The market for herbal and dietary supplements aimed at men’s health issues like benign prostatic hyperplasia (BPH), erectile dysfunction (ED), and low testosterone is immense. Patients frequently turn to pharmacists for guidance on these products. As taught in the Patient Care 5 and Patient Care I curricula, pharmacists must be prepared to provide an evidence-based assessment of these often-unregulated supplements, prioritizing patient safety and managing expectations. This quiz will test your knowledge on the common ingredients, purported mechanisms, safety concerns, and evidence base for herbals used in men’s health.
1. Which of the following is the most popular and well-studied herbal supplement for the management of benign prostatic hyperplasia (BPH) symptoms?
- a. St. John’s Wort
- b. Ginkgo Biloba
- c. Saw Palmetto
- d. Echinacea
Answer: c. Saw Palmetto
2. Large, high-quality clinical trials (like the CAMUS trial) have shown that saw palmetto is:
- a. Superior to finasteride for shrinking the prostate.
- b. Superior to tamsulosin for relieving symptoms.
- c. No more effective than placebo for improving BPH symptoms.
- d. A cure for BPH.
Answer: c. No more effective than placebo for improving BPH symptoms.
3. The purported mechanism of action for saw palmetto in BPH is thought to be:
- a. Potent alpha-1 receptor blockade.
- b. Mild inhibition of 5-alpha reductase and anti-inflammatory effects.
- c. Direct androgen receptor antagonism.
- d. A strong diuretic effect.
Answer: b. Mild inhibition of 5-alpha reductase and anti-inflammatory effects.
4. A major safety concern with over-the-counter supplements marketed for erectile dysfunction is:
- a. They are too effective.
- b. They are frequently adulterated with undeclared prescription PDE-5 inhibitors or their analogs.
- c. They have no side effects.
- d. They are regulated as strictly as prescription drugs.
Answer: b. They are frequently adulterated with undeclared prescription PDE-5 inhibitors or their analogs.
5. Yohimbine is an older herbal product for ED that works as an alpha-2 antagonist. It should be used with extreme caution or avoided due to what side effects?
- a. Sedation and bradycardia.
- b. Hypertension, tachycardia, and anxiety.
- c. Constipation and dry mouth.
- d. Weight gain.
Answer: b. Hypertension, tachycardia, and anxiety.
6. The “Self-care for Men’s Health Issues” is a specific learning module in which course?
- a. PHA5787C Patient Care 5
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5784C Patient Care 4
Answer: a. PHA5787C Patient Care 5
7. A patient taking nitrates for angina asks about an “all-natural” ED supplement from a gas station. The pharmacist’s most important warning is:
- a. The product may not be effective.
- b. The product may be expensive.
- c. The product could contain undeclared sildenafil-like ingredients, and the combination with nitrates could be fatal.
- d. The product may have a bad taste.
Answer: c. The product could contain undeclared sildenafil-like ingredients, and the combination with nitrates could be fatal.
8. L-arginine is a supplement used for ED based on the theory that it is a precursor to:
- a. Testosterone
- b. Dopamine
- c. Nitric Oxide (NO)
- d. Serotonin
Answer: c. Nitric Oxide (NO)
9. Which supplement, commonly marketed as a “testosterone booster,” has been shown in human trials to have no significant effect on testosterone levels?
- a. Vitamin D
- b. Zinc
- c. Tribulus terrestris
- d. Creatine
Answer: c. Tribulus terrestris
10. A patient taking finasteride for BPH asks if they should add saw palmetto. The best response is:
- a. “Yes, the combination is proven to be synergistic.”
- b. “No, because of a severe drug interaction.”
- c. “Saw palmetto has not been shown to provide additional benefit over placebo, so it is unlikely to help.”
- d. “Yes, but only if you double the dose of both.”
Answer: c. “Saw palmetto has not been shown to provide additional benefit over placebo, so it is unlikely to help.”
11. The federal regulation of dietary supplements is a topic within the Patient Care I curriculum.
- a. True
- b. False
Answer: a. True
12. Beta-sitosterol is a plant sterol found in some BPH supplements that is thought to:
- a. Shrink the prostate.
- b. Improve urinary symptoms.
- c. Increase testosterone.
- d. Cure prostate cancer.
Answer: b. Improve urinary symptoms.
13. A key role for the pharmacist when counseling on herbal products for men’s health is to:
- a. Guarantee results.
- b. Manage patient expectations and emphasize the lack of strong evidence for most products.
- c. Recommend the product with the most convincing testimonials.
- d. Create a custom herbal blend for the patient.
Answer: b. Manage patient expectations and emphasize the lack of strong evidence for most products.
