Exam 1 Flashcards
What holds a pill together as a binder and could affect dissolution?
Excipients (can be a buffer, binder, filler, emulsion, preservative).
Pills should always be third-party tested. What should you, as a dietitian, never provide a customer with and what should you give them when providing medication information?
Never from a .com website. Must be from a .gov like NIH.gov
What is the stamp on a pill to ensure it is 3rd party-tested and liable?
USP
What is the absorption of drugs called?
Pharmacokinetics
Two ways a drug can be absorbed?
Passive or Facilitated diffusion
Active transport
What would increase the possibility for food-drug interactions?
Malabsorption due to celiacs, IBD, Crohns, etc
The pregnancy drug categories are?
A: Safe
B: Should be safe- has some safe studies but proceed with caution
C: Some research points to unsafe- probably should not take
D: Research points to not being safe and risks are possible- don’t take
X: DO NOT take- death and health issues have been proved
Described as the fraction of a drug that reaches the systemic circulation
Bioavailability
An osteoporosis drug that can be significantly decreased (60%) in bioavailability if taken with coffee or orange juice. Must withhold from food before consumption as food is stomach makes absorption negligible.
Boniva
If in tube feed…make sure to stop tube feeding before.
What does Grapefruit do to some medications?
Blocks the metabolism and transport- which would cause the drug to build up in the body.
What drugs decrease the absorption of calcium-rich foods over time?
Corticosteroids
Are PO drugs less or more bioavailable than IV-administered drugs? Why?
Less due to excipients. IV drugs have a much less dose because of this.
What should you never take with iron supplements?
Calcium foods or supplements! Eggs, bran, fiber-rich foods/supplements, high-phytate foods, coffee, or tea.
Also do not take with food- but if you get nausea then can take something small with it just not those above foods.
What is it called when a drug reacts with certain nutrients and binds together like cement?
Chelation
Describe Chelation and which nutrients cause it
Binding together in tube feed formula. Iron, calcium, zinc, and magnesium can react.
Never take antibiotics (Cipro) with a multivitamin and iron or calcium!
What does ASPEN stand for?
American Society of Parenteral and Enteral Nutrition
Rules for crushing up pills for PN and EN
Do not mix medications or crush up into PN bag- use another bag and IV for meds.
For EN- crush up drugs.
What pills should you never crush up in a EN tube feed?
Extended Release Pills!
What drugs interact with Vitamin K? Understand this process and describe it.
Coumadin/Warfarin are blood thinners that dosage depends on Vitamin K in diet. Patient should keep Vitamin K in diet consistent.
How Gastrointestinal pH plays a role in absorption?
Some medications work better under a lowerr pH… so take with food in this case.
With what drug should tube feeding (EN) stop 2 hours before and 2 hours prior?
Phenytoin
What two drugs rely highly on Albumin for active transport?
Warfarin/Coumadin and Phenytoin
What medications can impair B12 status/absorption?
Proton-pump inhibitors and GERD medications. Need that stomach acid to absorb B12
What drugs damage the epithelial brush border and other epithelial cells?
Cancer treatment ( chemotheraputic agents), NSAIDS, long-term antibiotic use.
Damage the skin, mouth, and GI tract.
Effects of diuretics on nutrient excretion?
Diuretics like Lasix commonly excrete higher than normal amounts of sodium, potassium, magnesium, and chloride. Sodium and Potassium might be supplemented.. UNLESS the diuretic is a potassium saving drug.
What is the term for very low sodium?
Hyponatremia
Ace inhibitors and potassium-sparing diuretics together causes?
The combination of a potassium-sparing diuretic and an ACE inhibitor (decreases potassium excretion) increases the
danger of hyperkalemia
Explain MAOIs nutrient-drug interactions
Monoamine Oxidase Inhibitors. Inhibit the breakdown of tyramine (from tyrosine AA). Increased tyramine causes increase in blood pressure.
What is the name of the corticosteroid that decreases sodium excretion and over-time can affect/decrease calcium levels.
Prednisone
List how food and drugs can interact:
Drug may inhibit the ability for proper nutrient absorption/utilization
Nutrient may inhibit drug absorption or transportation
Taste and Smell might be altered - Xerostomia (dry mouth) is common
GI discomfort/distress can cause a decrease in appetite
Can affect glucose levels
How Alcohol affects drug interactions
- drugs increase the toxicity of alcohol
- inhibits gluconeogenesis- increased hypoglycemic state.
