Wellness Flashcards
It is thought that more time at home leads to…
more screen time and less outdoor physical activity = obesity
Quarantine issues:
- lack of sleep
- altered eating habits
- decreased physical activity
BMI utilizes a person’s…
height and weight
How to find BMI:
kg/m2 or (lbs/in2)x703
Overweight people have a BMI of…
25-29.9 kg/m2
Obese people have a BMI of…
30 or greater
Class 1 obesity has a BMI of…
30-34.9
Class 2 obesity has a BMI of…
35-39.9
Class 3 obesity has a BMI of…
over 40
BMI has limitation b/c of…
very muscular individuals
Instead of just relying on BMI, we can also consider…
measuring waist circumference
What waist circumference for males and females indicates that they are at risk for CVD and type 2 diabetes?
- males: over 40
- females: over 35
How to measure waist circumference:
- stand and place tape measure along belly button (above hipbones)
- tape should be horizontal and snug around waist
- look at number just after breathing out
Associated chronic health problems:
- cerebrovascular disease/stroke
- hypertension
- type 2 diabetes
- osteoarthritis
- sleep apnea
Obesity has the most effect on what health problem?
diabetes
Medications associated w/ weight gain:
- 2nd generation antipsychotics
- antidepressants
- hormonal contraceptives
- corticosteroids
- anticonvulsants
- insulin/sulfonylureas/thiazolidinediones
Initial goal of weight loss is to reduce body weight by…
5-10% over 6 months or by 1-2 pounds per week
What is the mainstay for weight loss therapy?
dietary modification or restriction
Exercise is less efficient _____, but important for ______
initially, maintenance and improving overall fitness
Reduced calorie diet and increased physical activity leads to…
greater weight loss and reduction of abdominal fat
Obesity/overweight management is only recommended as adjunct therapy to lifestyle interventions if BMI is…
over 30 kg/m2 or over 27kg/m2 w/ diseases or risk factors
OTC orlistat 60mg can be used if…
BMI is over 25 kg/m2
MOA of orlistat:
- reversible inhibitor of gastric and pancreatic lipases, which stops hydrolysis of TGs
- inhibits 30% of dietary fat absorption
OTC dose of orlistat:
60 mg capsule
- approved for ages > 18
- take TID before meals that have fat
Orlistat has been shown to have a weight loss of…
5-10 lb within 6 months and significant decrease in LDL cholesterol and blood pressure
Side effects of Orlistat:
- fatty/oily stool
- loose and frequent stools
- fecal urgency and incontinence
- intestinal gas with discharge
Orlistat decreases the…
absorption of fat soluble vitamins (ADEK)
- should take multivitamin at bedtime or separate at least 2 H from orlistat dose
Orlistat:
- minimally absorbed
- little systemic toxicity
- drug interactions unlikely
- warning of potential liver injury
Complementary therapies for obesity:
- usually not FDA approved
- lack scientific evidence
- botanical names not listed
- associated w/ serious adverse effects
Examples of complementary therapies for obesity:
- stimulants/E boosters
- fat/carb modulators
- laxatives
Examples of stimulants/E boosters:
- bitter orange
- caffeine
Examples of fat/carb modulators:
- green tea
- coffee
- chromium
Examples of laxatives:
- psyllium
- cascara sagrada
- casanthranol
- phenolphthalein
Stimulants/E boosters increase…
basal metabolism
Adverse effects of bitter orange:
- hypertension
- CV toxicity
- MI
- stroke
- seizure
Adverse effects of caffeine:
- GI distress
- headaches
- insomnia
- anxiety
- decreased appetite
- hypertension
Fat/carb modulators alter…
fat or carb metabolism, which leads to decreased body fat mass and increased lean muscle mass
Adverse effects of chromium:
- mood and sleep changes
- headaches
- cognition and perception dysfunction
Laxatives increase…
fecal loss
Adverse effects of laxatives:
- electrolyte imbalances
- can cause dependence
- severe cramping
Treatment goals of osteoporosis and osteopenia:
- maintain skeletal and bone mass
- prevent age-related bone loss
- optimize skeletal development
- avoid falls and fractures
Risk factors for osteoporosis and osteopenia:
- > 50 YO
- women more than men due to menopause
- smoking
- low calcium diets
- eating disorders
- family history
- low body weight
- sedentary lifestyle
- previous broken bones
- hormone imbalances
Calcium replacement as therapy for osteoporosis and osteopenia:
- aids in bone development/growth
- maintains overall bone strength
- often used in combo w/ vitamin D, which assists w/ reabsorption of calcium
Recommended dietary allowance of calcium and vitamin D for 19-50 YO:
- calcium: 1,000 mg
- vitamin D: 600 units
Recommended dietary allowance of calcium and vitamin D for 51-70 YO male:
- calcium: 1,000 mg
- vitamin D: 600 units
Recommended dietary allowance of calcium and vitamin D for 51-70 YO female:
- calcium: 1,200 mg
- vitamin D: 600 units
Recommended dietary allowance of calcium and vitamin D for > 70 YO:
- calcium: 1,200 mg
- vitamin D: 800 units
Common doses for calcium:
- body can only absorb in small doses
ex: 45 YO female would need to take 500 mg BID, not 1,000 mg QD
Adverse effects for calcium:
- GI distress
- constipation
- headache
- increased risk for kidney stones
Vitamin D:
- can be found as IU or mcg
- mcg x 140 = IU
Adverse effects of vitamin D:
- hypercalcemia
- hypercalciuria
- headache
- nausea
- weakness
- usually well tolerated
Types of calcium:
- carbonate
- phosphate
- citrate
Dosage of carbonate:
200-500 mg
- take w/ food to enhance absorption
Absorption of carbonate:
- not well absorbed
- water insoluble
- optimal in low pH environments
Dosage of phosphate:
600 mg
Absorption of phosphate:
- best absorbed
- water insoluble
Dosage of citrate:
200 mg
Absorption of citrate:
- acid not required
- water soluble
- preferred for patients on PPIs or histamine-2 antagonists (H2RAs)
Dosage forms of calcium:
- chewable tabs
- coated tabs
- gummies
- liquid
- soft chews
Insomnia:
- difficulty falling or staying asleep
- waking up too early and not returning to sleep
- not feeling refreshed after sleeping
Types of duration for insomnia:
- transient
- short-term
- chronic/long-term
Transient insomnia is…
- self limiting (< 1 week)
Causes of transient insomnia:
- traveling
- hospitalization
- studying for exam
Short-term insomnia lasts…
1-3 weeks
Causes of short-term insomnia:
- personal tragedy
- surgery recovery
Chronic/long-term insomnia lasts…
> 3 weeks to years
Causes of chronic/long-term insomnia:
- medical problems
- psychiatric disorders
- substance abuse
Classifications of causes for insomnia:
- primary
- secondary
Primary cause for insomnia:
- sleep difficulty for at least 1 month
- affects psychosocial functioning
- not caused by secondary disorders
Secondary cause for insomnia:
- sleep, medical, or psych disorders
- medications
Recommended sleep requirement for > 18 YO:
8 hours
Patients w/ symptoms of insomnia lasting _______ should be referred to PCP
over 4 weeks
Self care exclusions to insomnia:
- patients ages < 12 or > 65
- pregnancy
- frequent nighttime or early morning awakenings w/ difficulty falling back to sleep
- chronic insomnia
- sleep disturbances due to meds
OTC medications that can worsen insomnia:
- antihistamines (1st gen)
- caffeine
- decongestants
- nicotine
- valerian
Sleep hygiene:
- use bed for sleeping or intimacy
- establish regular sleep pattern
- avoid eating meals w/in 2 hours of bedtime
- avoid caffeine, alcohol, or nicotine w/in 4-6 hours before bed
Pharmacologic therapy for insomnia:
- diphenhydramine
- doxylamine
Diphenhydramine is the…
only FDA approved sleep aid proven to be safe and effective
Indication for diphenhydramine:
symptomatic management of transient and short-term sleep difficulty
Dosage for diphenhydramine:
50 mg QHS
- max sedation 3-6 hours after dose
- take 30 minutes before bed
- intermittent use for 3 days: take one night without med
Side effects of diphenhydramine:
- dry mouth
- dizziness/falls
- blurred vision
- constipation
- sedation
Warnings of diphenhydramine:
- no alcohol
- max use of 7-10 consecutive nights
- no driving or cooking until patient response is known
- no elderly
Doxylamine:
safety and efficacy is not established by FDA
Dosage for doxylamine:
25 mg taken 30 minutes before bed
Side effects of doxylamine:
- dry mouth
- dizziness/falls
- blurred vision
- constipation
- sedation
- same as diphenhydramine
Examples of complementary therapies for insomnia:
- melatonin
- valerian
Dosage for melatonin:
0.5-5 mg given 30-60 minutes before bed
Evening doses of melatonin advance…
circadian rhythm andinduce onset of sleep
Melatonin is induced by ___ and suppressed by ___
darkness, light
Side effects of melatonin:
- reduced focus and concentration
- lower body temp
Dosage for valerian:
400-900 mg given 30-120 minutes prior to bed
Continuous use of valerian for _____ required for best effects
several days/weeks
For valerian, patients should avoid:
kava
Drowsiness:
feeling of falling asleep
Fatigue:
weakness or exhaustion
Drowsiness and fatigue are caused by…
- inadequate sleep
- use of CNS depressants
- depression
- cancer
- hypothyroidism
- chronic pain
Examples of CNS depressants:
- antihistamines
- antipsychotics
- anticonvulsants
- opioids
Caffeine:
- pharmacological way to treat drowsiness and fatigue
- only FDA approved nonrx stimulant
- nonselective adenosine antagonist
- well absorbed
Dosage for caffeine:
100-200 mg Q3-4H prn for > 12 YO
Peak action of caffeine occurs within…
30-75 minutes
Side effects of caffeine:
- GI distress
- headaches
- insomnia
- restlessness
- agitation
- decreased appetite
- increased urination
- dehydration
High doses of caffeine ( > 400 mg) causes…
- dysrhythmias
- palpitations
- tachyarrhythmia
Warnings of caffeine:
- anxiety
- CV disease
- GI diseases
- hepatic/renal impairment
- seizure disorders
- pregnancy