14. Pygeum africanum is an extract from the bark of the African plum tree used for:
- a. Erectile dysfunction
- b. Low testosterone
- c. BPH symptoms
- d. Male pattern baldness
Answer: c. BPH symptoms
15. Counseling patients on the appropriate use of self-care products is a key objective for student pharmacists.
- a. True
- b. False
Answer: a. True
16. Which of the following is NOT a common claim for supplements marketed to men?
- a. Boosts testosterone
- b. Supports prostate health
- c. Enhances sexual performance
- d. Cures Type 2 Diabetes
Answer: d. Cures Type 2 Diabetes
17. “Evidence Based Practice with Dietary Supplements and CAM” is a specific learning module in the curriculum.
- a. True
- b. False
Answer: a. True
18. A patient taking an anticoagulant like warfarin should be cautious with many herbal supplements (like Ginkgo or Panax ginseng) due to:
- a. A risk of decreased INR.
- b. An increased risk of bleeding.
- c. A risk of hypertensive crisis.
- d. A risk of serotonin syndrome.
Answer: b. An increased risk of bleeding.
19. What is the most important first step when a patient asks about an herbal supplement?
- a. Recommending a brand.
- b. Assessing the patient’s underlying symptoms, health conditions, and current medications.
- c. Sharing a personal anecdote.
- d. Directing them to the correct aisle.
Answer: b. Assessing the patient’s underlying symptoms, health conditions, and current medications.
20. An active learning session on men’s health is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. The term “adaptogen,” sometimes used to market herbs like ashwagandha or ginseng, suggests the product:
- a. Helps the body adapt to stress.
- b. Is a potent stimulant.
- c. Is a sedative.
- d. Is FDA-approved.
Answer: a. Helps the body adapt to stress.
22. A patient with a shellfish allergy should avoid which supplement sometimes marketed for weight loss or joint health?
- a. Chitosan
- b. Psyllium
- c. Whey protein
- d. Soy protein
Answer: a. Chitosan
23. The “Introduction to Herbal/Plant-Based Products” is a lecture within the Patient Care I curriculum.
- a. True
- b. False
Answer: a. True
24. An active learning session on men’s health is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
25. A patient should be counseled that “testosterone boosters” purchased online:
- a. Are a safe and effective substitute for prescription testosterone.
- b. Could be adulterated with illegal anabolic steroids.
- c. Are guaranteed to work as advertised.
- d. Have been tested for safety by the FDA.
Answer: b. Could be adulterated with illegal anabolic steroids.
26. The active component in Horny Goat Weed, icariin, is thought to act as a:
- a. Weak PDE-5 inhibitor.
- b. Potent alpha-blocker.
- c. Testosterone analog.
- d. Diuretic.
Answer: a. Weak PDE-5 inhibitor.
27. A key safety principle for a pharmacist to communicate is that “natural” does not automatically mean “safe.”
- a. True
- b. False
Answer: a. True
28. An active learning session on men’s health is part of which course module?
- a. Module 8: Urological Disorders
- b. Module 1: Diabetes Mellitus
- c. Module 3: Women’s Health
- d. Module 6: Geriatrics
Answer: a. Module 8: Urological Disorders
29. The main reason a patient should report all herbal supplement use to their healthcare providers is:
- a. To track their spending.
- b. To check for potential drug-herb interactions and to ensure it doesn’t interfere with their medical conditions.
- c. Because the government requires it.
- d. So the provider can recommend more supplements.
Answer: b. To check for potential drug-herb interactions and to ensure it doesn’t interfere with their medical conditions.
30. The “Self-care for Men’s Health” lecture is within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. A patient with BPH who chooses to use saw palmetto should be counseled that:
- a. It will shrink their prostate significantly.
- b. It is crucial they still see a physician to rule out more serious conditions like prostate cancer.
- c. It will cure their condition.
- d. They should stop taking their tamsulosin.
Answer: b. It is crucial they still see a physician to rule out more serious conditions like prostate cancer.
32. DHEA is a supplement that is a precursor hormone to:
- a. Cortisol
- b. Progesterone
- c. Testosterone and estrogen
- d. Thyroid hormone
Answer: c. Testosterone and estrogen
33. The lack of regulation for herbal supplements means there is often poor:
- a. Quality control.
- b. Standardization of dose.
- c. Purity of ingredients.
- d. All of the above.
Answer: d. All of the above.
34. The pharmacist’s role in promoting public health includes educating the public on the safe use of supplements.
- a. True
- b. False
Answer: a. True
35. A patient asks if zinc supplements will boost his testosterone. The pharmacist should explain that:
- a. Zinc is a proven and potent testosterone booster for all men.
