Heart, Blood, Elimination, and Women's Medicines

Which of the following statements about toad venom (蟾酥, senso) formulated in cardiotonics is correct?

1. An internal solid preparation such as a pill or tablet containing senso is stated to be well chewed in the mouth before taking.
2. A medicine containing senso in excess of 1 mg per daily dose is designated a powerful drug.
3. It shows a strong cardiotonic action even in a minute amount, and nausea or vomiting can appear as a side effect even at the ordinary dose.
4. It is a crude drug derived from the musk gland secretion of the male musk deer, of the family Cervidae.

Which of the following statements about crude drug ingredients formulated in cardiotonics is correct?

1. Ox bezoar (牛黄, goo) is a crude drug derived from a gallstone formed in the gallbladder of cattle, of the family Bovidae, and is said to have, besides a cardiotonic action, actions such as lowering blood pressure through peripheral vasodilation and calming excitement.
2. Borneol (竜脳, ryuno) is a crude drug used for its expected sedative action on the central nervous system, and is a cardiotonic ingredient in which glycyrrhizic acid, a major substance present in borneol, is sometimes formulated.
3. Deer antler (鹿茸, rokujo) is a crude drug derived from the musk gland secretion of the male musk deer, of the family Cervidae, used for its expected cardiotonic action as well as an action that stimulates the respiratory center to heighten respiratory function.
4. Musk (麝香, jako) is a crude drug derived from the non-cornified young antler of the male deer, of the family Cervidae, used for its expected cardiotonic action.

Which of the following statements about musk (麝香, jako) is correct?

1. In addition to a cardiotonic action, it is said to have actions such as stimulating the respiratory center to heighten respiratory function, and reviving consciousness.
2. It is a crude drug ingredient in cardiotonics that shows a local anesthetic action on contact with skin or mucosa, and is therefore taken without chewing.
3. It is a crude drug derived from a gallstone formed in the gallbladder of cattle, of the family Bovidae.
4. It contains no crude drug ingredient expected to have a cardiotonic action, and is a crude drug mainly aimed at promoting the elimination of 'water toxin' through a diuretic action.

Which of the following statements about ryokeijutsukanto (苓桂朮甘湯) is incorrect?

1. It is mainly composed of crude drugs expected to have a cardiotonic action.
2. It is a kampo formula product containing glycyrrhiza among its constituent crude drugs.
3. It is mainly aimed at promoting the elimination of 'water toxin' through a diuretic action.
4. It is said to be suited to lightheadedness, dizziness, headache, ringing in the ears, palpitations, breathlessness, neurosis, and nervous sensitivity in a person of medium build or below with dizziness or unsteadiness, sometimes accompanied by flushing or palpitations.

Which of the following statements about ingredients formulated in high-cholesterol-improving medicines is correct?

1. Soybean unsaponifiable matter (soysterol) is said to have a function that promotes the absorption of cholesterol in the intestine, and is formulated in high-cholesterol-improving medicines.
2. Intake of vitamin E can turn the urine yellow, but this is a physiological change, not an abnormality such as a side effect requiring discontinuation of use.
3. Linoleic acid is formulated for the purpose of promoting blood circulation in peripheral blood vessels.
4. Pantethine is said to have actions such as promoting the catabolism and excretion of LDL and the like, and heightening lipoprotein lipase activity to increase HDL production.

Which of the following statements about cholesterol in the blood is incorrect?

1. High-density lipoprotein (HDL) is a lipoprotein that carries cholesterol from the liver to peripheral tissue.
2. Low-density lipoprotein (LDL) is a lipoprotein that carries cholesterol from the liver to peripheral tissue.
3. As test values measured at a medical institution, a state in which any of the following holds—LDL of 140 mg/dL or more, HDL under 40 mg/dL, or triglycerides of 150 mg/dL or more when fasting—is called lipid abnormality (dyslipidemia).
4. The production and metabolism of cholesterol is carried out mainly in the liver.

Which of the following statements about ingredients formulated in anti-anemia medicines (iron preparations) is correct?

1. Vitamin C may be formulated as a vitamin necessary for hemoglobin production.
2. Manganese sulfate may be formulated for the purpose of supplementing manganese, a constituent of vitamin B12, to heighten hematopoietic function in the bone marrow.
3. Copper has an important role in the metabolism and transport of iron in the process of hemoglobin production.
4. Cobalt sulfate may be formulated for the purpose of promoting energy synthesis.

