Exam 2 Flashcards
BMI Classification: Obesity
> 30 mg/kg2
BMI Classification: Overweight
25.0-29.9 mg/kg2
Treatment goal for obese: lose __% of total weight over _____. Average ____ lbs/wk.
- 10%, 6 months
- 1-2 lbs/wk
How many calories equal to 1 lb of weight gain?
3500 calories
Pharmacological therapy is appropriate if BMI ____, or ____ with ___ of co-morbid conditions
- 30
- 27 with 2 co-morbidities
OTC medication for weight loss: Name, dose, must take ____ when?
- Alli
- 60 mg with a fat containing meal, up to 3 doses daily
- Multivitamin at bedtime or 2 hrs from Alli dose
Urinary incontinence type: stress
- Involuntary leakage with sudden increase in abdominal pressure
- Urine leakage triggered by physical activity: cough, exercise, laugh, sneeze
Urinary incontinence type: overflow
- Over-distention of the bladder
- Decreased or incomplete urine stream
- Causes: obstruction (BPH) or dysfunctional bladder (diabetic/alcoholic)
Urinary incontinence type: urge (= overactive bladder)
- Frequency >8 times/day
- Nocturia
- Inability to reach toilet following urge to void
Urinary incontinence type: functional
- Urine loss due to physical or cognitive impairment
- Interferes with a person’s ability to reach toilet facilities
- Causes: stroke, diminished mobility
Urinary incontinence type: mixed
- Overactive bladder + stress
- More common in women
Urinary incontinence risk factors: medical disorders/procedures
- BPH, TURP, prostatectomy
- Diabetes
- Obesity
- Pregnancy
- Stroke
Urinary incontinence risk factors: physiologic factors
- Estrogen depletion
- High/low fluid intake
- Pelvic floor muscle weakness
Urinary incontinence risk factors: lifestyle factors
- Smoking, high-impact physical activities (running, jumping jacks)
Urinary incontinence risk factors: others
- Caucasian race
- Environmental barriers
- Medication
Medications that impact incontinence
- Anticholinergics
- Antidepressants (SSRIs, SNRIs)
- Hypnotics/sedatives
- Antipsychotics
- Narcotics
- Muscle relaxants
- Antihypertensives (ACEi, ARBs)
Urinary incontinence: non-pharmacologic tx
- Behavioral modification: toileting assistance, bladder training, pelvic floor muscle training
- Supplies: urinary catheters, absorbent pads, undergarments for protection
- Surgical = last line
Urinary incontinence: pharmacologic tx indication, SEs, DDIs, Counseling points
Oxybutynin transdermal patch
- Indication: overactive bladder/urge incontinence for women
- SEs: constipation, nausea, xerostomia
- DDIs: minor CYP3A4 substrate, acetylcholinesterase inhibitors
- Counsel: use when UI symptoms >3 months, do NOT cut the patch, rotate site of application, do NOT expose to sunlight, refer to HCP if no improvement after 2 weeks
Complementary therapies for UI
- Pumpkin seed oil
- Vitamin
- Cranberry
- Glycine
- Acupuncture (limited data)
BP monitors: potential confounding factors
- Stress
- Tobacco use
- Caffeine <60 mins prior to usage
- Medications such as pseudoephedrine
BP monitors: wrist and finger monitors
- Not as accurate
- Finger: not recommended
- Wrist: for obese patients
BP monitors: counseling points
- Assess any physical impairments to use the machine
- Importance of keeping track of BP values
- Medication adherence and healthy lifestyle choices
- Demonstrate proper technique to patients
Covid test if (+):
- Highly reliable/accurate
- Standard precautions to prevent spreading of disease (mask, social distancing)
Covid test if (-):
- Cannot rule out infection
- Need a PCR test or 2 (-) antigen tests that are 48 hrs apart
Covid test counseling points
- Rotate the swab in the second well prior to closing the card
- once the nasal swab sample is collected, immediately perform the test
- Ensure the pt is putting an adequate amount of extraction buffer on the sample
- Patient should be tested within the first 5-7 days of symptoms
- Emphasize the importance of preventing the spread
HIV routes of transmission
- Needle exchange
- Sexual intercourse
- Born to a mother infected with HIV
- Blood transfusion between 1978 to 1985
HIV test possible confounders
- Blood: inadequate blood sample
- Saliva: inadequate swabbing of gums, eating/drinking/using oral care products 30 mins prior to starting test
