Answers to Self-Assessment Questions - ACCP

or cardiovascular disease, drinking green tea or taking a
reliable, standardized green tea extract may be worth a try.
Therefore, Answer B (taking an extract may be worth a try)
is correct. Answer A (risks of adverse events with green tea
outweigh the benefits) is incorrect because it indicates there
are substantial adverse events with this approach, which is
not the case. It appears that both the catechin and caffeine
components of green tea may be important for any weight
loss or maintenance benefit. Green tea generally contains an
amount of caffeine considered sufficient for the beneficial
effect on weight, making Answer C (she will need to both
drink green tea and take an extract) incorrect. Although
patients with hypertension or cardiovascular disease may be
at increased risk of adverse events with green tea because
of its sympathetic activity, there is no reason to believe that
green tea extract would exacerbate osteoarthritis, making
Answer D incorrect.
1. Westerterp-Plantenga MS, Lejeune MP, Kovacs EM. Body
weight loss and weight maintenance in relation to habitual
caffeine intake and green tea supplementation. Obes Res
2005;17:1195–204.
2. Diepvens K, Westerterp KR, Westerterp-Plantenga MS.
Obesity and thermogenesis related to the consumption of
caffeine, ephedrine, capsaicin, and green tea. Am J Physiol
Regul Integr Comp Physiol 2007;292:R77–85.
3. Seeram NP, Henning SM, Niu Y, Lee R, Scheuller HS, Heber D.
Catechin and caffeine content of green tea dietary supplements
and correlation with antioxidant capacity. J Agric Food Chem
2006;54:1599–603.
66. Answer: D
According to DSHEA, a dietary supplement
manufacturer may make a structure or function claim on
the label as long as “This statement has not been evaluated
by the FDA. This product is not intended to diagnose, treat,
cure, or prevent any disease” also appears on the label. The
claim that cranberry helps promote urinary tract health is
clearly a function claim and is thus allowed as long as the
disclaimer is present (Answer D is correct). Sometimes the
distinction between structure or function claims and disease
prevention or treatment claims is very difficult to determine.
However, in this case, the claim would not be construed as
a disease prevention claim (e.g., “helps prevent urinary tract
infections”); therefore, Answer A (prevents bacteria from
invading and proliferating in the urinary tract) is incorrect.
If a claim is deemed to be a disease prevention or treatment
claim, the product would be considered a drug and thus
misbranded as a dietary supplement. Again, because this
is a function claim, the cranberry would not in this case
be considered a drug, making Answer B (decreases the
duration of urinary tract infections) incorrect. According
to the FDA, such a claim can only be made for drugs, not
dietary supplements. Structure or function claims can be
made based on a single ingredient within a multi-ingredient
product; therefore, Answer C (decreases the severity of
urinary tract infection symptoms) is incorrect. This claim
can be made if the product contains only cranberry or other
substances promoting urinary health; if it contains other
ingredients, it would be considered misbranded.
1. Overview of dietary supplements. U.S. Food and Drug
Administration Center for Food Safety and Applied Nutrition.
January 3, 2001. Available at www.cfsan.fda.gov/~dms/dsoview.html#regulate.
Accessed April 10, 2009.
2. U.S. Food and Drug Administration. Structure/function
claims. Available at www.cfsan.fda.gov/~dms/labstruc.html.
Accessed April 10, 2009.
67. Answer: C
U.W., a 45-year-old woman who takes Saint John’s
wort for depression, has been admitted to the hospital for
complications related to her diabetes. In its Statement on
the Use of Dietary Supplements, the American Society
of Health-System Pharmacists (ASHP) discourages selfadministration
of the patient’s own supply of dietary
supplements during hospitalization because of lack of
information regarding safety and efficacy, as well as
inadequate standards for product quality. Therefore, Answer
A (she may be allowed to self-administer her own supply if
ordered by her physician) and Answer B (she may be allowed
to self-administer her own supply after the pharmacist has
verified the identity and checked for drug interactions),
both of which concern self-administration of the patient’s
own supply of drug, are not consistent with the ASHP
recommendations and are incorrect. It is recommended that
hospitals have a general policy in place regarding inpatient
use of dietary supplements, but Answer D is not the best
response because Saint John’s wort is not actually on the
formulary but rather must be obtained for use in this patient.
Answer C best follows recommendations; the pharmacy
could supply the dietary supplement if Saint John’s wort
is on the formulary, the physician specifically prescribes
it, and the pharmacist checks the patient profile for drug
interactions; thus Answer C is correct.
1. American Society of Health-System Pharmacists Council on
Professional Affairs. ASHP statement on the use of dietary
supplements. Am J Health Syst Pharm 2004;61:1707–11.
2. Bizzie KL, Witmer DR, Pinto B, Bush C, Clark J, Deffenbaugh
J Jr. National survey of dietary supplement policies in acute
care facilities. Am J Health Syst Pharm 2006;63:65–70.
3. Cohen MH, Hrbek A, Davis RB, Schachter SC, Kemper KJ,
Boyer EW, et al. Emerging credentialing practices, malpractice
liability policies, and guidelines governing complementary
and alternative medical practices and dietary supplement
recommendations: a descriptive study of 19 integrative
health care centers in the United States. Arch Intern Med
2005;165:289–95.
68. Answer: B
The question relates to the design of a demographic
survey of dietary supplement use and what aspects of the
design could lead to overstating the prevalence of use.
Recent surveys of the use of dietary supplements in the
United States have reported a broad array of percentages of
the population using these supplements, largely because of
the population studied, the definition of dietary supplement,
and the definition of recent use. Dietary supplements are
used more commonly among women than men. Older
people use them more commonly than younger people,
making Answer C (excluding people older than 65 from the
survey) incorrect. Answer D (oversampling of minorities
with lower socioeconomic status) is also incorrect because
dietary supplement use in the United States is more common
in those of higher socioeconomic status and education
Gastroenterology and Nutrition Answers
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Pharmacotherapy Self-Assessment Program, 6th Edition