
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B) Aminoglycosides
C) Macrolides
D) Glycovestibulides

8) Which of the following drugs is bacteriostatic but can be bactericidal at high concentrations and has a toxic effect particularly
on the liver?
A) Sumycin
B) Panmycin
C) neomycin
D) Erythromycin

9) This class of bacteriostatic antimicrobials enhances the effects of Warfarin.

A) Tetracyclins
B) Aminoglycosides
C) Macrolides
D) Allicinides

10) Satins may cause myopathy when taken with this class of protein synthesis inhibiting antibacterials.
A) Tetracylins
B) Aminoglycosides
C) Macrolides
D) Atrophicyclins

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