MCQ Quiz: Self-Care (OTC and Herbals)

The world of self-care offers patients an overwhelming array of options, from FDA-regulated over-the-counter (OTC) medications to the vast and less-regulated market of herbal and dietary supplements. As the most accessible healthcare professionals, pharmacists are in a unique position to guide patients toward safe and effective self-treatment. This requires a strong foundation in product knowledge, evidence-based assessment, and the ability to recognize when a patient’s condition requires referral to another provider. The PharmD curriculum, especially in courses like Patient Care I and the Professional Skills Labs, is designed to build these exact skills, emphasizing patient assessment frameworks like SCHOLAR-MAC and the evidence behind common OTC and herbal products. This quiz will test your knowledge on these crucial self-care topics.

1. A patient asks for a recommendation for seasonal allergies. Before suggesting a product, what is the most appropriate first step for the pharmacist?

• a) Recommend the most expensive product.
• b) Gather information about the patient’s symptoms, other conditions, and current medications.
• c) Tell the patient to see a doctor immediately.
• d) Give the patient a coupon for a brand-name antihistamine. Answer: b) Gather information about the patient’s symptoms, other conditions, and current medications.

2. The SCHOLAR-MAC acronym is a tool used to systematically gather information from a patient seeking self-care. What does the ‘S’ stand for?

• a) Severity
• b) Symptoms
• c) Situation
• d) Self-treatment Answer: b) Symptoms

3. Which federal act defines and regulates dietary supplements, establishing that they do not need to be proven effective before being marketed?

• a) The Food, Drug, and Cosmetic Act of 1938
• b) The Kefauver-Harris Amendment of 1962
• c) The Dietary Supplement Health and Education Act (DSHEA) of 1994
• d) The Patient Protection and Affordable Care Act of 2010 Answer: c) The Dietary Supplement Health and Education Act (DSHEA) of 1994

4. A patient is looking for an herbal supplement to help with anxiety and insomnia. Which supplement has been associated with a risk of severe hepatotoxicity and should be recommended with extreme caution?

• a) Melatonin
• b) Valerian
• c) Kava
• d) Chamomile Answer: c) Kava

5. What is the maximum recommended daily dose of acetaminophen (Tylenol) for an adult without liver disease, according to the manufacturer’s label?

• a) 1000 mg
• b) 2000 mg
• c) 3000 mg
• d) 4000 mg Answer: c) 3000 mg

6. A patient taking warfarin asks if they can take St. John’s Wort for depression. Why is this combination dangerous?

• a) St. John’s Wort will increase the risk of bleeding.
• b) St. John’s Wort is a potent CYP3A4 inducer and can significantly decrease warfarin levels, increasing the risk of clotting.
• c) The combination causes severe sedation.
• d) There is no interaction between these two products. Answer: b) St. John’s Wort is a potent CYP3A4 inducer and can significantly decrease warfarin levels, increasing the risk of clotting.

7. A patient wants to buy an OTC decongestant. They have uncontrolled hypertension. Which ingredient should they avoid?

• a) Guaifenesin
• b) Dextromethorphan
• c) Pseudoephedrine
• d) Acetaminophen Answer: c) Pseudoephedrine

8. Which herbal supplement is commonly used for immune system support but has questionable efficacy and can interact with immunosuppressant drugs?

• a) Echinacea
• b) Ginkgo biloba
• c) Saw palmetto
• d) Black cohosh Answer: a) Echinacea

9. What is the primary mechanism of action of OTC proton pump inhibitors (PPIs) like omeprazole?

• a) They neutralize existing stomach acid.
• b) They block H2 receptors on parietal cells.
• c) They irreversibly inhibit the H+/K+ ATPase pump in parietal cells.
• d) They form a protective barrier over the stomach lining. Answer: c) They irreversibly inhibit the H+/K+ ATPase pump in parietal cells.

10. When counseling on a first-generation antihistamine like diphenhydramine, what is the most important side effect to mention?

• a) Increased energy
• b) Drowsiness and anticholinergic effects
• c) Weight loss
• d) Metallic taste Answer: b) Drowsiness and anticholinergic effects

11. A patient asks for an OTC recommendation for a dry, hacking cough. Which active ingredient would be most appropriate?

