nutrition exam #2 Flashcards
drugs that block all fat absorption of fat soluble vitamins
lomitapide, bile acid sequestrants, orlistat, mineral oil
fat soluble vitamins
vit A, D, E and K
normal intake of vitamin A
10 IU beta-carotene, 3.3 IU of retinol
s/s of vit A deficiency
eye issues
- soft corneas
- dry eye
- foamy plaques
- night blind
s/s of excess vit A
- Teratogenicity
- hepatotoxicity
- skin issues
- alopecia
- muscle and bone pain
2 main categories of vit A
retinol – animal derivied
carotenoids – (beta-carotene) precursor found in fruits and veggies
cause of vit A deficiency
- bad diet
- chronic alchohol intake
- lack of yellow, orange, green veggies
vit A dosing
An IU of beta-carotene creates ⅓ the retinol as other vitamin A products
1 RAE = 3.3 IU retinol = 10 IU beta
vit A supplement claims (measles mortality)
measles;
- treatment with 100,000-200,000 IU of vit A helped reduce pneumonia and mortality
- not a replacement for vaccine
vitamin D types
Ergo-calciferol (D3) and Cholecaciferol (D2)
s/s of vit D deficiency
bone issues;
- soft and malformed
- myopathy
- hyperparathyroidism
s/s of vit D excess
- kidney stones
- osteroporosis
- brain issues (seizures)
- heart issues (HTN, bradycardia)
cause of vit D deficiency
- poor intake of dairy, egg
- reduced skin synthesis
- sunscreen use
- older age
- liver/kidney issues
- Decreased bioavailability
– Malabsorption syndromes
– BMI > 30 kg/m2
vit D DDIs
ANTIEPILEPTICS –> that are CYP450 inducers
- phenytoin, carbemazepine
vit D activation
vit d2 –> d3 –> calcidiol –> calcitriol
storage form of vit D
calcidiol
active form of vit D
calcitriol
vit D function in body
regulate calcium uptake in the intestine
down regulate calcium excretion in urine
rickets
vit D deficiency in kids;
- bond deformities and lack of collagen
vitamin E types
synthetic –> need more of this than natural sources bc it is more potent
s/s of vit E defiency
- peripheral neuropathy
- hemolytic anemia
- skeletal myopathy
- ataxia
s/s of vit E excess
- antiplatlet induce bleeding
- diplopia
- fatigue and muscle weak
- N/V/D
vitamin E –> alpha tocopherol
most active form
other forms are tocopherols and tocotrienols
alpha tocopherol function
- Heme biosynthesis
- Antioxidant and free radical scavenger
- Protect cellular mem from oxidation
where is vit E stored?
adipose tissue, liver, muscle
vit E deficiency risk factors
- poor intake of nuts, seeds, whole grains, fatty meals
- disease and drugs that cause poor absoriton
- familial isolated deficiency
vit E claims (hemolytic anemia)
vit E prevents and treats anemia associated with vitamin E deficiency
vit K unique pearl
large quanities not stored in the body
intenstinal absorption requires bile salts
s/s of vit K deficiency
- bleeding
- osteoporosis
s/s of vit K excess
very low risk of toxicity
sources of vit K
- green leaf veggies
- veggie oil
- meat
vit K supplements
natural – vit K1 (phylloquinone)
synthetic – vit K1 (phytonadione)
warfarin
vit K antagonist to prevent clotting
water soluble vitamins
vit C, b1-b2-b3-b6-b9-b12
vit C (other name)
ascorbic acid
vit B1 (other name)
thiamine
vit B2 (other name)
riboflavin
vit B3 (other name)
niacin
vit b6 (other name)
pyridoxine
vit b9 (other name)
folic acid
vit B12 (other name)
cyanocobalmain
microcytic anemia
too few RBC (smaller)
iron and pyridoxine (b6)
macrocytic anemia
too few RBC (larger)
cycanobalmain (b12) and folate
scurvy
widespread bleeding spontaneous
vit C
swollen gums
vit C definciency
beri beri
peripheal neuropathies
thaimine (b1)
wernicke encephalopathy
severe beri-beri with mental confusion
thiamine (b1)
neural tube defect
embryo/fetal abnomatlities
folic acid (b9)
chelitis
cracked, dry corners of mouth
riboflavin (b2)
glossitis
burning and sore tounge
iron, folate, riboflavin (b2), niacin (b3), and cyanocobalmain (b12)
pellagra
dermatitis on hands, feet, neck –> diarrhea, dementia
niacin (b3)
CRAP GPS
- carbamazepine
- rifampin
- alcohol
- phenytoin
- griseofulvin
- phenobarbital
- sulphonylureas
monogram for all drugs interacting with all B-vitamins
loop diuretics
interact with and lead to thiamine (b1) deficiency
Methotrexate, Trimethoprim, and Pyrimethamine interact with?
