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Foundations 1 > 8/24/17 > Flashcards

8/24/17 Flashcards

1
Q

Micronutrients

A

Chemical substances that are required in trace amounts for normal growth and development

Composed of vitamins (organic) and minerals (inorganic)

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2
Q

Rickets

A

Defective mineralization of bones due to lack of calcium and vitamin D

Children look plump, have retarded growth, are bow legged

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3
Q

Osteomalacia

A

Rickets in adults, characterized by demineralization of the adult skeleton

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4
Q

Fat soluble vitamin uptake

A

Can be passive or facilitated

Absorbed with other dietary fats in the SI Na d are broken down by pancreatic lipase and bile acids

Ingested FSVs travel via chylomicrons in the lymphatic system to reach the blood

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5
Q

Vitamin D forms and metabolism

A

Cholesterol in the liver can be converted to Vitamin D3 with UV exposure from the skin

Vitamin D3 needs to be hydroxylated twice to be activated to calcitrol

Calcitrol production occurs in kidneys and regulated by hormone (prolactin, PTH) and mineral levels (phosphate)

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6
Q

Vitamin D biological function

A

Calcitrol binds to a nuclear receptor and modulates gene expression

Induce proteins involved in Ca2+ uptake in duodenum

Maintains plasma calcium homeostasis in conjunction with PTH, higher Ca levels means less PTH secretion

Calcitrol suppresses PTH gene expression and parathyroid cell proliferation

Rickets and osteomalacia are Vit D deficiencies

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7
Q

Vit D toxicity

A

10x RDA

Anorexia, excessive thirst, vomit, weight loss, hypercalcemia and deposit in soft tissues

Chronic: atherosclerosis and cardiac myopathy

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8
Q

Vit A biological function

A
  1. Retinal is the chromosphere for light receptors in the retina, bound to a protein called opsin to make rhodopsin

Three different opsins to correspond to red, blue, and green

  1. Retinoic acid binds to a receptor and can modulate gene expression

Integrity of epithelial cells, maintenance of immune function, embryonic development

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9
Q

Vit A deficiency

A

Rare in adults (malabsorption) but common in poor kids

Decreased retinal function: start with night blindness and then get Xerophthalmia with Bitot spots (clumps of keratin debris) and phlytcten (neovascularization)

Decreased epithelial differentiation: skin lesions like hyperkeratosis

Decreased myeloid differentiation: lower immune cell numbers so increased susceptibility to infection

Impaired embryonic development

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10
Q

Vit K biological function

A

Post-translational modification of proteins, creates conformational change for GOF like binding

Procoagulant: clotting factors, cofactors, platelets

Regulatory: antithrombin, Protein C, fibrinolysis

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11
Q

Vit K deficiency

A

Increase in prothrombin time, easy bruising, and bleeding if severe case

Adults: rare

  1. Fat malabsorption syndromes like Crohn’s
  2. Antibiotics that kill gut bacteria (make 50% of daily Vit K)
  3. Warfarin or dicoumerol for thromboembolic disease

Infants: common, low levels at birth due to limited placental transfer and sterile intestine, get Vit K shot

Early Vitamin K deficiency bleeding (VKDB) within first day, Classical VKDB within 2-7 days, Late VKDB within 3-8 weeks

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12
Q

Vit E Biological Function

A

Nonspecific antioxidant that prevents propagation of free radicals, prevents propagation of polyunsaturated FAs in membranes

Consequences of PUFA oxidation:
Reproductive failure, atherosclerosis, cancer, aging

Tocopherols are peroxyl radical scavengers that protect PUFAs

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13
Q

Vitamin E Deficiency

A

Mutation in alpha-tocopherol transfer protein (TTP) results in Ataxia with Vitamin E Deficiency (AVED)

Retinopathy: oxidative damage to photoreceptors that can lead to blindness

Neurological Changes: oxidative damage to neurons, peripheral neuropathy, hyoerflexia that can lead to ataxia

Can be from malabsorption syndrome like Crohn’s

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14
Q

BMI

A

Normal: 18-25

Overweight: 25 < BMI < 29.9

Obesity: BMI of 30+

Body weight (kg) / (Height in meters)^2

Simple, inexpensive measurement that correlates well with morbidity/mortality at the pop. level

