misc highlights Flashcards
average daily dietary intake sufficient to meet the nutrient deficiency of nearly all healthy indifiduals
RDA
average daily intake required to meet nutritional needs. (employed when experimental evidence is not enough to establish an RDA)
AI (adequate intake)
highest ave daily intake that can be consumed by nearly everyone without sig risk for adverse effect (not a recommended upper limit for intake)
UL (tolerable upper intake level)
level of intake that will meet nutrition requirements for 50% of the healthy individuals in any life stage or gender group
EAR (estimated average requirement)
range for macronutrients associated with optimal health
AMDR (acceptable macronutrient distribution range)
fat soluble vitamins
ADEK
water soluble
C and B complex
those on vegan diets may require what vitamins
A, B12, D and riboflavin
breastfed infants should be given
400IU of Vit D
women of childbearing age should receive
folic acid to prevent neural tube defects
People over 50 should be taking
vit B12
what vitamin may be beneficial for adults 65 and older
Vit D plus calcium
what vitamins recommended for postmenopausal women
vit D
calcium
what vitamin if taken in excess is linked to congenital deformities (pregnancy)
vit A
Prematurity increases risk for what vitamins
Vit A
Alcohol dependence increases risk for what vitamins
Vit B1 (thiamine) B3 B6 B7 (biotin) B9 (folate)
older age increases risk for what vitamins
B1 (thiamine)
B12 (cobalamin)
HIV/AIDS increases risk for what vitamins
B1
Bariatric Surgery increases risk for what vitamins
B1
DM increases risk for what vitamins
B1
pregnancy and lactating
B2
B7
Vit C
vegan increases risk for what deficiencies
B2
B12
impaired renal function increased risk for what deficiencies
B6 (pyridoxine)
Vit C - those on dialysis
strict vegetarian increased risk for what deficencies
B12
smokers are at risk for what vit deficiency
Vit C
inadequate food sources puts you at risk for what vit def
Vit C
cancer puts you at risk for what vit def
Vit C
newborns get what vit at birth
Vit K
taking PPIs and H2 receptor agonists can put you at increased risk for what vit def
Vit B12 def
taking metformin puts you at increased risk for what vit def
Vit B12
pernicious anemia at risk for what vit def
vit B12
what vit may delay progression of age related macular degeneration
E
what vit used to prevent and treat scurvy
Vit C
symptoms of scurvy
faulty bone and tooth development loosening of teeth gingivitis bleeding gums poor wound healing hemorrhage into muscles and joints ecchymoses
treat pellagra
nicotinamide
vit to reduce cholesterol
Vit B3 (niacin)
deficiency in this vit causes
sore throat angular stomatitis (cracks at corners of mouth) cheilosis (painful cracks in lips) glossitis (tongue inflammation) vascularization of cornea itchy derm of scrotum or vulva
Riboflavin
wet beriberi
severe thiamine deficiency causes fluid accumulation in legs palpitations ecg abnormalities high output HF
responds rapidly to treatment
dry beriberi
severe thiamine deficiency neurologic and motor defects anesthesia of feet ataxic gait foot drop wrist drop
responds slowly to treatment
serious disorder of the CNS- neuro and psych manifestations
nystagmus diplopia ataxia inability to remember recent past failure to correct -> irreversible brain damage
Wernicke-korsakoff
what should you do if you suspect Wernicke -Korsakoff
give parenteral thiamine immediately
what herb is a CYP inducer
St johns wort
what herbs suppress platelet aggregation and can increase risk for bleeding in pt receiving antiplatelet drugs
Ginkgo biloba
feverfew
garlic
cranberry juice
what herb can elevate BP and stimulate heart and CNS - therefore can intensify the effects of pressor agents, cardiac stimulants and CNS stim
Ma Huang (ephedra)
what herb should not be used to reduce hot flashes caused by tamoxifen and other SERMS
Black cohosh
interactions with Butterbur can occur with what type of drugs
CYP inducers
CoQ10 may _____ the effects of warfarin
antagonize
cranberry juice and warfarin
increase risk of bleeding in pt taking warfarin
allergic reaction to echinacea
can cause allergic reactions such as acute asthma, urticaria, angioedema, anaphylaxis
who needs to avoid echinacea
autoimmune disease (short term may stimulate immune function and long term can suppress immune function)
what syndrome is characterized by nervousness fatigue insomnia tension headache joint pain stiffness
postfeverfew syndrome
feverfew can decrease
what precautions
platelet aggregation and should be d/c 2 weeks before surgery
