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abbreviations (quiz A) > nutrition exam #2 > Flashcards

nutrition exam #2 Flashcards

1
Q

drugs that block all fat absorption of fat soluble vitamins

A

lomitapide, bile acid sequestrants, orlistat, mineral oil

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2
Q

fat soluble vitamins

A

vit A, D, E and K

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3
Q

normal intake of vitamin A

A

10 IU beta-carotene, 3.3 IU of retinol

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4
Q

s/s of vit A deficiency

A

eye issues
- soft corneas
- dry eye
- foamy plaques
- night blind

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5
Q

s/s of excess vit A

A
  • Teratogenicity
  • hepatotoxicity
  • skin issues
  • alopecia
  • muscle and bone pain
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6
Q

2 main categories of vit A

A

retinol – animal derivied

carotenoids – (beta-carotene) precursor found in fruits and veggies

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7
Q

cause of vit A deficiency

A
  • bad diet
  • chronic alchohol intake
  • lack of yellow, orange, green veggies
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8
Q

vit A dosing

A

An IU of beta-carotene creates ⅓ the retinol as other vitamin A products

1 RAE = 3.3 IU retinol = 10 IU beta

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9
Q

vit A supplement claims (measles mortality)

A

measles;
- treatment with 100,000-200,000 IU of vit A helped reduce pneumonia and mortality

  • not a replacement for vaccine
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10
Q

vitamin D types

A

Ergo-calciferol (D3) and Cholecaciferol (D2)

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11
Q

s/s of vit D deficiency

A

bone issues;
- soft and malformed
- myopathy
- hyperparathyroidism

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12
Q

s/s of vit D excess

A
  • kidney stones
  • osteroporosis
  • brain issues (seizures)
  • heart issues (HTN, bradycardia)
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13
Q

cause of vit D deficiency

A
  • poor intake of dairy, egg
  • reduced skin synthesis
  • sunscreen use
  • older age
  • liver/kidney issues
  • Decreased bioavailability
    – Malabsorption syndromes
    – BMI > 30 kg/m2
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14
Q

vit D DDIs

A

ANTIEPILEPTICS –> that are CYP450 inducers
- phenytoin, carbemazepine

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15
Q

vit D activation

A

vit d2 –> d3 –> calcidiol –> calcitriol

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16
Q

storage form of vit D

A

calcidiol

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17
Q

active form of vit D

A

calcitriol

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18
Q

vit D function in body

A

regulate calcium uptake in the intestine

down regulate calcium excretion in urine

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19
Q

rickets

A

vit D deficiency in kids;
- bond deformities and lack of collagen

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20
Q

vitamin E types

A

synthetic –> need more of this than natural sources bc it is more potent

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21
Q

s/s of vit E defiency

A
  • peripheral neuropathy
  • hemolytic anemia
  • skeletal myopathy
  • ataxia
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22
Q

s/s of vit E excess

A
  • antiplatlet induce bleeding
  • diplopia
  • fatigue and muscle weak
  • N/V/D
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23
Q

vitamin E –> alpha tocopherol

A

most active form

other forms are tocopherols and tocotrienols

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24
Q

alpha tocopherol function

A
  • Heme biosynthesis
  • Antioxidant and free radical scavenger
  • Protect cellular mem from oxidation
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25
Q

where is vit E stored?

A

adipose tissue, liver, muscle

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26
Q

vit E deficiency risk factors

A
  • poor intake of nuts, seeds, whole grains, fatty meals
  • disease and drugs that cause poor absoriton
  • familial isolated deficiency
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27
Q

vit E claims (hemolytic anemia)

A

vit E prevents and treats anemia associated with vitamin E deficiency

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28
Q

vit K unique pearl

A

large quanities not stored in the body

intenstinal absorption requires bile salts

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29
Q

s/s of vit K deficiency

A
  • bleeding
  • osteoporosis
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30
Q

s/s of vit K excess

A

very low risk of toxicity

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31
Q

sources of vit K

A
  • green leaf veggies
  • veggie oil
  • meat
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32
Q

vit K supplements

A

natural – vit K1 (phylloquinone)

synthetic – vit K1 (phytonadione)

