EXAM 4 Flashcards
What is tolerable upper intake level (UL)?
the highest average daily intake that CAN be consumed by nearly all safely; not a recommendation.
Examples of Ectoparasiticides?
scabies and pediculosis
Which vitamin is the only one that reaches toxic levels?
vitamin A
Adverse effect caused by high levels of vitamin E?
increases risk of hemorrhagic stroke
Effects of vitamin A toxicity?
birth defects; liver injury and bone related disorders.
What abx can be used for long-term therapy of Crohn’s tx?
Metronidazole (Flagyl)
How is Malathion (Ovide) administered for head lice?
- Saturate dry hair.
- Allow to dry naturally with hair uncovered.
- After 8–12 hr, wash and rinse.
- Afterward, use a fine-toothed comb to remove nits.
Which classes belong under anti-secretory agents?
PPIs and H2 blockers
Adverse effect of B1 and B6?
pain at injection site
What does Bactrim do to body lice?
It kills the bacteria that louse use to manufacture B vitamins.
If either TB skin test or blood test are positive what tests will then be ordered?
CXR and sputum culture
What is adequate intake (AI)?
estimate of the average daily intake required to meet nutritional needs
What is required to absorb fat soluble vitamins?
healthy pancreas, liver, and gall bladder
What are contraindications for laxative use?
- Sx of appendicitis, regional enteritis, diverticulitis, or ulcerative colitis.
- acute surgical abdomen.
- Fecal impaction or bowel obstruction.
- Habitual use.
Vitamin deficiencies are often the result of what?
poverty, fad diets, alcohol/drug abuse, or prolonged parenteral feedings
What are the goals for PUD tx?
- Alleviate sx
- Promote healing
- Prevent complications
- Prevent recurrence
Are abx effective for Crohn’s?
can control sx but not cure it
Contraindications for enteral nutrition?
Major GI issues (peritonitis, any obstruction, intractable diarrhea)
Use for parenteral nutrition?
patients who are unable to tolerate enteral feedings or don’t have a working GI
Which abx are 1st line of defense for H pylori tx?
Clarithromycin ; Amoxicillin; Bismuth compounds; Tetracycline; Metronidazole; Tinidazole
What adverse effect is shared with PPIs and H2 blockers?
PNA
When are patients given abx along with PPIs or H2 blockers to treat PUD?
Confirmed H pylori infection
Which parenteral nutrition requires a central line?
TPN
What receptors are involved in the emetic response?
Serotonin, glucocorticoids, substance P, neurokinin1, dopamine, acetylcholine, histamine
What are water soluble vitamins?
B1 (thiamine), B2, B3, B6 (niacin), B9, B12, and C
What are some potential complications of laxative abuse?
Diminished defecatory reflexes, electrolyte imbalance, dehydration, colitis.
What is Estimated Average Requirement (EAR)?
Level of intake that will meet nutritional requirements for 50% of healthy individuals in any life-stage or gender group
What may be used to treat traveler’s diarrhea caused by E coli?
Ciprofloxacin, norfloxacin
Which vitamin deficiencies take longer to manifest? Fat or water soluble.
Fat soluble because the vitamins are stored in the fat tissue.
What is the first round treatment strategy for H pylori?
Clarithromycin / Amoxicillin plus a PPI like omeprazole
Where are the most common sites of scabies infestation?
Adults: Wrists, elbows, nipples, navel, genital region, webs of the fingers
Children: Head, neck, buttocks
What are fat soluble vitamins?
D,A,K,E
Adverse effect of B12?
HA, arthralgia, and diarrhea
T/F. It is dangerous to give antidiarrheal med if they have an active infection.
True
Why should laxatives be used w/ caution in pregnancy and lactation?
it can induce labor by stimulating the GI and the laxative may be excreted in breast milk during lactation.
How long is the intensive phase of TB tx and how many drugs are used?
8 weeks and 4 drugs
Lice that remain on the body can be killed by which drugs?
permethrin and malathion
What abx is highly effective in patients w/ mild or moderate Crohn’s?
Ciprofloxacin (Cipro)
What is the primary sx of scabies?
