Neuropsychiatric and Respiratory Medicines

Which of the following statements about the common cold and cold remedies is correct?

1. When accompanied by a sudden fever, or when symptoms continue for 4 days or more, the likelihood of it being a common cold is considered high.
2. Because influenza (epidemic influenza) is, like the common cold, caused by respiratory infection with a virus, it is treated without distinction from the common cold.
3. A cold remedy is a medicine that has the action of suppressing the proliferation of a virus or removing it from the body.
4. About 80% of colds are caused by viral infection, but some are also caused by bacterial infection or, rarely, by a non-infectious factor such as cold air, dryness, or allergy.

Which of the following statements about ingredients formulated in cold remedies and their classification is incorrect?

1. Belladonna total alkaloids are formulated for the purpose of suppressing nasal secretion and sneezing through an anticholinergic action.
2. Methylephedrine hydrochloride is an antihistamine ingredient formulated for the purpose of suppressing sneezing and runny nose.
3. Tranexamic acid is an anti-inflammatory ingredient that suppresses the production of inflammation-causing substances in the body, thereby suppressing the occurrence of inflammation and relieving swelling.
4. Guaifenesin is an expectorant ingredient formulated for the purpose of loosening phlegm.

Which of the following statements about dipotassium glycyrrhizinate formulated in cold remedies is correct?

1. For medicines, the dosage is set so that daily intake as glycyrrhizic acid does not exceed 40 mg.
2. Regardless of who the intended user is, a product whose maximum daily dose amounts to 40 mg or more as glycyrrhizic acid should avoid long-term continued use.
3. Taking a large amount of glycyrrhizic acid risks causing aseptic meningitis.
4. Glycyrrhizic acid, the active component of dipotassium glycyrrhizinate, has a chemical structure resembling that of a vitamin-like substance.

Which of the following statements about kampo (Chinese herbal) formula products used to relieve cold symptoms is incorrect?

1. In addition to maoto (麻黄湯), both kakkonto and shoseiryuto (小青竜湯) contain ephedra herb (麻黄, mao) among their constituent crude drugs.
2. Hangekobokuto (半夏厚朴湯) contains glycyrrhiza (甘草, kanzo) among its constituent crude drugs.
3. Keishito (桂栃湯) is said to be suited to the early stage of a cold, with sweating, in a person of weak constitution.
4. Kakkonto (葛根湯) is said to be suited to the early stage of a cold (without sweating) in a person of medium build or above, as well as to a head cold, rhinitis, and headache.

Which of the following statements about shosaikoto (小柴胡湯) is correct?

1. Shosaikoto is stated to be particularly suited to a person of weak constitution (a person whose physical strength has declined, or a person of weak build), and unsuited to a person of robust constitution.
2. For a person undergoing treatment with an interferon preparation, shosaikoto is stated to need its use avoided, since the risk of the side effect of interstitial pneumonia is heightened.
3. Congestive heart failure and ventricular tachycardia are known as serious side effects of shosaikoto, and interstitial pneumonia or liver dysfunction is never seen, even rarely.
4. Shosaikoto, like maoto, kakkonto, and shoseiryuto, is a kampo formula product containing ephedra herb (麻黄, mao) among its constituent crude drugs.

Which of the following statements about the action of analgesic/antipyretic ingredients is incorrect?

1. Suppressing the production of prostaglandin at the periphery increases renal blood flow, so it carries no risk of worsening symptoms even where kidney function is impaired.
2. When prostaglandin's action of regulating gastric acid secretion and protecting the gastric mucosa is interfered with, gastric acid secretion increases while blood flow to the stomach wall decreases, making gastric mucosal damage more likely.
3. Prostaglandin acts to keep body temperature regulated at a higher level than normal, and is also involved in the occurrence of inflammation.
4. As for antipyresis, an action that promotes reabsorption of water in the kidney, increasing circulating blood volume, and promotes sweating, also contributes.

Which of the following statements about salicylate analgesic/antipyretic ingredients is correct?