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33
Q

warfarin

A

vit K antagonist to prevent clotting

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34
Q

water soluble vitamins

A

vit C, b1-b2-b3-b6-b9-b12

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35
Q

vit C (other name)

A

ascorbic acid

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36
Q

vit B1 (other name)

A

thiamine

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37
Q

vit B2 (other name)

A

riboflavin

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38
Q

vit B3 (other name)

A

niacin

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39
Q

vit b6 (other name)

A

pyridoxine

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40
Q

vit b9 (other name)

A

folic acid

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41
Q

vit B12 (other name)

A

cyanocobalmain

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42
Q

microcytic anemia

A

too few RBC (smaller)

iron and pyridoxine (b6)

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43
Q

macrocytic anemia

A

too few RBC (larger)

cycanobalmain (b12) and folate

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44
Q

scurvy

A

widespread bleeding spontaneous

vit C

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45
Q

swollen gums

A

vit C definciency

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46
Q

beri beri

A

peripheal neuropathies

thaimine (b1)

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47
Q

wernicke encephalopathy

A

severe beri-beri with mental confusion

thiamine (b1)

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48
Q

neural tube defect

A

embryo/fetal abnomatlities

folic acid (b9)

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49
Q

chelitis

A

cracked, dry corners of mouth

riboflavin (b2)

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50
Q

glossitis

A

burning and sore tounge

iron, folate, riboflavin (b2), niacin (b3), and cyanocobalmain (b12)

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51
Q

pellagra

A

dermatitis on hands, feet, neck –> diarrhea, dementia

niacin (b3)

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52
Q

CRAP GPS

A
  • carbamazepine
  • rifampin
  • alcohol
  • phenytoin
  • griseofulvin
  • phenobarbital
  • sulphonylureas

monogram for all drugs interacting with all B-vitamins

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53
Q

loop diuretics

A

interact with and lead to thiamine (b1) deficiency

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54
Q

Methotrexate, Trimethoprim, and Pyrimethamine interact with?

A

folic acid –> deficiency

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55
Q

acid suppression medication interact with?

A

cyanocobalamin (b12) –> deficiency

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56
Q

fluorouracil interact with?

A

thiamine (b1)

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57
Q

phenothiazines and TCAs interact with?

A

riboflavin (b2) –> less active form

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58
Q

vit C (ascorbic acid) overview

A
  • required for collagen synthesis
  • antioxidant
  • reducing agent –> absorption of non-heme
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59
Q

sources of vit C

A
  • acidic fruits
  • dark green leafy veggies
  • broccoli and bell peppers
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60
Q

s/s of vit C deficiency

A
  • scurvy
  • loose teeth
  • macular degeneration
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61
Q

adverse effects of vit C

A
  • megadose – kidney stones
  • chew-ables – cause dental erosion
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62
Q

thiamine (b1) overview

A
  • meta of glucose, AAs, and lipids
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63
Q

increase in thiamine (b1) when…

A

pregnant or deficiencies

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64
Q

cause of thiamine deficiency

A

food with anti-thiamine
- tea, coffee

alcohol use

gastric bypass surgery

foods with high level of thiaminases
- milled rice, raw fish

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65
Q

beri-beri types

A

dry
- muscle wasting with loss of function

wet
- heart failure with cardiomeagaly, edema, and SOB

Encephalopathy
- disorientation, short term memory loss

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66
Q

riboflavin (b2) needed for

A
  • cell growth
  • vision health
  • skin, hair, nails
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67
Q

sources of riboflavin (b2)

A

eggs, organ meats, lean meats

green veggies, milk, cheese

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68
Q

niacin (b3) supplementation used for

A

prevention and treatment of
- pellagra (derm, diarrhea, dementia)
- hyperlipemia (lower LDL)

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69
Q

types of pellagra

A

primary – inadequate intake of niacin

secondary – some condition is messing with absoprtion of vit b3

70
Q

sources of niacin

A

lean meats, fish, liver, grains, eggs, milk

71
Q

niacin ADEs

A

derm – flushing/rash

GI

hepatotoxicity

glucose intolerance

72
Q

niacin clinical pearls

A

dose-related hepatotoxicity with ER and SR doses

contraindicated in those with acute liver disease

73
Q

niacin DDIs

A

oral hypoglycemics

isoniazid

lipid lowering

74
Q

niacin nutrient interaction

A

enzyme –> synthesizing niacin requires riboflavin and B6

75
Q

pyridoxine (vit b6) purpose

A

converts dietary typtophan to niacin

syntheiss of numerous NTM

76
Q

sources of pyridoxine (b6)

