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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
Q

Who should not be given vitamin C? What might happen with abrupt discontinuation

A

G6PD deficiency.
Abrupt discontinuation might produce rebound scurvy

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26
Q

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?

A

Vitamin D (40,000 IU per day can cause this)

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27
Q

What is vitamin E

A

a lipid antioxidant, protecting and preserving integrity of cell and sub cellular membranes

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28
Q

When do we supplement vitamin E?

A

low intake of vegetable oils, nuts, seeds

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29
Q

Positive evidence for uses of Vitamin E

A

Cambridge heart antioxidant study supported vitamin E supplement in preventing second MI

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30
Q

Vitamin E toxicity

A

In excess of 1200 IU/day
Increased mortality, heart failure, diarrhea, headache, hemorrhagic stroke

synthetic vitamin E may cause cancer

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31
Q

How is low vitamin K identified

A

Prothrombin time (PT) - K is a cofactor in the extrinsic pathway.

Remember: We play tennis (PT) outside (extrinsic) and Knock it outta the park

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32
Q

What nutrient deficiency is associated with neural tube defects

A

Vitamin B9 (Folate)

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33
Q

Function of folate

A

Transfer single carbon units in metabolic processes.
Essential cofactor in AA and nucleic acid synthesis

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34
Q

Limited research suggests megadoses of folate of 10 mg/day may be beneficial in ___

A

cervical dysplasia

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35
Q

What dose of folate to prevent overt deficiency

A

100 micrograms/day

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36
Q

Folate toxicity dose and effects

A

10 mg/day can cause seizures.

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37
Q

What labs to assess folate?

A

Serum folate- but this fluctuates based on diet

RBC folate is better

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38
Q

What is the rationale for supplementation with Boron

A

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

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39
Q

Boron toxicity does what?

A

increases plasma estradiol concentration causingg nausea/vomiting/diarrhea/dermatiits, lethargy

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40
Q

Food sources of boron

A

Non-citrus fruit, green leafy veggies, nuts, legumes, beer, w wine, cider

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41
Q

What dietary intake increases loss of calcium in the urine?

A

Dietary intake of protein potentiates loss of calcium in urine.
Each 50g increase causes 60 mg calcium to be excreted.

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42
Q

What dietary intake inhibits calcium absorption?

A

High oxalate foods (spinach, rhubarb, beets), phytates,

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43
Q

Risks/Benefits of calcium supplementation

A

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
Q

What is milk-alkali syndrome

A

Milk alkali syndrome - large amounts of calcium and alkali can cause renal failures, memory loss, lethargy, coma, death

45
Q

What is the main role of chromium

A

Chromium is an insulin cofactor and may improve glucose tolerance

46
Q

What things impact chromium absorption/excretion?

A

Vitamin C: increases absorption
Antacids: decrease absorption
Diet high in simple sugars: increases excretion

47
Q

What dose is recommended for insulins resistance

A

1000 microgram/day

48
Q

Chromium drug interactions

A

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
Q

Copper deficiency

A

growth deficits, anemia, neutropenia, bone lesions, osteoporosis, decreased resistance against infections.

50
Q

Copper indications

A

osteoporosis, burns, peptic ulcer, RA, aneurysm prevention

51
Q

If deficient, this mineral may correct hypothyroidism and increase intelligence

A

Iodine

52
Q

What happens if iodine is given in pregnancy

A

irreversible mental and neurological impairment

53
Q

This mineral is useful in the tx of Restless leg syndrome

A

iron

54
Q

What causes magnesium loss

A

Thiazides and alcohol

55
Q

This is supplemented during pregnancy to reduce the risk of preeclampsia

A

Magnesium

56
Q

This nutrient may help with arrhythmias, htn, constipation, muscle cramps, migraine, asthma, kidney stones

A

magnesium

57
Q

A patient has end-stage renal disease, myasthenia gravis, and is recovering from cerebral hemorrhage…. can you give them magnesium?

A

No.

58
Q

Manganese is a cofactor for what

A

chondroitin sulfate for cartilage production and organic matrix of bone

59
Q

Manganese toxicity

A

Actually… pretty toxic. Manganese dust creates toxicity in miners (psychosis, Parkinsonism)

60
Q

Molybdenum is a cofactor for what

A

Xanthine oxidase (scavenger for free radicals)
sulfite oxidase
aldehyde oxidase

61
Q

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?

A

Molybdenum

62
Q

A patient with gout wants to know if he can take molybdenum to help him process sulfites. what say you?

A

It can increase uric acid levels, so its not a good idea

63
Q

Signs of hypokalemia

A

Fatigue, weakness, muscle cramps, palpitations, arrhythmias, hypertension, postural htn

64
Q

Hyperkalemia signs

A

Diarrhea, heart block, n/v

65
Q

What’s selenium’s function?

A

GSH peroxidase cofactor

vitamin E metabolism

conversion of t4-t3

66
Q

Selenium indications:

A

hypothyroidism
chronic asthma

67
Q

Can people take as much selenium as they want?

A

No. narrow margin of safety.
1000 ug/day max

Toxicity: hair loss, brittle nails, white spots on nails, dermatitis.