folic acid –> deficiency
acid suppression medication interact with?
cyanocobalamin (b12) –> deficiency
fluorouracil interact with?
thiamine (b1)
phenothiazines and TCAs interact with?
riboflavin (b2) –> less active form
vit C (ascorbic acid) overview
- required for collagen synthesis
- antioxidant
- reducing agent –> absorption of non-heme
sources of vit C
- acidic fruits
- dark green leafy veggies
- broccoli and bell peppers
s/s of vit C deficiency
- scurvy
- loose teeth
- macular degeneration
adverse effects of vit C
- megadose – kidney stones
- chew-ables – cause dental erosion
thiamine (b1) overview
- meta of glucose, AAs, and lipids
increase in thiamine (b1) when…
pregnant or deficiencies
cause of thiamine deficiency
food with anti-thiamine
- tea, coffee
alcohol use
gastric bypass surgery
foods with high level of thiaminases
- milled rice, raw fish
beri-beri types
dry
- muscle wasting with loss of function
wet
- heart failure with cardiomeagaly, edema, and SOB
Encephalopathy
- disorientation, short term memory loss
riboflavin (b2) needed for
- cell growth
- vision health
- skin, hair, nails
sources of riboflavin (b2)
eggs, organ meats, lean meats
green veggies, milk, cheese
niacin (b3) supplementation used for
prevention and treatment of
- pellagra (derm, diarrhea, dementia)
- hyperlipemia (lower LDL)
types of pellagra
primary – inadequate intake of niacin
secondary – some condition is messing with absoprtion of vit b3
sources of niacin
lean meats, fish, liver, grains, eggs, milk
niacin ADEs
derm – flushing/rash
GI
hepatotoxicity
glucose intolerance
niacin clinical pearls
dose-related hepatotoxicity with ER and SR doses
contraindicated in those with acute liver disease
niacin DDIs
oral hypoglycemics
isoniazid
lipid lowering
niacin nutrient interaction
enzyme –> synthesizing niacin requires riboflavin and B6
pyridoxine (vit b6) purpose
converts dietary typtophan to niacin
syntheiss of numerous NTM
sources of pyridoxine (b6)
meats, eggs, foritified cereals, banana
pyridoxine supp ADE
sensory neruopathy
- photosensitive
GI symp
pyridoxine deficiency
alcohol depend
chronic imparied renal function and
malabsoption
cyp inducing drugs
s/s of pyroxidine (b6) deficiency
- microctyic anemia
- inflmmation of lips
- glottis (sore tounge)
pyridoxine drug-nutrient interactions
decreased serum levels of phenytoin
isoniazid forms a complex over time to create a deficiency
folic acid (b9) overview
naturally occuring in foods
used in dietary supp
needed for protein, DNA/RNA synthesis and RBC maturation
food sources of folic acid
green leaf veggies, fruits
yeast, animal proteins
folic acid is used for?
neural tube defect prophylaxis
folic acid ADE
GI symp
bad/bitter taste
sleep or mental distubances
folic acid deficiency
inadeuate intake of folic contianig foods
impaired absorption
increased utilization
s/s of folic acid deficiency
- megaloblastic anemia
- N/V/D, oral lesions
- glottis
- cognitive impairments
folic acid pearls
- coexists with b12 deficiency
- anemia symp identical to b12
- partially reduce b12 deficiency
folic acid and anticonvulsant
b9 may decrease serum concetrations of ACs
- phenytoin, phenobarbital, primidone
drugs decrease folic acid levels via antagonism
bind to dihydrofolate reductase (synthesis enzyme)
- Pyrimethamine, methotrexate, trimethoprim
cycanobalmain (b12) needed for
hematopoiesis
maintence of myelin
production of epeithlail cells
metabolism of folates
sources of cyanocobalmain
animal proteins
causes of b12 deficiency
pernicious anemia
- absence of intrinsic factor
food bound malabsorption due to stomach acid
increased excretion
s/s of b12 deficiency
- megaloblastic anemia
- neurological symptoms
- GI
cyanocobalamin precautions
make sure you treat with b12 before b9
- b12 anemia is bad for the brain
cyanocobalamin DDIs
PPIs
metformin
minerals in dietary supp found where?