Which of the following statements about taking anti-anemia medicines (iron preparations) is correct?

1. Absorption of iron is higher after a meal than on an empty stomach.
2. Taking a food or drink containing tannic acid, such as green tea, black tea, or coffee, within 30 minutes before or after taking the medicine improves iron absorption, so it is preferable to take them around that time.
3. Taking a food or drink containing tannic acid (green tea, black tea, coffee, wine, persimmon, and the like) within 30 minutes before or after taking the medicine can react with the tannic acid and worsen iron absorption.
4. It is appropriate to continuously use an anti-anemia medicine (iron preparation) for prevention even before anemia symptoms appear, and there is no need to start use only after symptoms appear.

Which of the following statements about anti-anemia medicines (iron preparations) is correct?

1. If the stool turns black after taking it, there is a risk of a serious side effect, so use must be discontinued immediately.
2. Taking an iron preparation can turn the stool black, but this is not an abnormality such as a side effect requiring discontinuation of use.
3. If the stool was already black before taking the iron preparation, there is no need to compare it with the state of the stool before taking.
4. To reduce digestive side effects, it is preferable to take it on an empty stomach.

Which of the following statements about ubidecarenone is incorrect?

1. It is said to show an effect of improving blood circulation by heightening the oxygen utilization efficiency of the heart muscle to strengthen its contractile force.
2. It is a component present abundantly in organs such as the liver and heart, helping the function of an enzyme involved in energy metabolism, and is also called coenzyme Q10.
3. There is a product intended for a child under 15 years of age, used when a child has symptoms such as palpitations, breathlessness, or swelling from heart disease.
4. If no improvement in symptoms is seen after about 2 weeks of use, continuing use indefinitely is not appropriate.

Which of the following statements about hemorrhoids is correct?

1. Hemorrhoids (piles) are a condition in which the fine network of blood vessels present in the anus partially dilates, producing a wart-like swelling inside the anus, generally called 'piles'.
2. An anal fissure is a state in which fecal residue accumulates in a small depression called an anal crypt inside the anus, causing inflammation and suppuration.
3. An internal hemorrhoid is characterized by causing bleeding or pain in the affected area regardless of bowel movement, and is also called a 'pile' since it forms below the dentate line.
4. A hemorrhoid forming on the rectal mucosa above the dentate line is called an external hemorrhoid.

Which of the following statements about local anesthetic ingredients formulated in topical hemorrhoid medicines is correct?

1. A suppository or an injectable ointment containing lidocaine can rarely cause shock (anaphylaxis) as a serious side effect.
2. A local anesthetic ingredient acts on the sensory nerves around the affected area, irreversibly blocking nerve conduction of pain or itching stimuli.
3. A local anesthetic ingredient is one formulated for the purpose of protecting the mucosa and achieving hemostasis by binding with protein on the mucosal surface to form an insoluble film.
4. Ingredients used as local anesthetic ingredients include crotamiton, camphor, and menthol.

Which of the following correctly matches an ingredient formulated in a topical hemorrhoid medicine with its purpose of formulation?

1. Diphenhydramine hydrochloride — to prevent local infection accompanying hemorrhoidal disease
2. Allantoin — to promote healing of a wound at the anus caused by hemorrhoids
3. Crotamiton — to suppress itching by producing a cooling stimulus
4. Tannic acid — to achieve hemostasis through vasoconstriction from a stimulating action on the sympathetic nervous system

Which of the following statements about topical hemorrhoid medicines is incorrect?

1. Glycyrrhetinic acid is a component produced by the breakdown of glycyrrhizic acid, and shows an anti-inflammatory action similar to that of glycyrrhizic acid.
2. For a suppository or an injectable ointment, part of the ingredients is readily absorbed from the rectal mucosa and enters the circulating bloodstream, so a systemic effect can occur.
3. A suppository or injectable ointment containing a steroidal anti-inflammatory ingredient poses no problem with long-term continued use as long as the content is small.
4. A suppository or injectable ointment containing methylephedrine hydrochloride risks worsening symptoms in a person diagnosed with heart disease, high blood pressure, diabetes, or a thyroid function disorder.

