Block 3 Flashcards
(237 cards)
1
Q
Nicotine metabolism occurs where?
A
80% in liver via CYP2A6
20% in lungs and kidneys
2
Q
Nicotine inactive metabolite is…?
A
Cotinine
3
Q
Nicotine withdrawal Sx kick in when?
A
Appear in 1-2 days
Peak in 1 week
Subside in 2-4 weeks
4
Q
How do you assess addiction level for nicotine?
A
Based on # of cigs/day
Heavy ≥ 25
Moderate 11-24
Light 1-10
5
Q
What is the Fagerstrom Test?
A
Assess nicotine dependence
Assess possibility of severe withdrawal
6
Q
When do you use the Transtheoretical model? What are the parts to it?
A
To assess readiness to quit smoking
Precontemplation (no plan within 6 months)
Contemplation (thinking of change within 6 months, no plan)
Preparation (plan to change within 30 days w/ plan)
Action (has changed but less than 6 months)
Maintenance (has changed but greater than 6 months)
Termination (no temptation + change will be maintained)
7
Q
In the “assist” section of smoking cessation, what is STAR?
A
Set a quit date preferable within 2 wks
Tell a family member, friend, etc
Anticipate challenges like withdrawal
Remove tobacco products/paraphernalia
8
Q
In the “arrange” sectio of smoking cessation, when should you follow-up with patients?
A
Within 1 week of quit date
Second contact should be within 1 month
9
Q
Nicotine MOA?
A
Stimulates the nicotine receptors in the ventral tegmental area of the brain, leading to the dopamine release
10
Q
When is it contraindicated to use nicotine replacement therapy?
A
If they had any cardiovascular events in the past 2 wks
11
Q
When should you start using nicotine replacement therapy products?
A
Start on the quit date
12
Q
Dose and administration of nicotine patches are based on what criteria?
A
3 steps = more than 10cigs/day
2 steps = less than 10cigs/day
13
Q
How long do you use the nicotine patches?
A
3 steps = step 1 for 6 wks, step 2 for 2 wks, step 3 for 2wks
2 steps = step 2 for 6 wks, step 3 for 2 wks
14
Q
AE of nicotine patches?
A
Vivid dreams, insomnia
15
Q
Patient education points for nicotine patches?
A
Apply on hairless area between neck and waist, rotate areas
Dont apply after lotion use
If you experience sleep disruptions while using the patches, remove them at night
16
Q
Dose and administration of nicotine gum are based on what criteria?
A
2mg if you smoke your first cigarette greater than 30 min after waking
4mg if you smoke your first cigarette within 30min of waking
***lozenges follow the same schedule
17
Q
How long do you use the nicotine gum?
A
Initially, follow this schedule:
1 piece every 1-2 hours for 6 weeks.
Then every 2-4 hours for 2 weeks.
Then every 5-8 hours for 2 weeks.
PRN afterwards
***lozenges do NOT follow this schedule
18
Q
Nicotine gum AE?
A
Mouth soreness and dyspepsia
19
Q
Patient education points for nicotine gum?
A
Do not eat or drink 15 min before and while gum is in mouth
“Chew and park” method
Chew each piece for 30 min.
20
Q
How long do you use the nicotine lozenges?
A
Use 1 lozenge every 1-2 hours (at least 9; maximum 20) for 6 weeks.
Then every 2-4 hours for 2 weeks.
Then every 4-8 hours for 2 weeks.
PRN afterwards
21
Q
Nicotine lozenge AE?
A
Throat irritation, hiccups, indigestion/heartburn, nausea
22
Q
Patient education points for nicotine lozenges?
A
Do not eat or drink 15 min before and while lozenge is in mouth
Move lozenge from side to side while dissolving in mouth; do not chew
23
Q
Dose and administration of Nicotine Inhaler (Nicotrol)?
A
1 cartridge = 80 puffs = 4 mg of nicotine
Use 6-16 cartridges a day; can put away partially used cartridge and reuse when needed
up to 6 months :O
24
Q
Patient education points for nicotine Inhaler (Nicotrol)?
A
Use like smoking a cigarette
Decreased delivery if below 40 degrees Fahrenheit; keep in warm area or coat pocket
25
Dose and administration of Nicotine Nasal Spray (Nicotrol)?