HIV test if (+):
- Contact HCP for confirmation
- Counsel pt on precautions to avoid spreading infection
HIV test if (-):
- Confirm sufficient time has passed since potential exposure (saliva: 30 mins)
HIV test counseling points
- Determine if the elapsed time since possible exposure to the virus before recommending an HIV test
- Blood: fragility of blood samples -> not to delay mailing the specimen card, apply enough blood
- Saliva: adequate swabbing gums, 30 mins time frame
HCV: CDC recommends that all adults born _______ should be screened for HCV
- between 1945 to 1965 (“baby boomers”)
HCV tests for the presence of HCV _____, not the ____
- Antibodies; virus
HCV test results are typically available ____ days after the sample is received
2 to 7 days
HCV tests confounding factors
- Inadequate blood samples
- Immunosuppressant therapy: may not be able to produce sufficient levels of antibodies (ex., steroids)
HCV test if (+):
- HCP for evaluation
- Follow up with a HCV RNA test
HCV tests counseling points
- Pt recently infected (<6 months) may receive a false(-) result -> retest
- Fragility of blood samples -> not to delay mailing the specimen card
- Medical disorders that might rule out the use of a fingerstick-based test or physical limitations that may interfere with performing the test
UTI risk factors
- Diabetes
- Urinary stones/obstructions
- Pregnancy
- Anatomical differences: females much shorter urethral (more inflammation possibility) than males
- Presence of urinary catheters
UTI tests detect both ___ and ___
- Nitrite; leukocyte esterase
UTI tests possible confounders
- Strict vegetarian diet = false (-)
- Phenoazopyridine = false (+)
- Tetracyclines
- Vitamin C >250 mg
UTI test if (+):
Contact HCP immediately for assessment & treatment
UTI test if (-):
Contact HCP if symptoms persist
UTI counseling points
- Collect clean sample
- If symptoms present, contact HCP
- Diet and medications may potentially interfere with results
- OTC UTI detect only ~90% of infections
- Visual difficulties should be advised to seek assistance in interpreting test results
Substance abuse tests: clinical presentation
Fatigue, red eyes, drowsiness, slurred speech, chronic cough, withdrawal from normal acticities
Substance abuse tests: urine test detects ____ vs hair test detects ____
- Urine: low level, casual drug use (+: absence of line, -: presence of line)
- Hair: longer-term drug use
Substance abuse tests potential confounders
Codeine, poppy seeds, decongestants, dextromethorphan, anti-diarrheal agents
Substance abuse tests if (+)
Consider if any potential problems with test used
Substance abuse test if (-)
Cannot assume accuracy
Substance abuse test counseling points
- Limitations of the tests for confirming drug use and for identifying anything other than intended use
- Length of time of suspected drug and type of drug used
- Seek HCP advice and family counseling services
- Potential confounders such as legal rx or non-rx medications that the pt may already be taking
Pregnancy tests detect ____, which may be present as early as ____ after conception
human chorionic gonadotropin (hCG); day 7
Pregnancy test accuracy and when to use
- Will detect 95% of pregnancies
- Use first morning urine bc that’s when hCG is the most concentrated
Pregnancy tests: false (+) may be a result of
- Miscarriage or birth within previous 8 weeks
- Ovarian cysts
- Ectopic pregnancy
- Perimenopausal
Pregnancy tests if (+)
- Contact HCP ASAP
- Check if pt is on teratogenic medication (ex., methotrexate)
Pregnancy tests if (-)
Review procedure to ensure appropriate testing; test again in 1 week
Pregnancy tests counseling points
- Emphasize how and when to use the test: wait at least 1 week after the date of the expected period, morning urine, avoid getting up during the night to urinate
- Potential confounding factors can cause inaccurate results
- Seek medical attention if the 2nd test is (-) & menstruation has not begun
Insomnia exclusions for self-tx
- <12 yo
- > = 65 yo
- Pregnant or breastfeeding
- Frequent nocturnal awakenings or early morning awakenings
- Chronic insomnia (>=3 months)