1. Even in an OTC drug, aspirin (including aspirin aluminum) can be used by a child under 15 years of age if the dose is reduced.
2. Ethenzamide and salicylamide need to have their use avoided in a child under 15 years of age who has chickenpox (varicella) or influenza.
3. Aspirin is an ingredient said to cause gastrointestinal problems less readily compared with other analgesic/antipyretic ingredients.
4. Aspirin needs to have its use avoided in a pregnant woman within 4 weeks of her expected delivery date.

Which of the following statements about acetaminophen is correct?

1. It is used only as an oral medicine, and no product is used as a suppository.
2. Because it produces antipyresis and analgesia mainly through a central action, no anti-inflammatory action at the periphery can be expected.
3. Because it causes gastrointestinal problems more readily than other analgesic/antipyretic ingredients, it may never be taken on an empty stomach under any circumstances.
4. In OTC drugs, it must never be used under any circumstances in a child under 15 years of age.

Which of the following statements about ibuprofen is incorrect?

1. In OTC drugs, given the suggested occurrence of Reye's syndrome, it must never be used under any circumstances in a child under 15 years of age.
2. In a person with a history of a disease causing widespread inflammation of the digestive tract, such as a gastric or duodenal ulcer, ulcerative colitis, or Crohn's disease, it risks worsening symptoms or triggering a recurrence of that disease.
3. It can rarely cause the serious side effect of aseptic meningitis, but is said to occur less readily, if anything, in a person with systemic lupus erythematosus or mixed connective tissue disease.
4. It is not to be taken by a pregnant woman within 12 weeks of her expected delivery date.

Which of the following statements about recommending a doctor's visit and the like for cold remedies and analgesic/antipyretics is correct?

1. For an infant under 2 years of age, a cold remedy is stated to be given before having them seen by a doctor.
2. Ordinarily, if body temperature is 38°C or below, there is no risk of convulsions or marked exhaustion, so there is stated to be no need to use an analgesic/antipyretic until the temperature returns to normal.
3. Even when a fever has continued for a week or more, there is no need to consider the possibility that an infection other than a cold, or some other serious illness, is the cause.
4. It is stated to be preferable to use an analgesic/antipyretic preventively, before symptoms appear.

Which of the following statements about the antihistamine ingredient formulated in a drowsiness-inducing medicine (a hypnotic sedative) is incorrect?

1. Sleep disturbance that often occurs during pregnancy is not a use for which a sleep-aid medicine is intended.
2. A hypnotic sedative with an antihistamine ingredient as its main ingredient is intended for use by a person who has been diagnosed with insomnia at a medical institution.
3. Histamine plays a role in maintaining and regulating wakefulness, via stimulation of nerve cells at a site involved in sleep and wakefulness in the lower part of the brain.
4. Diphenhydramine hydrochloride, among antihistamine ingredients, has a particularly strong central action.

Which of the following statements about precautions for use of hypnotic sedatives is correct?

1. Allylisopropylacetylurea has an action that heightens excitement of the brain and sharpens pain sensation, so its use should be kept to a small amount.
2. In children and young people, an antihistamine ingredient can cause nervous excitability or central excitement, the opposite of drowsiness; in particular, use of a sleep-aid medicine containing an antihistamine ingredient should be avoided in a child under 15 years of age.
3. Bromovalerylurea has an action that suppresses excitement of the brain, but is an ingredient that never causes dependence even with repeated intake.
4. Because an effect on the fetus has been ruled out for bromovalerylurea, there is no need for a pregnant woman, or a woman thought to be pregnant, to avoid using it as a hypnotic sedative.

Which of the following statements about a crude drug ingredient formulated in a hypnotic sedative for its sedative action is incorrect?