• a) Guaifenesin
• b) Phenylephrine
• c) Dextromethorphan
• d) Loratadine Answer: c) Dextromethorphan

12. Glucosamine and chondroitin are popular dietary supplements used to manage pain associated with what condition?

• a) Migraines
• b) Osteoarthritis
• c) Gout
• d) Rheumatoid arthritis Answer: b) Osteoarthritis

13. A key counseling point for a patient purchasing OTC NSAIDs (e.g., ibuprofen, naproxen) is to:

• a) Take them on an empty stomach to increase absorption.
• b) Take them with food or milk to reduce the risk of GI upset.
• c) Use them for long-term pain management without consulting a doctor.
• d) Combine them with prescription NSAIDs for better effect. Answer: b) Take them with food or milk to reduce the risk of GI upset.

14. An “exclusion for self-treatment” is a sign or symptom that indicates the patient:

• a) Is a perfect candidate for self-care.
• b) Should be referred to a physician or other healthcare provider.
• c) Must purchase the most expensive OTC product.
• d) Is likely faking their illness. Answer: b) Should be referred to a physician or other healthcare provider.

15. Saw Palmetto is an herbal supplement frequently marketed for symptoms of:

• a) Benign Prostatic Hyperplasia (BPH)
• b) Menopause
• c) High cholesterol
• d) Insomnia Answer: a) Benign Prostatic Hyperplasia (BPH)

16. A patient complains of heartburn. They have tried antacids with minimal relief. What would be the next appropriate OTC recommendation for more prolonged relief?

• a) A bulk-forming laxative
• b) An H2-receptor antagonist like famotidine
• c) Loperamide
• d) Simethicone Answer: b) An H2-receptor antagonist like famotidine

17. What is the primary role of guaifenesin in OTC cough and cold products?

• a) It is an antitussive that suppresses the cough reflex.
• b) It is a decongestant that relieves nasal stuffiness.
• c) It is a protussive (expectorant) that helps loosen phlegm.
• d) It is an antihistamine for runny nose. Answer: c) It is a protussive (expectorant) that helps loosen phlegm.

18. Which common OTC product can cause rebound congestion (rhinitis medicamentosa) if used for more than 3-5 days?

• a) Saline nasal spray
• b) Oxymetazoline nasal spray
• c) Fluticasone nasal spray
• d) Cetirizine tablets Answer: b) Oxymetazoline nasal spray

19. Black cohosh is an herbal supplement sometimes used by women to alleviate symptoms associated with:

• a) Urinary tract infections
• b) Menopause
• c) Iron deficiency anemia
• d) Constipation Answer: b) Menopause

20. A patient requests a recommendation for an OTC topical antifungal for athlete’s foot (tinea pedis). Which of the following is an appropriate active ingredient?

• a) Hydrocortisone
• b) Salicylic acid
• c) Terbinafine
• d) Benzoyl peroxide Answer: c) Terbinafine

21. A major safety concern with kava is its potential for:

• a) Causing severe hypertension.
• b) Staining the teeth yellow.
• c) Inducing severe liver damage (hepatotoxicity).
• d) Increasing blood glucose. Answer: c) Inducing severe liver damage (hepatotoxicity).

22. According to DSHEA ’94, a supplement manufacturer is permitted to make which type of claim on its label?

• a) A claim that the product diagnoses, cures, mitigates, treats, or prevents a disease.
• b) A structure-function claim, such as “helps support a healthy immune system.”
• c) A claim that the product is a safe alternative to all prescription drugs.
• d) A claim that the product is approved for safety and efficacy by the FDA. Answer: b) A structure-function claim, such as “helps support a healthy immune system.”

23. Which second-generation antihistamine is known to have a higher potential for drowsiness compared to others in its class?

• a) Fexofenadine
• b) Loratadine
• c) Cetirizine
• d) Levocetirizine Answer: c) Cetirizine

24. A patient seeks a self-care option for constipation. What is the most appropriate first-line recommendation for most adults?

• a) A stimulant laxative like bisacodyl.
• b) A saline laxative like magnesium citrate.
• c) Increasing dietary fiber and water intake, possibly with a bulk-forming laxative like psyllium.
• d) An osmotic laxative like polyethylene glycol 3350. Answer: c) Increasing dietary fiber and water intake, possibly with a bulk-forming laxative like psyllium.

