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IPT: GI/Resp > Block 3 > Flashcards

Block 3 Flashcards

1
Q

Nicotine metabolism occurs where?

A

80% in liver via CYP2A6

20% in lungs and kidneys

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2
Q

Nicotine inactive metabolite is…?

A

Cotinine

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3
Q

Nicotine withdrawal Sx kick in when?

A

Appear in 1-2 days

Peak in 1 week

Subside in 2-4 weeks

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4
Q

How do you assess addiction level for nicotine?

A

Based on # of cigs/day

Heavy ≥ 25

Moderate 11-24

Light 1-10

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5
Q

What is the Fagerstrom Test?

A

Assess nicotine dependence

Assess possibility of severe withdrawal

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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)

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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

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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

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9
Q

Nicotine MOA?

A

Stimulates the nicotine receptors in the ventral tegmental area of the brain, leading to the dopamine release

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10
Q

When is it contraindicated to use nicotine replacement therapy?

A

If they had any cardiovascular events in the past 2 wks

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11
Q

When should you start using nicotine replacement therapy products?

A

Start on the quit date

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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

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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

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14
Q

AE of nicotine patches?

A

Vivid dreams, insomnia

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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

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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

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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

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18
Q

Nicotine gum AE?

A

Mouth soreness and dyspepsia

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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.

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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

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21
Q

Nicotine lozenge AE?

A

Throat irritation, hiccups, indigestion/heartburn, nausea

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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

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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

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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

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25
Q

Dose and administration of Nicotine Nasal Spray (Nicotrol)?

A

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

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26
Q

What are some safety concerns with using nicotine Nasal Spray (Nicotrol)?

A

Avoid use in severe airway disease

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27
Q

Patient education points for nicotine Nasal Spray (Nicotrol)?

A

Tilt head slightly back; do not sniff, inhale through nose, or swallow while spraying

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28
Q

Varenicline (Chantix) MOA?

A

Binds to neuronal nicotinic acetylcholine receptors (alpha-4-beta-2 subtype) as a partial agonist

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29
Q

What agonist and antagonist effects does varenicline have?

A

Agonist activity: produces weak nicotine-like effect which reduces craving

Antagonist activity: inhibits the pleasurable effect derived from smoking

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30
Q

Varenicline (Chantix) dosing?

A

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

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31
Q

Varenicline AE?

A

Seizure risk

Increased effects of alcohol

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32
Q

Patient education points for Varenicline (Chantix)?

A

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

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33
Q

Bupropion SR (Zyban) MOA?

A

Blocks dopamine and/or norepinephrine reuptake in the CNS

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34
Q

Bupropion SR (Zyban) dosing?

A

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

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35
Q

Bupropion SR (Zyban) AE?

A

Neuropsychiatric changes

Dose-related seizure risk

Increased blood pressure

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36
Q

Bupropion SR (Zyban) contraindications?

A

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
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37
Q

Patient education points for Bupropion SR (Zyban)?

A

Take evening dose with dinner instead of bedtime if insomnia occurs

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38
Q

Clonidine MOA?

A

Alpha-2-adrenergic receptor antagonist with decreases central sympathetic activity

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39
Q

Clonidine dosing?

A
  1. 125-0.75 mg PO daily

0. 1-0.3 mg transdermally daily

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40
Q

Nortriptyline MOA?

A

Tricyclic antidepressant which blocks the serotonin transporter and norepinephrine transporter which results in increased concentrations

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41
Q

Nortriptyline dosing?

A

75-100 mg PO daily

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42
Q

Are Electronic Nicotine Delivery Systems (ENDS) more beneficial than regular cigs?

A

There is insufficient evidence

Pros: fewer toxins

Cons: increased heart issues, lung disease, anxiety

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43
Q

How many cessation meetings should you have with your patients?

A

At least 4

Cessation rates are improved by more sessions or longer duration

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44
Q

What vaccinations should smokers get?

