Test 2 Flashcards
whole blood
common specimen type–collected via anti-coagulant—includes RBCs, WBCs, & platelets
serum
common specimen type–remaining fluid after blood has clotted & clots & platelets are removed by spinning
plasma
common specimen type–straw-colored blood component containing H2O, inorganic electrolytes, & clotting factors
blood cells
common specimen type–separated from anti-coagulated whole blood for analysis
erythrocytes
common specimen type–RBCs
leukocytes
common specimen type–WBCs
blood spot
common specimen type–dried whole blood from finger or heel prick—put on paper & tested for hormones & others (ex: infant PKU screening)
other tissues
common specimen type–from scrapings or biopsy samples
urine
common specimen type–concentrate of excreted metabolites
feces
common specimen type–detects presence of nut. not absorbed or used to determine gut flora composition
breath test
less common specimen type–evaluates met., use, & malabsorption of sugars
hair & nails
less common specimen type–identifies exposure to certain metals—if prob is evident here, it is severe
saliva
less common specimen type–evaluates functional adrenal stress & hormone levels
sweat
less common specimen type–detects sweat chloride levels to determine presence of cystic fibrosis
static assay
measures actual nut. level in specimen—gives most recent reading—limitation: influenced by decent dietary intake—ex: check Fe, folic acid, & Vit. B12 for anemia
functional assay
gives quantitative measure of biochem. or physiologic activity that depends on specific nut.—tests function —ex: serum ferritin (transportation prob?)
basic met. panel (BMP)
clinical chem. panel—8 tests for screening
comprehensive met. panel (CMP)
clinical chem. panel—8 BMP tests + 6 more tests—is most commonly ordered
complete blood count (CBC)
count of cells in blood & description of RBCs—tells what is in cells
urinalysis
screening test or diagnostic tool—detects substances (glucose, protein, albumin, & ketones) or cellular material in urine associated w/ dif. met. & kidney disorders
albumin
hepatic transport protein—transports major blood constituents, hormones, enzymes, meds, min., ions, FAs, AAs, & metabolites—maintains colloidal osmotic pressure—↓ means edema—1/2 life is 18-21 days (does NOT reflect current protein intake)
pre-albumin (PAB)
hepatic transport protein—transports thyroid hormones—1/2 life is 2 days→used as indicator of protein status–↓ is related to: inflammation, protein-wasting disease of GI tract, & Zn def.
retinol-binding protein (RBP)
hepatic transport protein—shortest 1/2 life (12 hrs)—binds & transports retinol (Vit. A)
transferrin
hepatic transport protein—transports Fe to bone marrow to produce Hgb—1/2 life is 8 days
(nut.) anemia
↓ in # RBCs / unit of blood volume OR ↓ in [Hbg] of blood to below needed level
microcytic anemia
“small cells”—Fe def.
macrocytic anemia
folate or Vit. B12 def—”large cells”
normocytic anemia
chronic & inflammatory diseases—*does NOT respond to Fe supp.
lab tests for Fe-def. anemia:
- Hct (packed cell volume)
- Hbg, serum ferritin
- effects of inflammation
- serum Fe
- total Fe-binding capacity (TIBC)
(liver of any animal is great source of Fe)
megaloblastic anemia
folate def.