0.5 mg/spray; 1 spray in each nostril; 1 mg per dose
1-2 doses/hour for 6-8 weeks (at least 8 doses/day); gradually decrease over 4-6 weeks
Typically 8-40 doses/day; maximum 5 doses/hour or 40 doses/day
for 3-6 months :o
26
What are some safety concerns with using nicotine Nasal Spray (Nicotrol)?
Avoid use in severe airway disease
27
Patient education points for nicotine Nasal Spray (Nicotrol)?
Tilt head slightly back; do not sniff, inhale through nose, or swallow while spraying
28
Varenicline (Chantix) MOA?
Binds to neuronal nicotinic acetylcholine receptors (alpha-4-beta-2 subtype) as a partial agonist
29
What agonist and antagonist effects does varenicline have?
Agonist activity: produces weak nicotine-like effect which reduces craving
Antagonist activity: inhibits the pleasurable effect derived from smoking
30
Varenicline (Chantix) dosing?
Dosing for up to 3 months
Take 0.5 mg PO daily for 3 days
Then take 0.5 mg PO BID for 4 days
Then take 1 mg PO BID starting on desired quit date
31
Varenicline AE?
Seizure risk
Increased effects of alcohol
32
Patient education points for Varenicline (Chantix)?
May need dose reduction in CKD
Take evening dose with dinner instead of bedtime, if patient experiences insomnia
Take with food to avoid nausea
Report mood changes
Patients may experience impaired ability to drive or operate machinery
33
Bupropion SR (Zyban) MOA?
Blocks dopamine and/or norepinephrine reuptake in the CNS
34
Bupropion SR (Zyban) dosing?
Dosing for 7-12 weeks; maintenance for up to 6 months
Start 1-2 weeks before desired quit date
Take 150 mg PO every morning for 3 days
Then take 150 mg PO BID
35
Bupropion SR (Zyban) AE?
Neuropsychiatric changes
Dose-related seizure risk
Increased blood pressure
36
Bupropion SR (Zyban) contraindications?
History of seizure disorder
History of eating disorder (anorexia nervosa, bulimia nervosa)
Use of MAOI in the past 14 days
```
Abrupt discontinuation of substances that could result in seizures
Alcohol
Benzodiazepines
Barbituates
Antiepileptic drugs
```
37
Patient education points for Bupropion SR (Zyban)?
Take evening dose with dinner instead of bedtime if insomnia occurs
38
Clonidine MOA?
Alpha-2-adrenergic receptor antagonist with decreases central sympathetic activity
39
Clonidine dosing?
0. 125-0.75 mg PO daily
| 0. 1-0.3 mg transdermally daily
40
Nortriptyline MOA?
Tricyclic antidepressant which blocks the serotonin transporter and norepinephrine transporter which results in increased concentrations
41
Nortriptyline dosing?
75-100 mg PO daily
42
Are Electronic Nicotine Delivery Systems (ENDS) more beneficial than regular cigs?
There is insufficient evidence
Pros: fewer toxins
Cons: increased heart issues, lung disease, anxiety
43
How many cessation meetings should you have with your patients?
At least 4
Cessation rates are improved by more sessions or longer duration
44
What vaccinations should smokers get?
One-time PPSV23 vaccine recommended for all those smoke ≥19 years of age
Yearly influenza vaccine
45
What are some non-pharm stuff you can do to help smokers quit?
Call 1-800-QUITNOW
Massages, acupuncture are not supported!!
Cold turkey
46
Which combo therapy for smoking cessation has the highest 6-Month Abstinence Rate?
Patch and varenicline - 65.1%
47
What are the airflow limitation GOLD classifications for COPD?
GOLD 1 = FEV1 ≥80 (mild)
2 = FEV1 50-80 (moderate)
3 = FEV1 30-50 (severe)
4 = FEV1 <30 (very severe)
**all patients have FEV1/FVC <0.7
48
What are the non-pharmacological essential, recommended, and shots to be given in someone classified as group A GOLD?
Essential = smoking cessation***
Recommend = physical activity
Shots = Flu and pneumococcal vaccines
***B-D = need addition of pulmonary rehab
49
What is the COPD pharm regimen for group A GOLD?
