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DEMS Unit 3 > Treating Metabolic D > Flashcards

Treating Metabolic D Flashcards

1
Q

Who uses integrated health more?
Gender
Age
Income + education

A

Females
45-65
Pts with Higher education and income

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2
Q

Highest utilized Integrative health domains

A

(Biologically based systems)

Herbals + diet

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3
Q 
Made from nature:
Morphine
Digoxin
Aspirin
Tamoxifen
A

Morphine: poppies
Digoxin: foxglove
Aspirin: willow bark
Tamoxifen: pacific yew tree

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4
Q

Dietary supplement and health education act DSHEA

A
  1. Regulate the evaluation of vitamins, herbals, aa and other botanicals
  2. Regulates herbal supplements more like food rather than medication
  3. Products cannot be put on same shelf as OTC or meds
  4. Prior to 1994 - all products were GRANDFATHERed

Manufacturers

  1. Do not need to register or get FDA approval
  2. Responsible to ensure product is safe
  3. Ensure product label info is truthful and not misleading
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5
Q

Most commonly used natural product by US adults

A

Fish oil/omega 3/DHA, EPA FA

  • safe
  • likely effective
  • consider recommending

*TG > 500 then you can get Pancreatitis

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6
Q

INcidations for Fish oil/Omega 3

- MOA

A

Hypertriglyceridemia

MOA:

  • Decrease in hepatic secretion of VLDL-C,
  • Increase in VLDL-D clearance,
  • Reduces TG transport
  • Omega 3 FA compete with arachidonic acid in the COX + lipoxygenase pathways
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7
Q

Effects of Fish oil/Omega 3

A

TG ↓ 20-50%
If TG > 500 = ↓ 45%
Combo with statin in TG lvl 200-499 = ↓ 30%

LDL neutral effects

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8
Q

Recommended tx with fish oil/omega 3

A

primary prevention: 500 mg qd or 2 fishy meals/week

Secondary prevention (CHD): 1000 mg qd
- had an event already, now its to prev another (larger dose)

tx option for pts who cannot take niacin due to gout and flushing rxn (good antiinflammatory)

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9
Q

Fish oil/Omega 3

  • adverse rxn
  • DDI
  • Herb intxn
A
  • adverse rxn:
    fishy taste, GI upset, heartburn, belching
  • DDI
    antihypertensive, contraceptives, and orlistat
  • Herb intxn (G’s)
    Garlic, Ginger, Ginkgo, and Ginseng
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10
Q

Effects of Fiber on heart disease

A

51% of whole grain or more, manufacturers can say that it reduces risk of heart disease

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11
Q

Niacin
Effects
Efficacy

A

↓ LDL-c 5-25%
↓ TG 20-50%
↑ HDL-c 15-35%

Might have ↓ risk of secondary MI but no sig ↓ in all cause mortality

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12
Q

Niacin side effects

A

Heart attack
GI
Flushing
Increase blood glucose and uric acid

Monitor: LFT due to HEPATOTOXICITY risk

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13
Q

Plant stERols
MOA
Effects
Adverse rxns

A

Inhibits ~50% of intestinal absorption of cholesterol
↓ Total cholesterol
↓ LDL-c
NO EFFECT ON HDL

Adverse:
Nausea, indigestion, diarrhea, constipation and gas

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14
Q

Plant stANols
MOA
Effects
Adverse rxns

A

Inhibits dietary and biliary cholesterol
↓ LDL-c 10-15%
With statin therapy:
↓ Total cholesterol 3-11%

Adverse:
Diarrhea + STEATORRHEA

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15
Q 
Plant sterols and stanols
Intxns?
Time till effectiveness?
Discontinue effects?
Which is more effective?
A

Herbs:
- beta carotene and Vit E
Drugs:
- Zetia

Takes 2-3 weeks to be effective
Cholesterol levels will rise back to baseline if discontinued
Both are equally effective

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16
Q

Which drugs/natural products help increase HDL?