rocks, shells, bones
lead
can lead to delayed puberty
decrease in birth weight, bone strength
increase in BP, LDL, and urinary protein excretion
can a drug contain more lead than deemed safe?
yes
big issue in calcium products
(bone meal > calcium carbonate > carbonate)
calcium overview
MOST ABUNDANT
99% in bones and teeth, 1% found extracell
bones reabsorbed to maintain low serum calcium
calcium supp for elderly
delays bone mineral loss – reduce fractures in the elderly by 25-70%
s/s of excessive calcium
hypercaclemia
kidney stones
milk-alkali syndrome
calcium supp functions
treat acid indigestion
osteoporosis
binds phosphorus
(take with meals to enhance absorption)
calcium label issues
some express as elemental calcium (pure)
if not elemental – calcium is a salt and is less than adversitsed
calcium pearls
constipation
GI upset
flatulence
calcium + thiazide diruetics
decrease renal calcium excretion
avoid excessive calcium intake – can cause high serum concentrations
calcium - drug nutrient interactions
decrease absorption of
- fluoroquinolone, iron supp
- levothyroxine
zinc overview
needed for
- wound healing
- blood clot
- immune function
rare deficiency
zinc supp used for?
macular degeneration
zinc ADEs
cause kidney failure
perment smell loss (nasal spray)
burning / itching (topical)
N/V/D
copper overview
mineral needed for
- iron storage
- bone strength
- wound healing
helps
- macular degeneration (part of cocktail)
high dose
- cause HTN
copper can reduce absorption of
penicillamine absorption
in general, what causes deficiency in minerals and vitamins?
- malabsorption
- surgery
- bad diet
- overweight
- TPN use
chromium uses and needs
turns macronutrients into energy
decrease blood glucose in type 2 DM
slows calcium loss during menopause
chromium sources
yeast, bread, molasses
meat, potato skin
chromium side effects
industrial exposure
- kidney damage, lung cancer, eczema
other than that, few side effects
calcium supp lower absorption of chromium
selenium uses
almost no one needs this supp
used for
- HIV
- malabsorption syndromes
- TPN patients
selenium sources
meats, fish, nuts
iron overview
- needed for hemoglobin in RBC
- myoglobin in muscle
- cyp450s
- cell respiration and growth
forms of iron
heme
- found in meat, seafood, poultry
non heme
- plants and iron-fortified foods
s/s of iron deficiency
- microcytic anemia
- RBC issues and low hemoglobin
s/s of iron excess
- lead to GI upset, N/V
- reduce zinc absorption
- more than 60mg – organ failure and death
hemochromatosis
mutation of HFE gene – excess buildup of iron
iron toxicity – liver cirrhosis, heart disease
iron supp DDIs
- prevent fluoroquinolone and tetracylcine abs
- reduced levadopa and levothyroxine abs
- PPI lowers nonheme supp; needs gastric acid
BMI (calculate)
weight (kg) / height (m) ^2
BMI health risks
start at above 25 BMI
obesity BMI =
> 30
extreme = > 40
obesity comorbidities
cardio
- heart fail, HTN, CAD, afib
metabolic
- diabetes, low HDL
reproducive
- infertility, PCOS
pulmonary
- sleep apnea
can increase risk of cancer
obesity prevalence dependent on
gender, age
ethnicity, socioeconomic status
obesity assessment; waist circumference
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)
obesity assessment: waist to hip ratio
waist circumference / hip circumference
clinical obesity;
- 1.0 (males) and 0.8-0.9 (female)
weight gain due to medications
anticonvulsants;
- gabapentin
- carbamazepine
- pregabalin
- valproic acid
medical conditions that can lead to weight gain
- hypothyroidism
- depression
- cushing’s syndrome
- PCOS
- smoking cess
- diabetes
treatment goals for obesity
- stop weight gain
- weight reduction
- prevent weight regain
- improve life
treatment options for obesity
- diet/lifestyle/behaviroal