A

One-time PPSV23 vaccine recommended for all those smoke ≥19 years of age

Yearly influenza vaccine

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45
Q

What are some non-pharm stuff you can do to help smokers quit?

A

Call 1-800-QUITNOW

Massages, acupuncture are not supported!!

Cold turkey

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46
Q

Which combo therapy for smoking cessation has the highest 6-Month Abstinence Rate?

A

Patch and varenicline - 65.1%

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47
Q

What are the airflow limitation GOLD classifications for COPD?

A

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

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48
Q

What are the non-pharmacological essential, recommended, and shots to be given in someone classified as group A GOLD?

A

Essential = smoking cessation***

Recommend = physical activity

Shots = Flu and pneumococcal vaccines

***B-D = need addition of pulmonary rehab

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49
Q

What is the COPD pharm regimen for group A GOLD?

A

Bronchodilator

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50
Q

What is the COPD pharm regimen for group B GOLD?

A

Long-acting bronchodilator

LAMA or LABA

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51
Q

What is the COPD pharm regimen for group C GOLD?

A

LAMA only

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52
Q

What is the COPD pharm regimen for group D GOLD?

A

LAMA

LAMA + LABA (usually CAT>20)

ICS + LABA (eos≥300)

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53
Q

If someone was on a LABA or LAMA and their issues were exacerbated, what is the next regimen?

A

LABA AND LAMA

or

LABA AND ICS if eos≥300 or eos≥100 with 2 moderate exacerbations or 1 hospitalization

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54
Q

If someone was on a LABA and ICS and their issues were exacerbated, what is the next regimen?

A

LABA + LAMA + ICS

If they de-escalate, remove ICS

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55
Q

If someone was on a LABA and LAMA AND ICS and their issues were exacerbated, what is the next regimen?

A

Azithromycin (if a smoker)

or

Roflumilast

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56
Q

With COPD treatment, if ICS is added, when should ICS be removed?

A

If no benefits from ICS

Pneumonia

Inappropriate original indication

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57
Q

If someone was on a LABA and LAMA and their issues were exacerbated, what is the next regimen?

A

Depends on eos level

> 100 = LABA + LAMA + ICS

<100 = Azithromycin (if a smoker)

or

Roflumilast

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58
Q

If someone had dyspnea while using either LABA or LAMA, whats next on the regimen?

A

LABA AND LAMA

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59
Q

If someone had dyspnea while using either LABA + ICS, whats next on the regimen?

A

LABA + LAMA + ICS

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60
Q

“Dose increases do not result in increasing benefit”

Is this statement true for COPD?

A

Yes

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61
Q

Onset of action of albuterol and ipratropium?

A

Albuterol - 5 min

Ipratropium - 15 min

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62
Q

Duration of action of albuterol and ipratropium?

A

Albuterol - <4hrs

Ipratropium - 6 hrs (MDI) or 8 hrs (neb)

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63
Q

Albuterol AE?

A

Tachycardia, tremors, hypokalemia

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64
Q

Ipratropium AE?

A

Dry mouth, urinary retention, increased ocular pressure

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65
Q

What are the LAMAs for COPD?

A

TAUG

Tiotropium

Aclidinium

Umeclidinium

Glycopyrrolate

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66
Q

LAMA MOA?

A

M1 and M3 receptor blockage

Longer duration vs LABA

Reduces exacerbation

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67
Q

LAMA AE?

A

Nasopharyngitis

Dry mouth

Tachycardia

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68
Q

LAMA + LABA, what is one advantage LAMA alone can do?

A

The combo regimen has not showed that it will consistently reduce exacerbation

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69
Q

Can you use ICS alone in COPD?

A

Nope

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70
Q

What can we learn about the WISDOM trial for COPD?

A

Take away ICS once patient is stable, their lung function is worse when on ICS

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71
Q

What can we learn about the TORCH trial for COPD?

A

Putting them on ICS may increase their chances of pneumonia

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72
Q

What can we learn about the FLAME trial for COPD?