A

meats, eggs, foritified cereals, banana

77
Q

pyridoxine supp ADE

A

sensory neruopathy
- photosensitive

GI symp

78
Q

pyridoxine deficiency

A

alcohol depend

chronic imparied renal function and

malabsoption

cyp inducing drugs

79
Q

s/s of pyroxidine (b6) deficiency

A
  • microctyic anemia
  • inflmmation of lips
  • glottis (sore tounge)
80
Q

pyridoxine drug-nutrient interactions

A

decreased serum levels of phenytoin

isoniazid forms a complex over time to create a deficiency

81
Q

folic acid (b9) overview

A

naturally occuring in foods

used in dietary supp

needed for protein, DNA/RNA synthesis and RBC maturation

82
Q

food sources of folic acid

A

green leaf veggies, fruits

yeast, animal proteins

83
Q

folic acid is used for?

A

neural tube defect prophylaxis

84
Q

folic acid ADE

A

GI symp

bad/bitter taste

sleep or mental distubances

85
Q

folic acid deficiency

A

inadeuate intake of folic contianig foods

impaired absorption

increased utilization

86
Q

s/s of folic acid deficiency

A
  • megaloblastic anemia
  • N/V/D, oral lesions
  • glottis
  • cognitive impairments
87
Q

folic acid pearls

A
  • coexists with b12 deficiency
  • anemia symp identical to b12
  • partially reduce b12 deficiency
88
Q

folic acid and anticonvulsant

A

b9 may decrease serum concetrations of ACs

  • phenytoin, phenobarbital, primidone
89
Q

drugs decrease folic acid levels via antagonism

A

bind to dihydrofolate reductase (synthesis enzyme)

  • Pyrimethamine, methotrexate, trimethoprim
90
Q

cycanobalmain (b12) needed for

A

hematopoiesis

maintence of myelin

production of epeithlail cells

metabolism of folates

91
Q

sources of cyanocobalmain

A

animal proteins

92
Q

causes of b12 deficiency

A

pernicious anemia
- absence of intrinsic factor

food bound malabsorption due to stomach acid

increased excretion

93
Q

s/s of b12 deficiency

A
  • megaloblastic anemia
  • neurological symptoms
  • GI
94
Q

cyanocobalamin precautions

A

make sure you treat with b12 before b9
- b12 anemia is bad for the brain

95
Q

cyanocobalamin DDIs

A

PPIs

metformin

96
Q

minerals in dietary supp found where?

A

rocks, shells, bones

97
Q

lead

A

can lead to delayed puberty

decrease in birth weight, bone strength

increase in BP, LDL, and urinary protein excretion

98
Q

can a drug contain more lead than deemed safe?

A

yes

big issue in calcium products
(bone meal > calcium carbonate > carbonate)

99
Q

calcium overview

A

MOST ABUNDANT

99% in bones and teeth, 1% found extracell

bones reabsorbed to maintain low serum calcium

100
Q

calcium supp for elderly

A

delays bone mineral loss – reduce fractures in the elderly by 25-70%

101
Q

s/s of excessive calcium

A

hypercaclemia

kidney stones

milk-alkali syndrome

102
Q

calcium supp functions

A

treat acid indigestion

osteoporosis

binds phosphorus

(take with meals to enhance absorption)

103
Q

calcium label issues

A

some express as elemental calcium (pure)

if not elemental – calcium is a salt and is less than adversitsed

104
Q

calcium pearls

A

constipation

GI upset

flatulence

105
Q

calcium + thiazide diruetics

A

decrease renal calcium excretion

avoid excessive calcium intake – can cause high serum concentrations

106
Q

calcium - drug nutrient interactions

A

decrease absorption of
- fluoroquinolone, iron supp
- levothyroxine

107
Q

zinc overview

A

needed for
- wound healing
- blood clot
- immune function

rare deficiency

108
Q

zinc supp used for?

