Nutrition Exam 2

Front 1

Vincristine & Vinblastine are indole alkaloids that have what effect?

Back 1

Anti-cancer

Front 2

Taxol (generic = paclitaxol) has what function?

Back 2

Anti-cancer

Front 3

Camptothecin has what function?

Back 3

Anti-cancer

Front 4

Tomatillos have what effect?

Back 4

Detoxifying agent

Have quinone reductase

Front 5

Noni has what effect?

Back 5

Free-radical scavenger (anti-oxidant)

Used in cancer, diabetes & hypertension

Front 6

The structure artemisinin from Arteether has what effect?

Back 6

Anti-malaria

Front 7

Galantimine is used as what?

Back 7

Treatment for Alzheimer's

Front 8

Tiotropium (a name we had to remember for IPPE) is used for what?

Back 8

COPD

Front 9

Calanolide A is used for?

Back 9

Anti-HIV

Front 10

Ixabepilone has the structure epothilone B which has what property?

Back 10

Anti-cancer

Front 11

What's the major challenge in drug discovery from natural sources?

Back 11

Can't do appropriate high through-put screening assays for effectiveness

Also: procurement of raw material & scaling up production (from mgs to kgs)

Front 12

What's the difference between a decoction & tincture?

Back 12

Decoction - made by simmering in boiling water for longer periods than tea

Tincture - made by soaking plant material in alcohol and water. Sold as a liquid and used for concentrating and preserving plant material.

Front 13

How do natural products vary from herbal medicine?

Back 13

Natural products need isolation and identification of single compounds, and require FDA approval

Herbal products do not need FDA approval for stated intent

Front 14

Why is there standardization in herbal medicines?

Back 14

Used to ""ensure" batch to batch consistency, i.e. the same amount in each dose.

Dietary supplements AREN'T REQUIRED to undergo standardization

Disadvantage is active components do not have to be identified or proven for stated purpose

Front 15

Are herbal medicines reviewed by the FDA?

Back 15

Yes, but not under the same regulations as Rx or OTC

Front 16

The herbal medicine regulation in 1994 was called the "Dietary Supplement Health and Education Act" aka DSHEA. What did it state?

(DSHEA covers herbals & NPs)

Back 16

1) Manufacturers are responsible for making sure supplement/ingredients is safe before marketing (Does not state it has to work)

2) The FDA is responsible for taking action against unsafe products in the market

3) If there is a structure/claim function on the bottle, a disclaimer must say : "Supplement not evaluated by FDA. Not intended to diagnose, treat, cure, or prevent any disease."

Front 17

~~Classes of Pharm. Active Compounds: Products from Acetate Pathway~~

What unique structure do fatty acids have?

Back 17

Long carbon chains without constituents

Front 18

~~Classes of Pharm. Active Compounds: Products from Acetate Pathway~~

The group Polyketides have what two sub-classes?

(For polyketides itself, just know its in the acetate pathway)

Back 18

Aromatic sub-class
Macrolide sub-class

Front 19

~~Classes of Pharm. Active Compounds: Products from Acetate Pathway~~

Prostaglandins have what general structure?

Back 19

Two features:
The carboxylic acid on one tail
The 5-member ring with OH and O

Front 20

~~Classes of Pharm. Active Compounds: Products from Acetate Pathway~~

Thromboxanes have what general structure?

Back 20

6-member ring with a 4-member ring overlapping it

The two rings share 3 carbons

Front 21

~~Classes of Pharm. Active Compounds: Products from Acetate Pathway~~

General structure of Leukotrienes?

Back 21

Hard to tell from fatty acid - thus likely won't be asked on it

The epoxy group is a unique feature

Front 22

~~Classes of Pharm. Active Compounds: Products from Shikimate Pathway~~

When generalized, what is the different between products of the shikimate and acetate pathways?

Back 22

Acetate products tend to be linear
Shikimate products tend to be aromatic

Front 23

~~Classes of Pharm. Active Compounds: Products from Shikimate Pathway~~

General structure of aromatic amino acids?

