Nutrition Test 4

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Author:
krug0043
ID:
79880
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Nutrition Test 4
Updated:
2011-04-18 21:20:55
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Nutrition
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nutrition
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  1. 7 Factors that may predispose patients to drug and nutrient interactions.
    • 1. Polypharmacy
    • 2. Chronic drug therapy
    • 3. Pre-existing disease, other medical conditions
    • 4. Poor nutritional status
    • 5. Extremes of age - peds and elderly
    • 6. Increased nutritional needs
    • 7. Herbal products?
  2. Describe 3 mechanisms by which food may adversely affect drug therapy.
  3. Identify 2 major drug-nutrient interactions and outline strategies for prevention/management.
  4. Outline the "Dilantin" - food/enteral issue.
    • Risk of SUB-therapeutic levels and loss of seizure control
    • May need to hold gastric tube feeding 1-2 hours before and after dose
    • may need to change to other dosage form, higher dose? Be careful!
    • Switch to different drug?
  5. Describe 3 common drug-enteral problems...
  6. "Take on an empty stomach" for better absorption
    • Tetracycline (avoid dairy), Penicillin, Levothyroxine
    • Azithromycin suspension, tabs +/-
    • Cipro > Levo.. chelation by cations
    • ECN: film and enteric coated, PCE dispertabs
    • Captopril: same time each day
    • INH (isoniazid)
    • Zidovudine (Retrovir), indinavir (crixivan), didanosine
    • Sucralfate (carafate): needs empty stomach for therapeutic effect.
    • Alendronate (fosamax): w/ H20 30 minutes before anything else
  7. "Take with food"
    • To lessen GI irritation: ex. KCL, NSAIDs, nitrofurantoin, estrogens
    • To decrease side effects: ex. misoprostol, quinidine
    • Enhanced absorption: EES, lovastatin, propranolol, metoprolol, nitrofurantoin, CSA (better with milk)
    • Best if taken with a high fat meal: griseofulvin, atovaquone, sironolactone, saquinavir
    • Maximum effect: glipizide, 30 min. ac, glyburide with first main meal of the day
  8. A patient calls in after a wine and cheese party...Splitting headache, racing pulse...

    Which of the following meds is most likely to be involved?
    A. captopril
    B. phenelzine
    C. Amphotericin
    D. lovastatin
    B. phenelzine
    (this multiple choice question has been scrambled)
  9. What drug(s) does the following nutrient interact with...

    Calcium
    Tetracycline
  10. What drug(s) does the following nutrient interact with...

    Potassium
    • Diuretics
    • ACE inh.
  11. What drug(s) does the following nutrient interact with...

    Vitamin K
    Warfarin
  12. What drug(s) does the following nutrient interact with...

    Vitamins A, D, E, K
    These are the fat soluble vitamins...

    Mineral oil
  13. What drug(s) does the following nutrient interact with...

    Phosphorus
    Aluminum-base antacids
  14. Regarding Grapefruit Juice...
    Intake can cause toxicity of certain medications by increasing their absorption.
    True
  15. Enteral feedings administered with _____ can result in _____ levels which may cause _____.

    Ways to resolve this interaction may include:
    1. _______
    2. _______
    3. _______
    Enteral feedings administered with PHENYTOIN can result in SUB-THERAPEUTIC levels which may cause LOSS OF SEIZURE CONTROL.

    • Ways to resolve this interaction may include:
    • 1. HOLD THE FEEDING 1-2 HOURS BEFORE AND AFTER THE DOSE.
    • 2. ALTERNATE CHOICE - CHANGE TO A DIFFERENT DRUG
    • 3. INCREASE THE DOSE- BUT WATCH OUT FOR TOXICITY IF CHANGE IN TF.
  16. General protein requirement in inflammatory bowel disease.
    1 -2 g/kg
  17. General Kcal requirement in inflammatory bowel disease.
    25 - 30 kcal/kg
  18. How much protein necessary for fistula patient.
    1.5 - 2.5 g/kg
  19. Important nutrient to replace in fistula patient.
    Zinc
  20. Fluid requirement in small bowel syndrome.
    ? > 4L/day
  21. Protein req in SBS
    1-1.5 g/kg
  22. Calorie req in SBS
    35 kcal/kg
  23. Vitamins to watch out for in SBS
    B12, Calcium, Magnesium
  24. Complications of nutritional support in SBS
    • Nephrolithiasis ( high oxalate)
    • Gastric hypersecretion
    • bacterial overgrowth
  25. When is hypocaloric feeding indicated?
    Very obese patient (>150% IBW)
  26. calories in obese
    20-25 kcal/kg IBW?
  27. Fat requirements in obese
    just enough to provide essential fatty acids
  28. protein in obese
    • 1.5 -2.5 g/kg based on LBW
    • check N balance
  29. When do you give 1.5-2.5 g/kg pro?
    • CRT therapy
    • Fistula
    • Very obese
  30. How do you calculate BMI
    body wt (kg)/Ht (m2)

    • obesity > 30
    • normal = 18.5-25
  31. Indications for bariatric surgery
    • BMI > 40kg/m2 = 200% IBW
    • or35 kg/m2 and co-morbidities such as
    • DM
    • HTN
    • Sleep apnea
  32. Stomach capacity after bariatric surgery
    about 30ml
  33. Bariatric Surgery Post op calorie/protein reg.
    • < 900 kcal/day
    • 60-120 g pro

    seperate solids and liquids
  34. Vomiting after bariatric surgery. What nutrient def could be responsible?
    Thiamine.

    Give 100 mg IM/IV x 7-14 days then 10 mg PO until Sx resolve.

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