- Sleep disorder secondary to psychiatric or general medical disorders
- Significant sleep disturbances as defined by sleep-onset latency, WASO, sleep efficiency, &/or total sleep time
Insomnia nonpharmacologic therapy
Good sleep hygiene
- Only use bed for sleeping
- Regular sleep pattern (including weekends)
- Make the bedroom comfortable for sleeping: cooler temp, minimum/white noise, minimum light
- Engage in relaxing activities before bedtime
- Avoid daytime napping or limit to 20-30 mins
- If unable to fall asleep after more than 20 mins, do not continue to try to sleep -> get out of bed and perform a relaxing activity until you feel tired
- Do not watch the clock at night
Insomnia pharmacologic therapy: diphenhydramine effects, recommended uses
- Effects: decrease time to fall asleep, improves quality of sleep
- Uses: transient insomnia, occasional sleep problems, NOT for chronic bc may develop tolerance
- Preferred agent
Insomnia pharmacologic therapy: doxylamine effects, recommended uses
- Effects: decrease time to fall asleep, improves quality of sleep
- Use: same as diphenhydramine; transient insomnia, occasional sleep problems, NOT for chronic bc may develop tolerance
Insomnia pharmacologic therapy: antihistamine warnings/precautions
- Benign Prostatic Hyperplasia (BPH): may cause urinary retention
- Glaucoma: may increase intraocular pressure
- Dementia/Cognitive impairment: may increase confusion, decrease cognition
- Cardiovascular disease: may increase HR
Insomnia pharmacologic therapy: antihistamine AEs
- Sedation
- “Hang over” effect
- Anticholinergic effects: dry mouth, constipation, blurred vision, dizziness, urinary retention
Insomnia pharmacologic therapy: antihistamine use in special populations (elderly, pregnant/lactating women, children)
- Elderly: sleep changes with age, avoid due to increased risk of falls & cognitive impairment
- Pregnant: category B for safety
- Lactating women: continuous use increases CNS effects in infants
- Children: paradoxical rxn
Insomnia pharmacologic therapy: ethanol effects, AEs
- Effects: decrease time to fall asleep
- AEs: tolerance, restless sleep (nocturnal awakenings and reduction in overall sleep duration), rebound insomnia with cessation
Insomnia complementary therapies: melatonin effects, uses, beneficial for ___
- Effects: helps with falling asleep
- Use: chronic insomnia, jet lag
- Beneficial for elderly & depressed pts
Insomnia complementary therapies: valerian effects, use, warnings/precautions
- Effect: decrease time to fall asleep by increasing GABA
- Use: chronic insomnia
- Should tapered off with regular use to avoid benzodiazepine-like withdrawal syndrome, cardiac, hepatotoxicity risk with chronic use
Insomnia complementary therapies: kava effects, use, AEs
- Effects: decreases time to fall asleep by increasing GABA, inhibit MAO, NE, DP
- Use: chronic insomnia
- AE: significant drowsiness and dizziness, hepatotoxicity, blood dyscrasias
Insomnia complementary therapies in special populations (elderly, pregnant/lactating women, children)
- Elderly: limited data, melatonin OK
- Pregnancy: avoid melatonin, valerian
- Lactating: limited data
- Children: melatonin may cause changes in hormonal levels
Drowsiness and Fatigue (DF) symptoms
- Feeling foggy or woozy
- Being responsive but not fully alert
- Having dream like thoughts
DF exclusions for self-tx
- <12 yrs
- Pregnant or breastfeeding
- Heart disease
- Anxiety disorders
- Medication induced drowsiness
- Chronic fatigue defined as >=6 months of fatigue
DF nonpharmacologic therapy
Good sleep hygiene
DF pharmacologic tx: caffeine effects, AEs, warnings/Precautions
- Effects: improves wakefulness by inhibiting adenosine A1 and A2A receptors -> adenosine promotes sleep
- AEs: HTN, tolerance, withdrawal, sleep disturbances
- W/P: CV
DF pharmacologic tx: caffeine dose-related SEs (low, moderate, high dose)
- Low: increased arousal, decreased fatigue, elevates mood
- Moderate: increased HR, BP
- High: anxiety, nausea, jitteriness, nervousness
DF complementary therapy: ginseng effects
- Boosts physical and mental energy
- Decreases impotence
