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Nplex II > Nutrients > Flashcards

Nutrients Flashcards

1
Q

What dose of Vitamin A is teratogenic?

A

10,000 IU - can cause osteoporosis and fracture

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2
Q

If a patient comes in with night blindness, growth deficits, impaired spermatogenesis, follicular hyperkeratosis, and decreased immune function… what nutrient do you suspect is deficient

A

Vitamin A

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3
Q

A patient tells you they are taking handfuls of supplements for their immunity during the pandemic, but they have new onset N/v/anorexia, confusion, increased intracranial pressure, abdominal pain, blurry vision, headache, and muscle weakness…. what supplement might you suspect

A

Vitamin A

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4
Q

What is beta-carotene useful for

A

Dementia and cognitive decline

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5
Q

A patient smokes 1 pack a day and drinks heavily and wants to prevent cognitive decline. She tells you she has been taking beta carotene…

A

Tell them to stop the supplement and to stop smoking/drinking ;)

Beta carotene increases incidence of lung cancer in smokers.

Beta carotene increases hepatotoxicity of ethanol when taken together

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6
Q

deficiency of what nutrient might prevent thiamine from being converted to its active form?

A

magnesium

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7
Q

What syndromes should be suspected in al alcoholic with psychiatric disturbances, ataxia, ocular palsy, and nystagmus

Or weight loss, weakness, neuropathies, tachycardia, CHF

A

Thiamine deficiency causing: wernicke’s encephalopathy for the CNS signs

beriberi for the more peripheral signs of thiamine deficiency

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8
Q

What are the indications for B2 supplementation

A

Migraines, Parkinsons, Psoriasis

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9
Q

A patient comes ins with glossitis, weakness, depression, lacrimation, decreased visual function, and seborrheic dermatitis

She says she is vegan and hates green leafy veggies/fruits/grains

What nutrient might be deficient?

A

B2

Note that B7 Biotin deficiency can also cause dermatitis (scaly), depression… but has more neuro signs like hallucinations/paresthesias/nausea

Note that B6 deficiency can also cause glossitis, but likely has weakness, neuropathy, cheilosis, and insomnia

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10
Q

A patient tells you that they eat 6 raw egg whites per day in a smoothie in an attempt at bulking up. They also take an anticonvulsant drug

What nutrient deficiency are they at risk for?

What sx should you look for?

A

B7/Biotin deficiency

Look for dermatitis, alopecia, hallucinations, paresthesias, nausea

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11
Q

This micronutrient can be synthesized from tryptophan and is important for tons of chemical reactions in the body

A

Niacin (Vitamin B3)

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12
Q

When might we consider Niacin supplementation?

A

In CVD atherosclerosis/ischemia.

In hypercholesterolemia - lowers LDL, raises HDL

In acne, psychiatric disorders, taste disorders

May enhance Insulin secretion in T1DM

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13
Q

A patient comes in with cracked, thick, scaly and darkly-pigmented skin rash that is symmetrical and worse in the sun.

She also says that she has diarrhea with undigested food int he stool

She says she has daily headaches, can’t sleep, forgets names all the time and feels confused, and last night had a hallucination of rats in her walls. PHQ-9 suggests severe depression.

She is vegan, GF, and allergic to legumes.

She thinks she might die if this doesn’t get figured out soon.

What is she deficient in? what does she have?

A

Pellagra - Niacin deficiency
The 4D’s

Dermatitis
Diarrhea
Dementia
Death

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14
Q

What side effect of Niacin?

A

Flushing and itching

Hepatotoxic at 3g+ per day

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15
Q

Mnemonic for the B vitamins

A

Then - Thiamine 1
Roland - Riboflavin 2
N - Niacin 3
Peter - Pantothenic Acid 5
Played - Pyridoxine 6
Bowling - Biotin 7
For - Folate 9
Coins - Cobalamin 12

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16
Q

Indications for B5 treatment

A

Acne vulgaris
Allergic Rhinitis
Hypoadrenalism

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17
Q

Low B6 is associated with elevations in what metabolite?

A

Homocysteine

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18
Q

Max dose of B6

A

250 mg/day

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19
Q

B6 deficiency signs

A

B6 deficiency can cause glossitis, weakness, neuropathy, cheilosis, and insomnia. + anemia, + seizures

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20
Q

B6 is neurotoxic at what dose?

A

500 mg/day. Can cause ataxia at 2-6 g/day

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21
Q

Causes of deficiency of b7

A

Antibiotic therapy, intestinal resection, raw egg whites

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22
Q

B12 deficiency can cause

A

microcytic anemia, neurological sx, psych stuff (memory loss, depression, confusion), glossitis, peripheral neuropathy

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23
Q

Patient with hyperhomocysteinemia, Peripheral neuropathy may be deficient in what B vitamins?