A

If on ICS, they have an increased chance of exacerbations and pneumonia, AE and death stayed the same

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73
Q

What can we learn about the FULFIL trial for COPD

A

Benefits of triple therapy

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74
Q

If 1 exacerbation per year the threshold for benefit is _______ eosinophil count/mcL

A

> 300

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75
Q

If ≥2 exacerbations per year the threshold for benefit is _______ eosinophil count/mcL

A

> 100

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76
Q

What is the triple therapy product called?

A

Trelegy Ellipta (fluticasone/umeclidinium/vilanterol)

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77
Q

Roflumilast MOA and dose?

A

Phosphodiesterase-4 inhibitor

500mcg PO daily

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78
Q

Benefits of Roflumilast?

A

Reduce inflammation by inhibiting breakdown of cyclic AMP

No bronchodilator activity

Add-on therapy for group D patients

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79
Q

Roflumilast CI?

A

Contraindicated in moderate to severe hepatic impairment (Child-Pugh Class B or C)

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80
Q

Which antibiotics could you take for COPD? Doses?

A

Azithromycin 250mg daily or 500mg three times a week

Erythromycin 500mg BID

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81
Q

Antibiotic role in COPD?

A

When taken for a year may reduce risk of exacerbations compared to usual care

Increases risk of bacterial resistance

No data past 1 year

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82
Q

Could you use methylxanthines for COPD?

A

You could, but not recommended

If pt is stable on Theophylline, take it away

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83
Q

When are mucolytics used in COPD?

A

End stage

N-acetylcysteine (inhaled)

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84
Q

What are the Alpha-1 antitrypsin (AAT) therapy options?

A

Glassia, Aralast, Prolastin, Zemaira; 60mg/kg weekly

Biologic from pooled donors

Cost $54,000/yr

Use: Augmentation in deficient patients

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85
Q

Should you step up doses for COPD like asthma?

A

Nope, use lowest ICS dose

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86
Q

What is the goal SaO2?

A

> 92%

It goes down during exacerbations!

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87
Q

Possible long-term at home therapy in patients with severe resting hypoxemia can qualify how?

A

SaO2 < 88 confirmed twice in 3 weeks

SaO2 < 88 AND pulmonary HTN, CHF, or polycythemia (Hct>55)

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88
Q

When should you never use ICS for COPD?

A

Repeated pneumonia events

Eosinophil <100

History of mycobacterial infections

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89
Q

When is routine monitoring for COPD?

A

Spirometry yearly

Assessment test (CAT) every 2-3 months

Symptom assessment every visit

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90
Q

What is used to treat COPD exacerbation?

A

Mild - SABA or SAAC

Moderate - Abx and/or OCS

Severe - hospitalization

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91
Q

When treating COPD exacerbation, what is the OCS dose?

A

Prednisone 40mg for 5-7days

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92
Q

What are the cardinal symptoms of COPD?

A

Increased sputum production

Increased sputum purulence

Increased SOB

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93
Q

How do you qualify for Abx to treat COPD exacerbation?

A

Have all 3 cardinal symptoms

or

2 of the 3 if purulent

or

Mechanically ventilated at ICU

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94
Q

COPD Exacerbation Discharge Criteria, what is it?

A

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

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95
Q

What are the main mechanisms of drug-induced pulmonary disease?

A
  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
Q

How do you treat acute pulmonary eosinophilia caused by nitrofurantoin? Chronic?

A

Acute - Stop rx and supportive care

Chronic - stop rx and give corticosteroids

97
Q

What drugs cause drug-induced SLE?

A

HIPPP

Hydralazine

Isoniazid

Phenytoin

Procainamide

Penicillamine

98
Q

How do you treat drug-induced SLE?

A

Stop medication

Corticosteroids

99
Q

What rx can cause Drug-Induced Pulmonary Fibrosis?

A

Chemo

Radiation

Oxygen (100% for 6-48hrs)

Methotrexate, Amiodarone

100
Q

What rx causes respiratory depression? How do you treat it?