Doesn’t account for % of lean muscle mass, location of fat deposits, 30% of individuals are misclassified as metabolically healthy or unhealthy

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15
Q

Waist Circumference and Waist-Hip Ratio

A

Android adiposity: Abdominal fat, higher health risk

Gynoid adiposity: thick thighs, lower health risk

At risk: men with 40+, women with 35+ inches

Waist-hip ratio: 1.0+ is at risk
Healthy men are 0.9 or less
Healthy women are 0.8 or less

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16
Q

Adipose changes with respect to weight changes

A

Hypertropic growth: adipocyte size increases

Hyperplastic growth: adipocyte number increases

Weight loss: same adipocyte number but size decrease

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17
Q

Satiety

A

Controlled in ventromedial hypothalamus

Arcuate nucleus

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18
Q

Ghrelin

A

Stimulate hypothalamus to secrete hormones to increase food intake

Fasting and hypoglycemia stimulate, short term factor released before an expected meal

Inhibited by food intake, hyperglycemia, obesity

Bariatric surgery reduces ghrelin secretion

Secreted by parietal cells in stomach

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19
Q

Protein tyrosine tyrosine

PYY

A

Made in ileum and colon

Suppress appetite and lower food intake

Slow passage of nutrients through gut

Short term factor, goes to hypothalamus

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20
Q

Orexin

A

Made in lateral hypothalamus

Stimulate appetite and increase food consumption, promote wakefulness, suppress REM sleep

Dysfunction of Orexin system: narcolepsy, daytime sleepiness and loss of muscle tone when strong emotions

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21
Q

Leptin

A

Reduce food intake, increase energy expenditure

Made by adipocytes for hypothalamus

22
Q

Sleep and obesity

A

Less sleep increases risk for obesity

Sleep depravation downregulates leptin and upregulates ghrelin

Light from eye transmitted to the suprachiasmatic nuclei (central circadian clock)

SCN affects peripheral clocks of adipose tissue, the liver, and muscle via autonomic innervation and hormones

Feeding regimens affect either central clock of SCN or peripheral clocks like liver

23
Q

Which of the macronutrient has the highest satiety index?

A

Protein then carbs and fat is the lowest

24
Q

How exercise help decrease risk for obesity

A

Increases lean muscle mass, which increases the BMR and energy expenditure

25
Q

Dietary Recommendations for Good Health

A

Unprocessed foods rich in fruits and veggies and whole grains

Restrict animal fats and trans fat from processed foods, limit refined starches

Fat in the form of monosaturatd and polyunsaturated oils

26
Q

Fad Diets

A

Atkins: very low carb, rapid short term but not long term, health risks like increased saturated fats and ketosis

South Beach: high fiber, low glycemic carbs, unsaturated fats, lean meat, starts with low carb then gradually increase food carbs while decreasing fats/proteins

Mediterranean: plants, healthy oils, lean meat, high in fat but are mono and polyunsaturated fats

Paleolithic:
Includes- veggies, fruits, nuts, roots, and fish
Excludes- dairy, grains, legumes, processed oils, salt and sugar

27
Q

Only drug approved by FDA for long term treatment of obesity

A

Orlistat

28
Q

Surgery for obesity

A
  1. Gastric banding: inflatable band on top of stomach increases fullness and restricts flow, reversible
  2. Gastric Bypass: separate stomach into 2 compartments and connect both to SI, reduces stomach volume and increases fullness, alter hormone levels like reduced ghrelin, long term weight loss
  3. Liposuction: regain weight, cosmetic

Bariatric surgery: banding and bypass, for morbidly obese

29
Q

Malnutrition

A

A disease

  1. Primary: insufficient or imbalanced diet, give better food
  2. Secondary: defective assimilation or utilization of nutrients, need mess or surgery
30
Q

Recommended Dietary Allowances

A

Values for people based on sex and age

Covers nutritional requirements for 97.5% of people in that group

To prevent nutrient deficiency

31
Q

Dietary Reference Intakes

A

Estimated Average Requirements: nutrient intake that meets the needs for the 50th percentile of an age/sex group, RDA come from this

Adequate Intake: amount that seems to sustain good health, not enough scientific data to put into RDA, somewhere between RDA and TUL

Tolerable Upper Limit: highest level of a nutrient that poses no risk to 98% of a pop.