68
Q

Hypernatremia signs

A

HTN, arrhythmias, muscle weakness, worsening chf, increased calcium excretion

69
Q

This is involved in dNA and protein synthesis growth, visual function, hearing, taste, spermatogenesis, immune function, and wound healing

A

Zinc

70
Q

Why is zinc helpful in Wilson’s dz?

A

It competes with copper for absorption

71
Q

PVT TIM HALL

A

Phenylalanine
Valine
Tryptophan

Threonine
Isoleucine
Methionine

Histidine
Arginine (in babies only)
Leucine
Lysine

72
Q

This amino acid is an immediate precursor to nitric oxide and thus may be useful in tx of HF, erectile dysfunction, Raynaud’s

A

arginine

73
Q

Toxicity of arginine

A

May cause hsv outbreak because it antagonizes lysine

May cause hyperkalemia in renal insufficiency

may worsen hepatic dysfunction

74
Q

Food sources of arginine

A

Wheat, chocolate, nuts, dairy products, meat, peanuts, brown rice, raisins, sesame, sunflower seeds, oats

75
Q

This AA has a role in maintaining SI structure and function, is stored in skeletal muscle, and is key in immune function

A

L-Glutamine

76
Q

When is L-glutamine most indicated

A

AIDS, alcohol addiction, burns, illness, gastroenteritis, pancreatitis, PUD

77
Q

L-Lysine is a precursor to what?

A

Carnitine

78
Q

L-Methionine is a precursor to what?

A

Precursor to cysteine and important in synthesis of carnitine and S-adenosylmethionine

79
Q

What is the most toxic amino acid? what does overload cause?

A

L-methionine

(meth is toxic)

overload causes Growth depression and anemia and leukocytosis and elevated homocysteine

80
Q

Phenylalanine precursor to what?

A

Tyrosine, dopa, NE, melanin

81
Q

Phenylalanine might be helpful in what conditions?

A

Vitiligo
Parkinsons dz
Depression
Pain

82
Q

Why does phenylketonuria lead to hypothyroidism and light skin

A

Because phenylalanine is not ale to be metabolized into tyrosine or melanin

83
Q

Taurine is synthesized endogenously from what?

A

Cysteine with B6

84
Q

Taurine does what?

A

Stabilizes cell membranes, functions as a neurotransmitter and osmoregulator

85
Q

Taurine deficiency can cause what? Is caused by what?

A

Retinal degeneration
Cardiac arrhythmias/hypercoaguability

taurine deficiency can be caused by chemo and radiation

86
Q

Tyrosine is created by what AA

A

phenylalanine

87
Q

Tyrosine is a precursor to what?

A

Dopamine, NE, Epi, Thyroxine (with B6: tyro + pyridoxine = thyroxine. cute!)

88
Q

You have a pregnant patient with narcolepsy and hypothyroidism and she asks about tyrosine supplementation… should she take it?

A

No. It causes neurological and behavioral abnormalities in infants

89
Q

L-Tryptophan is a precursor to what

A

Serotonin, melatonin, niacin, piccolini acid

requires b6
q

90
Q

When should l-tryptophan not be supplemented

A

with SSRI’s - may cause serotonin syndrome

91
Q

Function of Acetyl-L-carnitine

A

structurally similar to acetylcholine and functions as a cholinergic transmitter

92
Q

Carnitine is synthesized from what two AAs

A

lysine and methionine with cofactors Vitamin C, B6, and B3

93
Q

Carnitine biochem function?

A

shuttles fatty acids into mitochondria

94
Q

Supplementing carnitine may do what?

A

enhance exercise tolerance, improve oxidation metabolism in pt’s with angina/PVD, improve cardiac function, improve cognitive function,

95
Q

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?

A

creatine

96
Q

Ubiquinone biological function

A

functions in the electron transport chain, neutralizes free radicals, creates ATP

97
Q

CoQ10 absorption is improve with meals because…

A

CoQ10 is absorbed by chylomicrons for transport to the liver and later released into circulation via lipoproteins

98
Q

Creatine is made endogenously from what AA’?

A

glycine and arginine

99
Q

Indications for creatine

A

Post TBI headaches
neuromuscular disorders - can improve muscle strength
improved endurance in HF patients

100
Q

Dmethylaminoethanol is what?

A

A precursor to acetylcholine - indicated for Alzheimers and tar dive dyskinesia

101
Q

Flavonoids preserve what nutrient?

A

They help preserve vitamin C levels - low intake may lead to scurvy

102
Q

flavonoid uses

A

venous insufficiency: 50 mg/day
Retinopathy: 300 mg/day
Cancer prevention: 400 mg/day green tea polyphenols

103
Q

Para-amino benzoic acid

A

non-protein AA that is unofficially a B vitamin

Indicated as an anti fibrosis agent in dermatitis, scleroderma, vitiligo, and AI dz.

104
Q

food sources of PABA

A

brewers yeast

105
Q

Contraindications for PABA

A

Sulfa antibiotics are interfered with by PABA

Nplex II (10 decks)

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