25. Peppermint oil is an herbal product sometimes used for symptoms of which GI condition?

• a) Gastroesophageal reflux disease (GERD)
• b) Irritable bowel syndrome (IBS)
• c) Gastroparesis
• d) Peptic ulcer disease Answer: b) Irritable bowel syndrome (IBS)

26. Which of the following is a significant exclusion for self-treatment of a headache?

• a) A mild headache that has lasted for 2 hours.
• b) A headache that is relieved by acetaminophen.
• c) A “thunderclap” headache with an abrupt onset of severe pain.
• d) A tension-type headache. Answer: c) A “thunderclap” headache with an abrupt onset of severe pain.

27. As a transcending concept, the use of OTC and herbal products in the geriatric community must be handled with care because:

• a) Older adults have a higher risk of drug interactions and adverse effects.
• b) Older adults never use these products.
• c) These products are always safe for older adults.
• d) Insurance covers all herbal products for the elderly. Answer: a) Older adults have a higher risk of drug interactions and adverse effects.

28. A patient wants to buy dextromethorphan for their 3-year-old child’s cough. What is the pharmacist’s best recommendation?

• a) Sell them the adult-strength dextromethorphan.
• b) Recommend they see a doctor, as cough and cold products are not recommended for children under 4 years old.
• c) Suggest they use a double dose of children’s acetaminophen.
• d) Recommend a prescription opioid cough suppressant. Answer: b) Recommend they see a doctor, as cough and cold products are not recommended for children under 4 years old.

29. The USP Verified Mark on a dietary supplement label indicates that the product:

• a) Has been proven effective for a specific disease.
• b) Has been tested by the USP for purity, potency, and good manufacturing practices.
• c) Is approved by the FDA.
• d) Is free from all side effects. Answer: b) Has been tested by the USP for purity, potency, and good manufacturing practices.

30. Loperamide (Imodium) works as an antidiarrheal by:

• a) Adsorbing excess water in the intestine.
• b) Acting as a synthetic opioid agonist on the gut wall to slow motility.
• c) Killing infectious bacteria.
• d) Neutralizing stomach acid. Answer: b) Acting as a synthetic opioid agonist on the gut wall to slow motility.

31. OTC benzoyl peroxide is a first-line treatment for which dermatologic condition?

• a) Psoriasis
• b) Eczema
• c) Acne vulgaris
• d) Fungal infections Answer: c) Acne vulgaris

32. A patient asks about melatonin for sleep. What is a key counseling point?

• a) It is a potent sedative that will induce sleep within minutes.
• b) It is primarily useful for regulating the sleep-wake cycle, such as in cases of jet lag.
• c) Higher doses (e.g., 20 mg) are always more effective than lower doses (e.g., 1-3 mg).
• d) It is regulated by the FDA for safety and efficacy. Answer: b) It is primarily useful for regulating the sleep-wake cycle, such as in cases of jet lag.

33. What is the primary risk associated with the long-term, continuous use of OTC PPIs without a medical evaluation?

• a) They are highly addictive.
• b) They can mask the symptoms of a more serious underlying condition, like gastric cancer.
• c) They can cause severe hypertension.
• d) They are not effective for heartburn. Answer: b) They can mask the symptoms of a more serious underlying condition, like gastric cancer.

34. The “M” in the SCHOLAR-MAC acronym stands for:

• a) Money (cost of treatment)
• b) Medications (current prescriptions, OTCs, herbals)
• c) Medical history
• d) Both B and C are correct Answer: d) Both B and C are correct

35. A patient taking an oral contraceptive should be counseled that which herbal supplement can decrease its effectiveness?

• a) St. John’s Wort
• b) Echinacea
• c) Valerian
• d) Melatonin Answer: a) St. John’s Wort

36. The primary difference between second-generation antihistamines (e.g., loratadine) and first-generation (e.g., diphenhydramine) is that the second-generation agents are:

• a) More potent
• b) Less sedating because they do not readily cross the blood-brain barrier
• c) Available by prescription only
• d) Less effective for allergies Answer: b) Less sedating because they do not readily cross the blood-brain barrier

37. Which statement reflects an evidence-based approach to recommending herbal supplements?

• a) “All natural products are safe because they come from plants.”
• b) “This product is popular, so it must be effective.”
• c) “While some small studies suggest a benefit, the evidence is not strong, and there are potential drug interactions we should discuss.”
• d) “The manufacturer’s website says this product cures diabetes, so it is a good choice.” Answer: c) “While some small studies suggest a benefit, the evidence is not strong, and there are potential drug interactions we should discuss.”