Which of the following statements about ingredients formulated in oral hemorrhoid medicines is correct?

1. Scutellaria root (黄芩, ougon) is a crude drug derived from the root of Scutellaria baicalensis, of the family Lamiaceae, with the periderm removed, used mainly for its expected hemostatic effect.
2. Sophora flower bud (槐花, kaika) is a crude drug derived from the mature fruit of Styphnolobium japonicum, of the family Fabaceae.
3. Carbazochrome is used for its expected actions of promoting metabolism, antibacterial action, and anti-inflammatory action.
4. Sophora fruit (槐角, kaikaku) is a crude drug derived from the mature fruit of Styphnolobium japonicum, of the family Fabaceae, used mainly for its expected hemostatic effect.

Which of the following statements about kampo formula products used for hemorrhoids is correct?

1. Otsujito is a kampo formula product containing glycyrrhiza, ordinarily rhubarb root, and also ephedra herb among its constituent crude drugs.
2. Otsujito (乙字湯) is said to be suited to hemorrhoids (piles), anal fissure, constipation, and mild rectal prolapse in a person of weak constitution with a tendency to feel cold, and is thought to be unsuited to a person with hard stool and a tendency toward constipation.
3. Kyukikyogaito (芎帰膠艾湯) is said to be suited to hemorrhoidal bleeding, anemia, menstrual abnormality/excessive menstruation/irregular bleeding, and subcutaneous bleeding in a person of medium build or below with a tendency to feel cold, a bleeding tendency, and no digestive trouble.
4. No serious side effect that can rarely occur with otsujito is known.

Which of the following statements about crude drug ingredients formulated in other urological medicines is correct?

1. Bearberry leaf (ウワウルシ, uva ursi) is a crude drug derived from the leaf of Arctostaphylos uva-ursi, of the family Ericaceae, used for its expected diuretic action, as well as an antiseptic effect on the urinary tract from a metabolite excreted in the urine after oral intake that shows antibacterial action.
2. Catalpa fruit (キササゲ, kisasage) is a crude drug derived from the fruit of Catalpa ovata and the like, of the family Bignoniaceae, used as a decoction for reduced urine volume as well as its expected diuretic action.
3. Self-heal spike (夏枯草, kagoso) is a crude drug derived from the root bark of Morus alba, of the family Moraceae, used as a decoction for reduced urine volume.
4. Bearberry leaf listed in the Japanese Pharmacopoeia is used as a decoction for reduced urine volume, and is never used for a feeling of incomplete urination or discomfort during urination, nor for its expected antiseptic effect on the urinary tract.

Which of the following statements about kampo formula products used as urological medicines is correct?

1. Ryutanshakanto (竜胆瀉肝湯) can be used regardless of physical constitution, and is said to be suited to difficulty urinating and the like in a person with abnormal urination, sometimes with dry mouth.
2. Hachimijiogan (八味地黄丸) is said to be particularly suited to a person with strong flushing, a ruddy complexion, and robust physical constitution.
3. Rokumigan (六味丸) is said to be suited to painful urination, a feeling of incomplete urination, cloudy urine, vaginal discharge, and frequent urination in a person of medium build or above with a feeling of heat or pain in the lower abdomen.
4. Choreito (猪苓湯) can be used regardless of physical constitution, and is said to be suited to difficulty urinating, painful urination, a feeling of incomplete urination, frequent urination, and swelling in a person with abnormal urination, sometimes with dry mouth.

Which of the following statements about the constitution and symptoms targeted by women's medicines is incorrect?

1. Blood-path disorder (血の道症, chi no michi sho) is said to occur from physiological events such as menstruation, pregnancy, childbirth, the postpartum period, and menopause, or from abnormal physiology caused by a miscarriage, induced abortion, or sterilization surgery.
2. The menstrual cycle varies among individuals, ranging from about 21 to 40 days.
3. Premenstrual syndrome refers mainly to physical and mental symptoms that appear about 10 to 3 days before menstruation and disappear with the end of menstruation.
4. Before and after menopause, there is a transitional period called menopause (the perimenopausal period), during which the amount of female hormone in the body can fluctuate greatly.

Which of the following statements about the female hormone ingredient (ethinylestradiol) used in women's medicines is incorrect?