Bronchodilator
50
What is the COPD pharm regimen for group B GOLD?
Long-acting bronchodilator
| LAMA or LABA
51
What is the COPD pharm regimen for group C GOLD?
LAMA only
52
What is the COPD pharm regimen for group D GOLD?
LAMA
LAMA + LABA (usually CAT>20)
ICS + LABA (eos≥300)
53
If someone was on a LABA or LAMA and their issues were exacerbated, what is the next regimen?
LABA AND LAMA
or
LABA AND ICS if eos≥300 or eos≥100 with 2 moderate exacerbations or 1 hospitalization
54
If someone was on a LABA and ICS and their issues were exacerbated, what is the next regimen?
LABA + LAMA + ICS
If they de-escalate, remove ICS
55
If someone was on a LABA and LAMA AND ICS and their issues were exacerbated, what is the next regimen?
Azithromycin (if a smoker)
or
Roflumilast
56
With COPD treatment, if ICS is added, when should ICS be removed?
If no benefits from ICS
Pneumonia
Inappropriate original indication
57
If someone was on a LABA and LAMA and their issues were exacerbated, what is the next regimen?
Depends on eos level
>100 = LABA + LAMA + ICS
<100 = Azithromycin (if a smoker)
or
Roflumilast
58
If someone had dyspnea while using either LABA or LAMA, whats next on the regimen?
LABA AND LAMA
59
If someone had dyspnea while using either LABA + ICS, whats next on the regimen?
LABA + LAMA + ICS
60
"Dose increases do not result in increasing benefit"
Is this statement true for COPD?
Yes
61
Onset of action of albuterol and ipratropium?
Albuterol - 5 min
Ipratropium - 15 min
62
Duration of action of albuterol and ipratropium?
Albuterol - <4hrs
Ipratropium - 6 hrs (MDI) or 8 hrs (neb)
63
Albuterol AE?
Tachycardia, tremors, hypokalemia
64
Ipratropium AE?
Dry mouth, urinary retention, increased ocular pressure
65
What are the LAMAs for COPD?
TAUG
Tiotropium
Aclidinium
Umeclidinium
Glycopyrrolate
66
LAMA MOA?
M1 and M3 receptor blockage
Longer duration vs LABA
Reduces exacerbation
67
LAMA AE?
Nasopharyngitis
Dry mouth
Tachycardia
68
LAMA + LABA, what is one advantage LAMA alone can do?
The combo regimen has not showed that it will consistently reduce exacerbation
69
Can you use ICS alone in COPD?
Nope
70
What can we learn about the WISDOM trial for COPD?
Take away ICS once patient is stable, their lung function is worse when on ICS
71
What can we learn about the TORCH trial for COPD?
Putting them on ICS may increase their chances of pneumonia
72
What can we learn about the FLAME trial for COPD?
If on ICS, they have an increased chance of exacerbations and pneumonia, AE and death stayed the same
73
What can we learn about the FULFIL trial for COPD
Benefits of triple therapy
74
If 1 exacerbation per year the threshold for benefit is _______ eosinophil count/mcL
>300
75
If ≥2 exacerbations per year the threshold for benefit is _______ eosinophil count/mcL
>100
76
What is the triple therapy product called?
Trelegy Ellipta (fluticasone/umeclidinium/vilanterol)
77
Roflumilast MOA and dose?
Phosphodiesterase-4 inhibitor
500mcg PO daily
78
Benefits of Roflumilast?
Reduce inflammation by inhibiting breakdown of cyclic AMP
No bronchodilator activity
Add-on therapy for group D patients
79
Roflumilast CI?
Contraindicated in moderate to severe hepatic impairment (Child-Pugh Class B or C)
80
Which antibiotics could you take for COPD? Doses?
Azithromycin 250mg daily or 500mg three times a week
Erythromycin 500mg BID
81
Antibiotic role in COPD?
When taken for a year may reduce risk of exacerbations compared to usual care
Increases risk of bacterial resistance
No data past 1 year
82
Could you use methylxanthines for COPD?
You could, but not recommended
If pt is stable on Theophylline, take it away
83
When are mucolytics used in COPD?