Back 23

They have the AA unit (blue) and some aromatic structure (green)

Front 24

~~Classes of Pharm. Active Compounds: Products from Shikimate Pathway~~

General structure of cinnamic acids?

Back 24

Benzene with carboxylic acid

Front 25

~~Classes of Pharm. Active Compounds: Products from Shikimate Pathway~~

General structure of Lignans/lignin?

Back 25

Look like two cinnamic acids put together

Front 26

~~Classes of Pharm. Active Compounds: Products from Shikimate Pathway~~

General structure of Coumarins?

Back 26

Front 27

~~Classes of Pharm. Active Compounds: Products from Shikimate Pathway~~

General structure of flavonoids? (This one is actually important to know for the parent structure)

Back 27

6-member ring, generally with an O in it
Always has an aromatic ring to the left
Always have a total of 3 rings

(This applies to the 7 out of 8 flavonoids and we ignore the last odd one)

Front 28

~~Classes of Pharm. Active Compounds: Products from Shikimate Pathway~~

General structure of quinones? (Important to know parent structure)

Back 28

6-member ring
Two double bonds
Usually 2 double-bonded O, but they may be OH

Front 29

~~Classes of Pharm. Active Compounds: Products from Shikimate Pathway~~

General structure of Xanthones?

Back 29

3 rings directly next to one another

Front 30

~~Classes of Pharm. Active Compounds: Products from Mevalonate & Deoxyxylulose Pathways~~

General structure of terpenoids? (This class includes monoterpenes, iridoids and others than end in -terpene)

Back 30

Can be hard to tell as a varied class
Tend to have isoprene units
Sometimes have steroid structure (steroids technically a subclass of terpenoids but we consider them separately)

Front 31

~~Classes of Pharm. Active Compounds: Products from Mevalonate & Deoxyxylulose Pathways~~

General structure of steroids?

Back 31

Must have A, B, C, D ring
Tend to have isoprene tails, but not required (this picture has one on the right)

Front 32

~~Classes of Pharm. Active Compounds~~

Alkaloids have what general structure?

Back 32

Have heterocyclic nitrogen (Mescaline is the exception)
Able to donate H

Front 33

~~Classes of Pharm. Active Compounds~~

General structure of peptides, proteins & AA derivatives?

Back 33

If you don't know what it is and it's large, it's probably this class

Front 34

What is the extraction technique used for herbal products/plants?

Back 34

Extraction with methanol (crude products stop here)
Extract with more higher % methanol, dilute with water and partition with CHCl3 (One carbon, three chloride)
The product is now semi-purified.

Front 35

Evalulation of botanicals include purity, bioavailability, safety and efficacy.

What two pairs of the 4 choices above correlate to the same idea?

Back 35

Purity - Safety
Bioavailability - Efficacy

There are two separate ideas used in evaluation:
Is it safe?
Is it being absorbed in the patient?

(Notice still not too much about does it do its intended function)

Front 36

In the authentication of botanicals, what is the potential danger of growing plants to be used as medicine outdoors/in a field?

Back 36

Plants in natural settings will be subject to insects, and plants can up-regulate the compounds they make as defense. Depending on the compound, it could be a massive overdose

Plants are preferred to be grown in a controlled greenhouse

Front 37

Macroscopic authentication differs from traditional/classic authentication in what way(s)?

Back 37

Classical is more "broad" verification techniques, such as noting the location, the taste/smell (if applicable) and growth patterns.

Macroscopic, as the name suggests, looks at harder to notice characteristics, including leaf shape/morphology, root characteristics and flower characteristics. The results are then generally compared to known samples.

Front 38

Which of the three authentication techniques is considered the most important for authenticity?

Back 38

Microscopic authentication

Uses light and/or scanning electron microscopy to find features such as cell types, pollen & seed morphology as well as any adulteration for authentication

Front 39

What number am I thinking of?