38. A patient presents with severe abdominal pain that has lasted for 3 days. This is an exclusion for self-treatment, and the pharmacist should:

• a) Recommend a stimulant laxative.
• b) Recommend an OTC PPI.
• c) Refer the patient for immediate medical evaluation.
• d) Recommend a high-dose NSAID. Answer: c) Refer the patient for immediate medical evaluation.

39. Topical hydrocortisone 1% is an appropriate OTC recommendation for:

• a) A large, open, infected wound.
• b) Mildly inflamed, itchy skin from an insect bite.
• c) Severe psoriasis covering the whole body.
• d) Fungal infections. Answer: b) Mildly inflamed, itchy skin from an insect bite.

40. Ginger is an herbal supplement with a long history of use for what condition?

• a) Nausea and vomiting
• b) High blood pressure
• c) Depression
• d) Hair loss Answer: a) Nausea and vomiting

41. The legal distinction between an OTC drug and a prescription drug is established by which amendment?

• a) The Food, Drug, and Cosmetic Act of 1938
• b) The Durham-Humphrey Amendment of 1951
• c) The DSHEA of 1994
• d) The Kefauver-Harris Amendment of 1962 Answer: b) The Durham-Humphrey Amendment of 1951

42. Which of the following is an important counseling point for bulk-forming laxatives like psyllium?

• a) They must be taken with plenty of water to avoid esophageal or intestinal obstruction.
• b) They provide immediate relief within minutes.
• c) They should be taken on an empty stomach.
• d) They can be taken without any fluids. Answer: a) They must be taken with plenty of water to avoid esophageal or intestinal obstruction.

43. A patient asks about ginkgo biloba. The pharmacist should be aware that it can increase the risk of what?

• a) Bleeding, especially if taken with anticoagulants or antiplatelet drugs.
• b) Constipation
• c) High blood pressure
• d) Sedation Answer: a) Bleeding, especially if taken with anticoagulants or antiplatelet drugs.

44. A patient is pregnant and has a cold. What is the pharmacist’s most appropriate action?

• a) Recommend any OTC product without checking its safety.
• b) Tell her she cannot take any medications at all.
• c) Evaluate the specific symptoms and recommend products considered safe in pregnancy, or refer her to her obstetrician.
• d) Recommend an herbal supplement because they are all safe in pregnancy. Answer: c) Evaluate the specific symptoms and recommend products considered safe in pregnancy, or refer her to her obstetrician.

45. Why is it important for a pharmacist to ask about a patient’s medical conditions before recommending an OTC product?

• a) To satisfy their own curiosity.
• b) The active ingredients in OTC products can exacerbate underlying conditions.
• c) It is not important to ask.
• d) To charge the patient a higher price. Answer: b) The active ingredients in OTC products can exacerbate underlying conditions.

46. A patient is looking for an OTC product to treat a common wart. Which active ingredient is considered a first-line self-treatment?

• a) Hydrocortisone
• b) Clotrimazole
• c) Salicylic acid
• d) Bacitracin Answer: c) Salicylic acid

47. A “drug-herb” interaction is a key safety concern because:

• a) Herbal products cannot interact with prescription drugs.
• b) Many herbal products can affect CYP450 enzymes, altering the metabolism of prescription drugs.
• c) All herbal products are standardized, so interactions are predictable.
• d) The FDA tests all herbal products for potential interactions. Answer: b) Many herbal products can affect CYP450 enzymes, altering the metabolism of prescription drugs.

48. Which of the following symptoms would be an “exclusion for self-treatment” for diarrhea?

• a) Mild diarrhea that has lasted for one day.
• b) Diarrhea in a healthy 30-year-old adult.
• c) Severe diarrhea with a high fever or blood in the stool.
• d) Diarrhea that resolves after taking loperamide. Answer: c) Severe diarrhea with a high fever or blood in the stool.

49. The self-care pharmacist’s primary responsibility is to:

• a) Sell as many products as possible.
• b) Ensure the patient receives a safe and effective recommendation for their specific condition.
• c) Diagnose complex medical conditions.
• d) Take the place of a primary care physician. Answer: b) Ensure the patient receives a safe and effective recommendation for their specific condition.

50. What is a key difference in the labeling of an OTC drug versus a dietary supplement?

• a) Only dietary supplements have a “Supplement Facts” panel.
• b) An OTC drug has a “Drug Facts” label with standardized sections, while a supplement label is less standardized.
• c) Only OTC drugs can list their ingredients.
• d) There is no difference in their labeling requirements. Answer: b) An OTC drug has a “Drug Facts” label with standardized sections, while a supplement label is less standardized.