1. Uncaria hook (釣藤鉤, chotoko) is a crude drug derived from the typically thorny part of Uncaria species and the like, of the family Rubiaceae.
2. Jujube seed (酸棵仁, sansonin) is a crude drug derived from the seed of Ziziphus jujuba var. spinosa, of the family Rhamnaceae.
3. Valerian root (カノコソウ, kanokoso) is also known as 'passiflora', a plant of the family Passifloraceae native to South America.
4. Even a sedative consisting solely of crude drug ingredients should avoid combining multiple sedatives or long-term continued use.

Which of the following statements about kampo formula products intended to improve symptoms such as nervousness, mental unrest, and insomnia is correct?

1. For sansoninto (酸棵仁湯), if no improvement in symptoms is seen after about a week of use, it is stated that continuing use indefinitely should be avoided and a response such as visiting a medical institution is needed.
2. Saikokaryukotsuboreito (柴胡加竜骨牡蠣湯) contains glycyrrhiza (甘草, kanzo) among its constituent crude drugs.
3. Keishikaryukotsuboreito (桂栃加竜骨牡蠣湯) is said to be suited to a person of medium build or above with mental unrest, accompanied by palpitations, insomnia, and constipation.
4. Yokukansan (抑胆散) is stated to carry no possibility of causing heart failure.

Which of the following statements about the action of caffeine formulated in an anti-drowsiness medicine is incorrect?

1. Caffeine has an action that suppresses the heart muscle, and can cause bradycardia as a side effect.
2. Caffeine has an action that suppresses reabsorption of sodium ions (and, along with them, water) in the kidney, bringing about an increase in urine volume (diuresis).
3. Caffeine has an action that increases gastric juice secretion, and can cause gastrointestinal problems such as loss of appetite and nausea/vomiting as side effects.
4. Caffeine has the property, though its action is weak, of forming dependence with repeated intake.

Which of the following statements about caffeine intake and the like in anti-drowsiness medicines is correct?

1. For caffeine in an anti-drowsiness medicine, the upper limit is 200 mg as caffeine per single intake, and 500 mg as caffeine per day.
2. For caffeine in an anti-drowsiness medicine, the upper limit for daily intake is 200 mg as caffeine.
3. Because caffeine taken in does not transfer into breast milk, there is no need to consider the effect on the infant even if a breastfeeding woman takes a large amount.
4. Although caffeine has an action that increases gastric juice secretion, there is no need for a person with excess stomach acid or a gastric ulcer to avoid taking an anti-drowsiness medicine.

Which of the following statements about the use of anti-drowsiness medicine is incorrect?

1. Because drowsiness occurring during infection with a bacterium, virus, or the like has no relation to the body's defenses, there is no problem in suppressing it with an anti-drowsiness medicine.
2. Even after getting sufficient sleep, if drowsiness or malaise continues that use of an anti-drowsiness medicine cannot suppress, a response such as visiting a medical institution is necessary.
3. It is not appropriate to use an anti-drowsiness medicine to suppress drowsiness caused by using a cold remedy, antiallergic drug, or the like.
4. Because sleep is important for the development of a growing child, there is no anti-drowsiness medicine for children, and care must be taken to ensure it is never used in a child under 15 years of age.

Which of the following statements about ingredients formulated in motion-sickness prevention medicines is correct?

1. Scopolamine hydrobromide hydrate is metabolized slowly in the liver, so its action lasts longer compared with other antihistamine ingredients.
2. Meclizine hydrochloride is an antihistamine ingredient characterized by its action appearing faster and its duration being shorter compared with other antihistamine ingredients.
3. Difenidol hydrochloride shows a regulating action on the nerve connecting the vestibule in the inner ear to the brain (the vestibular nerve), as well as an action that improves blood flow to the inner ear.
4. Dimenhydrinate is the generic name of an anticholinergic ingredient formulated exclusively in motion-sickness prevention medicines.

Which of the following statements about precautions for use of motion-sickness prevention medicines is incorrect?