Back 39

42

Front 40

Genetic fingerprinting (for plants) in authentication can be difficult to do. What does it do/attempt to accomplish?

Back 40

Used esp. in multi-component plants/mixtures
Needs high quality DNA extraction from plant and compared to pure plant DNA database for authenticity.

Downside is DNA extraction is tough, and the plant DNA databases aren't nearly as good as microbe databases.

Front 41

The following types of identification methods are used in what kind of fingerprinting?: High-performance liquid cinematography, mass spectrometry & gas chromatography

Back 41

Analytical chemical fingerprinting

(They all sound chemistry related --> chemical)

Front 42

CAM safety is CONSIDERED safe mostly through what type of evidence?

Back 42

History of use

If a culture used herbal X for hundreds of years and live to be 80+, it's CONSIDERED safe

Front 43

What are 3 issues in testing the efficacy of CAM herbals/products?

Back 43

1) For ethical reasons, we don't test in humans off the bat. But how does in vitro testing correlate to humans?

2) Adulteration of CAM products before testing - FDA doesn't strictly regulate as it does with drugs

3) Natural variability of CAM products - plants just want to be themselves, not identical

Front 44

If you decided to use the internet, what sites would be reliable for CAM information?

Back 44

Reliable - NNCAM (run by National Institute of Health)
FDA
Office of Dietary Supplements (ODS)
PubMed (peer-reviewed, but not guaranteed accurate)
MedlinePlus (run by NIH)
Clinical Trials
Natural Standard (not government associated)

Front 45

Noni (morinda citrifolia) has a free radical-scavenging component - What is the name of the active structure?

Back 45

Polynesian culture uses it as a caloric filler during famines. Used traditionally as a dye, for joint pain & skin conditions, fertility in women

Used today for cancer, CV, DM, tea/juice, tablets

Front 46

Noni (morinda citrifolia) should not be used in what type of restricted diet?

Back 46

Noni has high potassium content, thus potassium restricted patients should not use.

Front 47

Noni (morinda citrifolia) has what active compounds in it?

Back 47

Phenolic acids
Anthocyamins (antioxidant)
Flavanoids

Basically has two actions:
Tyrosinase inhibition
Free radical scavenging (Has many OH groups)

Front 48

Noni (morinda citrifolia) may have anti-tuberculosis effects (what doesn't it do). This effect varies and is dependent upon what?

Back 48

Noni needs to be ripe for greatest effect

Front 49

Noni (morinda citrifolia) is taken by a patient with chronic renal impairment. Why should Noni not be used in this population?

Back 49

Poor renal function in addition to Noni's relatively high dose of potassium can lead to hyperkalemia

(On a slightly related note, anthraquinones in Noni may cause hepatotoxicity)

Front 50

What fruit has the highest free radical protection shown in tests?

Back 50

Acai (Euterpe oleraceae)

Has anthocyanin (antioxidant) at 10x higher concentration than red wine & grapes

Effective at low concentrations

Front 51

Acai (Euterpe oleraceae) has what "other effects" than from anti-oxidation?

Back 51

Anti-inflammatory (COX1/2 inhibition)
Skin and seeds --> vasodilators
Decrease NO and decreased leukemia proliferation

Front 52

What 4 major bodies do CAM treatment certification?

Back 52

USP
ConsumerLab.com
Natural Products Association
National Sanitation Foundation

Front 53

What does a "certification seal" indicate on a herbal product? (as stated by Kaiser Permanente)

Back 53

The seal guarantees that the product "is what it says it is". Basically this means no contaminates and some seals offer good manufacturing processes.

Doesn't say the product does its intended effect.

Manufacturers must pay the certifying companies

Front 54

What does the USP mark verify on supplements? (Highly important to know the 4)

Back 54

Contains listed ingredients at correct amounts & potency
Does not contain harmful levels of SPECIFIED contaminants
Will breakdown and release within a specified amount of time (unique to USP seal)
Has been made according to FDA good manufacturing practices using sanitary and well-controlled procedures

Front 55

Why does ConsumerLab.com suck?