A

macular degeneration

109
Q

zinc ADEs

A

cause kidney failure

perment smell loss (nasal spray)

burning / itching (topical)

N/V/D

110
Q

copper overview

A

mineral needed for
- iron storage
- bone strength
- wound healing

helps
- macular degeneration (part of cocktail)

high dose
- cause HTN

111
Q

copper can reduce absorption of

A

penicillamine absorption

112
Q

in general, what causes deficiency in minerals and vitamins?

A
  • malabsorption
  • surgery
  • bad diet
  • overweight
  • TPN use
113
Q

chromium uses and needs

A

turns macronutrients into energy

decrease blood glucose in type 2 DM

slows calcium loss during menopause

114
Q

chromium sources

A

yeast, bread, molasses

meat, potato skin

115
Q

chromium side effects

A

industrial exposure
- kidney damage, lung cancer, eczema

other than that, few side effects

calcium supp lower absorption of chromium

116
Q

selenium uses

A

almost no one needs this supp

used for
- HIV
- malabsorption syndromes
- TPN patients

117
Q

selenium sources

A

meats, fish, nuts

118
Q

iron overview

A
  • needed for hemoglobin in RBC
  • myoglobin in muscle
  • cyp450s
  • cell respiration and growth
119
Q

forms of iron

A

heme
- found in meat, seafood, poultry

non heme
- plants and iron-fortified foods

120
Q

s/s of iron deficiency

A
  • microcytic anemia
  • RBC issues and low hemoglobin
121
Q

s/s of iron excess

A
  • lead to GI upset, N/V
  • reduce zinc absorption
  • more than 60mg – organ failure and death
122
Q

hemochromatosis

A

mutation of HFE gene – excess buildup of iron

iron toxicity – liver cirrhosis, heart disease

123
Q

iron supp DDIs

A
  • prevent fluoroquinolone and tetracylcine abs
  • reduced levadopa and levothyroxine abs
  • PPI lowers nonheme supp; needs gastric acid
124
Q

BMI (calculate)

A

weight (kg) / height (m) ^2

125
Q

BMI health risks

A

start at above 25 BMI

126
Q

obesity BMI =

A

> 30

extreme = > 40

127
Q

obesity comorbidities

A

cardio
- heart fail, HTN, CAD, afib

metabolic
- diabetes, low HDL

reproducive
- infertility, PCOS

pulmonary
- sleep apnea

can increase risk of cancer

128
Q

obesity prevalence dependent on

A

gender, age

ethnicity, socioeconomic status

129
Q

obesity assessment; waist circumference

A

abdominal fat associated with health risks

  • high risks;
    >40 (male) and >35 (female)

associated with type 2 diabetes, HTN, coronary disease

predictor of obesity in specific populations (asian, elderly)

130
Q

obesity assessment: waist to hip ratio

A

waist circumference / hip circumference

clinical obesity;
- 1.0 (males) and 0.8-0.9 (female)

131
Q

weight gain due to medications

A

anticonvulsants;
- gabapentin
- carbamazepine
- pregabalin
- valproic acid

132
Q

medical conditions that can lead to weight gain

A
  • hypothyroidism
  • depression
  • cushing’s syndrome
  • PCOS
  • smoking cess
  • diabetes
133
Q

treatment goals for obesity

A
  • stop weight gain
  • weight reduction
  • prevent weight regain
  • improve life
134
Q

treatment options for obesity

A
  • diet/lifestyle/behaviroal
  • pharm
  • bariatric surgery
135
Q

realistic weight management goals

A
  • weight loss of 5-10% of baseline weight within 6 months

realistic – 1-2 pounds / week

136
Q

dietary therapy

A

a diet to achieve weight loss of 5-10% via reduced calorie intake

137
Q

calorie deficit

A

500-750 calorie deficit from original intake

~ 1200-1500 (women)

~ 1500-1800 (men)

138
Q

diet counseling points

A

limit fats, alcohol, sugar

increase water and fiber

eat low energy dense foods

139
Q

energy food

A

high = 4-9 calories/gram

medium = 1.5-4 calories/g

low = 0 - 1.5 calories / gram

140
Q

idaho plate method

A

9 inch plate

1/2 plate veggies, 1/4 bread and meat

limit eating out – portion control

141
Q

physical activity goals

A

increase energy expenditure

enhance cardio and health improvements

achieve weight reduction and management

142
Q

physcial acitivty guidelines

A

at least 30 minutes at least 5 times a week

for obese – 60-90 min per day may be needed

143
Q

bariatric surgery

A

50-70% total body weight reduction

improvements in related conditions

Significant post op issues and guidelines

144
Q

post op requirements of bariatric surgery

A

small frequent meals

no lipids during meals

b12 supp

protein and probiotic supp

145
Q

pharmacological therapy

A

candidates for therapy;