A

Fibrates (↑ 5-15%)
Niacin (↑ 35%)
Statins (↑ 6-14%)

17
Q

Atkins diet

A

High fat, Low carb
Max of 40 g/day

First 10 days ketosis = Rapid weight loss

18
Q

Macrobiotic

A

Low fat
Emphasizes whole grains, vegies
Restrict fluid intake

19
Q

Ornish

A

Only 10% of their calories from fat

Allows fruits and vegies

20
Q

South beach

A

Low carb
Focus on glycemic index
“Good” carbs and fats (no saturated/trans fat)

21
Q

Zone

A

40% carbs
30% protein
30% fat

22
Q

Ephedra (no longer on market)
MOA
Efficacy
adverse rxns

A

ephedrine and pseudoephedrine are non selective α + β receptor agonist which stimulate the nervous system

Efficacy
- Weight loss of 0.9kg/month. Up to 6 mo. With

23
Q

Bitter orange
MOA
Adverse effects
Caution in

A

contains 1-6% of synephrine (related to ephedrine)

Adverse: same problems

  • Dizziness, anxiety, insomnia, HA, dry mouth, n/v, heartburn, tachycardia, palpitations, ↑ BP
  • SEIZURES, CARDIOMYOPATHY, MI, ARRYTHMIAS, SUDDEN DEATH

Caution in HTN, and CV pts

generally recognized as safe

24
Q

Calcium

  • efficacy
  • adverse rxn
  • clinical pearl
A

Pts with low Ca intake will often gain more weight and have higher BMI

Efficacy
- 800-1200 mg/qd shows ↑ weight reduction and body fat loss

Adverse:
- belching, flatulence

Pearl:
Supplement calcium alone ≠ low fat dietary intake

25
Q

Orlistat (OTC weight loss agent)

  • MOA
  • Efficacy
  • Adverse RXN
A

(Safest - OTC weight loss agent)

Reversible inhibitor of pancreatic and gastric lipase

Efficacy:

  • pts with BMI > 27 saw weight loss ~ 3%
  • FDA approved for long term use

Adverse:
Headache, oily spotting, abdominal discomfort, gas, fecal urgency, steatorrhea, LIVER RELATED EVENTS
- adverse with psyllium!

26
Q

orlistat

- DDI

A

Anticoagulant, amiodarone, levothryoxine & vitamins

Take a MVI 2 hours before or after dose

Due to risk of liver injury, inform pts sx - monitor LFTs

27
Q

Chromium III (food)
Use + effects
MOA
Adverse effects

A

Commonly taken to supplement diabetes tx

  • ↓ FBG from 190 to 150
  • ↓ HBa1c 8.2% to 7.6%
  • ↓ Tc 235 to 213

might reduce oxidative stress
low levels are associated with impaired glucose & insulin

adverse:
HA, insomnia, irritability, mood changes & sleep disturbances
Vomiting, diarrhea, & hemorrhage

28
Q

Chromium intxns

A

Herbs:
- bilberry, brewer yeast, iron, Vit CC, Zn

Drugs:
- Insulin, levothyroxine, NSAIDS, corticosteroids

29
Q

Vanadium
MOA
Efficacy
Adverse rxn

A

Activates insulin rcptr proteins
Stimulates glucose oxidation & transport
Liver: stimulates glycogen synthesis
Adipose: inhibits lipolysis
Skeletal muscle: promotes glucose uptake
- overall: improve insulin sensitivity, reduce blood glucose levels

EFFECTIVE IN T2D ONLY, NOT T1D

Adverse:
- GI upset, kidney toxicity, fatigue, lethargy, tongue discoloration (green?)

30
Q

Vanadium intxns

A

Herbs “G’s”
- garlic, ginger, ginkgo, ginseng

Drugs:
Anticoagulants and antiplateletes

Disease:
diabetes and renal dysfxn

31
Q 
Garlic
Indications
MOA
Adverse rxn
DDI
Herb Intxn
A

Indications
HTN
Hyperlipidemia

MOA
Inhibits hepatic cholesterol synthesis
activates production of endothelium derived relaxation factor to relax sm and vasodilation

Adverse:
Halitosis, body odor, heartburn, GI upset

Drug intxn:
Anticoagulants
Antiplatelets
CYP3A4
CYP2E1

Herb intxn:
Ginger, ginkgo, Vit E

Discontinue 2-3 weeks prior to surgery (bleeding)

32
Q

Coenzyme Q10
Indications
MOA
Efficacy

A

Indications

  • CHF if taken with prescription tx
  • Preventing statin induced myopathy

MOA

  • Has antioxidant properties to stop damage and give E to cells
  • Cofactor in metabolic pathways
33
Q

Coenzyme Q10
Use
Drug intxn

A

cigarette smoking may deplete body stores, so use supplements

Drug intxn:
anticoagulants

DEMS Unit 3 (26 decks)

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