pernicious anemia
Vit. B12 def. (found in meat products only→vegans must inject)—activated by intrinsic factor (IF) in stomach—is absorbed in ↓er colon
hematocrit (Hct)
measure of % RBCs in total blood volume—is usually 3x ↑er than [Hgb]—affected by extremely ↑ WBC count & hydration status
hemoglobin (Hgb)
measure of total amt. Hgb in peripheral blood
ferritin
Storage protein that sequesters Fe normally gathered in liver, spleen, & marrow—synthesis ↑ w/ inflammation
serum Fe
amt. circulating Fe bound to transferrin—poor index of Fe status
total Fe-binding capacity (TIBC)
measure of all proteins available to bind mobile Fe–depends on # free binding sites on plasma transferrin (Fe-transport protein)
Schilling Test
detects defects in Vit. B12 absorption (is gold standard for measuring Vit. B12)
serum retinol
measures Vit. A status
plasma-25-hydroxyvitamin D (25-OH-D3)
measures Vit. D status–Vit. D def. can lead to 2° malabsorption of Ca
Hgb A1C
does NOT reflect more recent ∆glucose levels–does NOT diagnose DM but reflects control of glucose
lipi indices of CV risk:
- ↑ LDL
- ↑ triglycerides
- ↑ apoprotein B
- ↑ Hs-CRP
- ↑ serum homocysteine
oxidation
break-down of cells b/c stress (is fought by anti-oxidants: Vit. A, Vit. C, Vit. E, & Se)–markers are ↓ed by carotenoids & smoking cessation
IBW (male)
IBW (male) = 106 lbs. for 5’ + 6 lb./in. ± 10%
IBW (female)
IBW (female) = 100 lbs. for 5’ + 5 lb./in. ± 10%
drug-nut. interaction
specific changes to pharmacokinetics of drug caused by nut.(s) or changes to kinetics of nut.(s) caused by drug
food-drug interaction
effects of med. on nut. status
- altered response to med. (+ or -)
- drug toxicity
- altered nut. status
pharmacodynamics
study of biochem. & physiologic effects of drug
pharmacokinetics
study of time course of drug in body involving absorption, distribution, met., & excretion of drug
absorption
process of movement of drug form site of administration to bloodstream
distribution
drug leaves systemic circulation & travels to various regions of body
cytochrome P-450 enzyme system
facilitates drug met. & is + or - affected by food & dietary supp.–involved in liver detoxification
benefits of minimizing drug interactions:
- meds. achieve intended effects
- pts. do not discontinue drugs
- minimize need for add’l meds
- avoid adverse side effects
- preserve optimal nut. status
- avoid accidents & injuries
- minimize disease complications
- ↓ cost of health care services
- meet licensing agency requirements
risk factors for food-drug interactions:
- polypharmacy (concern: overdose, overworking liver & kidneys)
- chronic disease
- older pts.
- malnut.
- cancer & AIDS
- GI tract alterations–ex: diarrhea
- body composition (muscle works better w/ drugs than fat)
- fetus, infant, pregnant woman
pharmacogenomics
genetically determined variations revealed only by effects of drugs–ex: green tea, soy, turmeric, broccoli
drug absorption process:
-bioavailability (drug fraction fully absorbed)
med. & enteral nut. interactions:
- physical incompatibility:
- granulation
- gel formation
- separation
- clogged feeding tubes
- interruption of delivery
- emulsion breakage w/ acidic syrups
- drug bioavailability:
- individual variability
- may need 1-hr to 4-hr feeding-free interval
effect of grapefruit on met. enzymes:
inhibition of met. of Lipitor–interferes w/ Cyt. P-450 enzymes–also interferes w/ diabetic drugs & Ca-channel blockers
neoplastic
cancer drugs–worst mucosal damage is in mouth→nut. absorption ↓ed
effect of anti-psychotic drugs on met.
