Midterm 2 pt. 1 Flashcards
(128 cards)
1
Q
nutrients have a ________ dose response curve
A
u shaped
2
Q
drugs have a ________ dose response curve
A
sigmoid
3
Q
which is more specific, drugs or nutrients
A
drugs
4
Q
drugs are a type of
A
xenobiotic
5
Q
the potential for ________ exists with all drugs
A
drug-nutrient interaction
6
Q
interaction between drugs and food are ________
A
bi-directional
7
Q
which effects are more subtle, drugs or nutrients?
A
nutrients
8
Q
nutrients and oral drugs share
A
the same metabolic processes and can have overlapping molecular targets
9
Q
a drug-nutrient interaction is clinically significant if
A
it alters the therapeutic drug response or compromises nutrition status
10
Q
pharmacokinetics include
A
absorption, distribution, metabolism, excretion
11
Q
patient outcome can be measured by
A
nutrition status (improved or worsened), or drug effect (toxic/ineffective or optimal)
12
Q
physiologic outcome can be measured by
A
change in bioavailability
change in volume of distribution
change in clearance
change in biomarkers
13
Q
what is a drug?
A
any chemical used for prevention, treatment of symptoms, or cure of disease
14
Q
foods/supplements and enteral feedings are
A
oral (PO)
15
Q
how is parenteral nutrition/IV administered?
A
intravenously (directly into the vein)
16
Q
the pharmacokinetic stage consists of
A
absorption, distribution, metabolism, and elimination
17
Q
What is ADME?
A
the pharmacokinetic stage: absorption, distribution, metabolism, and elimination
18
Q
the pharmacodynamics stage is
A
the body’s physiological response to drugs
19
Q
drug absorption factors that influence pharmacokinetics include
A
drug-associated factors
patient-associated factors
20
Q
drug distribution factors that influence pharmacokinetics include
A
membrane permeability
plasma protein binding
depot storage
21
Q
what drug metabolism factors influence pharmacokinetics
A
enzyme systems
22
Q
what facilitates absorption of polar drug compounds into intestinal epithelial cells
A
membrane transport proteins
23
Q
membrane transport proteins act as
A
gatekeepers to regulate uptake + efflux of nutrients and drugs
24
Q
transport proteins are found in
A
many tissues, at apical and basolateral sides of cells
25
transport proteins transport
drugs and nutrients
26
what happens during first pass metabolism
most nutrients are taken up across the GI tract, and capillaries take them into the portal vein which goes directly to the liver (liver has first pass of metabolizing nutrients)
27
the efficiency of metabolism of a nutrient depends on
first pass metabolism (usually in liver)
28
metabolic reactions can transform
an active drug into a less-active/inactive form
a pro-drug (inactive or less active drug) into an active form
29
phase I reaction
(non synthetic) drugs are oxidized or reduced to a more polar form
30
phase II reaction
(synthetic) a polar group is conjugated to the drug
31
phase I is conducted by
cytochrome p450 enzymes (CYP P450)
32
phase II is conducted by
GST, QR, etc.
33
what reactions occur during phase 1?
oxidation
reduction
hydrolysis
acetylation
34
what reaction occurs during phase 2?
sulfate conjugation
glucuronide conjugation
glutathione conjugation
amino acid conjugation
35
list the drug excretion routes
urine, feces, exhaled air, sweat, saliva, tears, breast milk
36
which renal processes influence drug excretion
glomerular filtration
tubular secretion
tubular reabsorption
37
drug absorption may be influenced by
stomach and intestinal pH
gastric emptying and GI tract motility
absorptive capacity of cells
presence of food
presence of certain nutrients in GI lumen
38
achlorhydria
happens with aging & low stomach acidity and decreases drug absorption
39
a high fat meal will
slow gastric emptying rate
40
malnutrition can
damage integrity of GI enterocytes and decrease absorption
41
calcium will
chelate tetracycline and decrease absorption
42
citrus juice will
increase iron absorption
43
fosamax absorption is decreased by
food
44
levodopa absorption is decreased by
neutral amino acids in proteins
45
taking st. john's wort will
decrease the absorption of HIV drugs
46
what drugs are affected by grapefruit juice
statins (to lower chol)
calcium blockers
immunosuppressants
47
what do blood thinners do?
reduce the rate at which blood clots form
48
people on coumadin
should eat MORE vit K (on blood thinners)
49
high fiber diets results in
increased excretion of fat-soluble compounds
50
acidic urine will cause
increased clearance of alkaline drugs (amphetamines)
51
alkaline urine
increased excretion of acidic drugs (phenobarbital)
52
unintended drugs that decrease appetite include
drugs that act on CNS & drugs for CA treatment (chemo)
53
intentional drugs that decrease appetite are
drugs for wt loss (anorexic agents)
54
anorexic agents include
adrenergic agents (wt mgmt)
serotoninergic agents
GLP-1 receptors
55
unintended drugs that increase appetite include
corticosteroids
56
intended drugs that increase appetite include
megestrol acetate
57
what is dysgeusia?
a condition characterized by altered taste perception
58
what is hypogeusia?
a condition characterized by reduced acuity of taste perception
59
how do drug luminal effects influence drug activity?
transit time in the gut & affects bile acid activity
60
what drug influences transit time in the gut
cathartic
laxatives
drugs that cause diarrhea
61
affecting bile activity also affects
absorption of fat, fat-soluble vitamins, carotene, & chol
62
antacids (such as ____________) does what?