1) BMI > 27 + increased medical risk + failed 6-month diet therapy

2) BMI > 30

146
Q

off label agents for obesity

A

ozempic (semaglutide, GLP-1 agonist) and herbals

147
Q

noradrenergicrs / sympathomimetics combination

A

phentermine + topiramate extended release

148
Q

phentermine + topiramate MOA

A

enhance catecholamine transmission in the CNS (stimulatory) –>

–> increase sympathetic activity – reduce appetite

149
Q

phentermine + topiramate ADEs

A

increased BP, HR, nervousness

insomnia

constipation

euphoria and abuse potential

teratogenic
- causes an abnormality if fetal exposed during pregnancy

150
Q

phentermine + topiramate contradindications

A

patients with concomitant conditions worsened by the ADEs
- like cardiac issues and hyperthyroidism

151
Q

Qsymia; phentermine + topiramate

A

10-14% weight loss

imporves LDL, blood glucose

152
Q

topiramate ADRs

A

sedation, fatigue, nausea, cognitive impairment, psychiatric disturbance, increase in seizure frequency

in the brain

153
Q

gastric lipase inhibitor

A

Orlistat

154
Q

Orlistat overview

A

Xenical (rx) and Alli (otc)

  • inhibits pancreatic and gastric lipase
    –> prevent hydrolysis of fat into fatty acids

fat is excreted in feces

155
Q

Orlistat ADEs

A

low systemic absorption

oily feces

increased urinary oxalate

156
Q

orlistat DDIs (MOST LIKELY ON EXAM)

A

vit A, D, E, and beta-carotene
- decreases vitamin levels

warfarin
- dec vit K absorption – increased PT/INR and risk of bleeding

antiepileptic
- dec drug levels so monitor and change dose

157
Q

opioid antagonist / NDRI antidepressant

A

Naltrexone + Bupropion – Contrave

158
Q

Contrave efficacy

A

reduces subjective reward of food intake

5% weight loss reduction from baseline

DO NOT TAKE WITH HIGH FAT MEALS – inc abs

159
Q

contrave contraindications

A

HTN

seizure disorders

chronic opioid use

use of other bupropion products

160
Q

cotrave black box warning

A

suicidial thoughts and behaviors

Neuropsychiatric reactions

161
Q

glucagon like peptide-1 (GLP-1) receptor agonists

A

liraglutide (saxenda and victoza)

semaglutide (ozempic)

162
Q

GLP-1 agonist MOA

A
  • deliver synthetic GLP-1
  • lower blood glucose via slowing gastric emptying
  • sends “full” signals to brain
  • prevents glucagon release after meals
  • stimulate beta cells to inc insulin
163
Q

liraglutide

A

hyperglycemia in type 2 DM

obesity (3mg)

164
Q

semaglutide

A

hyperglycemia in type 2 DM

Wegovy – approved for weight reduction

165
Q

Dual GIP/GLP-1 agonists

A

Tirzepatide – Mounjaro and Zepbound

approved for type 2 DM
NOT OBESITY

166
Q

Tirzepatide DDIs

A

hypoglycemia w/ cocontaminat use of insulin

delays gastric emptying – oral drugs (toxic)

oral hormonal contraceptives

167
Q

Tirzepatide dosing (IMP!)

A

2.5 mg once a week for 4 weeks

every 4 weeks increase the dose by 2.5 mg til 15mg once a week

SQ injections

168
Q

Tirzepatide black box warning

A

risk of thyroid C-cell tumors

169
Q

Tirzepatide warnings

A
  • severe GI issues
  • acute pancreatitis
  • diabetic neuropathy complications
  • gallbladder disease
170
Q

GLP-1 agonist common ADR

A

N/V/D/C

dec appetite, abdominal pain

dyspepsia

abbreviations (quiz A) (2 decks)

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