met. is ↑ed
5 tyramine foods to avoid when on MAOIs:
- aged cheeses
- aged meats
- soy sauce
- teriyaki sauce
- flava beans
effect of caffeine when on tranquilizers
anti-anxiety effects counteracted (nervous symptoms ↑ed–acts as stimulant–is inefficient)
alcohol-drug interactions: Antabuse
vomiting
drugs with similar effect: Flagyl, Cefobid, & Diabinese
excipient
inactive ingredient added to act as:
- buffer
- binder
- filler
- diluent
- disintegrant
- glidant
- flavoring
- dye
- preservative
- suspending agent
- coating
MNT for food-drug interactions: prospective
all MNT offered when pt. first starts drug
MNT for food-drug interactions: retrospective
evaluation of symptoms to determine if med. probs. might be result of food-drug interactions
MNT for food-drug interactions: diet history
OTCs, alcohol, supp., & herbals
Ciprofloxacin
brand name: Cipro–anti-biotic
Lovastatin
brand name: Mevacor–anti-hyperlipidemic
Lithium
brand name: Eskalith–anti-depressant
Gemfibrozil
brand name: Lopid–anti-hyperlipidemic
Furosemide
brand name: Lasix–diuretic
Fluoxetine
brand name: Prozac–anti-depressant
Warfarin
brand name: Coumadin–anti-coagulant
Naproxen
brand name: Aleve–NSAID
Amitriptyline
brand name: Elavil–anti-depressant
Acetylsalicylic Acid
brand name: Aspirin–NSAID
Cefuroxime
brand name: Ceftin–anti-biotic
Atorvastatin
brand name: Lipitor–anti-hyperlipidemic
Olanzapine
brand name: Zyprexa–anti-psychotic
Propranolol
brand name: Inderal–β-blocker
Bile Acid Sequestrant Cholestyramine
brand name: Questran–anti-hyperlipidemic
Metronidazole
brand name: Flagyl–anti-biotic & anti-fungal
Alendronate
brand name: Fosamax–osteoporosis & Paget’s Disease
Clozapine
brand name: Clorazil–anti-psychotic
Clarithromycin
brand name: Biaxin–antibiotic
Ibuprofen
brand name: Advil–NSAID
Phenytoin
brand name: Dilantin–anti-epileptic
Isoniazid
brand name: INH–anti-TB & anti-mycobacterium
Cimetidine
brand name: Tagamet–anti-ulcer, anti-GERD, & anti-secretory
excretion
process–drug / nut. or metabolites are removed from body primarily by kidneys
metabolism
process–drug / nut. is chemically changed by action of enzymes (usually in liver)
nut. kinetics
study of absorption, distribution, met., & excretion of nut.
chelation
rxn btwn. certain drugs & cations (+) Ca, Mg, Al, Fe, & Zn
prolonged use of anti-ulcer drugs may ↓ absorption of:
Vit. B12, thiamin, & Fe
anti-hyperlipidemic drugs adsorb:
Vit. A, Vit. D, Vit. E, & Vit. K (fat-soluble vit.)
anti-convulsants ↑ met. of:
folic acid, Vit. D, & Vit. K
anti-TB drugs inhibit conversion of ______ to active form
pyridoxine (Vit. B6)
loop diuretics ↑ excretion of:
Na, K, Cl, Mg, & Ca
↑ caffeine intake may ↑ adverse effects of:
theophylline (nervousness, tremors, & insomnia)
tyramine & dopamine in food enhance toxic effects of ______, which may cause ______
MAOIs
hypertensive crisis
Vit. K aids production of clotting factors in direct oppo. to:
Warfarin (Coumadin)
NSAIDs may cause ______ irritation, sometimes leading to sudden, serious bleeding
stomach
anti-neoplastic drugs cause ∆ taste→ ______
stomatitis, glossitis, esophagitis, & N / V
anti-cholinergic drugs (anti-psychotics, anti-depressants, & anti-histamines) slow peristalsis→ ______
constipation
anti-convulsant drugs require supp. for ______
folate, Vit. D, & Vit. K
cytotoxic effects of anti-neoplastics→ _______
stomatitis, glossitis, & esophagitis
ex: Cysplastin & Methotrexate
anti-biotics may result in ______
bitter taste in saliva, suppression on natural oral bacteria, & metallic taste in mouth
(ex: penicillin)
tricyclic anti-depressants & most anti-psychotics→ ______
stimulate appetite & wt. gain
ex: Elavil & Clorazil
SSRI anti-depressants may result in _______
anorexia & wt. loss (is oppo. of anti-depressants)
ex: Prozac
tricyclic anti-depressants→
dry mouth, metallic taste, & sour taste
ex: Elavil
charting / documentation rules:
- black pen or typed
- complete, clear, concise, objective, legible, & accurate
- date, time, service, pt. name, & pt.’s hosp. #
- correct spelling & grammar (complete sentences are optional)
- *entries are consistent, non-contradictory, & chronological
- sign all entries–include credentials
- NO personal opinions or criticisms
- document only at time of service (NEVER in advance)
- identify late entries
- do NOT use white out–draw line through & correct mistake or replace w/ new copy
- initial corrections
- note addendums, date, & initials for omissions
Health Insurance Portability & Accountability Act (HIPAA)
passed in 1996–ensures privacy & security of personal info. in health care settings