1. For ingredients containing promethazine, such as promethazine hydrochloride, because fatal respiratory depression has been reported overseas, use needs to be avoided in a child under 15 years of age.
2. When ethyl aminobenzoate is formulated, use needs to be avoided in a child under 6 years of age.
3. Because a motion-sickness prevention medicine also contains an ingredient mainly intended to suppress nausea, using it to cope with the nausea of morning sickness is appropriate.
4. Motion sickness is said to hardly ever occur in a child under 3 years of age, and there is no motion-sickness prevention medicine product intended for an infant under 3 years of age.

Which of the following statements about crude drug preparations and kampo formula products indicated for a child's 'kan' (fretfulness/night-crying) is correct?

1. Antelope horn (レイヨウカク, reiyokaku) is a crude drug derived from the horn of the saiga antelope and the like, of the family Bovidae, used for its expected action of calming tension and excitement.
2. Agarwood (沈香, jinko) is a crude drug derived from the wood of Aquilaria and the like, of the family Thymelaeaceae, used for its expected laxative action.
3. A sedative for children is recommended to be used with priority given to securing the guardian's own restful sleep and the like.
4. A kampo formula product may be used even in an infant under 3 months of age, as long as no lower age limit is set in its dosage and administration.

Which of the following statements about antitussive ingredients formulated in antitussive/expectorant medicines is incorrect?

1. Dextromethorphan hydrobromide hydrate is classified as a narcotic antitussive ingredient.
2. Pinellia tuber (半夏, hange) is a crude drug derived from the tuber, with the cork layer removed, of Pinellia ternata of the family Araceae, and shows a central antitussive action.
3. Codeine phosphate hydrate and dihydrocodeine phosphate are also called narcotic antitussive ingredients.
4. A cough is a response triggered when some abnormality occurs in the trachea or bronchi, the stimulus is conveyed to the central nervous system, and the cough center in the medulla oblongata acts.

Which of the following statements about codeine phosphate hydrate and dihydrocodeine phosphate is correct?

1. They show an action that increases motility of the digestive tract, and diarrhea can appear as a side effect.
2. Even if taken during pregnancy, none of the absorbed component crosses the blood-placenta barrier and transfers to the fetus.
3. Because they never transfer into breast milk, they may be taken without any problem even by a person breastfeeding.
4. From the standpoint of reducing the risk of respiratory depression in children, it was decided, in principle, that a caution be issued so that medicines containing these are not used in a child under 12 years of age and the like.

Which of the following statements about bronchodilator ingredients formulated in antitussive/expectorant medicines is incorrect?

1. Xanthine-derivative ingredients such as diprophylline dilate the bronchi by relaxing the smooth muscle of the bronchi via the autonomic nervous system.
2. Adrenergic ingredients such as methylephedrine hydrochloride show an action that stimulates the sympathetic nervous system to dilate the bronchi.
3. For adrenergic ingredients and ephedra herb, a person diagnosed with heart disease, high blood pressure, diabetes, or hyperthyroidism should consult a doctor or pharmacist about their suitability before use.
4. Ephedra herb (麻黄, mao) is a crude drug derived from the above-ground stem of a plant of the family Ephedraceae, and is also expected to have actions such as promoting sweating and diuresis, in addition to bronchodilation.

Which of the following statements about expectorant ingredients formulated in antitussive/expectorant medicines is correct?

1. Guaifenesin shows an action that dissolves and reduces the molecular size of viscous protein in phlegm, decreasing its viscosity.
2. Carbocisteine shows an action that adjusts the proportion of mucus components, improving the ease of expelling phlegm.
3. Bromhexine hydrochloride shows only an action that suppresses secretion of mucus from the airway mucosa.
4. Ethyl cysteine hydrochloride improves the ease of expelling phlegm by suppressing ciliary movement of the airway mucosa.

Which of the following statements about glycyrrhiza (甘草, kanzo) used in antitussive/expectorant medicines is correct?

