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Flashcards in 14 Deck (99):
1

early 30's reaches physiological maturity (2)

1. maximum height
2. formation of peak bone mass

2

young adulthood

20-35 yr

3

muscle change in young adulthood

muscle mass increase until 3rd decade

4

when does maximal strength, endurance and agility occur

5 years after maximum height

5

middle adulthood

50-69 yr

6

what can prevent/ slow down the decrease in bone and muscle mass

physical activity

7

does obesity rate always lower for women all life stages

no
except when they hit 75 yr

8

overweight by >25 lbs

increased risk for CHD in female

9

BMI> 25, whats the concern

chronic disease

10

important to educate individuals in their middle years about exercise and food habits

1. delay onset of chronic disease and aging
2. increase quality of life in present
3. increase optimal function for longer period of time

11

population aging

occurs when the median age of a country/ region rises due to rising life expectance and/ or declining birth rates

12

compare usual age and successful age

usual age:
aging process accelerated by disease and life style factors
poor exercise habit and alcohol and tobacco abuse
successful age:
age- related changes that are not increased due to lifestyle or disease
have sound nutritional habits, exercise regularly and have a good BP control
Centenarians: non smoker, no XS alcohol, no diabetes, no obesity and no HTN

13

nutritional intervention

a practical approach for modulating immune function compared to pharmacological intervention

14

what is one of the most effective nutrients for its effect on immune cell functions

vitamin E supplement

15

what is the best characterized feature of immunosenescence

decline in T- cell funtion

16

how can vitamin E show the immune function

inhibit prostaglandin E2 production in macrophage, PGE2 at high concentration may inhibit T cell proliferation which inhibit immune response.

17

what happened next to the vitamin E action

1. reverse the altered cytokine profile of T cells
2. reduced Th1 cytokine, IL-2 and IFN- gamma production, IL-2 receptor expression

18

cataracts, dementia may be inhibited by which kind of treatment

nutrient supplement

19

green vegetables (vitamin C and vitamin E)'s 4 functions

1. boost immune function
2. decreased incidence of cataracts
3. improved mental ability
4. prevent some forms of dementia

20

folate supplement functions (2)

1. decreased dementia like symptoms
2. decreased mental functioning

21

folate deficiency in ederly

three times risk to have dementia

22

what is change in folate metabolism responsible for?

physical changes/weight loss

23

benefits of fish and fish oil

1. better cognitive performance
2. less likely to develop dementia or cognitive problems later in life

24

body composition changes as age

decrease in LBM and increase in adipose tissue
decrease in total body water, decrease in BMR, decline in the resilience of the HPA axis

25

the changes as age are due to (2)

1. decreased physical activity
2. hormonal change

26

the hormonal changes as age include (3)

1. growth hormone decreases
2. estrogen and testosterone --> changes in BMD
3. testosterone contributes to decreased muscle mass

27

fat mass rather than BMI is a better indicator of ??

true fat mass and hence obesity

28

increased insulin resistance is related to the increase of?

intramyocellular fat mass

29

physically inactive will result in (2)

decrease in muscle mass and muscle strength

30

key to sustain muscle mass

adequate calorie/ protein consumption + physical activity

31

sarcopenia

age- related loss of muscle mass and function (not sufficient myofibrillar to contract )

32

what can be used to prevent sarcopenia

resistance training

33

frail classification

three or more of the following:
muscle weakness
slow walking speed
exhaustion
low PA
unintentional weight loss

34

theories of aging (6)

1. free radicals
2. immune function deterioration
3. cellular mutation
4. decreased hormonal secretion
5. cross- linking
6. pre- programmed aging under genetic control

35

what can cause DNA damage of decreased DNA repair activity

UV, radiation, mutagens, drugs

36

the small errors accumulating may affect? (3)

DNA translates
RNA and protein synthesis
decrease function of the cell

37

high methylation status is a better predictor of

mortality

38

methyl group is added onto?

cytosine

39

DNA methylation can be called?

epigenetic clock

40

decreased level of hormone

1. testosterone --> decreased bone mass and decreased ability to maintain protein store
2. estrogen --> decreased ability to maintain protein stores
3. insulin
4. growth hormone --> increased adipose tissue and decreased lean body mass

41

what causes cross- linking between protein molecules

glycation

42

AGE

advanced glycation end production

43

what will AGE cause

intracellular damage and apotosis

44

what will happen if immune system deterioration

1. decreased immune competence
2. increased likelihood of autoimmune disorders and chronic inflammatory disease

45

thymic involution

shrinking of the thymus --> decreased maturation of thymocytes to T cells -- less production of T cells