Prevent nutrient deficiency and reduce risk of chronic diseases

32
Q

MyPlate

A

Reminds Americans about healthier choices, provides tools for leaders to promote healthy lifestyles

Super Tracker: helps you plan, analyze, and track your diet and physical activity while setting goals and having coaching

Avoid oversized portions, half of plate should be veggies and fruits, switch to 1% milk, choose low salt, drink water instead of pop

Remind to eat healthier, not to change consumer behavior alone

33
Q

Healthy Eating Plate

A

Made by people at Harvard

Potato not a vegetable
Drink water, coffee, or tea and limit milk
Doesn’t set limit on fats but say choose healthier oils

Stress whole grains

Not put limit on calories, just give proportion of plate since age, sex, and activity determine calories

34
Q

Indications of blood draws

A

Indications-
1. Amount of cells: playlets, RBCs, WBCs, Heme

  1. Chemistry levels: electrolytes, glucose, enzymes
  2. Drug levels: digoxin, antibiotics, street drugs
  3. Infection: fungi, bacteria, and viruses
35
Q

Complications of a blood draw

A

Only if done incorrectly

  1. Hematomas and bruising: needle partially inserted in vein or through or if tourniquet on for more than a minute, make sure to remove tourniquet as last specimen tube is filling and remove last specimen tube from vacutainer
  2. Infection: do circular motion with alcohol and let dry naturally, glove before sticking, don’t let needle touch anything else
  3. Pain: don’t make tourniquet too tight, do z technique, don’t move needle around once in person
  4. Arterial Puncture: palpate and trace path of vein, stop immediately if hit artery (bright red blood and hematoma, apply pressure for 5 mins) or nerve (say shooting electric pain) and report
36
Q

Contraindications of a blood draw

A

Don’t do anything if have pink armband

Side affected by stroke has lower blood circulation
Side affected by mastectomy has higher infection risk since less lymph nodes

Super Vena Cava syndrome, deep vein thrombosis, side of burn/scar/graft, side of AV fistula, with IV or peripheral device

37
Q

Tourniquet protocol

A

Have one flap that can be loosened quickly

On for less than a min to not cause hematoma or have IF leak, creates erroneously high value

Put halfway between shoulder and elbow, elbow should be straightened (make fist if necessary)

38
Q

Needles for a blood draw

A

Direct draw:
Antecubital area only, 21 gauge

Butterfly needle:
Use anywhere, 23 gauge

39
Q

Choosing a vein for a blood draw

A

Median antecubital or cephalic

Lower arm and hand veins are smaller, less straight, and roll

Ask doc before use foot vein since less circulation and increased infection risk

No back of wrist cuz nerves

40
Q

Blood Draw Procedure

A

Attach needle to vacutainer holder and then rest first specimen tube in vacutainer, don’t puncture rubber stopper

Stretch skin 1” below site

Go at 15-30° with bevel up

Last 3 steps:
1. Release tourniquet as last specimen tube is filling

  1. Remove last specimen tube after it is full, put on cotton ball but don’t apply pressure
  2. Retract needle and use safety device, apply pressure, ask if bandaid or gauze, gently invert specimen 8-10 times

At end label specimen tubes: full name, ID number, collection date and time, your initials

Document patient’s tolerance in objective manner

41
Q

Thiamin (B1)

A

Use TPP (the pyrophosphate form) for decarboxylation reactions like PDH and alpha-ketoglutamate dehydrogenase, also for sugar conversion in the PPP

Deficiency: mainly affects nervous cells, problem for white rice eaters

Beriberi:anorexia, muscle weakness, peripheral paralysis, edema (more severe B1 form)

Wernicke-Korsakoff Syndrome: mental confusion, ataxia, opthalmoplegia (chronic alcoholics, moderate form of B1)