End stage
N-acetylcysteine (inhaled)
84
What are the Alpha-1 antitrypsin (AAT) therapy options?
Glassia, Aralast, Prolastin, Zemaira; 60mg/kg weekly
Biologic from pooled donors
Cost $54,000/yr
Use: Augmentation in deficient patients
85
Should you step up doses for COPD like asthma?
Nope, use lowest ICS dose
86
What is the goal SaO2?
>92%
It goes down during exacerbations!
87
Possible long-term at home therapy in patients with severe resting hypoxemia can qualify how?
SaO2 < 88 confirmed twice in 3 weeks
SaO2 < 88 AND pulmonary HTN, CHF, or polycythemia (Hct>55)
88
When should you never use ICS for COPD?
Repeated pneumonia events
Eosinophil <100
History of mycobacterial infections
89
When is routine monitoring for COPD?
Spirometry yearly
Assessment test (CAT) every 2-3 months
Symptom assessment every visit
90
What is used to treat COPD exacerbation?
Mild - SABA or SAAC
Moderate - Abx and/or OCS
Severe - hospitalization
91
When treating COPD exacerbation, what is the OCS dose?
Prednisone 40mg for 5-7days
92
What are the cardinal symptoms of COPD?
Increased sputum production
Increased sputum purulence
Increased SOB
93
How do you qualify for Abx to treat COPD exacerbation?
Have all 3 cardinal symptoms
or
2 of the 3 if purulent
or
Mechanically ventilated at ICU
94
COPD Exacerbation Discharge Criteria, what is it?
Able to use long-acting medications
SABA required no more frequently than Q4H
Can walk across room if previously ambulatory
Clinically stable and ABGs stable for 12-24 hours
Can eat and sleep without dyspnea
Follow-up arrangements made
95
What are the main mechanisms of drug-induced pulmonary disease?
1. Direct cytotoxic effect
2. Oxidant injury (constant use of nitrofurantoin, APAP)
3. Deposition of phospholipids within cells (amiodarone, amphophilic rx)
4. Systemic lupus erythematosus (SLE) (Hydralazine, Phenytoin, etc)
5. Bronchospasm (ASA, BB)
96
How do you treat acute pulmonary eosinophilia caused by nitrofurantoin? Chronic?
Acute - Stop rx and supportive care
Chronic - stop rx and give corticosteroids
97
What drugs cause drug-induced SLE?
HIPPP
Hydralazine
Isoniazid
Phenytoin
Procainamide
Penicillamine
98
How do you treat drug-induced SLE?
Stop medication
Corticosteroids
99
What rx can cause Drug-Induced Pulmonary Fibrosis?
Chemo
Radiation
Oxygen (100% for 6-48hrs)
Methotrexate, Amiodarone
100
What rx causes respiratory depression? How do you treat it?
Opioids
Benzos/barbituates
Neuromuscular blockers
Aminoglycosides
Tx = stop medication or use lowest possible doses
101
How does tylenol cause drug-induced asthma?
Reduction of glutathione-impaired respiratory antioxidant defenses
NSAIDs can also cause it too
102
What rx can cause drug-induced bronchospasm?
ASA
Cox inhibition prevents generation of prostaglandins
Highest chance in those with triad of asthma, rhinitis, nasal polyposis
Tx = d/c ASA, leukotriene modifiers, desensitization
103
BB use and Asthma/COPD
Asthma - use BB selective ones (atenolol, bisoprolol, metoprolol, acebutolol)
COPD - use whatever
**asthma patients could use some non selective BB with ISA or alpha blocking such as carvedilol, labetalol, nadolol, propranolol
104
Which patients are at high risk of malnutrition?
Underweight (< 80% ideal body weight)
Overweight (>120% ideal body weight)
Recent unintentional weight loss of > 10% body weight
Substance abusers
Increased needs (e.g., sepsis, burns)
No oral intake for > 7-10 days
Pharmacologically induced problems (e.g., diuretics, laxatives)
105
IBW calculations?
Males: 50 kg + (2.3 x inches over 5 feet)
Females: 45.5 kg + (2.3 x inches over 5 feet)
106
ABW calculations?