DF therapies in special populations (elderly, pregnant/lactating women, children)
- Elderly: prolonged t1/2
- P/LW: limit to <200mg/day to decrease risk of preterm birth or infant irritability
- Children: more susceptible to CV and CNS effects
Insomnia & DF: refer to PCP if symptoms persist ____ days
> 7-10 days
Adult Nutrition (AN): causes of deficiency -> inadequate intake
- Alcohol absorption
- Vegetarian diet
- Eating disorders
AN: causes of deficiency -> disease conditions
- Crohn’s disease
- Surgical resection
- Bacterial overgrowth
AN: causes of deficiency -> malabsorption
- From food
- Lack of intrinsic factor
- Lack of parietal cells
AN: Estimated Average Requirement (EAR) is
Average intake level estimated to meet the nutrient requirements of 50% of healthy people
AN: Recommended Dietary Allowance (RDA) is
Average daily level of intake sufficient to meet the nutrient requirements of nearly all 97.5% healthy people
AN: Adequate Intake (AI) is
Established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy based on observation
AN: Tolerance Upper Intake Level (UL) is
Maximum daily intake unlikely to cause adverse effects
AN: Stages of vitamin deficiency
- Inadequate nutrient delivery or absorption
- Depletion of nutrient stores
- Biochemical changes
- Physical manifestation of deficiency
- Morbidity and death
AN: vitamin and mineral deficiency clinical presentation of nails, hair, mouth, other
- Nails: lack of luster to nail surfaces
- Hair: loss and thin texture
- Mouth: stomatitis, glossitis, pale gums, poor dentition
- Other: visible goiter, poor skin color/texture, obesity/thinness, edema
AN: deficiency lifestyle modification
- Consuming a balanced diet with food from all energy sources
- Variety of nutrient-dense foods in moderate portion sizes
AN: purpose of supplementation and what supplements are NOT intended for
- Prevent nutritional deficiencies
- Replenish compromised nutrient stores
- Maintain present nutritional status
- NOT intended for self-tx for deficiency
AN: what are vitamins?
- Nutrients that cannot be synthesized in the body in sufficient quantities and must be obtained through diet
- Used as dietary supplements and therapeutic agents to treat deficiencies or other conditions
AN: Function, signs of deficiency, safety considerations, food sources of Vitamin A
- F: visual adaptation to darkness, maintenance of epithelial cells, immune function, embryonic development, skin health
- SD: night blindness, loss of appetite, impaired taste/smell
- SC: hepatotoxicity, hypervitaminosis A, retinol (teratogenic at high doses)
- FS: carotenoids (carrots, leafy greens, apricots, peaches), retinol (fatty fish, liver, meats, dairy, egg yolk)
AN: Function, signs of deficiency, safety considerations, sources of Vitamin D
- F: bone formation and mineral homeostasis
- SD: fatigue, bone pain, muscle weakness, rickets in children, osteoporosis in adults
- SC: hyperCa, soft tissue calcification, kidney stones
- S: red meat, egg yolks, fatty fish (tuna, salmon), sun exposure
AN: Function, signs of deficiency, safety considerations, food sources of Vitamin E (tocopherol)
- F: antioxidant that protects cellular membranes from oxidative damage
- SD: peripheral neuropathy, intermittent claudication, muscle weakness
- SC: risk of bleeding/hemorrhagic stroke, increased risk of mortality (elderly with CVD)
- FS: vegetable oils, nuts, seeds, leafy greens, fortified cereals
AN: Function, signs of deficiency, safety considerations, food sources of Vitamin K (phytonadione)
- F: synthesis of clotting factors 2, 7, 9, 10 & anticoagulation proteins C, S
- SD: increased/prolonged bleeding, elevated INR
- SC: consistent dietary intake should not interfere with warfarin activity, changes to supplemental intake can significantly alter INR
- FS: leafy greens (spinach, kale, swiss chard, brussel sprouts, broccoli)
AN: Function, signs of deficiency, safety considerations, food sources of Vitamin C (ascorbic acid)
- F: precursor of collagen/osteoid/dentin, aids in wound healing, absorption of iron, immune function, common cold symptoms
- SD: scurvy, fatigue, petechiae, swollen gums, may impair wound healing
