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1. Which of the following appropriately characterizes a probiotic:

A. Commensal native bacteria B. Live organism that provides the host with a health benefit C. Metabolic byproduct of bacteria that affects the host function D. Nondigestible substance that stimulates bacterial growth

2. Which of the following is the term used to describe a product that contains both a bacteria known to provide a health benefit and a nondigestible substance that selectively stimulates the favorable growth or activity of the bacteria:

A. Prebiotic B. Probiotic C. Postbiotic D. Synbiotic

3. The word probiotic means

A. For life B. Good bacteria C. Healthy bacteria D. Healthy intestine

4. Microbes in the gastrointestinal tract are most plentiful in the

A. Mouth B. Ileum C. Jejunum D. Colon

5. The effects of probiotic organisms are _________ specific.

A. Bacteria B. Genus C. Species D. Strain

6. Probiotics work through a number of mechanisms. Which of the following is an immune mechanism:

A. Competition for essential nutrients B. Increasing the acidic environment of the intestine C. Stimulation of cytokine production D. Strengthening the intestinal barrier

7. Which of the following is TRUE regarding the use of probiotics to treat diarrhea:

A. Antibiotic-associated diarrhea is not significantly reduced by use of lactic acid probiotics B. Probiotic use in the first day or 2 can decrease stool frequency and duration of diarrhea C. Saccharomyces boulardii has been shown to be effective in treating pediatric rotaviral infection D. Traveler's diarrhea has been significantly reduced (>50%) by probiotic administration

8. The best evidence to date for effective treatment of Clostridium difficile infection with probiotics is a regimen of:

A. Lactobacillus acidophilus and Lactobacillus bifidus B. S boulardii alone C. S boulardii with vancomycin, metronidazole or both D. No probiotic has been shown to have activity against Clostridium difficile infection

9. The best evidence to date for effective treatment of irritable bowel syndrome with probiotics using appropriately designed trials is with:

A. Bifidobacterium infantis 35624 B. E coli Nissle 1917 C. S boulardii D. VSL#3

10. A probiotic product that has shown effectiveness in trials for treatment of pouchitis is:

A. Escherichia coli Nissle 1917 B. Lactobacillus rhamnosus GG (LGG) C. S. boulardii D. Combination of lactobacillus, bifodobacterium, and Streptococcus thermophilus

11. A form of inflammatory bowel disease that has had disappointing study results with regard to the effectiveness of probiotic therapy is

A. Crohn's disease B. Pouchitis C. Ulcerative colitis D. Results have been disappointing with all 3 of these diseases

12. The addition of probiotics to infant formula is based primarily on which of the following:

A. Clinical studies showing efficacy in the prevention of colic B. Comparison studies between probiotic formulas and breastfeeding C. Evidence that the early microbial environment affects overall health D. Beneficial organisms needed by seriously ill patients

13. Healthy immunocompetent patients are most likely to experience the following risk when using lactobacillus or bifidobacterium-containing probiotics:

A. Acidosis B. Antibiotic resistance C. Sepsis D. None of the above is significant for healthy patients

14. All of the following factors can affect the viability of a probiotic ingredient in a proprietary product, EXCEPT:

A. Other ingredients in a food product B. Storage temperature C. Time since date of manufacture D. All of the above affect probiotic viability

15. In the United States, most probiotic products are marketed as

A. Dietary supplements B. Drugs C. Foods D. Vitamins

16. Which of the following is an appropriately labeled probiotic ingredient:

A. Lactobacillus bulgaricus B. Lactobacillus plantarum 299V C. Bifidobacterium adolescentis D. S thermophilus

17. Which of the following would be an improper disease-related claim by a probiotic dietary supplement:

A. Improves digestive health B. Regulates intestinal function C. Stimulates proper digestive function D. Treats irritable bowel syndrome and constipation

18. Recommendations for use of probiotic products should be based on all of the following, EXCEPT:

A. “Best by” date B. Dose of CFUs used in clinical trials C. Legal definition of probiotic D. Strain of bacteria used in clinical trials

19. When comparing doses of probiotic products

A. Activity at time of manufacture is the most important factor B. The appropriate dose is strain-specific and based on condition treated C. The number of colony forming units (CFUs) per dose is the deciding factor on which product will be more effective D. All of the above are important factors in comparing doses

20. Patients who take a probiotic to prevent or treat antibiotic-associated diarrhea should

A. Pretreat with the probiotic for 24 hours B. Take the probiotic and antibiotic doses together C. Take the probiotic dose 2 hours after the antibiotic D. Take the probiotic dose 4 hours after the antibiotic

Evaluation Questions

21. In an effort to better determine the overall impact of continuing education activities, the Postgraduate Institute for Medicine (PIM) is conducting measurements of educational effectiveness. Listed below are several demographic questions to better identify who is in the audience and several statements for which we would like you to rate your level of agreement/disagreement. All information obtained in this process will be used and reported in aggregate only, without individual attribution. Thank you for your participation. What is your profession?

A. Pharmacist B. Pharmacy Technician C. Other

22. What is your area of specialization?

A. Clinical pharmacy B. Managed care C. Retail/community pharmacy D. Research E. Industry/manufacturing F. Regulatory/government G. Other

23. How many years have you been in practice?

A. < 5 B. 5 -10 C. 11 – 20 D. > 20

24. To what extent do you agree with the following statement: Current evidence suggests the use of probiotics as adjunctive therapy appears to reduce the severity and duration of acute infectious diarrheal illness when initiated within the first 24 to 48 hours of symptoms.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

25. To what extent do you agree with the following statement: Probiotics are not recommended for routine clinical use to prevent or treat C difficile.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

26. To what extent do you agree with the following statement: There is evidence to support the use of probiotics for the prevention and treatment of pouchitis in postsurgical patients with inflammatory bowel disease.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

27. To what extent do you agree with the following statement: The probiotic product having the highest number of colony forming units (CFUs) would likely have the most probiotic activity, regardless of species/strain.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

28. Now that you have participated in this activity, how often do you plan to engage in the following practice behavior? Counsel patients with milk allergy or lactose intolerance to check probiotic labels for the presence of lactose or milk products.

A. Never B. Rarely C. Sometimes D. Very Often E. Always F. Not within my scope of practice