IBW + 0.4 (ABW – IBW)
107
What is considered the "normal" weight?
90-120% of IBW
108
BMI classifications?
Underweight < 18.5
Normal 18.5-24.9
Overweight 25-29.9
Obese
Class I 30-34.9
Class II 35-39.9
Class III ≥40
109
At what waist circumference has an increased risk for obesity-related complications?
Men ≥40 inches
Women ≥35
110
When do you expect albumin levels to decrease?
Overhydration
Increased in dehydration
111
When do you expect transferrin levels to increase?
Blood loss, iron deficiency
Decreased in infection, burns
112
When do you expect prealbumin levels to increase?
Kidney dysfunction
Decreased also in kidney dysfunction, inflammation
113
What are the normal values of albumin, transferrin, and prealbumin?
Albumin = 18-20
Transferrin = 8-9
Prealbumin = 2-3
114
What is the independent predictor of obesity-related complications?
Waist circumference + BMI
115
What is the independent risk factor for adverse health outcomes?
Waist-to-hip and waist-to-height ratios
>0.9 ratio in men
>0.85 ratio in women
116
What is the Mifflin-St. Jeor Equation?
Male: (10 x weight in kg) + (6.25 x height in cm) – (5 x years in age) + 5
Female: (10 x weight in kg) + (6.25 x height in cm) – (5 x years in age) – 161
117
What multipliers do you use in the Mifflin-St. Jeor Equation?
Sedentary 1.2
Lightly active 1.3 (1-3/wk)
Moderately active 1.5 (3-5/wk)
Very active 1.7 (6-7/wk)
Extremely active 1.9 (2/day)
118
1 pound body weight = ____ calories
3500
119
In terms of carbs, proteins, and fats, what % should you aim for?
55% carbs
15% proteins
30% fats
120
How does sodium affect the RAAS system?
Increase in blood volume, cardiac output, arterial pressure and leads to increased blood pressure of the patient
121
HTN and diet/lifestyle, what should be in it?
Try to reduce salt by >1g/day
Do not exceed 2.4g salt/day
Limit sugar
Add veggies, fruits, and whole grains
Incorporate DASH
Increase potassium intake to 4.7g/day
Maintain BMI<25
Exercise 3-4 sessions/week
Average 40 min/session
Moderate-to-vigorous intensity
122
HF and diet/lifestyle, what should be in it?
<2g salt/day
≤1.5-2L of fluids/day
123
When is emergency care needed in HF and weight gain?
Weight gain of 2-3 lbs in 24 hours
Weight gain of 5 lbs in one week
New or worsened s/sx of HF
124
Dyslipidemia and diet/lifestyle, what should be in it?
Pretty much the same as HTN diet
Avoid saturated (replace w/ MONOunsaturated) and trans fat
125
What are the supplements with more robust evidence on lipid-lowering effects?
Niacin
Red yeast rice
Omega-3 fatty acids
Pantethine
126
What is the USDA MyPlate Method?
5 portions divided amongst 1 cup and 4 sides on a 9in plate
Grains, proteins, fruits, veggies, + dairy (1% or low-fat)
127
What is the exchange list meal planning?
Foods that are alike in carbohydrates (CHO), protein, fat, and calories
Creates a variety for people
128
What is carb. counting?
Males: 4-5 CHO choices per meal; 1-2 CHO choices per snack
Females: 3-4 CHO choices per meal; 1-2 CHO choices per snack
Glycemic index can be used to fine tune it
129
What is glycemic index?
Measurement and ranking of how CHO-containing foods affect BG levels
Says nothing about the amount of CHO!
130
What affects glycemic index?
Higher fat? Lower GI
More ripe fruit? Higher GI
More processed? Higher GI
Longer cook time? Higher GI
131
Per the Institute of Medicine, do not exceed ____ of total daily calories for sweeteners
>25
132
Whats some info to know about artificial sweetners?
Sweetens foods without promoting tooth decay or weight gain
No evidence in sustaining long-term weight loss
133
(T/F)
Routine supplementation not advised in diabetics without underlying deficiencies
True
134
Alcohol and BG?
Drink a lot? Increase BG
135
Which rx for diabetes should be taken with food or before food?