A

Opioids

Benzos/barbituates

Neuromuscular blockers

Aminoglycosides

Tx = stop medication or use lowest possible doses

101
Q

How does tylenol cause drug-induced asthma?

A

Reduction of glutathione-impaired respiratory antioxidant defenses

NSAIDs can also cause it too

102
Q

What rx can cause drug-induced bronchospasm?

A

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
Q

BB use and Asthma/COPD

A

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
Q

Which patients are at high risk of malnutrition?

A

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
Q

IBW calculations?

A

Males: 50 kg + (2.3 x inches over 5 feet)

Females: 45.5 kg + (2.3 x inches over 5 feet)

106
Q

ABW calculations?

A

IBW + 0.4 (ABW – IBW)

107
Q

What is considered the “normal” weight?

A

90-120% of IBW

108
Q

BMI classifications?

A

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
Q

At what waist circumference has an increased risk for obesity-related complications?

A

Men ≥40 inches

Women ≥35

110
Q

When do you expect albumin levels to decrease?

A

Overhydration

Increased in dehydration

111
Q

When do you expect transferrin levels to increase?

A

Blood loss, iron deficiency

Decreased in infection, burns

112
Q

When do you expect prealbumin levels to increase?

A

Kidney dysfunction

Decreased also in kidney dysfunction, inflammation

113
Q

What are the normal values of albumin, transferrin, and prealbumin?

A

Albumin = 18-20

Transferrin = 8-9

Prealbumin = 2-3

114
Q

What is the independent predictor of obesity-related complications?

A

Waist circumference + BMI

115
Q

What is the independent risk factor for adverse health outcomes?

A

Waist-to-hip and waist-to-height ratios

> 0.9 ratio in men

> 0.85 ratio in women

116
Q

What is the Mifflin-St. Jeor Equation?

A

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
Q

What multipliers do you use in the Mifflin-St. Jeor Equation?

A

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
Q

1 pound body weight = ____ calories

A

3500

119
Q

In terms of carbs, proteins, and fats, what % should you aim for?

A

55% carbs

15% proteins

30% fats

120
Q

How does sodium affect the RAAS system?

A

Increase in blood volume, cardiac output, arterial pressure and leads to increased blood pressure of the patient

121
Q

HTN and diet/lifestyle, what should be in it?

A

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
Q

HF and diet/lifestyle, what should be in it?

A

<2g salt/day

≤1.5-2L of fluids/day

123
Q

When is emergency care needed in HF and weight gain?

A

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
Q

Dyslipidemia and diet/lifestyle, what should be in it?

A

Pretty much the same as HTN diet

Avoid saturated (replace w/ MONOunsaturated) and trans fat

125
Q

What are the supplements with more robust evidence on lipid-lowering effects?

A

Niacin
Red yeast rice
Omega-3 fatty acids
Pantethine

126
Q

What is the USDA MyPlate Method?

A

5 portions divided amongst 1 cup and 4 sides on a 9in plate

Grains, proteins, fruits, veggies, + dairy (1% or low-fat)

127
Q

What is the exchange list meal planning?

A

Foods that are alike in carbohydrates (CHO), protein, fat, and calories

Creates a variety for people

128
Q

What is carb. counting?

A

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
Q

What is glycemic index?

A

Measurement and ranking of how CHO-containing foods affect BG levels

Says nothing about the amount of CHO!

130
Q

What affects glycemic index?

A

Higher fat? Lower GI

More ripe fruit? Higher GI

More processed? Higher GI

Longer cook time? Higher GI

131
Q

Per the Institute of Medicine, do not exceed ____ of total daily calories for sweeteners

A

> 25

132
Q

Whats some info to know about artificial sweetners?

A

Sweetens foods without promoting tooth decay or weight gain

No evidence in sustaining long-term weight loss

133
Q

(T/F)

Routine supplementation not advised in diabetics without underlying deficiencies

A

True

134
Q

Alcohol and BG?

