Nutrition & Heme Flashcards
What is the preferred prokinetic agent for AN and what is a side effect of it/what needs to be done?
Prokinetics = inc gastric motility
Domperidone preferred dt dec EPS symptoms
Risk of prolonged QTc esp with hypokalemia or hypoglycemia
Do ECG 1 wk before and after start of prokinetic. DC if Qtc inc by 50msec & switch to Prucalopride
What interventions should we give stable AN patients treating in the office and how often should you see them?
Weekly follow up appointments
Counselling on diagnosis, normalize eating, inc intake for wt gain
Thiamine IM x5 days with start of referring + PO zinc 100mg with meals x 2months
Can also attempt prokinetic agent at this point - domperidone (ECG)
Should follow up with non-urgent psych eval
If unstable, pt directly referred for urgent psych assessment
What popular antiemetic should not be used in eating disorder patients? What should be used instead?
Zofran is ineffective for this population
Metoclopramide instead as it has prokinetic and anti-nausea effects
Why is thiamine given to AN patients?
To prevent Wernicke-Korsakoff syndrome (encephalopathy induced by thiamine deficiency)
What prokinetic is preferred for constipation or for chronic laxative usage?
Prucalopride
What is refeeding syndrome?
A serious complication dt electrolyte disturbances - especially hypophosphatemia, which can occur when patients are fed after a prolonged period of minimal caloric intake or starvation
What is the first line treatment for bulimia?
Counselling and if after 2m ineffective, progress to pharm
What is the pharmacological treatment for bulimia?
SSRI - Fluoxetine (Prozac) - most evidence for BN
also SNRI - Venlafaxine (Effexor), SARI - Trazodone
Can Wellbutrin be used for ED its with depression?
No, it is contraindicated due to seizure risk
What BMI is classified as obese?
> 30 BMI
What can be used to stage obesity and show mortality risk?
Edmonton Obesity Staging System
0 (no risk factors) - 4 (sever disabilities/limitations)
What are the first line treatments recommended for obesity?
Behaviorally based interventions focused on diet, exercise or lifestyle changes alone or in combination.
Life-style changes include counselling, education or support, and/or environmental changes in addition to changes in exercise and/or diet.
What are the obese waist circumferences in males and females?
Males 102cm (40in)
Females 88cm (35in)
What is the treatment strategy in phase 1 of weight loss?
Caloric deficit of 500kcal/day = 1-2kg loss/month
Ensure high quality protein intake & participate in resistance training
After 3-6m advance to phase 2
What is the treatment strategy in phase 2 of wt loss?
Continue restricting energy intake indefinitely to the same level as was consumed at the time of the weight-loss plateau. Any increase in energy intake will result in weight regain. Deep-rooted lifestyle changes, intense physical activity, medication and surgery can significantly reduce the likelihood of weight regain.
What are the non-harm weight loss strategies?
- caloric restriction
- diet counselling
- 3 meals & 3 snacks/day
- Avoid fasting or skipping meals
- Avoid night time eating close to bedtime
- Ensure an adequate carbohydrate intake of ≥100 g/day
- Ensure a protein intake of ≥1 g/kg/day of high-quality mixed proteins
- Fat intake should not exceed 30–35% of total calories consumed, with ≤10% from trans and saturated fat
- Increased physical activity, 30mins of activity 5x/wk
- Exercise coupled with a judicious caloric-deficit meal plan accelerates fat loss while maintaining lean body mass, and helps sustain weight loss over the long term
- Walking 10 000 steps/day
- Treadmill stress test recommended if cardio risk present prior to activity
- Bariatric surgery can be considered for severe obesity
What are some appetite suppressant drugs we can give for obesity? What does the BMI have to be to start these?
Bupropion (mild suppressant) plates at 24wks - not recommended Bupropion/Naltrexone preferred: naltrexone combo allows for further wt loss to occur over 48wks
CI in MAOIs & opioids
Liraglutide (Saxenda) SC injection (GLP-1 Agonist): used for T2DM and wt management to suppress appetite, slow gastric emptying = wt reduction of 8kg through 2 years. Start at 0.6mg weekly and titrate up by 0.6mg increments until 3mg is reached
++GI effects
BMI >/= 30 or >/=27 + 1 wt-related comorbidity
What is orlistat used for?
It is a lipase inhibitor that reduces dietary fat absorption
++GI effects with high fat intake
Recommended to take a multivitamin with it taken 2hr prior to orlistat
Poor side effects oily, gas discharge and fecal urgency
What are the fat soluble vitamins?
A, D, E & K
What are the water-soluble vitamins?
Thiamine (B,) riboflavin (B2), niacin (B3), pantothenic acid (B5), biotin (B7), folic acid (B 9), CYANOCOBALAMIN (B12) & ascorbic acid (C).
What supplements are recommended in pregnancy & Breastfeeding?
Folic Acid amt ranges dependent on neural-tube risk from 0.4mg-4mg/day
0.4 - mild risk
1mg (until 12wks) then 0.4-1mg until 4-6wks PP or BF stopped - mod risk Diabetes, fam hx, malabsorption
4mg High Risk - personal hx (yourself born with defect) or personal pregnancy with defect until 12wks
Calcium 1000mg/day for >19yrs of age
Vit D 600-2000u/day (higher range for pregnancy during Winter)
Iron (only if deficient) 27mg/day
What supplements would be recommended for vegans?
Vit B12, D, Ca, Iron, zinc, Omega-3 fatty acids
What supplements would be recommended for alcohol abuse pts?
Vit B1, B2, B6, C, folic acid
What supplements would be recommended for the elderly?
Vit B12 (if deficient) and D
