Nutrition

Question 1

Protein: calories, required daily intake

Answer 1

4 kcal/gram
Adults = 10-35% diet
75 g/day

Question 2

Carbs: calories, required daily intake

Answer 2

4 kcal/gram
Adults = 45-65% daily intake
130/day minimum, usually 225

Question 3

Fat: calories, required daily intake

Answer 3

9 kcal/ gram
Adults = 20-35% daily intake
67g/day

Question 4

fiber: required daily intake

Answer 4

14g/1,000 calories, OR 0.5g fiber/ kg body weight/ day

21-38 g/day

Question 5

Thiamin B1 deficiency

Answer 5

malabsorption/ nutrition or alcoholism
s/s start as muscle cramping, parasthesias,
wet beriberi= affects CV system- HF symptoms
dry beriberi= affects CNS (wernike korsakoff encephalitis– amnesia, nystagmus) loss of reflexes, neuropathy,

Question 6

Cardiac diet indication

Answer 6

Hyperlipidemia, CVD

low fat, low cholesterol

Question 7

Low and High Fiber diets, indications

Answer 7

Low Fiber: diverticulitis, crohn’s, ulcerative colitis flair

High Fiber: diverticulosis, constipation

Question 8

High calorie diet indications

Answer 8

underweight, cancer, hypermetabolism d/t disease: COPD, ALS, burns

Question 9

low sodium diet indications

Answer 9

heart failure, liver disease, HTN, transplant

Question 10

protein diet indication

Answer 10

restricted: CKD
increased: wounds, burns, liver disease

Question 11

carb restricted diet indication

Answer 11

diabetes

Question 12

renal diet indications, what it is

Answer 12

indicated for : kidney disease, dialysis
what is it: low sodium, low phosphorus, low potassium
not all restrictions always needed

Question 13

Fluid restrictions, indications

Answer 13

volume overload: heart, liver, renal failure

Question 14

indications for ensure

Answer 14

intolerance of solid food poor oral intake

Question 15

Enteral Nutrition indications

Answer 15

impaired nutrient ingestion (trauma)
inability to take nutrition orally (hyperemesis, comatose)
impaired digestion, absroption (severe gastroparesis, pancreatitis)

Question 16

Enteral Nutrition types

Answer 16

Nasoenteric= short term
PEG= long term, gastric
PEJ= long term, jejunal

Question 17

Parenteral Nutrition indications, risks

Answer 17

GI incompetency, critical illness w/ poor access or tolerance to EN
RISKS: infection, gut mucosal breakdown and increased permeability

Question 18

Statins MOA

Answer 18

HGM-COA reductase inhibitor

prevents production of cholesterol in the liver

Question 19

Statins – LDL reduction capability, intensity doses

Answer 19

High Intensity >/= 50%
mod intensity 30-49%
low intensity

Question 20

who should be on a statin?

Answer 20

• has ASCVD (2ndary prevention)
• LDL >190 (primary prevention)
• Diabetes 40-75 y.o. (primary prevention)
• age 40-75 and >7.5% 10 yr ASCVD risk

Question 21

Statins AEs, CIs,

Answer 21

“generally well tolerated”
AE: myopathy, increased liver enzymes, memory loss, new onset diabetes rhabdomylosis
CI: active liver disease
Precautions: drug interactions

Question 22

myopathy in statins, prevelence?

Answer 22

up to 20% in practice

dose related

Question 23

statin myopathy risk factors

Answer 23

higher dose, age, alcohol abuse, hypothyroidism, female, multisystem disease
OR on other Rxs
G PACMAN : grapefruit, Protease inhibitors, Azoles cyclosporine, macrolides, amiodarone, non dihydropyridien CCB

Question 24

why don’t you mix gemfibrozile and statin?

Answer 24

increased risk of rhabdomyolysis

Question 25

statin monitoring

Answer 25

fasting lipid profile (4-12 weeks after starting, changing dose) CK (only for muscle pain) screen for new onset DM hepatic ALT baseline only

Question 26

when to use statins with non-statins?

Answer 26

when cholesterol goals not met with statin alone.

Question 27

oxidative/ reductive vitamins

Answer 27

thiamin (B1) riboflavin (B2) niacin (B3) pantothenic acid (B5)

Question 28

carboxylation/ transamination

Answer 28

biotin (B7) | vitamin B6

Question 29

gene regulation/ post translational

Answer 29

vit A vit D vit K

Question 30

antioxidants

Answer 30

vit E vit C carotinoids

Question 31

1-C metabolism

Answer 31

folate vit B12 choline

Question 32

Riboflavin B2 function, deficiency, toxicity

Answer 32

FUNCTION: coenzyme: oxidative reduction, CP450 DEFICIENCY: ariboflavinosis -- chelosis (red crusties on corner of mouth), glossitis TOXICITY: none

Question 33

Niacin (B3) function, deficiency, toxicity

Answer 33

FUNCTION: oxidative reductive, cofactor NAD, NADP.... DEFICIENCY: starts anorexia/irritabiliy/glossitis, then to Pellegra, dementia, death TOXICITY: AE when used in high doses to treat hypertriglycemia

Question 34

Pantothenic Acid (B5) function, deficiency, toxicity

Answer 34

FUNCTION: oxidative reductive, role in making heme, fatty acids, amino acids, vit D, A DEFICIENCY: rare. parasthesias, burning feet syndrome TOXICITY: none

Question 35

Pyroxidine (B6) function, deficiency, toxicity

Answer 35

FUNCTION: carboxylation/transamination, Heme biosynthesis DEFICIENCY: often from Rx interactions, chelosis, irritability, glossitis --> neuropathy, seizures TOXICITY: sensory neuropathy

Question 36

Biotin (B7) function, deficiency, toxicity

Answer 36

FUNCTION: carboxlation/transamination, histone modications DEFICIENCY: rare, large amounts of egg whites will do this. severe= squamous dermatitis TOXICITY: none

Question 37

Folate (B9) function, deficiency, toxicity

Answer 37

FUNCTION: 1C metabolism DEFICIENCY: from bad diet, alcoholism, drugs: sulpha, phenytoin, Bactrim neural tube defects, like B12 minus neuro TOXICITY: none

Question 38

Cyanocobalamin (B12) function, deficiency, toxicity

Answer 38

FUNCTION: IC metabolism DEFICIENCY: anemia, neuropathy, vegan diet, pernicious anemia (processed by intrinsic factor) TOXICITY: none

Question 39

statin drug interactions: GPACMAN

Answer 39

``` G rapefruit P rotease inhibitors A azoles C yclosporine M acrolids A amidarone N ondy....CCBs ```