46

what happen if cells lose telomere function

trigger chronical activation of P53 --> stop cellular proliferation --> deleterious for cells that have a rapid turnover

47

specific genes that pre- determine life span

death gene (P53)

48

risk factors for malnutrition in older adults (8)

1. decrease in body function
2. multiple medication
3. chronic disease
4. needs assistance with self- care
5. tooth loss or oral pain
6. eating poorly
7. reduced social contact
8. economic hardship

49

decrease in body functions include (7)

1. progressive loss of vision and hearing
2. osteoarthritis
3. decreased energy need but unchanged nutrients need
4. poor oral health, problem in chewing
5. sensory impairment
6. psychosocial and environmental changes
7. sarcopenia

50

needs assistance with self-care

1. physical disabilities (decreased eyesight and bone fracture, decreased ability to produce and prepare food)
2. surgery, injury, infection (anorexic effect of physical trauma and decreased ability to prepare food and decreased intake), decreased muscle strength

51

changes in organ function with aging (8)

1. decreased number and functional taste buds
2. decreased salivary secretion
3. decreased esophageal function
4. decreased gastric function and emptying
5. decreased liver/ biliary function
6. decreased pancreatic secretion
7. changes in intestinal morphology
8. changes in renal morphology

52

decreased saliva secretion can be caused by which drug

antidepressant, antihypertensie, bronchodilators

53

decreased gastric function can lead to (4)

1. decreased gastric acid production, decreased parietal cells mass and decreased maintenance of commensal flora balance
2. decreased pepsin by 25%, decreased optimal nutrient absorption
3. increase proximal pH and increased bacterial colonization, compete for B vitamins, decreased optimal nutrient availability
4. increased risk of ulcers

54

decreased liver/ biliary function can lead to

1. decreased bile acid production, increased food tolerance, increased GI distress
2. decreased drug metabolizing enzymes, increased drug- related toxicity

55

decreased pancreatic secretion

decreased nutrient absorption

56

changes in intestinal morphology

1. decreased intestinal function
2. higher incidence of constipation
3. diverticulosis
4. lactose intolerance, increased risk of vitamin A, D, B2 riboflavin and protein deficiencies

57

changes in renal morphology (4)

1. decreased renal function
2. decreased capacity to excrete waste products
3. decreased ability to bioactive vitamin D to metabolically active form
4. impaired thirst system --> increased risk of dehydration

58

type 3 hypersensitivity response

accumulation of drug metabolites due to decrease liver and kidney function, IgG and complement components try to get rid of metabolites by bind metabolites and form immune complexes

59

anti vitamin drugs block action of vitamins (5)

1. enhance the catabolism
2. enhance the excretion
3. inhibit the absorption
4. binding to them in the body to make them unavailable to the tissues
5. causing an inhibition of their activation in the body to an active form

60

movement of drugs through the body by (4)

1. absorption
2. distribution
3. metabolism
4. excretion

61

grapefruit/ juice

inhibit intestinal metabolism of numerous drugs (HMG CoA inhibitor, calcium channel blockers, anti- anxiety agent)

62

Warfarin

prevent conversion of vitamin K to a useable form

63

methotrexate and pyrimethamine

folic acid antagonists
treat with folanic acid

64

what may affect absorption of drug

food component

65

what may affect distribution of drug

only drugs that are not bound, can leave the blood and target the organs

66

what may affect metabolizing of drug (3)

1. bio- transforming: occur in liver, cytochrome p-450 facilitates drug metabolism.
2. change the fat- soluble component to water soluble component to be excreted
3. foods or supplements can increase or decrease the enzyme systems can change or extend the drug metabolism

67

what is the main route of excretion of drug

renal excretion
can be affected renal function and urinary pH

68

bile acid sequestrants, cholestyramine

cholesterol lowering drug

69

what is the mechanism of cholestyramine

prevent the bile acid reabsorption

70

cholestyramine

antihyperlipidemic bile acid sequestrants, adsorbs fat soluble vitamin A, D, E, K and folic acid

71

drug- nutrient interaction

result of action between a drug and a nutrient that would happen with the nutrient or the drug alone

72

food- drug interaction

a broad term including drug- nutrient interactions and effect of a medication on nutritional status

73

neomycin

antibiotic drugs, decreased nutrient absorption

74

anti- inflammatory drugs (2)

1. inhibit lactase enzyme
2. directly damage gut and decrease fat and micronutrient absorption

75

laxative (2)

1. dissolve fat and fat soluble vitamins -> excreted in feces
2. decrease in transit time --> decreased absorption of Ca and K