A

B12/B9

Don’t replete folate without repleting B12 as folate supplementation can mask B12 deficiency

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24
Q

Signs of scurvy

A

Bleeding abnormalities (hemarthrosis), delayed wound healing, infections, bone pain, osteoporosis, edema, fatigue, depression

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25
Who should not be given vitamin C? What might happen with abrupt discontinuation
G6PD deficiency. Abrupt discontinuation might produce rebound scurvy
26
A patient says they have been slamming vitamins they got from an instagram influencer and labs show hypercalcemia +they just had a kidney stone. What vitamin might be at toxic serum levels?
Vitamin D (40,000 IU per day can cause this)
27
What is vitamin E
a lipid antioxidant, protecting and preserving integrity of cell and sub cellular membranes
28
When do we supplement vitamin E?
low intake of vegetable oils, nuts, seeds
29
Positive evidence for uses of Vitamin E
Cambridge heart antioxidant study supported vitamin E supplement in preventing second MI
30
Vitamin E toxicity
In excess of 1200 IU/day Increased mortality, heart failure, diarrhea, headache, hemorrhagic stroke synthetic vitamin E may cause cancer
31
How is low vitamin K identified
Prothrombin time (PT) - K is a cofactor in the extrinsic pathway. Remember: We play tennis (PT) outside (extrinsic) and Knock it outta the park
32
What nutrient deficiency is associated with neural tube defects
Vitamin B9 (Folate)
33
Function of folate
Transfer single carbon units in metabolic processes. Essential cofactor in AA and nucleic acid synthesis
34
Limited research suggests megadoses of folate of 10 mg/day may be beneficial in ___
cervical dysplasia
35
What dose of folate to prevent overt deficiency
100 micrograms/day
36
Folate toxicity dose and effects
10 mg/day can cause seizures.
37
What labs to assess folate?
Serum folate- but this fluctuates based on diet RBC folate is better
38
What is the rationale for supplementation with Boron
May play a role in metabolism of calcium, phos, mag, steroid hormones, and vitamin D. May enhance impact of estrogen on bone density. Thus it is used for preventing osteoporosis/arthritis Possibly for prevention of urolithiasis and CVD by increasing endogenous estrogen
39
Boron toxicity does what?
increases plasma estradiol concentration causingg nausea/vomiting/diarrhea/dermatiits, lethargy
40
Food sources of boron
Non-citrus fruit, green leafy veggies, nuts, legumes, beer, w wine, cider
41
What dietary intake increases loss of calcium in the urine?
Dietary intake of protein potentiates loss of calcium in urine. Each 50g increase causes 60 mg calcium to be excreted.
42
What dietary intake inhibits calcium absorption?
High oxalate foods (spinach, rhubarb, beets), phytates,
43
Risks/Benefits of calcium supplementation
May lower BP, may protect against colon cancer, may increase bone density (but not lower risk of fx) Calcium supplementation > 500 mg daily may increase risk of cardiovascular events Calcium depletes magnesium Increased risk for stones not seen in dietary intake Milk alkali syndrome - large amounts of calcium and alkali can cause renal failures, memory loss, lethargy, coma, death
44
What is milk-alkali syndrome
Milk alkali syndrome - large amounts of calcium and alkali can cause renal failures, memory loss, lethargy, coma, death
45
What is the main role of chromium
Chromium is an insulin cofactor and may improve glucose tolerance
46
What things impact chromium absorption/excretion?
Vitamin C: increases absorption Antacids: decrease absorption Diet high in simple sugars: increases excretion
47
What dose is recommended for insulins resistance
1000 microgram/day
48
Chromium drug interactions
Insulin, glybruride, metformin may be beneficial in combo with chromium... but may cause hypoglycemia. Chromium may improve efficacy of SSRIs by increasing peripheral availability of tryptophan
49
Copper deficiency
growth deficits, anemia, neutropenia, bone lesions, osteoporosis, decreased resistance against infections.
50
Copper indications
osteoporosis, burns, peptic ulcer, RA, aneurysm prevention
51
If deficient, this mineral may correct hypothyroidism and increase intelligence
Iodine
52
What happens if iodine is given in pregnancy
irreversible mental and neurological impairment
53
This mineral is useful in the tx of Restless leg syndrome
iron
54
What causes magnesium loss
Thiazides and alcohol
55
This is supplemented during pregnancy to reduce the risk of preeclampsia
Magnesium
56
This nutrient may help with arrhythmias, htn, constipation, muscle cramps, migraine, asthma, kidney stones
magnesium
57
A patient has end-stage renal disease, myasthenia gravis, and is recovering from cerebral hemorrhage.... can you give them magnesium?
No.
58
Manganese is a cofactor for what
chondroitin sulfate for cartilage production and organic matrix of bone
59
Manganese toxicity
Actually... pretty toxic. Manganese dust creates toxicity in miners (psychosis, Parkinsonism)
60
Molybdenum is a cofactor for what
Xanthine oxidase (scavenger for free radicals) sulfite oxidase aldehyde oxidase
61
A patient has chronic aches and pains + asthma. She also notes that she gets worse when she eats sulfur containing foods like onions or eggs. what might help her?