Pruritus, most intense just after going to bed
What is laxative effect?
Production of soft, formed stool over 1 or more days; usually for everyday use.
Are abx effective for UC?
No
Infection w/ resistant TB results from?
- Contact with someone who has resistant bacteria.
2. Inadequate tx
How is Nix permethrin administered?
- Apply to damp shampooed hair.
- Leave on 10 minutes and then rinse with warm water.
- Use fine-toothed comb to remove nits.
- Repeat if living lice are noted 1 week later
What are the 5 key classes of anti-ulcer drugs?
- Abx
- Anti-secretory
- Mucosal protectants
- Anti-secretory that enhance mucosal defenses.
- Antacids
Adverse effect of vitamin K?
pain at injection site, facial flushing
What is the leading cause of PUD?
H pylori
How is Elimite Permethrin administered?
- Massage into skin from head to soles of feet.
- Leave on 8–14 hr before washing.
- Re-treat if living mites are seen 2 weeks after treatment.
Why is the relapse rate high following discontinuation of anti-ulcer drugs?
They don’t alter the disease process but create conditions that will aid in healing
T/F. Vitamins have few adverse effects when taken responsibly.
True
What are the 6 antiviral classes for HIV?
- Nucleoside reverse transcriptase inhibitors (NRTI).
- Nonnucleoside reverse transcriptase inhibitors (NNRTI).
- Protease inhibitors (PI).
- Integrase strand transfer inhibitors (INSTI).
- HIV infusion inhibitors
- CCR5 antagonist.
Complications of parenteral nutrition?
mechanical: clogged IV
metabolic: fluid overload, refeeding syndrome, electrolyte imbalances.
infectious: TPN has high glucose.
Why might there be an order for “free water” with tube feeding?
it fails to provide adequate water
What 2 diagnostic tests will give a diagnosis of possible TB exposure?
TB skin test or Quantefirum gold test
What are Ectoparasiticides?
parasites that live on the surface of a host.
What is pediculosis ciliaris?
lice on the eyelashes
What is catharsis?
prompt fluid evacuation of the bowel.Tends to be about bowel prep
Baseline evaluation prior to all TB meds?
CXR, microbiology sputum, and liver function tests
All TB 1st line agents are hard on which organ?
The liver
Adverse effects of Permethrin?
temporary burning, stinging & numbness.
Prolonged use of high-dose metronidazole can increase risk of what?
Peripheral neuropathy
What is Extensively-drug resistant TB (XDR TB)
Resistance to:
- Isoniazid (INH) and Rifampin
- All fluoroquinolones
- At least one of the injectable second-line drugs.
What are causative factors of TB relapse?
- Treatment time too short.
2. Surviving bacilli may cause TB later
Is Malathion approved for children?
> 6
Why does someone need to take pancreatic enzymes?
Deficiency of enzymes compromise digestion
Complications of enteral nutrition?
aspiration, N/V/D, refeeding syndrome, clogged feeding tube.
What are pancrelipase?
Pancreatic enzyme for clinical use; mixture of lipases, amylases, and proteases prepared from hog pancreas.
Adverse effect of vitamin D?
metallic taste
Use of enteral nutrition?
When there’s a working GI system but unable to take PO.
Which mineral supplements are often needed in women and children?
iron and calcium
How many drugs are given during the continuation phase?
at least 2
Abx should only be used for what kind of infectious diarrhea?
Salmonella, Shigella, Campylobacter, or C diff
T/F. All minerals are toxic when taken in excess
True
What is multidrug-resistant TB (MDR TB)?
Resistant to both isoniazid and rifampin
Which parenteral nutrition can use peripheral access?
PPN
Sx for lithium level <1.5
N/V/D, thirst, polyuria, lethargy, slurred speech, msl weakness, fine hand tremors
Sx for lithium level 1.5-2
persistent GI upset, coarse hand tremor, confusion, hyperirritability of msls, EKG changes, sedation, incoordination
Sx for lithium level 2-2.5
Ataxia, fasciculations, seizures, stupor
Sx for lithium level >2.5
generalized convulsions, oliguria, death