herb that has been shown decrease plasma levels of total cholesterol and LDL
Flaxseed
Cranberry juice and urine
does not acidify the urine
daily consumption of cranberry juice can
prevent UTI
quadruple G - antiplatelet herbs
Garlic
ginger
Ginko
glucosamine
uses for peppermint
decrease nausea
confirmed benefit for mgmt of IBS (RCTs)
therapy for small intestinal bacterial overgrowth (SIBO)
due to antibiotic properties
prevent nipple cracking and pain when breastfeeding
functional abd pain
tension headaches (apply to temples) - comparable to tylenol
Peppermint is bactericidal against what bacteria
E.coli
H.Pylori
Salmonella enterididis
how does peppermint help with pain
activates opioid receptors
TRPM8 receptors in GI
Adverse effects peppermint
esophageal reflux
allergic reactions have been reported
excessive can cause renal problems
perianal burning in high doses
in standard doses - no serious side effects
peppermint oil and antispasmotics
may have an additive effect when taken together (Bentyl)
garlic and cardiovascular
may lower BP
may decrease rate of atherosclerosis
antiplatelet effects
garlic can reduce levels of what 2 drugs
cyclosporine (immunosuppressant)
Saquinavir (protease inhibitor for HIV)
ginger is used for
suppression of n/v for morning sickness (proven)
motion sickness, seasickness and gen anesthesia (inconclusive)
antiinflammatory for arthritis and other chronic inflammatory (not proven)
Ginger interactions
antiplatelet
lower Blood sugar
ginko biloba used for
improve memory
halt progression of dementia (not proven)
decrease intermittent claudication
treatment of ED
antiplatelet
people eating raw or roasted ginko seeds can cause
seizures and fatalities
who should not take ginko
seizures people on antiplatelet drugs antipsychotics antidepressants cholinesterase inhibitors decongestants first gen antihistamines systemic glucocorticoids
glucosamine and chondroitin
usually given together
used to treat osteoarthritis (not proven for pain relief)
American college of rheum does not recommend
who should not take glucosamine and chondroitin
shellfish allergy
can raise levels of glucose
antiplatelet
what plant is green tea made from
camellia sinensis plant
uses for green tea
lose weight
improve mental clarity
prevent and treat cancers of stomach, skin, bladder, breast
interactions for green tea
small amount of Vit K so opposes warfarin anticoagulant effects
if you take nadolol - decreases absorption of nadolol
3 types of bacteria in probiotics
lactobacilli
bifidobacteria
also
Saccharomyces boulardii
adverse effect for probiotic
fungemia has occured when packets of S.boulardii (florastor) have been opened at the bedside in the ICU - contraindicated in pt with central lines
blood infection with lactobacilli and fungi after yogurt in severely ill
Resveratrol
antioxidant
found in red wine purple grape juice blueberries cranberries peanuts
Probiotics should be taken no sooner than ___ hours after dosing with antibacterial or antifungals
2
interactions for Saw Palmetto
antiplatelet effects
soy taken to relieve
hot flashes and may slow the progression of osteoporosis in perimenopausal/postmenopausal women
soy should not be combined with
tamoxifen and other drugs that block estrogen receptors
MAO inhibitors (because soy contains tyramine)
St Johns equal to what type of antidepressant
Tricyclic antidepressants
St johns and digoxin
greatly reduces levels of digoxin
St johns with other antidepressants and stim
MAO inhibitors SSRIs Tricyclic agents (amitriptyline, clomipramine) duloxetine nefazodone venlafaxine
Serotonin syndrome
Valarian root works on
GABA agonist
harmful supplements to avoid
comfrey - severe liver damage
kava - severe liver damage
Ephedra - stroke, MI, death
intermediate acting insulin
NPH (Humulin N, Novolin N)
Long acting insulins
INsulin glargine (lantus) Insulin detemir (levemir)
Ultralong insulins
Insulin glargine (U-300) (Toujeo) INsulin degludec (TResiba)
difference in methotrexate and entanercept
methotrexate is a traditional dmard
etanercept (enbrel) is a biologic dmard - no live vaccines, TB and Hep B testing prior to start, close monitoring of CBC
bisphosphonate used to prevent and treat osteoporosis in postmenopausal women
Alendronate (Fosamax)
education important for Alendronate (Fosamax)
Esophagitis is the primary concern
take with full glass of water and sit/stand for 30 min
rarely musculoskeletal pain
atypical femur fractures
while a pt is on Cromolyn for allergic conjunctivitis
what can you prescribe while that begins to work?