Before food = sulfonylureas
With food = insulin, GLP-1 agonists, metformin, and alpha-glucosidase inhibitor
136
What is the rule of 15 for hypoglycemia?
Check your BG if symptomatic
Eat 15 g CHO if BG ≤ 70 mg/dL
Wait 15 minutes and recheck BG
Eat another 15 g CHO if BG remains ≤ 70 mg/dL and next meal is > 1 hour away
137
What are examples of 15g of CHO?
```
Glucose tabs (see instructions)
4 ounces or ½ cup of juice
4 ounces or ½ cup of regular soda
1 tbsp honey or corn syrup
2 tbsp of raisins
Chew or crush hard candies
```
138
Diet and sick days?
3-4 CHO servings should be consumed every 3-4 hours
If solid foods are not tolerated, consume liquid or soft CHO-containing foods
Consume ample amounts of liquid every hour
If nausea/vomiting, take small sips every 15-30 minutes
Monitor BG and urine ketones at least 4x/day
139
What is complementary medicine?
When ‘Alternative’ or ‘Traditional’
practice is combined with Standard Medical Care
Complementary medicine includes natural products
and other practices such as massage, meditation,
homeopathy, etc.
140
Who regulates supplements?
```
Dietary Supplement Health and Education Act
of 1994 (DSHEA)
```
141
What can or cannot the supplement labels have?
Label cannot claim to treat/cure a disease but can promote better xyz
Disclaimer that the information on the label has
not been reviewed by the FDA
142
What does the USP seal tell you?
The ingredient amounts listed on the label are
correct
Not if they are safe, effective, or that the product is better than others without the seal
143
What are the main issues with supplements?
1. False sense of Safety
2. False sense of Efficacy
3. False sense of High Quality
4. Drug-supplement interactions
144
Who should avoid St. John's Wort?
Pretty much everyone, in can last in your body for weeks
It induces most CYP enzymes
If they are taking it for depression, ask them to go to the doctor for real rx
Mostly PK interactions (Induction or suppression of metabolizing enzymes and drug transporters; Solution = adjust dose)
145
Issues with Gingko?
Decreases platelet aggregation
Messes with insulin
Neurotoxicity due to seeds
Induces CYP3A4 and 2C19/2C9
Also interacts w/ St. John's Wort
Ppl use it for dementia, headaches, memory, etc
Mostly PD interactions (Enhance or combat drug action; Solution = remove drug or supplement
146
What are some examples of altered GI pH that affect rx absorption?
Increased gastric pH:
decreases azole concentration
dissolves enteric coated products in stomach
increases absorption of benadryl
147
What are some examples of altered GI/urinary pH that affect rx excretion?
Alkaline urine increases excretion of aspirin (weak acid)
Acidic urine will excrete amphetamines (weak base)
Lithium competes w/ sodium for reabsorption
148
Inducers and inhibitors of CYP3A4?
Inducer - St. John's wort + Echinacea (liver)
Inhibitor - grapefruit and certain orange juices, echinacea (intestines), peppermint oil, and piperine
149
How can P-gp be altered by food-drug interactions?
P-gb = efflux transporter
Stimulated by CHRONIC use of St. John's wort
Inhibited by by ACUTE use of St. John's wort, piperine, and milk thistle
150
How does a protein diet affect enzymes?
High protein diet = stimulates CYP450 enzymes
151
Which foods should be taken on an empty stomach due to it binding to fiber?
Digoxin + APAP
152
Which foods should be taken on an empty stomach because it will have increased absorption?
Abx and anti-HTN
153
Which foods should be taken with food to increase absorption with high fat meals?
Theophylline and Griseofulvin
154
Because statins deplete CoQ10, what other classes of drugs might this interfere with?
Thiazides, BB, older psychotropic drugs
155
What nutrients do valproic acid deplete?
Carnitine, Folate, Biotin
156
What nutrients do phenytoin deplete?
Folate, Biotin, Vit. D + K, Thiamine
157
What nutrients do thiazides deplete?
Folate and as a result, homocysteine is increased
158
What nutrients do loop diuretics deplete?
Electrolytes and B vitamins
159
What nutrients do cephalosporins deplete?
Gut flora, Vit. K
160
What nutrients do corticosteroids deplete?