76

tricyclic antidepressants

decreased absorption due to high fiber diet

77

NSAIDs, chemotherapeutic agents (2)

1. alters ability to absorb minerals, Fe and Ca
2. damage the gut mucosa

78

anti- ulcer drugs (cimetidine)(3)

1. decreased HCl
2. decreased amount of vitamin B 12 released from food
3. decreased available for binding with intrinsic factor for absorption

79

loop diuretics (furosemide) (4)

1. for blood pressure control
2. increased excretion of thiamin --> cardiac abnormalities
3. inhibit the co- transporter Na- K- Cl, act on kidney
4. increase the excretion of K, Mg, Na, Cl, Ca

80

loop diuretics (thiazide) (4)

1. potassium depletion --> increased risk of cardiac arrhythmias
2. decrease the excretion of Ca
3. work by increasing the diuresis and vasodilation.
4. increased excretion of K, Mg

81

K sparing diuretics(2)

1. increase the excretion of Na, Cl, and Ca
2. hyperkelamia if take K supplementation

82

corticosteroid (5)

1. decreased excretion of Na
2. Na and water retention
3. increased K and Ca excretion
4. low Na, high K diet is recommended
5. Ca and vitamin D supplement are recommended to prevent osteoporosis

83

aspirin mechanism

bind with folate binding sites on plasma protein
may cause gastric bleeding

84

ciprofloxacin and tetracycline complex (antibiotics)

with Ca, Mg, Fe, Zn

85

alendronate

anti- osteoporosis drug
sit upright for 30min, avoid esophagitis

86

what is the most common cause of diarrhea in elderly

drug therapy, dose related rather than drug reaction

87

what is the most common iatrogenic cause of diarrhea in elderly and how (3)

antibiotics
1. alteration of colonic bacteria
2. damage to small intestine mucosa
3. cause osmotic diarrhea

88

serum 17b- estradiol and serum estrone levels decrease

during menopause transition

89

factors that increase the likelihood of developing osteoporosis (13)

1. family history
2. fracture history
3. body size (small thin women)
4. caucasian
5. age (older, less GH, decreased IGF-1)
6. anorexia
7. estrogen deprivation
8. hypogonadism
9. low body weight (low Ca and malnutrition)
10. glucocorticoids (suppress bone formation, impaired osteoblastogenesis, inhibit IGF-1 synthesis)
11. physical activity
12. alcohol
13. smoking

90

type 1 osteoporosis (5)

1. increased osteoclast activity
2. decreased estrogen level and testosterone level
3. onset 50-70 yr
4. more in vertebral bone crush, wrist and spine
5. estrogen dampens the bone resorbing effect of PTH when there is a decreased blood Ca

91

estrogen function in bone (4)

1. stimulates the apoptosis of osteoclast precursor cells, decrease osteoclast precursor differentiation
2. transforming growth factor beta includes osteoclasts apoptosis and bone structure
3. promotes the formation of TGF-beta
4. suppress production of bone resorbing cytokines and prostaglandins

92

trabecular bone

lacy network of Ca containing crystals which fill the Ca storage bank, responds to daily Ca intake

93

type 2 osteoporosis (11)

1. age related
2. prominent feature: accumulation of bone marrow fat at the expense of osteoblastogenesis
3. slow and steady with age
4. loss of cortical bone
5. sarcopenia may contribute
6. estrogen diffiency
7. PTH secretion increases --> bone resorption, increased osteoclast activity and cortical bone loss
8. Ca and vitaminD deficiency --> increased osteoclastic activity --> cortical bone loss
9. decreased Ca absorption and intake
10. start at 40
11. due to osteoblast underactivity

94

preventive care for osteoporosis (7)

1. acquisition of maximum bone mass in premanopausal years
2. screening of osteopenia in the perimenopausal period
3. control of bone mineral loss
4. 12-18 month supplementation in elderly women
5. calcitriol with postmenopausal osteoporosis
6. hormone replacement therapy
7. exercise, calcium, limit alcohol, stop smoking

95

bisphosphonates

first line to treat osteoporosis

96

bisphosphonates mechanism

osteoblast proliferation
osteoclast apoptosis
inhibit bone marrow adipogenesis

97

modifiable risk factors that can affect bone losss

increased Ca, P, protein diet, vitamin D deficiency, low PA, excess alcohol, caffeine, and smoking

98

recommendation for postmenopausal women

1. aerobic exercise for 20min 3 times/ week
2. weight training regimen

99

PA

increase muscle strength and coordination
decreased risk of fall- related fracture