A

Drink a lot? Increase BG

135
Q

Which rx for diabetes should be taken with food or before food?

A

Before food = sulfonylureas

With food = insulin, GLP-1 agonists, metformin, and alpha-glucosidase inhibitor

136
Q

What is the rule of 15 for hypoglycemia?

A

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
Q

What are examples of 15g of CHO?

A 
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
Q

Diet and sick days?

A

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
Q

What is complementary medicine?

A

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
Q

Who regulates supplements?

A 
Dietary Supplement Health and Education Act
of 1994 (DSHEA)
141
Q

What can or cannot the supplement labels have?

A

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
Q

What does the USP seal tell you?

A

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
Q

What are the main issues with supplements?

A
  1. False sense of Safety
  2. False sense of Efficacy
  3. False sense of High Quality
  4. Drug-supplement interactions
144
Q

Who should avoid St. John’s Wort?

A

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
Q

Issues with Gingko?

A

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
Q

What are some examples of altered GI pH that affect rx absorption?

A

Increased gastric pH:

decreases azole concentration

dissolves enteric coated products in stomach

increases absorption of benadryl

147
Q

What are some examples of altered GI/urinary pH that affect rx excretion?

A

Alkaline urine increases excretion of aspirin (weak acid)

Acidic urine will excrete amphetamines (weak base)

Lithium competes w/ sodium for reabsorption

148
Q

Inducers and inhibitors of CYP3A4?

A

Inducer - St. John’s wort + Echinacea (liver)

Inhibitor - grapefruit and certain orange juices, echinacea (intestines), peppermint oil, and piperine

149
Q

How can P-gp be altered by food-drug interactions?

A

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
Q

How does a protein diet affect enzymes?

A

High protein diet = stimulates CYP450 enzymes

151
Q

Which foods should be taken on an empty stomach due to it binding to fiber?

A

Digoxin + APAP

152
Q

Which foods should be taken on an empty stomach because it will have increased absorption?

A

Abx and anti-HTN

153
Q

Which foods should be taken with food to increase absorption with high fat meals?

A

Theophylline and Griseofulvin

154
Q

Because statins deplete CoQ10, what other classes of drugs might this interfere with?

A

Thiazides, BB, older psychotropic drugs

155
Q

What nutrients do valproic acid deplete?

A

Carnitine, Folate, Biotin

156
Q

What nutrients do phenytoin deplete?

A

Folate, Biotin, Vit. D + K, Thiamine

157
Q

What nutrients do thiazides deplete?

A

Folate and as a result, homocysteine is increased

158
Q

What nutrients do loop diuretics deplete?

A

Electrolytes and B vitamins

159
Q

What nutrients do cephalosporins deplete?

A

Gut flora, Vit. K

160
Q

What nutrients do corticosteroids deplete?

A

Calcium and magnesium (bone loss)

161
Q

What nutrients do 5-ASA (mesalamine) deplete?

A

Folate and as a result, homocysteine is increased

162
Q

What are the antithrombotic interactions to look out for?

A

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
Q

What is the largest determinant of energy expenditure in the body?

A

Metabolic rate

164
Q

What does neuropeptide Y, alpha-melanocyte-stimulating hormone, orexin, and ghrelin do?

A

Neuropeptide Y - stimulates eating

alpha-melanocyte stimulating hormone - inhibits eating

Orexin - stimulates food intake

Ghrelin - stimulates appetite

165
Q

What Rx will cause weight gain?

A

Corticosteroids
Antihistamines
Estrogen

Insulins
Anti-psych
Antidepressants

Anticonvulsants
Alpha-adrenergic blockers
BB (just propranolol)

166
Q

What conditions will cause weight gain?

A

CHF, cushings

Hypothyroidism

PCOS, Prader-Willi syndrome

167
Q

What are the main guidelines to use for weight loss?

A

BMI centric (goal to lose weight) = AHA/ACC/TOS

Complication centric

168
Q

Using the BMI centric guidelines, if patient is ready to lose weight, what is the goal of weight loss?