proton pump inhibitors; changes pH of stomach and decreases absorption of calcium and B12
63
corticosteroids decreases
calcium absorption
64
what are the side effects of using alpha glucosidase inhibitors?
gastrointestinal intolerance
65
what do chemotherapy drugs do?
disrupt enterocyte replication
66
orlistat
reduces fat absorption
67
what do methotrexate pyrimethamine do?
competes w/ folic acid
68
isoniazid competes with
vit B6
69
corticosteroids increases
rate of gluconeogenesis in liver (hyperglycemia)
70
what do diuretics do?
increases urinary output & excretion of potassium
71
diuretics are taken for
high blood pressure
72
some drugs reduce
re-absorption of nutrients in renal tubule
73
polypharmacy
the practice of taking multiple medications daily; taking >4 meds/day
74
who's most likely to have polypharmacy
old people w/ chronic dz
75
polypharmacy may contribute to
risk of malnutrition
76
what are effectors?
compound found in food (ingested molecule, modified molecule, part of molecule, general chemical)
77
what are targets (in the context of food)?
biological system
78
bioactives are
not essential, but they are necessary to optimize health
79
examples of phytochemicals and sources
beta carotene - carrots/squash
cellulose - most plant foods (fiber)
catechins - cocoa, apples
lignans - flax, rye
80
polyphenols
are protective against CA, DM, CVD, neurologic disorders
81
phytochemical profiles
differ in different varieties of the same plant (broccoli sprouts vs. mature)
82
pharmacokinetics
pharmacodynamics
ADME
physiological response
83
primary research
original data, experimental data
84
secondary research
meta-analyses systemic/narrative reviews
85
categories of research evidence
A - very strong evidence
B - strong evidence
C - moderate evidence
D - weak evidence
86
A
very strong evidence
- randomized controlled trials
- meta analyses
- large epidemiologic studies
87
B
strong evidence
- cohort + case-controlled studies
88
C
moderate evidence
- individual case studies
89
D
weak evidence
- anecdotal evidence
90
functional medicine tenets
seeks the address the root cause for each individual
91
functional medicine seeks balance between
mind, body, and spirit
92
the radial of integrative/functional medical nutrition therapy includes
food, lifestyle, environment
nutrition physical signs and symptoms
biomarkers
metabolic pathways
systems
93
CAM stands for
complementary and alternative medicines
94
complementary and alternative medicines are
not generally considered to be a part of conventional medicine
95
complementary medicine is used along with
used along with conventional medicine
96
alternative medicine is used
in place of conventional medicine
97
three categories of CAM
whole body/systems of medicine
mind & body practices
natural products
98
list examples of whole body/systems of medicine
ayurvedic medicine (yoga, meditation, herbal supplements)
traditional chinese medicine (herbal supplements, tai chi, acupuncture)
homeopathic medicine (small amounts of active substances)
99
examples of mind and body practices
focuses on interactions between brain, mind, body, behavior
- acupuncture, meditation, tai chi, relaxation techniques
100
categories of mind and body practices
meditation, yoga, acupuncture
101
can yoga help improve glycemic control
yes
102
most widely used CAM therapy in US are
natural products (herbs, vitamins, minerals)
103
what are the challenges of CAM
not many well designed trials
not covered by insurance
goes unreported
no standardizing
104
nutraceutical are
purified compound not usually associated w/ food
105
health claims describe
relationship between food and disease, strong robust evidence
106
structure function claims are
statement that describes the role a nutrient plays in maintaining a structure of the body or promoting a normal body function, not related to disease
107
qualified health claim are
limiting the statement, has strong but not as conclusive evidence as a health claim
108
what is diabetes?
group of disease characterized by high levels of blood glucose which results from problems with insulin production, action, or both
109
what is type 1 DM
disease where the body can't make insulin
110
what is type 2 DM
disease where the body cannot use the insulin made (insulin resistance)
111
type 1 DM is an
autoimmune disease
112
type 2 DM is characterized by
either progressive decreased insulin secretion or lack of response to insulin at tissues (insulin resistance)
113
gestational DM is characterized be
high blood glucose developing during pregnancy
114
diabetes can be caused by other conditions such as
cystic fibrosis
115
impaired glucose tolerance is when
blood glucose levels not yet high enough for diagnosis of DM (i.e. metabolic syndrome)
116
GDM (gestational diabetes) poses risk to
mother and child, both during pregnancy, birth, and later in life
117
which lifestyle shows the greatest clinical significance of prevention of type II DM
weight reduction and physical activity
118
key point for type 2 DM
some insulin is around, but there may be limited response at the tissue
119
insulin resistance occurs
after the point when insulin binds to the receptor (many possible mechanims)
120
key point for type 1 DM
no insulin is around
121
what are the two pathways initiated by insulin
PI3K - inability to uptake glucose
Ras > MAPK > ERK - decreased gene expression, cell growth and proliferation
122
sources of glucose
diet, liver gluconeogenesis, kidney gluconeogenesis
123
insulin promotes
net storage of triglycerides
124
insulin inhibits
lipolysis of triglycerides
125
insulin signals a ___________ state
anabolic (making TGs and glycogen)
126
in insulin resistance, ________________ interfere with insulin signaling
inflammatory cytokines
127
in insulin resistance
insulin-stimulated GLUT4 glucose uptake is inhibited
lipolysis is NOT inhibited
128
what is the net result of insulin resistance
glucose not taken up --> FFA released instead
