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Therapeutics > Nutrition > Flashcards

Nutrition Flashcards

1
Q

FDA requirement for supplements

A

safe, but does not determine effectiveness

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2
Q

what are the fat soluble vitamins

A

A, E, K, D

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3
Q

role of vitamin A

A

vision

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4
Q

role of vitamin E

A

antioxidant

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5
Q

role of vitamin K

A

required for synthesis of clotting factors

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6
Q

when may vit K need to be supplemented

A

warfarin (supratherapeutic INR)
infants

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7
Q

sign of deficient vitamin K

A

hemorrhagic disease

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8
Q

role of vitamin D

A

calcium absorption, bone health

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9
Q

what is required for Vit D activation?
which precursor is monitored?

A

2 hydroxylation to activate
25(OH)D is monitored

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10
Q

risk for vit D deficiency

A

limited sun exposure
kidney dysfunction
breastfed infant without supplementation

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11
Q

what vit D level is considered deficient

A

<12 ng/mL

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12
Q

what vit D level is considered inadequate

A

<20 ng/mL

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13
Q

what vit D level is considered toxic

A

> 50 ng/mL

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14
Q

preventative vit D dosing

A

600-1000U (15-25 mcg) QD

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15
Q

high dose VIt D treatment is used if

A

Vit D <12ng/mL, symptomatic, or concomitant hypocalcemia

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16
Q

high dose VIt D treatment dosing

A

50,000 U (1250 mcg) QW for 6-12 weeks

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17
Q

low dose vit D treatment is used if

A

levels 12-20 ng/mL without symptoms or concomitant hypocalcemia

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18
Q

low dose vit D treatment dosing

A

800-1000 U (20-25 mcg) QD for 3-4 months
not responding –> increase to 2000 U QD

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19
Q

maintenance dose of vit D

A

600-2000 U (15-50 mcg) QD

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20
Q

populations that may need higher vit D doses

A

obesity, malabsorption, gastrectomy

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21
Q

what are the water soluble vitamins

A

thiamine/B1, riboflavin/B2, niacin/B3, pyridoxine/B6, cyanocobalamin/B12, folate/B9, vitamin C

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22
Q

role of thiamine/B1

A

energy metabolism

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23
Q

major sign and risk factor for thiamine deficiency

A

wernicke’s
alcohol use disorder

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24
Q

role of riboflavin

A

component of 2 enzymes involved in energy production, cell function, growth, and development

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25
Q

role of niacin

A

energy and development/function of cells

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26
Q

sign of deficient niacin

A

pellagra

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27
Q

role of pyridoxin

A

various

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28
Q

signs of deficient B6

A

anemia, weakness, insomnia, cns dysfunction, peripheral neuropathy

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29
Q

role of cyanocobalamin

A

various

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30
Q

signs of deficient B12

A

megaloblastic anemia, peripheral neuropathy

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31
Q

role of folate

A

makes dna and genetic material

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32
Q

sign of deficient B9

A

megaloblastic anemia

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33
Q

risks for deficient B9

A

poor diet, alcoholism, malabsorptive disorder

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34
Q

when is folate supplement recommended

A

women of childbearing age and pregnancy

35
Q

role of vitamin c

A

antioxidant

36
Q

sign of vit C deficiency and who may need more supplementation

A

scurvy, smokers

37
Q

recommended supplement if pregnant
and what supplement to avoid

A

prenatal
avoid vit A (high conc teratogenic)

38
Q

what supplement is recommended in breastfeeding

A

iodine, choline

39
Q

what supplement is recommended for bariatric surgery

A

bariatric multivitamin
vit a/d/e/k/b1/b12/folate etc.

40
Q

essential nutrients for elderly that may need supplementation

A

b12, b6, d, and calcium

41
Q

supplement for age-related macular degeneration

A

AREDs2

42
Q

which supplements might breastfed infants need

A

vitamin D and iron

43
Q

deficiencies in alcohol use disorder

A

thiamine, pyridoxine, folate

44
Q

outpatient supplement for AUD

A

multivit with thiamine, pyridoxine, and folate

45
Q

inpatient treatment for wernickes

A

200-500mg IV thiamine TID for 2-7 days then 250 mg IV QD for 3-5 days

46
Q

maintenance supplement for wernickes

A

100 mg thiamine po qd

47
Q

deficiency caused by antiepileptics

A

calcium

48
Q

deficiency caused by isoniazid

A

b6

49
Q

deficiency caused by loops

A

K and Mg

50
Q

deficiency caused by metformin

A

B12

51
Q

deficiency caused by methotrexate

A

folate

52
Q

deficiency caused by orlistat

A

beta-carotene, fat-soluble vitamins

53
Q

deficiency caused by PPIs

A

Mg, B12

54
Q

when is enteral nutrition considered

A

after 7 days if hospitalized
consider earlier if ICU

55
Q

when to use enteral vs parenteral

A

if the gut works use it

56
Q

how to administer meds with an NG, ND or G tube

A

crush and flush

57
Q

DDIs where EN feeds need to be held 1-2 hours before and after dosing

A

phenytoin, quinolones, levothyroxine, warfarin

58
Q

typical kcal/ml range of EN formulas

A

1-1.8kcal/ml
higher = more concentrated

59
Q

EN requirements for fluid restricted diets

A

lower volume formula

60
Q

EN requirements for renal disease

A

lower K and phosphate

61
Q

EN requirements for DM

A

more fat and fiber, fewer carbs

62
Q

EN requirements for burn/trauma patients

A

high protein

63
Q

EN requirements for pancreatitis

A

low fat

64
Q

bolus EN G tube administration rate

A

200-400 mL over 15-60 minutes

65
Q

continuous EN administration rate

A

start at 20mL/hr and uptitrate Q4H

66
Q

what to use if you have a clogged EN tube

A

cola, pancreatic enzymes, and sodium bicarb

67
Q

when to initiate PN in adults

A

nourished, stable– 7 days
nutritionally at risk– 3-5 days
baseline malnourished– ASAP

68
Q

when to initiate PN in peds

A

infants– 1-3 days
children– 4-5 days

69
Q

when to initiate PN in neonates

A

very LBW– promptly after birth
preterm/critically ill- whenever needed

70
Q

what is refeeding syndrome

A

severe reduction in K, phosphate, and Mg due to intracellular shift/repletion of stores during rapid initiation of nutrition

71
Q

max mOsm/L of EN that can be used in a peripheral line

A

900 mOsm/L

72
Q

minimum % of 3-in-1 components for stability

A

AA 4%, dextrose 10%, ILE2%

73
Q

what must be used if medications are added to a PN

A

1.2 um filter

74
Q

concerns with 3-in-1 PN

A

creaming & cracking

75
Q

how many kcal does protein provide

A

4kcal/gram

76
Q

how many kcal does dextrose provide

A

3.4 kcal/gram

77
Q

mOsm/% of protein

A

100

78
Q

mOsm/% of dextrose

A

50

79
Q

common lipid product and its kcal content

A

intralipid 20%
2kcal/mL

80
Q

what must be used when administering lipids in PN

A

1.2 um filter

81
Q

what may be a contraindication to lipid product

A

egg, soybean, and fish allergy

82
Q

max infusion rate for lipids in PN

A

peds: 0.15 g/kg/hr
adults: 0.11 g/kg/hr

83
Q

monitoring for lipids in PN

A

IFALD, TGs, and EFAD

84
Q

when adding electrolyte to PN, consider precipitation of ____… and add what first to minimize risk

A

calcium phosphate precipitation
add phosphate first

Therapeutics (20 decks)

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