A.33

Question 1

Nutrients, traditional plant medicines, vitamins, anorectic drugs

Answer 1

1.traditional plant medicines: Garlic, Grapefruit, Ginko biloba, Echinacea, Rib-wort, Ginseng, Milk thistle, St John’s wort, Camomile, Valeriana officinalis, Pumpkin seed oil, Sabre palm extract, Flavonoids
2. anorectic drugs: Orlistat, Phenteramin/topiramatem, Bupropion/Naltrexone

Question 2

Orlistat

Answer 2

MOA: reversible inhibitor of gastric and pancreatic lipase enzymes (reduces the absorption of ingested lipids by ~30%);
Kinetics: not absorbed from GI, administered 3x daily with meals;
IND: BMI>30kg/m2 or >27kg/m2 with comorbidities; SEs: edema, headache, steatorrhea, GI discomfort, tenesmus, flatulence

Question 3

Phentermin/Topiramate

Answer 3

MOA:
-Phentermin- sympathomimetic similar to amphetamines.
-Topiramate- antiepileptic, increases GABA activity, AMPA antagonist, Na+ channel blocker;
Administration: 1x/day for 2-12 weeks;
SEs: CV (tachycardia, arrhythmias), KIR (paresthesia, headache, insomnia), xerostomia, constipation

Question 4

Bupropion/Naltrexone

Answer 4

MOA:
-Bupropion- mild monoamine reuptake inhibitory effect.
-Naltrexone- non-selective opioid antagonist; Administration: 1x/day with slow upward titration of dose;
IND: BMI>30kg/m2 or >27kg/m2 with comorbidities; SEs: Headache, insomnia, nausea, constipation, vomiting, HTN

Question 5

Anorectic drugs: Treatment of obesity

Answer 5

1. Physical activity
2. Appropriate diet
3. Pharmacological treatment

Question 6

Pharmacological treatment

Answer 6

1) Fat digestion influensing drugs (Orlistat)
2) GLP-1 agonists (Liraglutid)
3) Anorectics (Phentermin/Topiramate, Bupropion/Naltrexone, Sibutramine, Lorcaserine

Question 7

Nutrients

Answer 7

Infant formula and follow-on formula
Foods for special medical purposes (supervised patients)
Foods to replace a complete daily diet

Question 8

Garlic

Answer 8

dministration: plant consumption / active in tablet form;
Main use: CV prevention (effect not clinically proven), Prevention of colorectal cc (limited credible evidence), Febrile symptoms (no proven efficacy), Hepatopulmonary syndrome (garlic reduced mortality); Interactions: may enhance the effects of antocoagulants;
SEs: garlic odour

Question 9

Grapefruit

Answer 9

Administration: Fruit juices, grapefruit drops, grapefruit seed capsules;
Main use: “immune boosting”, antiviral, antibacterial action (no evidence of efficacy in vivo);
Interaction: the most dangerous food supplement!, irreversible CYP enzyme inhibitory effect (CYP3A4/1A2/2C9/2D6), MDR-1 inhibitory effect (multidrug resistance transporter, P-glycoprotein), increased plasma concentration of certain drugs (e.g. DHP Ca2+ channel blockers, statins, certain chemotherapeutic agents, antidepressants…)

Question 10

Ginkgo biloba

Answer 10

Administration: powder/tablet/capsule;
Main use: dementia, memory impairement, cerebrovascular diseases (no proven efficacy in human);
SEs: GI discomfort, may provoke headache; Interactions: bleeding risk when administered with antiplatelet agents, may increase the risk of serotonin syndrome when given with sertonergic agents

Question 11

Echinacea

Answer 11

Administration: drops, capsules;
Main use: upper respiratory tract infections (not proven);
SEs: GI side effects, allergy, anaphylaxis

Question 12

Rib-wort

Answer 12

Administration: syrop, tea, candy, ointment;
Main use: upper respiratory tract infections, insect bite, superficial skin lesions;
SEs: GI symptoms, allergy

Question 13

Ginseng

Answer 13

Administration: tea, capsules, drops;
Main use: tumor fatigue/weakness, many different preparations with different expected effects;
SEs: GI symptoms, irritability, fever, HTN, headache, blurred vision, bleeding

Question 14

Milk thistle

Answer 14

Administration: mainly capsules;
Main use: chronic liver diseases (HCV, HBV, Mushroom poisonings);
SEs: GI symptoms

Question 15

St John’s wort

Answer 15

Administration: Tablets, tea, drink, creams;
Main use: Antidepressant effect (SSRIs or TCAs are much more effective), treatment of wounds/insect bites;
Interactions: Dangerous interactions! May disrupt antidepressant/antipsychotic drug therapy, Risk of serotonin sy. increases, may cause anxiety, CYP inducer;
SEs: allergy/anaphylaxis, photosensitivity

Question 16

Camomile

Answer 16

Administration: creams, tea, eye drops;
Main use: Nervousness/anxiety (not proven effect), Upper respiratory tract infections (probably no effect), DM “treatment” (probably no effect), Antiinflammatory effect (not proven);
Interactions: may enhance anticoagulant effect, may worsen pollen allerg

Question 17

Valeriana officinalis

Answer 17

Administration: tablet, tea;
Main use: commonly use sedative/sleeping pill, has a GABA agonist action (or barbiturate-like);
Interactions: alcohol, BZDs

Question 18

Pumpkin seed oil

Answer 18

Administration: tablet;
Main use: BPH, GI disorders:

Question 19

Sabre palm extract

Answer 19

Administration: fruit extract → capsule;
Main use: BPH; SEs: rarely GI

Question 20

Flavonoids

Answer 20

Can be found in: bluberries, grapefruit, parsley, oranges;
Combined with: often combined with antioxidant vitamins (A, C, E);
Main use: chronic venous insufficiency of the lower limb, symptomatic treatment of acute hemorrhoidal crisis;
SEs: GI symptoms;
MOA: reduces capillary permeability, inhibits venous dilatation and reduces venous stasis (not well understood mechanisms);
Kinetics: should be taken with foods