- SC: nausea, cramps, diarrhea, kidney stones, may interact with continuous glucose monitor if >500mg/day
- FS: citrus, tomatoes, strawberries, broccoli, potatoes, kiwi, brussel sprouts, red/green peppers
AN: Function, signs of deficiency, safety considerations, food sources of Vitamin B12 (cyanacobalamin)
- F: RBC formation, cell metabolism, nerve function and the production of DNA
- SD: neuropathy, mental confusion, agitation, poor muscular coordination, pernicious anemia
- SC: excessive doses have not resulted in toxicity
- FS: beef, fish, milk, cheese, eggs
AN: Function, signs of deficiency, safety considerations, food sources of Vitamin B9 (folic acid)
- F: cell devision/DNA production/brain & spinal cord development, women of child-bearing age should consume daily (prevent neural tube defects)
- SD: soreness/ulcerations in mouth, diarrhea, irritability, forgetfulness
- SC: excessive doses have not resulted in toxicity; may reduce efficacy of methotrexate used for cancer
- FS: broccoli, brussel sprouts, leafy greens, chickpeas, kidney beans
AN: Function, signs of deficiency, safety considerations, food sources of Vitamin B6 (pyridoxine)
- F: heme & GABA production, heals with pregnancy-induced N/V
- SD: peripheral neuropathy, oral lesions, scaliness of skin, dulled mentation
- SC: may be toxic at high doses, causes sensory neuropathy
- FS: pork, chicken, turkey, peanuts, oats, bananas
AN: Function, signs of deficiency, safety considerations, food sources of Vitamin B1 (thiamine)
- F: necessary for myocardial function, nerve cell function, CHO metabolism
- SD: peripheral neuritis, weakness, Wernicke’s encephalopathy
- SC: X toxicity
- FS: whole grains, pork, fish, beans, lentils, green peas, sunflower seeds
AN: Function, signs of deficiency, safety considerations, food sources of Calcium
- F: muscle contraction/relaxation, catalyze activation of plasma clotting factors, supplementation often used in osteoporosis
- SD: bone deformities, behavioral disorders, growth deficiencies
- SC: renal stones, permanent renal damage, N/V, constipation, polyuria
- FS: milk, cheese, dairy products, leafy green
AN: which calcium formulation is acid-dependent?
Calcium carbonate
AN: Function, signs of deficiency, safety considerations, food sources, interactions of Iron
- F: oxygen and electron transport
- SD: blood loss, spoon shaped nails, sore tongue, dyspnea on exertion
- SC: abdominal cramps, N/V, constipation, dark colored stools
- FS: heme (beef, chicken, organ meats, oysters, clams, mussels), non-heme (beans, lentils, spinach, nuts, fortified cereals
- I: separate 2-4 hrs from tetracyclines, fluoroquinolones, bisphosphonates, levothyroxine
AN: Function, signs of deficiency, safety considerations, food sources of Magnesium
- F: bone structure formation, maintenance of nerve and muscle electrical potentials
- SD: neuromuscular irritability, increased CNS stimulation, delirium, convulsions
- SC: diarrhea may occur with large doses, muscle weakness, lethargy
- FS: almonds, cashews, peanuts, spinach, pumpkin seeds
AN: what are functional foods (FF)?
- Foods claimed to have additional function by adding new ingredients or increasing amount of existing ingredients
- Foods in which concentration of one or more ingredients has been altered to enhance the nutrient content
AN: FF claim categories - Authorized Health Claims
- Require publication of FDA regulation after extensive review of literature
- Undergo the most thorough review by the FDA and meets significant scientific agreement
- Cannot quantify degree of risk reduction and the terms “may” or “might” must be used
AN: FF claim categories - Qualified Health Claims
- Level of evidence does not achieve “significant scientific agreement” but evidence of health benefits is still emerging
- Require specific “qualifying terms” by the FDA
AN: FF claim categories - Structure-Function Claims
- FDA authorization is not required before use
- Prior notification of FDA regarding the claim is required
- Cannot claim to reduce risk or cure disease
AN: exclusions for self-care enteral formulas
- Organ dysfunciton
- GI dysfunction
- Significant unintended weight loss
- Disease states affected by diet (DM, COPD)