Calcium and magnesium (bone loss)
161
What nutrients do 5-ASA (mesalamine) deplete?
Folate and as a result, homocysteine is increased
162
What are the antithrombotic interactions to look out for?
Aspirin + Vit. E = decreased platelet aggregation = increases risk for bleed
Herbal coumarins + Vit. K increase INR = increases risk for bleed
Fish oil may inhibit platelet aggregation (no evidence of increased bleed risk)
163
What is the largest determinant of energy expenditure in the body?
Metabolic rate
164
What does neuropeptide Y, alpha-melanocyte-stimulating hormone, orexin, and ghrelin do?
Neuropeptide Y - stimulates eating
alpha-melanocyte stimulating hormone - inhibits eating
Orexin - stimulates food intake
Ghrelin - stimulates appetite
165
What Rx will cause weight gain?
Corticosteroids
Antihistamines
Estrogen
Insulins
Anti-psych
Antidepressants
Anticonvulsants
Alpha-adrenergic blockers
BB (just propranolol)
166
What conditions will cause weight gain?
CHF, cushings
Hypothyroidism
PCOS, Prader-Willi syndrome
167
What are the main guidelines to use for weight loss?
BMI centric (goal to lose weight) = AHA/ACC/TOS
Complication centric
168
Using the BMI centric guidelines, if patient is ready to lose weight, what is the goal of weight loss?
≥5%
Add pharm. if BMI≥30 or ≥27 with comorbidity
Surgery if BMI≥40 or ≥35 with comorbidity
169
How much exercise should one get for weight loss?
≥150min/week
170
Phendimetrazine MOA?
Sympathomimetic amine that acts in CNS to reduce appetite
171
Phendimetrazine duration and CI?
Duration: 12 weeks
CI: MAOI use within 14 days, glaucoma, hyperthyroidism
172
Phendimetrazine AE?
CNS depression, heart issues
173
Phentermine MOA?
Decreases appetite by increasing norepi and dopamine release
174
Phentermine duration and CI?
Duration: 12 weeks
CI: MAOI use within 14 days, glaucoma, pregnancy, heart issues,
175
Phentermine AE?
Heart issues
176
Diethylpropion MOA?
Decreases appetite by increasing norepi and dopamine release
177
Diethylpropion duration and CI?
Duration: 12 weeks
CI: MAOI use within 14 days, glaucoma, hyperthyroidism
178
Diethylpropion AE?
Dry mouth, constipation, insomnia
179
Orlistat MOA?
Gastric and pancreatic lipase inhibitor; reduces absorption of dietary fat
Give multivitamins, but separte admin time
180
Orlistat duration and CI?
Long term use
CI: Pregnancy, malabsorption syndrome, cholestasis
181
Orlistat AE?
GI effects
182
Liraglutide MOA?
GLP-1 Receptor agonist
Increases glucose-dependent insulin secretion, decreases glucagon
183
Liraglutide duration and CI?
Long term use
CI: History of MTC, MEN 2, pregnancy
184
Liraglutide AE?
N/V/D, pancreatitis
185
Belviq MOA?
Activates serotonin 2C receptors in hypothalamus
Dont give in renal impairment
186
Belviq duration and CI?
Long term.
Stop if <5% weight loss at 12 weeks though
CI: MAOI use within 14 days, pregnancy, heart issues, depression
187
Belviq AE?
General stuff, dry mouth
188
Qsymia MOA?
Phentermine + topiramate (blocks sodium channels and increases GABA)
Part of REMS program
189
Qsymia duration and CI?
Long term use
CI: MAOI use within 14 days, glaucoma, pregnancy, hyperthyroidism, depression
190
Qsymia AE?
Parasthesia
191
Contrave MOA?
Acts on hypothalamus and mesolimbic circuit
192
Contrave duration and CI?
Long term use
CI: Chronic opioid use, MAOI use within 14 days, pregnancy
193
Contrave AE?
N/V/D, constipation, seizures
194
Which Vit. K is derived from diet?
K1
195
Where do water-soluble vitamins get absorbed?
Blood
196
Fat vs water soluble vitamins
Which one requires protein carriers?
