Nutrition Flashcards
Protein: calories, required daily intake
4 kcal/gram
Adults = 10-35% diet
75 g/day
Carbs: calories, required daily intake
4 kcal/gram
Adults = 45-65% daily intake
130/day minimum, usually 225
Fat: calories, required daily intake
9 kcal/ gram
Adults = 20-35% daily intake
67g/day
fiber: required daily intake
14g/1,000 calories, OR 0.5g fiber/ kg body weight/ day
21-38 g/day
Thiamin B1 deficiency
malabsorption/ nutrition or alcoholism
s/s start as muscle cramping, parasthesias,
wet beriberi= affects CV system- HF symptoms
dry beriberi= affects CNS (wernike korsakoff encephalitis– amnesia, nystagmus) loss of reflexes, neuropathy,
Cardiac diet indication
Hyperlipidemia, CVD
low fat, low cholesterol
Low and High Fiber diets, indications
Low Fiber: diverticulitis, crohn’s, ulcerative colitis flair
High Fiber: diverticulosis, constipation
High calorie diet indications
underweight, cancer, hypermetabolism d/t disease: COPD, ALS, burns
low sodium diet indications
heart failure, liver disease, HTN, transplant
protein diet indication
restricted: CKD
increased: wounds, burns, liver disease
carb restricted diet indication
diabetes
renal diet indications, what it is
indicated for : kidney disease, dialysis
what is it: low sodium, low phosphorus, low potassium
not all restrictions always needed
Fluid restrictions, indications
volume overload: heart, liver, renal failure
indications for ensure
intolerance of solid food poor oral intake
Enteral Nutrition indications
impaired nutrient ingestion (trauma)
inability to take nutrition orally (hyperemesis, comatose)
impaired digestion, absroption (severe gastroparesis, pancreatitis)
Enteral Nutrition types
Nasoenteric= short term PEG= long term, gastric PEJ= long term, jejunal
Parenteral Nutrition indications, risks
GI incompetency, critical illness w/ poor access or tolerance to EN
RISKS: infection, gut mucosal breakdown and increased permeability
Statins MOA
HGM-COA reductase inhibitor
prevents production of cholesterol in the liver
Statins – LDL reduction capability, intensity doses
High Intensity >/= 50%
mod intensity 30-49%
low intensity
who should be on a statin?
- has ASCVD (2ndary prevention)
- LDL >190 (primary prevention)
- Diabetes 40-75 y.o. (primary prevention)
- age 40-75 and >7.5% 10 yr ASCVD risk
Statins AEs, CIs,
“generally well tolerated”
AE: myopathy, increased liver enzymes, memory loss, new onset diabetes rhabdomylosis
CI: active liver disease
Precautions: drug interactions
myopathy in statins, prevelence?
up to 20% in practice
dose related
statin myopathy risk factors
higher dose, age, alcohol abuse, hypothyroidism, female, multisystem disease
OR on other Rxs
G PACMAN : grapefruit, Protease inhibitors, Azoles cyclosporine, macrolides, amiodarone, non dihydropyridien CCB
why don’t you mix gemfibrozile and statin?
increased risk of rhabdomyolysis
statin monitoring
fasting lipid profile (4-12 weeks after starting, changing dose)
CK (only for muscle pain)
screen for new onset DM
hepatic ALT baseline only
when to use statins with non-statins?
when cholesterol goals not met with statin alone.
oxidative/ reductive vitamins
thiamin (B1)
riboflavin (B2)
niacin (B3)
pantothenic acid (B5)
carboxylation/ transamination
biotin (B7)
vitamin B6
gene regulation/ post translational
vit A
vit D
vit K
antioxidants
vit E
vit C
carotinoids
1-C metabolism
folate
vit B12
choline
Riboflavin B2 function, deficiency, toxicity
FUNCTION: coenzyme: oxidative reduction, CP450
DEFICIENCY: ariboflavinosis – chelosis (red crusties on corner of mouth), glossitis
TOXICITY: none
Niacin (B3) function, deficiency, toxicity
FUNCTION: oxidative reductive, cofactor NAD, NADP….
DEFICIENCY: starts anorexia/irritabiliy/glossitis, then to Pellegra, dementia, death
TOXICITY: AE when used in high doses to treat hypertriglycemia
Pantothenic Acid (B5) function, deficiency, toxicity
FUNCTION: oxidative reductive, role in making heme, fatty acids, amino acids, vit D, A
DEFICIENCY: rare. parasthesias, burning feet syndrome
TOXICITY: none
Pyroxidine (B6) function, deficiency, toxicity
FUNCTION: carboxylation/transamination, Heme biosynthesis
DEFICIENCY: often from Rx interactions, chelosis, irritability, glossitis –> neuropathy, seizures
TOXICITY: sensory neuropathy
Biotin (B7) function, deficiency, toxicity
FUNCTION: carboxlation/transamination, histone modications
DEFICIENCY: rare, large amounts of egg whites will do this. severe= squamous dermatitis
TOXICITY: none
Folate (B9) function, deficiency, toxicity
FUNCTION: 1C metabolism
DEFICIENCY: from bad diet, alcoholism, drugs: sulpha, phenytoin, Bactrim
neural tube defects, like B12 minus neuro
TOXICITY: none
Cyanocobalamin (B12) function, deficiency, toxicity
FUNCTION: IC metabolism
DEFICIENCY: anemia, neuropathy, vegan diet, pernicious anemia (processed by intrinsic factor)
TOXICITY: none
statin drug interactions: GPACMAN
G rapefruit P rotease inhibitors A azoles C yclosporine M acrolids A amidarone N ondy....CCBs
