misc highlights Flashcards
(118 cards)
1
Q
average daily dietary intake sufficient to meet the nutrient deficiency of nearly all healthy indifiduals
A
RDA
2
Q
average daily intake required to meet nutritional needs. (employed when experimental evidence is not enough to establish an RDA)
A
AI (adequate intake)
3
Q
highest ave daily intake that can be consumed by nearly everyone without sig risk for adverse effect (not a recommended upper limit for intake)
A
UL (tolerable upper intake level)
4
Q
level of intake that will meet nutrition requirements for 50% of the healthy individuals in any life stage or gender group
A
EAR (estimated average requirement)
5
Q
range for macronutrients associated with optimal health
A
AMDR (acceptable macronutrient distribution range)
6
Q
fat soluble vitamins
A
ADEK
7
Q
water soluble
A
C and B complex
8
Q
those on vegan diets may require what vitamins
A
A, B12, D and riboflavin
9
Q
breastfed infants should be given
A
400IU of Vit D
10
Q
women of childbearing age should receive
A
folic acid to prevent neural tube defects
11
Q
People over 50 should be taking
A
vit B12
12
Q
what vitamin may be beneficial for adults 65 and older
A
Vit D plus calcium
13
Q
what vitamins recommended for postmenopausal women
A
vit D
calcium
14
Q
what vitamin if taken in excess is linked to congenital deformities (pregnancy)
A
vit A
15
Q
Prematurity increases risk for what vitamins
A
Vit A
16
Q
Alcohol dependence increases risk for what vitamins
A
Vit B1 (thiamine) B3 B6 B7 (biotin) B9 (folate)
17
Q
older age increases risk for what vitamins
A
B1 (thiamine)
B12 (cobalamin)
18
Q
HIV/AIDS increases risk for what vitamins
A
B1
19
Q
Bariatric Surgery increases risk for what vitamins
A
B1
20
Q
DM increases risk for what vitamins
A
B1
21
Q
pregnancy and lactating
A
B2
B7
Vit C
22
Q
vegan increases risk for what deficiencies
A
B2
B12
23
Q
impaired renal function increased risk for what deficiencies
A
B6 (pyridoxine)
Vit C - those on dialysis
24
Q
strict vegetarian increased risk for what deficencies
A
B12
25
smokers are at risk for what vit deficiency
Vit C
26
inadequate food sources puts you at risk for what vit def
Vit C
27
cancer puts you at risk for what vit def
Vit C
28
newborns get what vit at birth
Vit K
29
taking PPIs and H2 receptor agonists can put you at increased risk for what vit def
Vit B12 def
30
taking metformin puts you at increased risk for what vit def
Vit B12
31
pernicious anemia at risk for what vit def
vit B12
32
what vit may delay progression of age related macular degeneration
E
33
what vit used to prevent and treat scurvy
Vit C
34
symptoms of scurvy
```
faulty bone and tooth development
loosening of teeth
gingivitis
bleeding gums
poor wound healing
hemorrhage into muscles and joints
ecchymoses
```
35
treat pellagra
nicotinamide
36
vit to reduce cholesterol
Vit B3 (niacin)
37
deficiency in this vit causes
```
sore throat
angular stomatitis (cracks at corners of mouth)
cheilosis (painful cracks in lips)
glossitis (tongue inflammation)
vascularization of cornea
itchy derm of scrotum or vulva
```
Riboflavin
38
wet beriberi
```
severe thiamine deficiency
causes fluid accumulation in legs
palpitations
ecg abnormalities
high output HF
```
responds rapidly to treatment
39
dry beriberi
```
severe thiamine deficiency
neurologic and motor defects
anesthesia of feet
ataxic gait
foot drop
wrist drop
```
responds slowly to treatment
40
serious disorder of the CNS- neuro and psych manifestations
```
nystagmus
diplopia
ataxia
inability to remember recent past
failure to correct -> irreversible brain damage
```
Wernicke-korsakoff
41
what should you do if you suspect Wernicke -Korsakoff
give parenteral thiamine immediately
42
what herb is a CYP inducer
St johns wort
43
what herbs suppress platelet aggregation and can increase risk for bleeding in pt receiving antiplatelet drugs
Ginkgo biloba
feverfew
garlic
cranberry juice
44
what herb can elevate BP and stimulate heart and CNS - therefore can intensify the effects of pressor agents, cardiac stimulants and CNS stim
Ma Huang (ephedra)
45
what herb should not be used to reduce hot flashes caused by tamoxifen and other SERMS
Black cohosh
46
interactions with Butterbur can occur with what type of drugs
CYP inducers
47
CoQ10 may _____ the effects of warfarin
antagonize
48
cranberry juice and warfarin
increase risk of bleeding in pt taking warfarin
49
allergic reaction to echinacea
can cause allergic reactions such as acute asthma, urticaria, angioedema, anaphylaxis
50
who needs to avoid echinacea
autoimmune disease (short term may stimulate immune function and long term can suppress immune function)
51
```
what syndrome is characterized by
nervousness
fatigue
insomnia
tension headache
joint pain
stiffness
```
postfeverfew syndrome
52
feverfew can decrease