Fat
Water soluble circulates freely in water-filled parts of body
197
Deficiency of Vit. K main causes?
* infants
* chronic small intestine diseases
* malabsorption syndrome
* broad spectrum Abx use
198
Symptoms of Vit. K deficiency?
Unusual or excessive bleed
Liver disease
Low bone density
199
Fat vs water soluble vitamins
Which one has a higher risk of hypervitaminosis?
Fat
Water; only in chronic high doses
200
Fat vs water soluble vitamins
Deficiency occurs when storage is depleted
Fat
Water; develops in weeks to months
201
Where do fat-soluble vitamins get absorbed?
Lymphs first, then blood
202
Which Vit. K is the more active part?
K2; K1 is converted in the gut and periphery
203
Function of K1?
Clotting factors
204
Function of K2?
Forms bone proteins
205
Symptoms of Vit. K toxicity?
Adults : no known symptoms
Infants: jaundice, hemolytic anemia
206
Risk factors of Vit. D deficiency?
Renal disease
Northern latitudes
Dark skin
Smoking
Drugs that alter its metabolism
Air pollution
207
Beta-carotene is converted where?
Gut
208
Deficiency of Vit. A main causes?
Diet
Chronic small intestinal diseases
Liver disease or bile duct obstruction
209
Symptoms of Vit. A deficiency?
Increased infection risk
Change in vision and skin
Mild = asymptomatic
210
Symptoms of Vit. A toxicity?
Acute = blurred vision, bone pain, appetite loss
Chronic = osteoporosis, anemia, weight loss, menstrual irregularities
211
Active form of Vit. D is converted where?
Skin, liver, kidneys
212
Vit. D treats what?
Osteomalacia or Rickets
213
Symptoms of B1 deficiency?
Beriberi + Wernicke's encephalopathy
214
Pt specific factors of Vit. D deficiency?
Renal disease
Northern latitudes
Dark skin
Smoking
215
Symptoms of Vit. D deficiency?
Muscle weakness, bone pain
Cognitive impairment, fatigue
Rickets in kids
Osteomalacia in adults
216
What is an important counseling point for Vit. E?
Has anticoagulant effects
217
Causes of Vit. E deficiency?
Diet or chronic small intestinal diseases
218
Symptoms of Vit. E deficiency?
Muscle weakness, muscle loss
Vision changes
Unsteady gait
Kidney/liver damage
219
Symptoms of Vit. E toxicity?
Blotchy skin, increased bleed risk and TG, less thyroid production
Stroke or even premature death
220
Which vitamin is not found in plants?
Vit. B12 (cobalamin)
221
Symptoms of B2 (riboflavin) deficiency?
Cheilosis, glossitis
222
Symptoms of B3 (niacin) deficiency?
Aggression, isomnia
223
Symptoms of B5 (pantothenic acid) deficiency?
Acne
224
Symptoms of B6 (pyridoxine) deficiency?
Seborrheic dermatitis
225
Symptoms of B7 (biotin) deficiency?
Impaired growth and neurological disorders in infants
226
Symptoms of B9 (folate) deficiency?
Macrocytic anemia
Neural tube defects if pregnant
227
Symptoms of B12 (cobalamin) defiency?
Macrocytic anemia
228
Which Vit. B toxicity masks B12 deficiency?
Vit. B9 (folate)
229
Which Vit. B toxicity is associated with flushing and glucose intolerance?
Vit. B3 (niacin)
230
Symptoms of Vit. C deficiency?
Scurvy
231
Risk factors for Vit. C deficiency?
Diet
Alcoholism
Infants fed by cow's milk
Smokers
232
Symptoms of Vit. C toxicity?
Gout, kidney stones
Decreased copper absorption
233
Which thyroid condition causes calcium deficiency?
Hypoparathyroidism
Hyper causes toxicity
234
Which vitamins should pregnant women take?
Vit. B9 (folate) + Vit. D
235
Which vitamins should vegans take?
Vit. D + Vit. B12 + Calcium + Iodine
236
Which vitamins should alcoholics take?
Vit. B1 (thiamine)
237
What kind of vitamins have a higher risk of toxicity and deficiency?
Toxicity = fat-soluble
Deficiency = water-soluble