1. Because no occurrence of congenital abnormality in the fetus from intake of a female hormone ingredient during pregnancy has been reported, there is no need for a pregnant woman or a woman thought to be pregnant to avoid its use.
2. It is a type of artificially synthesized female hormone that supplements estradiol, and when applied to the vaginal mucosa or the vulva, it is absorbed from the site of application and transfers into the circulating blood.
3. Long-term continued use risks causing thrombosis, and can also raise the probability of occurrence of conditions such as breast cancer or stroke.
4. Part of the absorbed component is thought to transfer into breast milk, so a woman who breastfeeds should avoid its use.

Which of the following statements about crude drug ingredients formulated in women's medicines is correct?

1. Saffron (サフラン) and cyperus rhizome (香附子, kobushi) may be formulated for their expected sedative and analgesic actions, as well as an action that promotes a woman's stagnated menstruation.
2. Jujube seed and valerian root may be formulated in women's medicines not for a sedative action but for their expected diuretic action of increasing urine volume.
3. Cnidium rhizome (川芎, senkyu), Japanese angelica root (当帰, toki), and rehmannia root (地黄, jio) have no action of improving blood circulation, and are crude drugs used mainly for their expected hemostatic effect during menstruation.
4. Japanese angelica root is a crude drug derived from the stigma of Crocus sativus, of the family Iridaceae, showing sedative and analgesic actions.

Which of the following statements about tokishakuyakusan (当帰芍薬散) is correct?

1. It contains ephedra herb among its constituent crude drugs, and is said to be suited to menstrual irregularity in a person of medium build or below.
2. It is said to be suited to menstrual irregularity, dysmenorrhea, dysmenorrhea, menopausal disorder, and lower back pain in a person of medium build or above with flushing and a tendency toward constipation.
3. It is said to be suited to menstrual irregularity, menstrual abnormality, dysmenorrhea, and menopausal disorder in a person of relatively robust constitution, sometimes complaining of lower abdominal pain, stiff shoulders, heaviness in the head, dizziness, and flushing with cold feet.
4. It is said to be suited to menstrual irregularity, menstrual abnormality, dysmenorrhea, and menopausal disorder in a person of weak constitution with a tendency to feel cold and anemic, tiring easily, sometimes complaining of lower abdominal pain, heaviness in the head, dizziness, stiff shoulders, ringing in the ears, and palpitations.

Which of the following statements about kamishoyosan (加味逍遙散) is correct?

1. It is said to be suited to a person of weak constitution with a tendency to feel cold, dry skin, and a poor complexion, with no digestive trouble.
2. It is known to rarely cause liver dysfunction and mesenteric phlebosclerosis as serious side effects.
3. It does not contain glycyrrhiza among its constituent crude drugs.
4. It is said to be particularly suited to menstrual irregularity and menopausal disorder in a person with a weak digestive system.

Which of the following correctly matches a kampo formula product used as a women's medicine with the constitution (sho) it is said to suit?

1. Saikokeishikankyoto (柴胡桂枝乾姜湯) — a person of medium build or above with a feeling of flushing and facial flushing, nervous sensitivity, and palpitations or breathlessness
2. Tokakujokito (桃核承気湯) — a person of weak constitution with a tendency to feel cold and anemic, tiring easily, sometimes complaining of lower abdominal pain or heaviness in the head
3. Keishibukuryogan (桂枝茯苓丸) — a person of relatively robust constitution, sometimes complaining of lower abdominal pain, stiff shoulders, heaviness in the head, dizziness, and flushing with cold feet
4. Unkeito (温経湯) — a person of medium build or above with flushing and a tendency toward constipation, complaining of menstrual irregularity or dysmenorrhea

Which of the following statements about kampo formula products used as women's medicines is correct?

1. Tokakujokito contains rhubarb root among its constituent crude drugs, and goshakusan contains ephedra herb among its constituent crude drugs.
2. No serious side effect that can rarely occur, such as interstitial pneumonia or liver dysfunction, is known for saikokeishikankyoto.
3. Unkeito and kamishoyosan are both kampo formula products that do not contain glycyrrhiza among their constituent crude drugs.
4. Unseiin (温清飲) is a kampo formula product containing ephedra herb among its constituent crude drugs.