A

≥5%

Add pharm. if BMI≥30 or ≥27 with comorbidity

Surgery if BMI≥40 or ≥35 with comorbidity

169
Q

How much exercise should one get for weight loss?

A

≥150min/week

170
Q

Phendimetrazine MOA?

A

Sympathomimetic amine that acts in CNS to reduce appetite

171
Q

Phendimetrazine duration and CI?

A

Duration: 12 weeks

CI: MAOI use within 14 days, glaucoma, hyperthyroidism

172
Q

Phendimetrazine AE?

A

CNS depression, heart issues

173
Q

Phentermine MOA?

A

Decreases appetite by increasing norepi and dopamine release

174
Q

Phentermine duration and CI?

A

Duration: 12 weeks

CI: MAOI use within 14 days, glaucoma, pregnancy, heart issues,

175
Q

Phentermine AE?

A

Heart issues

176
Q

Diethylpropion MOA?

A

Decreases appetite by increasing norepi and dopamine release

177
Q

Diethylpropion duration and CI?

A

Duration: 12 weeks

CI: MAOI use within 14 days, glaucoma, hyperthyroidism

178
Q

Diethylpropion AE?

A

Dry mouth, constipation, insomnia

179
Q

Orlistat MOA?

A

Gastric and pancreatic lipase inhibitor; reduces absorption of dietary fat

Give multivitamins, but separte admin time

180
Q

Orlistat duration and CI?

A

Long term use

CI: Pregnancy, malabsorption syndrome, cholestasis

181
Q

Orlistat AE?

A

GI effects

182
Q

Liraglutide MOA?

A

GLP-1 Receptor agonist

Increases glucose-dependent insulin secretion, decreases glucagon

183
Q

Liraglutide duration and CI?

A

Long term use

CI: History of MTC, MEN 2, pregnancy

184
Q

Liraglutide AE?

A

N/V/D, pancreatitis

185
Q

Belviq MOA?

A

Activates serotonin 2C receptors in hypothalamus

Dont give in renal impairment

186
Q

Belviq duration and CI?

A

Long term.

Stop if <5% weight loss at 12 weeks though

CI: MAOI use within 14 days, pregnancy, heart issues, depression

187
Q

Belviq AE?

A

General stuff, dry mouth

188
Q

Qsymia MOA?

A

Phentermine + topiramate (blocks sodium channels and increases GABA)

Part of REMS program

189
Q

Qsymia duration and CI?

A

Long term use

CI: MAOI use within 14 days, glaucoma, pregnancy, hyperthyroidism, depression

190
Q

Qsymia AE?

A

Parasthesia

191
Q

Contrave MOA?

A

Acts on hypothalamus and mesolimbic circuit

192
Q

Contrave duration and CI?

A

Long term use

CI: Chronic opioid use, MAOI use within 14 days, pregnancy

193
Q

Contrave AE?

A

N/V/D, constipation, seizures

194
Q

Which Vit. K is derived from diet?

A

K1

195
Q

Where do water-soluble vitamins get absorbed?

A

Blood

196
Q

Fat vs water soluble vitamins

Which one requires protein carriers?

A

Fat

Water soluble circulates freely in water-filled parts of body

197
Q

Deficiency of Vit. K main causes?

A
  • infants
  • chronic small intestine diseases
  • malabsorption syndrome
  • broad spectrum Abx use
198
Q

Symptoms of Vit. K deficiency?

A

Unusual or excessive bleed

Liver disease

Low bone density

199
Q

Fat vs water soluble vitamins

Which one has a higher risk of hypervitaminosis?

A

Fat

Water; only in chronic high doses

200
Q

Fat vs water soluble vitamins

Deficiency occurs when storage is depleted

A

Fat

Water; develops in weeks to months

201
Q

Where do fat-soluble vitamins get absorbed?

A

Lymphs first, then blood

202
Q

Which Vit. K is the more active part?

A

K2; K1 is converted in the gut and periphery

203
Q

Function of K1?