Enriched in foods like grains/flour

Heat, raw fish, tannins in tea/coffee destroy thiamin

42
Q

Riboflavin (B2)

A

Converted into FMN and FAD, forms flavoenzymes for metabolism of carbs/FAs

Deficiency: pathology of skin and mucous membrane

Dermatitis, glossitis (tounge), cheilosis (lips)

Milk, grain, meat, poultry, fish
Destroyed by light so milk in cloudy plastic jug

43
Q

Niacin (B3)

A

Synthesized from Trp, found in NAD and NADP

Deficiency-
Hartnup Disease: recessive disorder that affects absorption of no polar AAs like Trp

Isoniazid antibiotic: when used long term for treat TB

Pellagra: dermatitis, diarrhea, dementia

Common in corn, beef, milk, eggs

44
Q

Pantothenate (B5)

A

Component of CoA, acetylation reactions

Deficiency is unlikely, possible neuromotor disorders

Whole grains, liver, kidney, egg, yolk

45
Q

Pyridoxine (B6)

A

Pyridoxal (PL) and Pyridoxamine (PM) and their phosphorylated forms, used in transamination reactions of AA metabolism

Without B6 all AAs become essential

Uptake involves dephosphorylation then passive diffusion

Deficiency:
Microcytic hypochromic anemia from inadequate heme production, itchy rashes, cheilosis and glossitis

Uncommon risks from deficiency: renal disease, autoimmune, alcohol dependence

Toxicity: from supplements and reversible, nerve damage to arms and legs, sensitivity to sun

Meat, fish, fruits, grains, veggies

46
Q

Biotin (B7)

A

Used in carboxylation reactions like pyruvate carboxylase

Deficiency: rare but in pregnant women, alcoholics, elderly, long term antibiotics

Avidin from raw eggs

Dry skin and dermatitis

Liver, milk, egg yolk, intestinal bacteria

47
Q

Folate (B9)

A

Tetrahydrofolate (THF) does single carbon transfers for AA and nucleic acid synthesis

Deficiency: pregnant women for fetal development, elderly, alcoholics, infants if get goat milk

Megaloblastic anemia: diminished nucleus acids so cells can’t make DNA to divide

Fatigue, tongue lesions, spina bifida

Spinach, fortified in cereal grains, liver, whole grains

48
Q

Cobalamin (B12)

A

Corrine ring with ribose, phosphate, and base attached, has cobalt ion in the ring

Synthesize active folate and for folate metabolism like homocysteine to methionine reaction, converts methylmalonyl CoA to succinyl CoA

Taken up by intrinsic factor in the terminal ileum

Deficiency: elderly or vegan

Megaloblastic anemia (large, abnormal immature RBCs), pernicious anemia (lack intrinsic factor), nerve damage (needle feel in limbs)

Intestinal bacteria and only animal products, NOT plants but some cereals are fortified

49
Q

Vitamin C

A

Humans and few other mammals can’t make from glucose

Main water soluble antioxidant, used by neutrophils against ROS and RNS, regenerates glutathione and Vitamin E

For hydroxylation reactions, keeps Cu or are in reduced state

Hormone and AA biosynthesis, carnitine biosynthesis

Collagen hydroxylation (hydroxylysine and hydroxyproline)

Deficiency: scurvy causes small blood vessels to rupture, bones to weaken, joints to swell

Citrus fruits, potato skins, fruits, veggies

50
Q

Zinc

A

Essential for enzyme function and transcription factors

Babies often deficient, not common in complementary foods after weaning, many child deaths

Deficiency: poor growth, skin lesions, hair loss

51
Q

Selenium

A

Incorporate selenocysteine and selenomethionine into slenoproteins like glutathione/thioredoxin reductase and thyroid hormone deiodinase

Deficiency: cause illness and predispose to other if stress

Keshan: cardiomyopathy triggered by stress like infection or chemical exposure

Toxicity:
Selenosis: high levels of Se lead to GI upsets, hair loss, bad breath, fatigue, mild nerve damage

Major sources from plants cuz in soil, nuts, seafood, meats

Foundations 1 (19 decks)

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