| what precautions
platelet aggregation and should be d/c 2 weeks before surgery
53
herb that has been shown decrease plasma levels of total cholesterol and LDL
Flaxseed
54
Cranberry juice and urine
does not acidify the urine
55
daily consumption of cranberry juice can
prevent UTI
56
quadruple G - antiplatelet herbs
Garlic
ginger
Ginko
glucosamine
57
uses for peppermint
decrease nausea
confirmed benefit for mgmt of IBS (RCTs)
therapy for small intestinal bacterial overgrowth (SIBO)
due to antibiotic properties
prevent nipple cracking and pain when breastfeeding
functional abd pain
tension headaches (apply to temples) - comparable to tylenol
58
Peppermint is bactericidal against what bacteria
E.coli
H.Pylori
Salmonella enterididis
59
how does peppermint help with pain
activates opioid receptors
| TRPM8 receptors in GI
60
Adverse effects peppermint
esophageal reflux
allergic reactions have been reported
excessive can cause renal problems
perianal burning in high doses
in standard doses - no serious side effects
61
peppermint oil and antispasmotics
may have an additive effect when taken together (Bentyl)
62
garlic and cardiovascular
may lower BP
may decrease rate of atherosclerosis
antiplatelet effects
63
garlic can reduce levels of what 2 drugs
cyclosporine (immunosuppressant)
Saquinavir (protease inhibitor for HIV)
64
ginger is used for
suppression of n/v for morning sickness (proven)
motion sickness, seasickness and gen anesthesia (inconclusive)
antiinflammatory for arthritis and other chronic inflammatory (not proven)
65
Ginger interactions
antiplatelet
lower Blood sugar
66
ginko biloba used for
improve memory
halt progression of dementia (not proven)
decrease intermittent claudication
treatment of ED
antiplatelet
67
people eating raw or roasted ginko seeds can cause
seizures and fatalities
68
who should not take ginko
```
seizures
people on antiplatelet drugs
antipsychotics
antidepressants
cholinesterase inhibitors
decongestants
first gen antihistamines
systemic glucocorticoids
```
69
glucosamine and chondroitin
usually given together
used to treat osteoarthritis (not proven for pain relief)
American college of rheum does not recommend
70
who should not take glucosamine and chondroitin
shellfish allergy
can raise levels of glucose
antiplatelet
71
what plant is green tea made from
camellia sinensis plant
72
uses for green tea
lose weight
improve mental clarity
prevent and treat cancers of stomach, skin, bladder, breast
73
interactions for green tea
small amount of Vit K so opposes warfarin anticoagulant effects
if you take nadolol - decreases absorption of nadolol
74
3 types of bacteria in probiotics
lactobacilli
bifidobacteria
also
Saccharomyces boulardii
75
adverse effect for probiotic
fungemia has occured when packets of S.boulardii (florastor) have been opened at the bedside in the ICU - contraindicated in pt with central lines
blood infection with lactobacilli and fungi after yogurt in severely ill
76
Resveratrol
antioxidant
```
found in red wine
purple grape juice
blueberries
cranberries
peanuts
```
77
Probiotics should be taken no sooner than ___ hours after dosing with antibacterial or antifungals
2
78
interactions for Saw Palmetto
antiplatelet effects
79
soy taken to relieve
hot flashes and may slow the progression of osteoporosis in perimenopausal/postmenopausal women
80
soy should not be combined with
tamoxifen and other drugs that block estrogen receptors
MAO inhibitors (because soy contains tyramine)
81
St Johns equal to what type of antidepressant
Tricyclic antidepressants
82
St johns and digoxin
greatly reduces levels of digoxin
83
St johns with other antidepressants and stim
```
MAO inhibitors
SSRIs
Tricyclic agents (amitriptyline, clomipramine)
duloxetine
nefazodone
venlafaxine
```
Serotonin syndrome
84
Valarian root works on
GABA agonist
85
harmful supplements to avoid
comfrey - severe liver damage
kava - severe liver damage
Ephedra - stroke, MI, death
86
intermediate acting insulin
NPH (Humulin N, Novolin N)
87
Long acting insulins
```
INsulin glargine (lantus)
Insulin detemir (levemir)
```
88
Ultralong insulins
```
Insulin glargine (U-300) (Toujeo)
INsulin degludec (TResiba)
```
89
difference in methotrexate and entanercept
methotrexate is a traditional dmard
| etanercept (enbrel) is a biologic dmard - no live vaccines, TB and Hep B testing prior to start, close monitoring of CBC
90
bisphosphonate used to prevent and treat osteoporosis in postmenopausal women
Alendronate (Fosamax)
91
education important for Alendronate (Fosamax)
Esophagitis is the primary concern
take with full glass of water and sit/stand for 30 min
rarely musculoskeletal pain
atypical femur fractures
92
while a pt is on Cromolyn for allergic conjunctivitis
| what can you prescribe while that begins to work?