1. Glycyrrhiza is a crude drug used only in medicines, and is never used as a sweetener in ordinary foods, so there is no need to draw attention to the total amount of glycyrrhizic acid either.
2. Glycyrrhiza is a crude drug derived from the root and stolon of a plant of the family Fabaceae, and in addition to the anti-inflammatory action of glycyrrhizic acid, is also expected to have actions such as promoting mucus secretion from the airway mucosa.
3. A product whose maximum daily dose amounts to 10 g or more as glycyrrhiza (converted to crude drug equivalent) should avoid long-term continued use, since it risks causing pseudoaldosteronism.
4. Kanzoto (甘草湯) is a kampo formula product consisting of two constituent crude drugs, glycyrrhiza and ephedra herb.

Which of the following statements about crude drug ingredients formulated in antitussive/expectorant medicines is incorrect?

1. Ophiopogon tuber (麦門冬, bakumondo) is a crude drug derived from the enlarged part of the root of Ophiopogon japonicus, of the family Liliaceae, used for its expected antitussive, expectorant, and tonic actions.
2. Nandina fruit (南天実, nantenjitsu) is a crude drug derived from the whole flowering plant of Plantago asiatica, of the family Plantaginaceae, used for its expected expectorant action.
3. Sekisan (石蒜) is a crude drug derived from the bulb of Lycoris radiata, of the family Amaryllidaceae, used for its expected expectorant action.
4. Apricot kernel (杏仁, kyonin) is a crude drug derived from the seed of Prunus armeniaca var. ansu, Prunus armeniaca, and the like, of the family Rosaceae, and part of the metabolite produced from its breakdown in the body is said to show an action that sedates the respiratory center and cough center in the medulla oblongata.

Which of the following statements about senega and onji is correct?

1. A caution regarding ingredients and their amount is noted for a product containing 10 g or more of senega, as crude drug, at its maximum daily formulated amount.
2. Senega and onji are both crude drugs derived from a plant of the family Polygalaceae, used for their expected expectorant action.
3. Onji is a crude drug derived from the root of a plant of the family Campanulaceae.
4. Intake of these crude drug ingredients can affect blood pressure test values.

Which of the following statements about recommending a doctor's visit and the like for antitussive/expectorant medicines is incorrect?

1. No antipyretic ingredient is formulated in antitussive/expectorant medicines, so an effect of bringing down a fever cannot be expected.
2. If symptoms such as coughing, phlegm, and breathlessness have continued for a long period, chronic obstructive pulmonary disease (COPD), such as chronic bronchitis or emphysema, may be a possibility.
3. If asthma attacks recur repeatedly, it is preferable to continue using an OTC antitussive/expectorant medicine.
4. A continuing dry cough without phlegm can potentially be an early symptom of interstitial pneumonia and the like.

Which of the following statements about how to use oral/throat medicines and gargle preparations is correct?

1. Because a gargle preparation is more effective the more concentrated the prepared liquid is, it is best used undiluted with water.
2. A troche or lozenge has its active ingredient absorbed more quickly and its effect heightened by being chewed and swallowed, rather than sucked slowly in the mouth to dissolve.
3. For a spray-type liquid preparation, it is preferable to spray while inhaling deeply, so that the liquid reaches all the way to the back of the pharynx.
4. For a gargle preparation, it is stated to be effective to generally hold about 10 to 20 mL of the liquid in the mouth, tilt the face upward, gargle repeatedly so the liquid reaches all the way to the back of the pharynx, and then spit it out, repeating this several times.

Which of the following statements about germicidal/antiseptic ingredients formulated in oral/throat medicines and gargle preparations is incorrect?

1. A gargle preparation containing chlorhexidine gluconate is stated to be less irritating and easy to use, even for a person with a wound or severe sore in the oral cavity.
2. With a gargle preparation containing povidone-iodine, its use can discolor a silver-containing dental material (such as dentures).
3. Iodine loses its germicidal action, undergoing decolorization, when it reacts with a component such as vitamin C contained in lemon juice or tea.
4. When an iodine-based germicidal/antiseptic ingredient is used in the oral cavity, it can result in intake of iodine, potentially affecting hormone production in the thyroid gland.