Back 55

Don't really have a seal program
For profit organization
Site looks like an advertisement
Need to be a paying member to see data

Front 56

What does the NPA seal/standard verify?

Back 56

Contains "at least almost" natural ingredients
A product labeled natural should avoid any ingredient with a suspected human health risk. (Very unusual as they are defining natural. Ephedra is natural but has a human health risk)
No animal testing
Natural products should be biodegradable and have eco-friendly packaging

(If there is no animal testing, how do we get in vivo data to prove this "natural" product has no suspected human health risk?)

Front 57

Out of the 4 certifying bodies for herbal supplements, which two seals are considered superior?

Back 57

NSF & USP seals

(But still doesn't prove product is effective, just that it is pure)

Front 58

What does the NSF seal verify in herbal supplements?

Back 58

Ingredients match what is listed on the label
No contaminants (unspecified ingredients)
Third point talks about no contamination again

Front 59

What are the top 5 in the twenty top-selling herbal medicines of 2010?

Back 59

1) Noni
2) Acai
3) Mangosteen
4) Green tea
5) Golgi berries

(Echinacea is 8 & St. John's Wort is 19)

Front 60

Acai (Euterpe oleraceae) has a major difference between indigenous use & modern use. What are the differences?

Back 60

Indigenous- caloric filler, GI problems

Modern- Detox, Weight loss, ED, high cholesterol, arthritis, general health

(List states little evidence for general health, arthritis and cholesterol)

Front 61

Acai (Euterpe oleraceae) has anthocyanins make up only 10% of its compounds. Is this significant for the antioxidant effect?

Back 61

Yes - 10% is a lot

Other products have active ingredients of 0.5%

Front 62

Acai (Euterpe oleraceae) has oleic acid as 56% of its monounsaturated fats. What benefit does this give?

Back 62

Oleic acid is credited with:
Aiding heart with omega-3 FAs
Protect against irregular rhythms
Lessens MI risk

(Does vasodilation)

Front 63

How can the modern claims for use of Acai be aided?

Back 63

Look at indigenous rates of obesity, cholesterol and dietary consumption

Of course this only helps to a certain degree has the two lifestyles differ in many other aspects

Front 64

Why is Mangosteen going to be on the exam?

Back 64

Balunas has a patent on one med and did her PhD on this

Front 65

Compared to plasma levels, breast cancer has what percent increase in estrogen levels?

Back 65

20x higher (2000%)

Front 66

What is the rate-limiting enzyme that is thought to be a good target to reduce estrogen levels?

Back 66

Aromatase

Front 67

How does Tamoxifen prevent estradiol from increasing estrogen levels?

Back 67

It blocks estradiol from binding and forming a dimer on its receptor

Front 68

Why do aromatase inhibitors and Tamoxifen cause baldness?

Back 68

They stop estrogen production not just in cancer but system-wide

Front 69

What does Aromatase change chemically in the conversion of male hormones to female hormones?

Back 69

It forms an aromatic ring

Front 70

Using the picture, what structure do you think would make a good aromatase inhibitor?

Back 70

Steroids (yum yum yum)

Front 71

What compound structure in Mangosteen (Garcinia mangostana) was tested to be useful in breast cancer? (aromatase inhibition)

Back 71

Xanthones

Showed Chemoprevention Index of 5.2

Front 72

What structure is this?

Back 72

Xanthone (aromatase inhibitor)

Front 73

Mangosteen (Garcinia mangostana) has what position in the top 20?

Back 73

3

Front 74

Although not FDA-approved, Mangosteen (Garcinia mangostana) has been concluded to do what in hormone-dependent breast cancer?

Back 74

Act as a aromatase inhibitor

Front 75

Goji Berries (Lycium species) have what cautions/contraindications of note?