- b. Zinc supplementation may only help restore normal testosterone levels in men who are truly zinc deficient.
- c. Zinc has no role in male health.
- d. High doses of zinc are safe and effective.
Answer: b. Zinc supplementation may only help restore normal testosterone levels in men who are truly zinc deficient.
36. A patient with BPH has an AUA symptom score of 25 (severe). What is the appropriate recommendation?
- a. Recommend he try saw palmetto first.
- b. Recommend he see a physician, as self-care is not appropriate for severe symptoms.
- c. Recommend a combination of three different herbal products.
- d. Tell him the symptoms are a normal part of aging.
Answer: b. Recommend he see a physician, as self-care is not appropriate for severe symptoms.
37. The FDA regulates herbal supplements under which act?
- a. The Food, Drug, and Cosmetic Act
- b. The Controlled Substances Act
- c. The Dietary Supplement Health and Education Act (DSHEA)
- d. The Affordable Care Act
Answer: c. The Dietary Supplement Health and Education Act (DSHEA)
38. The lecture “Self-care: Men’s Health” is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
39. A patient is taking prescription sildenafil and wants to add an herbal ED supplement. The pharmacist should advise against this due to:
- a. The risk of additive effects and toxicity from undeclared ingredients.
- b. A known interaction that makes sildenafil ineffective.
- c. The high cost.
- d. The bad taste.
Answer: a. The risk of additive effects and toxicity from undeclared ingredients.
40. An active learning session covering men’s health is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
41. The best evidence for or against an herbal supplement comes from:
- a. Customer testimonials.
- b. The manufacturer’s website.
- c. Well-designed, placebo-controlled clinical trials.
- d. Centuries of traditional use.
Answer: c. Well-designed, placebo-controlled clinical trials.
42. Which of the following is NOT an appropriate role for a pharmacist regarding herbal supplements?
- a. Evaluating the evidence for safety and efficacy.
- b. Guaranteeing that a product will work.
- c. Screening for drug interactions.
- d. Counseling on potential side effects.
Answer: b. Guaranteeing that a product will work.
43. A USP Verified Mark on a supplement bottle indicates:
- a. The product is FDA-approved.
- b. The product has been tested for purity, potency, and good manufacturing practices.
- c. The product is effective for its intended use.
- d. The product is 100% safe.
Answer: b. The product has been tested for purity, potency, and good manufacturing practices.
44. The most important counseling point for any patient considering an herbal supplement for a medical condition is:
- a. To take a double dose for the first week.
- b. To discuss its use with their primary healthcare provider.
- c. To buy it from the cheapest online source.
- d. To stop all of their prescription medications.
Answer: b. To discuss its use with their primary healthcare provider.
45. Fenugreek, sometimes used as a testosterone booster, can have what effect on blood sugar?
- a. It can cause hyperglycemia.
- b. It can cause hypoglycemia.
- c. It has no effect on blood sugar.
- d. It causes insulin resistance.
Answer: b. It can cause hypoglycemia.
46. A “proprietary blend” on a supplement label makes it difficult for the pharmacist and patient to know:
- a. The brand name.
- b. The exact amount of each individual ingredient.
- c. The expiration date.
- d. The number of capsules in the bottle.
Answer: b. The exact amount of each individual ingredient.
47. A patient with BPH who is taking tamsulosin should be advised that adding saw palmetto is:
- a. A proven, effective combination.
- b. Unlikely to provide any additional benefit.
- c. Recommended by all clinical guidelines.
- d. Necessary to make the tamsulosin work.
Answer: b. Unlikely to provide any additional benefit.
48. An active learning session on self-care for men’s health is part of which course module?
- a. Module 8: Urological Disorders
- b. Module 1: Diabetes Mellitus
- c. Module 4: Medication Safety
- d. Module 6: Geriatrics
Answer: a. Module 8: Urological Disorders
49. The overall safety profile of most herbal supplements for men’s health is:
- a. Well-established through rigorous clinical trials.
- b. Often unknown or poorly studied.
- c. Better than any prescription medication.
- d. Guaranteed by the manufacturer.
Answer: b. Often unknown or poorly studied.
50. The ultimate goal of learning about herbals for men’s health is to:
- a. Become an expert in herbal medicine.
- b. Be able to guide patients toward safe and evidence-based decisions, protecting them from harm and ineffective therapies.
- c. Pass the final exam.
- d. Promote the sale of supplements in the pharmacy.
Answer: b. Be able to guide patients toward safe and evidence-based decisions, protecting them from harm and ineffective therapies.