2+ weeks to become max effective
antihistamines (H1 receptor antagonists)
-azelastine and olopatadine
NSAID - Ketorolac / glucocorticoid (loteprednol)
ocular decongestants - naphazoline and phenylephrine
congenital hypothyroidism can cause
developmental problems
when is the fetal thyroid fully functional
second trimester - at this point the fetus can supply their own thyroid hormones
when women taking thyroid supplements become pregnant how does their dosage change
by as much as 50%
need increased between weeks 4-8 of gestation and levels off by week 16 and stays teady until partuition
hypothyroid in newborn. how long to continue meds before trial
how long is trial
If TSH is high what does that mean
3 years
4 weeks off
test TSH and T4
if TSH is high - then they are hypothyroid, continue meds
if TSH is normal - d/c meds, it was transient
if TSH is low, hypo or hyper thyroid
Hyperthyroid
hyperthermia (105 or higher) severe tachycardia restlessness agitation tremor
after surgery or sepsis
Thyrotoxic crisis (thyroid storm)
unconsciousness
coma
hypotension
heart failure may ensue
what do you give for thyroid storm
high doses of potassium iodide or strong iodine solution
b blocker for heart rate
sedation, cooling, giving glucocorticoids
iv fluids
pregnant with thyroid storm
PTU
levothyroxine and warfarin
levothyroxine accelerates the degradation of vit K dependent clotting factors - > effects of warfarin are enhanced - warfarin needs to be reduced
if someone needs to switch synthroids what is important to know
once you start you don’t want to switch because bioavailability can be different
monitor closely
if someone on synthroid when do you re-evaluate levels
1 month to reach plateau
6-8 weeks after starting treatment
check at least once a year after dosing is established
increased TSH means
hypothyroid
how often should a diabetic taking insulin check their blood glucose
6-7 xs a day
step 1 for treating type 2 DM
lifestyle changes and metformin
at diagnosis for t2DM, when do you skip to step 2 for treatment
A1c of 9% or greater at time of diagnosis
what opioid has the lowest risk for abuse
Petazocine (Talwin)
most common adverse effect of bisphosphonates
esophagitis
muscle pain rair
osteonecrosis of jaw rare
QT prolongation meds
methadone
Butrans
Hydroxychloroquine
first line for RA treatment
methotrexate - takes 3-6 weeks to work
NSAIDS in the mean time
still doesnt work
glucocorticoid -
someone on methotrexate needs what nutritional supplement
folic acid
what NSAID is a second gen approved for RA that will only inhibit cox 2 - easier on stomach
Celebrex
triptans and SSRI
cannot take together - serotonin syndrome
if need the SSRI (Fluoxetine - Prozac), wait 24 hours and start on Ergo (Elavil)
taking Elavil and now has cold hands, feet with nausea
erotism -stop the ergo
Boniva (ibandronate) is given for
what organ do you need to be careful with this one
what route and how often
postmenopausal osteoporosis - only for this
renal function checked before each dose
PO once a month - must sit up for 60 min after taking
or
IV every 3 months
older than 60 on steroids long time, what are measures to prevent osteoporosis
check baseline vit d
give vit d and calcium
as kids grow what happens with synthroid dose
increase as they grow, monitor TSH
