1 . Which of the following statements regarding the regulation of 1,3-DMAA is TRUE?
| A) | | 1,3-DMAA is a Schedule IV controlled substance. |
| B) | | Products containing 1,3-DMAA may be legally sold and consumed in the United States. |
| C) | | 1,3-DMAA has been included on the prohibited lists of the World Anti-Doping Agency (WADA). |
| D) | | Health Canada determined that 1,3-DMAA is derived from geranium and therefore may be included in dietary supplements. |
ABUSE POTENTIAL RELATED TO WEIGHT LOSS AND/OR ATHLETIC PERFORMANCE
In 2011, Health Canada determined that 1,3-DMAA should be
considered a drug and is not allowed to be included in dietary supplements [2]. In 2013, the FDA declared products
containing 1,3-DMAA to be illegal and to have potential health risks. 1,3-DMAA has been
included on the prohibited lists of the World Anti-Doping Agency (WADA) and the U.S.
Department of Defense (DoD) for more than 10 years [2].
2 . What are the most common adverse effects reported with bitter orange-containing products, particularly in combination with caffeine and/ or other stimulant ingredients?
| A) | | Hypertension and tachycardia |
| B) | | Hypotension and syncope |
| C) | | Asthma and pulmonary hypertension |
| D) | | Depression and psychosis |
ABUSE POTENTIAL RELATED TO WEIGHT LOSS AND/OR ATHLETIC PERFORMANCE
Most of the severe adverse effects related to bitter
orange are associated with its use in combination products. Hypertension and tachycardia
are the most common adverse effects reported with bitter orange-containing products,
particularly in combination with caffeine and/or other stimulant ingredients. Other
adverse effects reported with the use of bitter orange- or synephrine-containing
multi-ingredient products, with or without other stimulants, include blackout, cardiac
arrest, collapse, ischemic stroke, myocardial infarction, QT prolongation,
tachyarrhythmia, tachycardia, variant angina, ventricular fibrillation, and death [3].
3 . Taking ephedra in combination with which other substance is most likely to increase the risk of severe cardiovascular effects?
| A) | | Alcohol |
| B) | | CNS depressant |
| C) | | Stimulant |
| D) | | Opioid |
ABUSE POTENTIAL RELATED TO WEIGHT LOSS AND/OR ATHLETIC PERFORMANCE
Most of the severe adverse effects related to bitter
orange are associated with its use in combination products. Hypertension and tachycardia
are the most common adverse effects reported with bitter orange-containing products,
particularly in combination with caffeine and/or other stimulant ingredients. Other
adverse effects reported with the use of bitter orange- or synephrine-containing
multi-ingredient products, with or without other stimulants, include blackout, cardiac
arrest, collapse, ischemic stroke, myocardial infarction, QT prolongation,
tachyarrhythmia, tachycardia, variant angina, ventricular fibrillation, and death [3].
4 . Caffeine tablets contain up to about
| A) | | 20 mg of caffeine. |
| B) | | 200 mg of caffeine. |
| C) | | 800 mg of caffeine. |
| D) | | 2 g of caffeine. |
ABUSE POTENTIAL RELATED TO WEIGHT LOSS AND/OR ATHLETIC PERFORMANCE
Caffeine is also available alone or in combination with other
ingredients in some prescription and over-the-counter products that are approved for
specific medical uses (e.g., to help restore mental alertness and wakefulness when
experiencing fatigue or drowsiness). Caffeine tablets contain up to about 200 mg of caffeine
[5].
5 . What is the most likely reason a patient might misuse or abuse caffeine?
| A) | | Improve anxiety symptoms |
| B) | | Improve athletic performance |
| C) | | Manage allergy symptoms |
| D) | | Manage pain |
ABUSE POTENTIAL RELATED TO WEIGHT LOSS AND/OR ATHLETIC PERFORMANCE
Caffeine has been demonstrated to improve athletic
performance. It decreases perceived levels of exertion, enabling athletes to feel less tired
and increase their performance. It can also improve anaerobic exercise performance. Within
limits, the NCAA allows caffeine consumption. During competition, however, urine
concentrations must not exceed 15 mcg/mL. Consumption of 600–800 mg of caffeine would need
to be consumed two to three hours prior to performance in most people in order to achieve
this urine concentration [5].
6 . All of the following plants contain ephedrine alkaloids, EXCEPT:
| A) | | Ephedra sinica. |
| B) | | Sida cordifolia. |
| C) | | Pinellia ternate. |
| D) | | Ephedra nevadensis. |
ABUSE POTENTIAL RELATED TO WEIGHT LOSS AND/OR ATHLETIC PERFORMANCE
While most Ephedra species
contain ephedrine alkaloids, Mormon tea (Ephedra
nevadensis or Ephedra viridis) is a plant in
the Ephedra genus that is devoid of ephedrine and other
alkaloids. Some other plants also contain ephedrine alkaloids, including Sida cordifolia and Pinellia
ternate
[6].
7 . Following oral administration, the laxative effects of senna usually occur within
| A) | | 1 to 2 hours. |
| B) | | 2 to 6 hours. |
| C) | | 6 to 10 hours. |
| D) | | 12 to 24 hours. |
Because sennosides are prodrugs, they are not absorbed in the
gastrointestinal (GI) tract and are instead activated by enzymes in the colon. The cathartic
properties of the senna leaf are greater than the fruit. Effects usually occur within 6 to
10 hours after oral administration [7].
8 . The loss of which electrolyte is of particular concern with laxative abuse due to the risk for arrhythmias?
| A) | | Calcium |
| B) | | Chloride |
| C) | | Sodium |
| D) | | Potassium |
Stimulant laxatives can cause abdominal pain and discomfort,
bloating, cramping, diarrhea, faintness, flatulence, fecal urgency, and nausea. Use of
laxatives at high doses and for long periods might be unsafe. Abuse of laxatives can cause
fluid and electrolyte, particularly potassium, losses. Theoretically, this can increase the
risk for arrhythmias. There is also a risk of malabsorption as a result of intestinal
hypermotility [7,8].
9 . What will you share with a colleague about gamma butyrolactone (GBL) and 1,4-butanediol (BD)?
| A) | | They are decreasing in popularity. |
| B) | | They have similar effects to gamma hydroxybutyrate (GHB). |
| C) | | They are easy to detect on toxicologic screens. |
| D) | | They are slowly converted to GHB in the body. |
ABUSE POTENTIAL RELATED TO RECREATIONAL USE
Several chemically related analogs of GHB, including gamma
butyrolactone (GBL) and 1,4-butanediol (BD), are rapidly converted to GHB in the body and
have similar effects to the parent compound. Popularity of these analogs increased with the
regulatory restriction of GHB as a Schedule I controlled substance. These analogs are
legally available as industrial solvents, but are also sold illicitly as supplements for
bodybuilding, weight loss, reversal of baldness, drug addiction, and other uses. GBL and BD
are abused for the same reasons as GHB. Routine toxicologic screens do not detect the
presence of these analogs, so abuse can be difficult to identify [16].
10 . Which main active constituent of kratom has the highest affinity for the mu-opioid receptor?
| A) | | 7-hydroxymitraginine |
| B) | | 9-hydroxycorynantheidine |
| C) | | Corynantheidine |
| D) | | Mitragynine |
ABUSE POTENTIAL RELATED TO OPIOID-LIKE EFFECTS
Kratom contains the mu-opioid receptor agonist
7-hydroxymitragynine. 7-Hydroxymitragynine is estimated to be approximately 10 times as
potent as morphine [14].