What drug blocks the breakdown of fat and causes oily diarrhea?
Orlistat (OTC- over the counter)
How do drugs affect glucose levels and give examples
- can inhibit or stimulate glucose uptake
- Can increase insulin sensitivity
- Corticosteroids (prednisone) cause an increase in gluconeogenesis
What drug excipient is used with sedation and explain
Propofol is used with sedation. The 10% lipid emulsion adds about 1.1 kcal/ml. So, patient is getting extra calories from fat from this medication.
IBW equation
UBW%
IBW%
women: 100 + (5lbs x inches over 60)
men: 106 + (6lbs x inches over 60)
UBW : current bw/ usual bw
IBW: current bw/ibw
waist circumference risk factors
> 40 inch for men
35 inch for women
waist to hip ratio risk factors
> 1.0 for men
0.8 for women
Healthy BMI range
18.5-24.9
When is waist to hip not the best indicator?
when over 35 BMI or under 60 inches
Importance of mid-arm circumference?
Helps see disease state and malnutrition
Mifflin St. Jeor Equation variables:
Weight (kg), Height (cm), and Age
BMI equation
kg/m^2
Protein Requirements
0.8 g/kg
1.2-2.0g/kg in disease state (trauma, wounds, disease, metabolic stress)
10-35 % AMDR (acceptable macronutrient distribution range)
Other ways to estimate caloric needs:
kcal/kg
ex: 20kcal/kg actual body weight
if BMI > 50 then use kcal/ IBW
- For critically ill patients on ventilation or EN/PN use IBW or admitted weight (whichever is lowest)
know these abbreviations:
OT
SLP
CRT/RRT
PT
PA
MD
DO
LCSW
Occupational therapist
speech-language pathologist
certified/registered respiratory therapist
physical therapist
physicians assistant
doctor of medicine
doctor of osteopathic medicine ( example would be psychiatrist or cardiologist)
Licensed counselor social worker
Other abbreviations:
TPN
CPN
PPN
PN
EN
NPO
PO
NGT
PEG
G tube
J tube
ND tube
NJ tube
Total Parenteral nutrition
central parenteral nutrition
peripheral parenteral nutrition
parenteral nutrition
enteral nutrition
nothing by mouth
by mouth
nasogastric tube
percutaneous endoscopic gastronomy
gastronomy tube
jejunostomy tube
nasoduodenal
nasojejunal tube
Screening Tool Abbreviations and Meanings:
MUST
MNA
GNRI
- Malnutrition Universal Screening Tool
- Mini Nutrition Assessment
- Geriatric Nutritional Reference Index
Goal of Screenings
To identify if someone is malnourished or at risk and to identify if nutrition therapy is needed or a possible solution.
- is INDIVIDUAL
MNT Definition
The assessment, nutrition diagnosis, interventions, monitoring, and evaluation for
established disease
* Individualized nutrition based treatment plan provided by a RDN
Deciphering Nutrition Care Priority- Categories
Hx (medical history)
Dx ( diagnosis )
PO
TPN
PPN
Wt loss
BMI
High priority Dx
Acute or Chronic Renal failure
GI or Head/Neck Cancer
Burns
Coma
Ileus ( intestines not working right)
Malnutrition/ FTT
Pressure Ulcers/Wounds
Dysphagia
Sepsis
Pulmonary Failure (ventilation)
Transplantation
Cystic Fibrosis
Diabetes
Assessment includes
Collection of medical history, medications, diet history, lab values, anthropometrics, physical exam, social history
What is the IBW equation called?
Hamwi Equation
- does NOT adjust for age or race
BMI calculation
pounds/inches/inches x 703
What is the standard for technologically figuring out body composition? Explain
Bioelectrical Impedance
Low body fat and more muscle/water = resistance and impedance is low
High body fat = high resistance and impedance
DEXA
Dual-Energy X-Rap Absorptiometry
How does inflammation affect blood glucose?
Increased insulin resistance and Hyperglycemia
Positive acute phase proteins
CRP (C-Reactive Protein) and Ferritin (iron storage)
Negative acute phase proteins
Transferrin, Albumin, and Pre-albumin