- pharm
- bariatric surgery
realistic weight management goals
- weight loss of 5-10% of baseline weight within 6 months
realistic – 1-2 pounds / week
dietary therapy
a diet to achieve weight loss of 5-10% via reduced calorie intake
calorie deficit
500-750 calorie deficit from original intake
~ 1200-1500 (women)
~ 1500-1800 (men)
diet counseling points
limit fats, alcohol, sugar
increase water and fiber
eat low energy dense foods
energy food
high = 4-9 calories/gram
medium = 1.5-4 calories/g
low = 0 - 1.5 calories / gram
idaho plate method
9 inch plate
1/2 plate veggies, 1/4 bread and meat
limit eating out – portion control
physical activity goals
increase energy expenditure
enhance cardio and health improvements
achieve weight reduction and management
physcial acitivty guidelines
at least 30 minutes at least 5 times a week
for obese – 60-90 min per day may be needed
bariatric surgery
50-70% total body weight reduction
improvements in related conditions
Significant post op issues and guidelines
post op requirements of bariatric surgery
small frequent meals
no lipids during meals
b12 supp
protein and probiotic supp
pharmacological therapy
candidates for therapy;
1) BMI > 27 + increased medical risk + failed 6-month diet therapy
2) BMI > 30
off label agents for obesity
ozempic (semaglutide, GLP-1 agonist) and herbals
noradrenergicrs / sympathomimetics combination
phentermine + topiramate extended release
phentermine + topiramate MOA
enhance catecholamine transmission in the CNS (stimulatory) –>
–> increase sympathetic activity – reduce appetite
phentermine + topiramate ADEs
increased BP, HR, nervousness
insomnia
constipation
euphoria and abuse potential
teratogenic
- causes an abnormality if fetal exposed during pregnancy
phentermine + topiramate contradindications
patients with concomitant conditions worsened by the ADEs
- like cardiac issues and hyperthyroidism
Qsymia; phentermine + topiramate
10-14% weight loss
imporves LDL, blood glucose
topiramate ADRs
sedation, fatigue, nausea, cognitive impairment, psychiatric disturbance, increase in seizure frequency
in the brain
gastric lipase inhibitor
Orlistat
Orlistat overview
Xenical (rx) and Alli (otc)
- inhibits pancreatic and gastric lipase
–> prevent hydrolysis of fat into fatty acids
fat is excreted in feces
Orlistat ADEs
low systemic absorption
oily feces
increased urinary oxalate
orlistat DDIs (MOST LIKELY ON EXAM)
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
opioid antagonist / NDRI antidepressant
Naltrexone + Bupropion – Contrave
Contrave efficacy
reduces subjective reward of food intake
5% weight loss reduction from baseline
DO NOT TAKE WITH HIGH FAT MEALS – inc abs
contrave contraindications
HTN
seizure disorders
chronic opioid use
use of other bupropion products
cotrave black box warning
suicidial thoughts and behaviors
Neuropsychiatric reactions
glucagon like peptide-1 (GLP-1) receptor agonists
liraglutide (saxenda and victoza)
semaglutide (ozempic)
GLP-1 agonist MOA
- 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
liraglutide
hyperglycemia in type 2 DM
obesity (3mg)
semaglutide
hyperglycemia in type 2 DM
Wegovy – approved for weight reduction
Dual GIP/GLP-1 agonists
Tirzepatide – Mounjaro and Zepbound
approved for type 2 DM
NOT OBESITY
Tirzepatide DDIs
hypoglycemia w/ cocontaminat use of insulin
delays gastric emptying – oral drugs (toxic)
oral hormonal contraceptives
Tirzepatide dosing (IMP!)
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
Tirzepatide black box warning
risk of thyroid C-cell tumors
Tirzepatide warnings
- severe GI issues
- acute pancreatitis
- diabetic neuropathy complications
- gallbladder disease
GLP-1 agonist common ADR
N/V/D/C
dec appetite, abdominal pain
dyspepsia