Molybdenum
62
A patient with gout wants to know if he can take molybdenum to help him process sulfites. what say you?
It can increase uric acid levels, so its not a good idea
63
Signs of hypokalemia
Fatigue, weakness, muscle cramps, palpitations, arrhythmias, hypertension, postural htn
64
Hyperkalemia signs
Diarrhea, heart block, n/v
65
What's selenium's function?
GSH peroxidase cofactor vitamin E metabolism conversion of t4-t3
66
Selenium indications:
hypothyroidism chronic asthma
67
Can people take as much selenium as they want?
No. narrow margin of safety. 1000 ug/day max Toxicity: hair loss, brittle nails, white spots on nails, dermatitis.
68
Hypernatremia signs
HTN, arrhythmias, muscle weakness, worsening chf, increased calcium excretion
69
This is involved in dNA and protein synthesis growth, visual function, hearing, taste, spermatogenesis, immune function, and wound healing
Zinc
70
Why is zinc helpful in Wilson's dz?
It competes with copper for absorption
71
PVT TIM HALL
Phenylalanine Valine Tryptophan Threonine Isoleucine Methionine Histidine Arginine (in babies only) Leucine Lysine
72
This amino acid is an immediate precursor to nitric oxide and thus may be useful in tx of HF, erectile dysfunction, Raynaud's
arginine
73
Toxicity of arginine
May cause hsv outbreak because it antagonizes lysine May cause hyperkalemia in renal insufficiency may worsen hepatic dysfunction
74
Food sources of arginine
Wheat, chocolate, nuts, dairy products, meat, peanuts, brown rice, raisins, sesame, sunflower seeds, oats
75
This AA has a role in maintaining SI structure and function, is stored in skeletal muscle, and is key in immune function
L-Glutamine
76
When is L-glutamine most indicated
AIDS, alcohol addiction, burns, illness, *gastroenteritis*, pancreatitis, *PUD*
77
L-Lysine is a precursor to what?
Carnitine
78
L-Methionine is a precursor to what?
Precursor to cysteine and important in synthesis of carnitine and S-adenosylmethionine
79
What is the most toxic amino acid? what does overload cause?
L-methionine (meth is toxic) overload causes Growth depression and anemia and leukocytosis and elevated homocysteine
80
Phenylalanine precursor to what?
Tyrosine, dopa, NE, melanin
81
Phenylalanine might be helpful in what conditions?
Vitiligo Parkinsons dz Depression Pain
82
Why does phenylketonuria lead to hypothyroidism and light skin
Because phenylalanine is not ale to be metabolized into tyrosine or melanin
83
Taurine is synthesized endogenously from what?
Cysteine with B6
84
Taurine does what?
Stabilizes cell membranes, functions as a neurotransmitter and osmoregulator
85
Taurine deficiency can cause what? Is caused by what?
Retinal degeneration Cardiac arrhythmias/hypercoaguability taurine deficiency can be caused by chemo and radiation
86
Tyrosine is created by what AA
phenylalanine
87
Tyrosine is a precursor to what?
Dopamine, NE, Epi, Thyroxine (with B6: tyro + pyridoxine = thyroxine. cute!)
88
You have a pregnant patient with narcolepsy and hypothyroidism and she asks about tyrosine supplementation... should she take it?
No. It causes neurological and behavioral abnormalities in infants
89
L-Tryptophan is a precursor to what
Serotonin, melatonin, niacin, piccolini acid requires b6 q
90
When should l-tryptophan not be supplemented
with SSRI's - may cause serotonin syndrome
91
Function of Acetyl-L-carnitine
structurally similar to acetylcholine and functions as a cholinergic transmitter
92
Carnitine is synthesized from what two AAs
lysine and methionine with cofactors Vitamin C, B6, and B3
93
Carnitine biochem function?
shuttles fatty acids into mitochondria
94
Supplementing carnitine may do what?
enhance exercise tolerance, improve oxidation metabolism in pt's with angina/PVD, improve cardiac function, improve cognitive function,
95
A bodybuilder patient comes in complaining of n/v/abdominal cramps, diarrhea, and you notice they smell "fishy". After reviewing their supplement list, you notice they are taking more than 3g/day of what supplement?
creatine
96
Ubiquinone biological function
functions in the electron transport chain, neutralizes free radicals, creates ATP
97
CoQ10 absorption is improve with meals because...
CoQ10 is absorbed by chylomicrons for transport to the liver and later released into circulation via lipoproteins
98
Creatine is made endogenously from what AA'?
glycine and arginine
99
Indications for creatine
Post TBI headaches neuromuscular disorders - can improve muscle strength improved endurance in HF patients
100
Dmethylaminoethanol is what?
A precursor to acetylcholine - indicated for Alzheimers and tar dive dyskinesia
101
Flavonoids preserve what nutrient?
They help preserve vitamin C levels - low intake may lead to scurvy
102
flavonoid uses
venous insufficiency: 50 mg/day Retinopathy: 300 mg/day Cancer prevention: 400 mg/day green tea polyphenols
103
Para-amino benzoic acid
non-protein AA that is unofficially a B vitamin Indicated as an anti fibrosis agent in dermatitis, scleroderma, vitiligo, and AI dz.
104
food sources of PABA
brewers yeast
105
Contraindications for PABA
Sulfa antibiotics are interfered with by PABA

Nplex II (10 decks)

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