CAM EXAM SCRIPT UPDATED COMPLETE
QUESTIONS AND ANSWERS EXPERT
REVIEWED
●● CAMs are classified as what under U.S. law?
Answer: Dietary supplements (considered food, not drugs)
●● Under the Dietary Supplement Health and Education Act (1994),
herbal products must prove safety and efficacy before marketing?
Answer: No
●● Who is responsible for proving safety/efficacy of CAMs in the U.S.?
Answer: The manufacturing companies
●● Name the three required label elements for CAMs
Answer: Structure/function claim + FDA disclaimer + list of ingredients
●● What major safety issue has been found on lab analysis of CAM
products?
Answer: Active ingredient variation (up to 10-fold) and adulterants
(heavy metals, conventional drugs)
,●● Which country classifies herbal medicines as drugs and evaluates
them via Commission E?
Answer: Germany
●● Why is causation between CAMs and adverse anesthetic events
difficult to prove?
Answer: Lack of regulation, variability in ingredients, lack of RCTs
●● CAMs can cause perioperative complications through what 3
mechanisms?
Answer: Intrinsic pharmacologic effects + Pharmacodynamic
interactions + Pharmacokinetic interactions
●● Define pharmacodynamic interaction in CAM context
Answer: Additive or antagonistic effects at the same receptor or
physiologic pathway
●● Define pharmacokinetic interaction in CAM context
Answer: Altered absorption, distribution, metabolism, or elimination of
conventional drugs
●● Most common drug involved in herb-drug interactions?
Answer: Warfarin
, ●● Most common herb involved in drug-herb interactions?
Answer: St. John's Wort
●● Most prevalent drug-herb interaction overall?
Answer: Altered coagulation
●● Most common perioperative concern with CAMs overall?
Answer: Altered coagulation
●● Second major perioperative concern?
Answer: Altered sedation
●● Which two systems are most commonly affected in surgical patients?
Answer: Coagulation and sedation
●● Estimated herb-drug interaction rate in surgical patients?
Answer: ~2%
●● Why is 2% still clinically significant?
Answer: Millions of anesthetics annually → large absolute number
●● Approximately what percentage of preoperative patients use CAMs?
QUESTIONS AND ANSWERS EXPERT
REVIEWED
●● CAMs are classified as what under U.S. law?
Answer: Dietary supplements (considered food, not drugs)
●● Under the Dietary Supplement Health and Education Act (1994),
herbal products must prove safety and efficacy before marketing?
Answer: No
●● Who is responsible for proving safety/efficacy of CAMs in the U.S.?
Answer: The manufacturing companies
●● Name the three required label elements for CAMs
Answer: Structure/function claim + FDA disclaimer + list of ingredients
●● What major safety issue has been found on lab analysis of CAM
products?
Answer: Active ingredient variation (up to 10-fold) and adulterants
(heavy metals, conventional drugs)
,●● Which country classifies herbal medicines as drugs and evaluates
them via Commission E?
Answer: Germany
●● Why is causation between CAMs and adverse anesthetic events
difficult to prove?
Answer: Lack of regulation, variability in ingredients, lack of RCTs
●● CAMs can cause perioperative complications through what 3
mechanisms?
Answer: Intrinsic pharmacologic effects + Pharmacodynamic
interactions + Pharmacokinetic interactions
●● Define pharmacodynamic interaction in CAM context
Answer: Additive or antagonistic effects at the same receptor or
physiologic pathway
●● Define pharmacokinetic interaction in CAM context
Answer: Altered absorption, distribution, metabolism, or elimination of
conventional drugs
●● Most common drug involved in herb-drug interactions?
Answer: Warfarin
, ●● Most common herb involved in drug-herb interactions?
Answer: St. John's Wort
●● Most prevalent drug-herb interaction overall?
Answer: Altered coagulation
●● Most common perioperative concern with CAMs overall?
Answer: Altered coagulation
●● Second major perioperative concern?
Answer: Altered sedation
●● Which two systems are most commonly affected in surgical patients?
Answer: Coagulation and sedation
●● Estimated herb-drug interaction rate in surgical patients?
Answer: ~2%
●● Why is 2% still clinically significant?
Answer: Millions of anesthetics annually → large absolute number
●● Approximately what percentage of preoperative patients use CAMs?