2+ weeks to become max effective
antihistamines (H1 receptor antagonists)
-azelastine and olopatadine
NSAID - Ketorolac / glucocorticoid (loteprednol)
ocular decongestants - naphazoline and phenylephrine
93
congenital hypothyroidism can cause
developmental problems
94
when is the fetal thyroid fully functional
second trimester - at this point the fetus can supply their own thyroid hormones
95
when women taking thyroid supplements become pregnant how does their dosage change
by as much as 50%
need increased between weeks 4-8 of gestation and levels off by week 16 and stays teady until partuition
96
hypothyroid in newborn. how long to continue meds before trial
how long is trial
If TSH is high what does that mean
3 years
4 weeks off
test TSH and T4
if TSH is high - then they are hypothyroid, continue meds
if TSH is normal - d/c meds, it was transient
97
if TSH is low, hypo or hyper thyroid
Hyperthyroid
98
```
hyperthermia (105 or higher)
severe tachycardia
restlessness
agitation
tremor
```
after surgery or sepsis
Thyrotoxic crisis (thyroid storm)
unconsciousness
coma
hypotension
heart failure may ensue
99
what do you give for thyroid storm
high doses of potassium iodide or strong iodine solution
b blocker for heart rate
sedation, cooling, giving glucocorticoids
iv fluids
100
pregnant with thyroid storm
PTU
101
levothyroxine and warfarin
levothyroxine accelerates the degradation of vit K dependent clotting factors - > effects of warfarin are enhanced - warfarin needs to be reduced
102
if someone needs to switch synthroids what is important to know
once you start you don't want to switch because bioavailability can be different
monitor closely
103
if someone on synthroid when do you re-evaluate levels
1 month to reach plateau
6-8 weeks after starting treatment
check at least once a year after dosing is established
104
increased TSH means
hypothyroid
105
how often should a diabetic taking insulin check their blood glucose
6-7 xs a day
106
step 1 for treating type 2 DM
lifestyle changes and metformin
107
at diagnosis for t2DM, when do you skip to step 2 for treatment
A1c of 9% or greater at time of diagnosis
108
what opioid has the lowest risk for abuse
Petazocine (Talwin)
109
most common adverse effect of bisphosphonates
esophagitis
muscle pain rair
osteonecrosis of jaw rare
110
QT prolongation meds
methadone
Butrans
Hydroxychloroquine
111
first line for RA treatment
methotrexate - takes 3-6 weeks to work
NSAIDS in the mean time
still doesnt work
glucocorticoid -
112
someone on methotrexate needs what nutritional supplement
folic acid
113
what NSAID is a second gen approved for RA that will only inhibit cox 2 - easier on stomach
Celebrex
114
triptans and SSRI
cannot take together - serotonin syndrome
if need the SSRI (Fluoxetine - Prozac), wait 24 hours and start on Ergo (Elavil)
115
taking Elavil and now has cold hands, feet with nausea
erotism -stop the ergo
116
Boniva (ibandronate) is given for
what organ do you need to be careful with this one
what route and how often
postmenopausal osteoporosis - only for this
renal function checked before each dose
PO once a month - must sit up for 60 min after taking
or
IV every 3 months
117
older than 60 on steroids long time, what are measures to prevent osteoporosis
check baseline vit d
| give vit d and calcium
118
as kids grow what happens with synthroid dose
increase as they grow, monitor TSH
