Commonly Abused Supplements

Course #98020 - $15 -


Self-Assessment Questions

    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].

    Click to Review



    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].

    Click to Review



    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].

    Click to Review



    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].

    Click to Review



    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].

    Click to Review



    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].

    Click to Review



    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.

    LAXATIVES

    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].

    Click to Review



    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

    LAXATIVES

    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].

    Click to Review



    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].

    Click to Review



    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].

    Click to Review