Back 75

Acts on 2C9 (don't know if inhibitor or inducer)
Not to be used while pregnant/breast feeding (betaine - miscarriage)
Warfarin may have an increased half-life

Front 76

GoChi Juice RCT using Goji Berries (Lycium species) had what conclusion on goji berries?

Back 76

People "said" they felt "less fatigued" (too subjective, can't scientifically measure, placebo effect)

LBP (L barbarum polysacc.) had an effect on RBC (which may be linked to fatigue, more scientific, can be measured)

Serum antioxidant levels increased 8.4% & glutathione peroxidase increased by 9.04% (possible anti-aging?)

Front 77

Goji berries (Lycium barbarum) polysacc. are thought to be protective of what?

Back 77

Anti-tumorigenic

LBP's had some ability to suppress insulin-like growth factor --> stops cell proliferation in breast cancer

(Done in an animal study)

Front 78

Camillia sinensis can be made into different teas. How do you make it into green tea?

Back 78

Fresh leaves are steamed to produce green tea

(Black tea is made with elevated temperatures)

Front 79

Green tea (Camillia sinensis) extract can be concentrated into a capsule. What health risk does this possibly have?

Back 79

Highly concentrated amounts with have affects on the liver

Front 80

What herbal supplement product for genital warts has been FDA-approved? (Important as not many are FDA certified)

Back 80

A specific Green tea (Camillia sinensis) extract ointment, sold under the brand name Veregen

Front 81

Green tea (Camillia sinensis) is likely effective for what two uses? What is it possibly effective for?

Back 81

Likely- genital warts (one specific extract) and mental alertness (due to caffeine)

Possibly effective for ovarian cancer/cancer

(Has shown ineffectiveness/negative results for colon cancer)

Front 82

Green tea (Camillia sinensis) has a possible side effect with what prescription drug?

Back 82

Warfarin as it has small amounts of vitamin K

Front 83

Green tea (Camillia sinensis) has EGCG has its main constituent. What structure is this?

Back 83

Flavanoid

Breaks some general structure "rules" (5-member O ring and total of 3 rings) but it does have an aromatic ring to its left and does contain a heterocyclic oxygen

Front 84

Green tea (Camillia sinensis) is undergoing clinical trials for uses in obesity, cancer, hepatitis, etc. Why is this of significance?

Back 84

The get FDA clinical trials means you typically need a certain amount of evidence to begin them.

Front 85

Unlike the top 5 sellers, echinacea (Echinacea purpurea) & St. John's wort are found where?

Back 85

'Murica

(US(

Front 86

Echinacea (Echinacea purpurea) has had mixed results on what effect?

Back 86

Preventing/treating upper respiratory infections (immune system)

(Possibly effective for yeast infections too)

Front 87

What study inconsistencies does Echinacea (Echinacea purpurea) have that St. John's wort has much worse?

Back 87

Trials of Echinacea has been using the three different species, showing mixed results.

The three species of Echinacea have activity however, while only one species of St. John's wort has activity

Front 88

If you are allergic to daisies, which of the 7 covered herbals should you not use?

Back 88

Echinacea

Front 89

The above is 1 of 2 major constituents in Echinacea. What is the structure?

Back 89

Alkylamides

Front 90

The above is 1 of 2 major constituents in Echinacea. What is the structure?

Back 90

Phenols (The aromatic ring with two OH on the left)

Front 91

St. John's wort (Hypericum perforatum) is likely effective for depression. What drug interactions does it have? (Too many to name)

Back 91

Interactions with: antidepressants, oral birth contral, cyclosporine, digoxin, warfarin, seizure drugs

Just too many

Front 92

St. John's wort (Hypericum perforatum) taken with antidepressants have what risk?

Back 92

Serotonin-syndrome

Front 93

St. John's wort (Hypericum perforatum) has what two active constituents?

Back 93

Hypericin & hyperforin (Easy to remember due to latin name)

Front 94

Here's the names of the top 20. No question here.

Back 94

'Murica