A 63-year-old man comes to the clinic for a new patient visit. He is pleasant and says he "has never felt healthier." The patient presents a list of regularly taken medications, which include atenolol, sildenafil, terbinafine, minoxidil (topical), aspirin, and saw palmetto. He has no known drug allergies and has a remote history of cholecystectomy. He drinks an ounce of bourbon before bed each night. The patient has a remote 15-pack-year smoking history and has never used illicit drugs. He is married, has 3 grown children, and was recently transferred to this city to assume direction of a local factory. Physical examination is remarkable for a soft midsystolic murmur that is loudest in the second right intercostal space. There is some bony enlargement of the distal interphalangeal joints bilaterally. The patient wishes to discuss his medication list in more depth and indicates an increasing interest in alternative medicines.
Which of the following conditions is saw palmetto most commonly used to treat?

Question

A 63-year-old man comes to the clinic for a new patient visit.  He is pleasant and says he "has never felt healthier."  The patient presents a list of regularly taken medications, which include atenolol, sildenafil, terbinafine, minoxidil (topical), aspirin, and saw palmetto.  He has no known drug allergies and has a remote history of cholecystectomy.  He drinks an ounce of bourbon before bed each night.  The patient has a remote 15-pack-year smoking history and has never used illicit drugs.  He is married, has 3 grown children, and was recently transferred to this city to assume direction of a local factory.  Physical examination is remarkable for a soft midsystolic murmur that is loudest in the second right intercostal space.  There is some bony enlargement of the distal interphalangeal joints bilaterally.  The patient wishes to discuss his medication list in more depth and indicates an increasing interest in alternative medicines. 
Which of the following conditions is saw palmetto most commonly used to treat?

Quizplus · Accepted Answer

Explanation: Alternative medicine is gaining increasing popularity within the United States, with as many as 83 million adults reporting the use of complementary therapies. Herbal preparations are not regulated by governmental agencies and are generally classified as food or dietary supplements, enabling manufacturers to avoid the same scientific scrutiny that prescription drugs receive as they are readied for market. The limited data on herbal preparations is, unfortunately, often flawed. Despite these difficulties, health care practitioners should make an effort to recognize the primary uses and adverse effects of the more popular herbal remedies. Saw palmetto is a popular herbal preparation most often used by men to treat benign prostatic hyperplasia. Its use has not been shown to significantly improve urinary symptoms or flow measures. In addition, saw palmetto does not appear to affect prostate-specific antigen levels or prostate size. (Choice A) Kava kava is an herbal preparation that may help with symptoms of anxiety and insomnia; however, its use is not recommended due to the potential risk of severe liver toxicity. (Choice C) St. John's wort is frequently used in the treatment of depression; however, there is inconsistent evidence supporting its efficacy. (Choice D) Hypercholesterolemia is sometimes treated with garlic preparations; however, there is limited data regarding its efficacy. Fish oil supplementation can be effective in the treatment of refractory hypertriglyceridemia. (Choice E) Osteoarthritis is often treated with glucosamine and chondroitin. Although these agents appear to be safe, studies demonstrating their clinical benefit are limited. Educational objective: Saw palmetto is commonly used in the treatment of benign prostatic hyperplasia, garlic is often used for hypercholesterolemia, St. John's wort is frequently used in the treatment of depression, and glucosamine and chondroitin are used for osteoarthritis. None of these popular herbal preparations have been shown to be significantly efficacious. References: Serenoa repens for benign prostatic hyperplasia. (http://www.ncbi.nlm.nih.gov/pubmed/23235581)

A 63-Year-Old Man Comes to the Clinic for a New