A

Clotting factors

204
Q

Function of K2?

A

Forms bone proteins

205
Q

Symptoms of Vit. K toxicity?

A

Adults : no known symptoms

Infants: jaundice, hemolytic anemia

206
Q

Risk factors of Vit. D deficiency?

A

Renal disease

Northern latitudes

Dark skin

Smoking

Drugs that alter its metabolism

Air pollution

207
Q

Beta-carotene is converted where?

A

Gut

208
Q

Deficiency of Vit. A main causes?

A

Diet

Chronic small intestinal diseases

Liver disease or bile duct obstruction

209
Q

Symptoms of Vit. A deficiency?

A

Increased infection risk

Change in vision and skin

Mild = asymptomatic

210
Q

Symptoms of Vit. A toxicity?

A

Acute = blurred vision, bone pain, appetite loss

Chronic = osteoporosis, anemia, weight loss, menstrual irregularities

211
Q

Active form of Vit. D is converted where?

A

Skin, liver, kidneys

212
Q

Vit. D treats what?

A

Osteomalacia or Rickets

213
Q

Symptoms of B1 deficiency?

A

Beriberi + Wernicke’s encephalopathy

214
Q

Pt specific factors of Vit. D deficiency?

A

Renal disease

Northern latitudes

Dark skin

Smoking

215
Q

Symptoms of Vit. D deficiency?

A

Muscle weakness, bone pain

Cognitive impairment, fatigue

Rickets in kids

Osteomalacia in adults

216
Q

What is an important counseling point for Vit. E?

A

Has anticoagulant effects

217
Q

Causes of Vit. E deficiency?

A

Diet or chronic small intestinal diseases

218
Q

Symptoms of Vit. E deficiency?

A

Muscle weakness, muscle loss

Vision changes

Unsteady gait

Kidney/liver damage

219
Q

Symptoms of Vit. E toxicity?

A

Blotchy skin, increased bleed risk and TG, less thyroid production

Stroke or even premature death

220
Q

Which vitamin is not found in plants?

A

Vit. B12 (cobalamin)

221
Q

Symptoms of B2 (riboflavin) deficiency?

A

Cheilosis, glossitis

222
Q

Symptoms of B3 (niacin) deficiency?

A

Aggression, isomnia

223
Q

Symptoms of B5 (pantothenic acid) deficiency?

A

Acne

224
Q

Symptoms of B6 (pyridoxine) deficiency?

A

Seborrheic dermatitis

225
Q

Symptoms of B7 (biotin) deficiency?

A

Impaired growth and neurological disorders in infants

226
Q

Symptoms of B9 (folate) deficiency?

A

Macrocytic anemia

Neural tube defects if pregnant

227
Q

Symptoms of B12 (cobalamin) defiency?

A

Macrocytic anemia

228
Q

Which Vit. B toxicity masks B12 deficiency?

A

Vit. B9 (folate)

229
Q

Which Vit. B toxicity is associated with flushing and glucose intolerance?

A

Vit. B3 (niacin)

230
Q

Symptoms of Vit. C deficiency?

A

Scurvy

231
Q

Risk factors for Vit. C deficiency?

A

Diet

Alcoholism

Infants fed by cow’s milk

Smokers

232
Q

Symptoms of Vit. C toxicity?

A

Gout, kidney stones

Decreased copper absorption

233
Q

Which thyroid condition causes calcium deficiency?

A

Hypoparathyroidism

Hyper causes toxicity

234
Q

Which vitamins should pregnant women take?

A

Vit. B9 (folate) + Vit. D

235
Q

Which vitamins should vegans take?

A

Vit. D + Vit. B12 + Calcium + Iodine

236
Q

Which vitamins should alcoholics take?

A

Vit. B1 (thiamine)

237
Q

What kind of vitamins have a higher risk of toxicity and deficiency?

A

Toxicity = fat-soluble

Deficiency = water-soluble

IPT: GI/Resp (4 decks)

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