medical nutrition therapy exam 2

2. Why are the elderly most vulnerable to adverse effects from medications? a. Impaired function of the liver or kidneys b. Inability to afford multiple medications c. The focus on older adults among clinical trials d. Susceptibility to acute infections

A) Impaired function to the liver or kidneys

Drug Nutrient Interactions 1. Which of the following patients would be most likely to experience adverse effects from drugs? a. Pregnant and nursing women b. Young adult males c. People with a cold d. People with diabetes

A) Pregnant and nursing women

4. Samantha is providing her patient with education regarding warfarin. She encourages her patient to: a. maintain her intake of green leafy vegetables. b. increase her intake of green leafy vegetables. c. supplement with dong quai. d. supplement with vitamin K.

A) maintain her intake of green leafy vegetables

2. Serving size on nutrition labels is determined by a. the government, which sets individual standards. b. the manufacturer of the product. c. the types of stores that sell the product. d. the package size of the product.

A) the government, which sets individual standards.

Exam 2 practice questions Therapeutic diets, Dysphagia 1. A lactoovovegetarian a. eats only eggs and vegetables. b. eats dairy products and eggs but no other animal products. c. does not eat any food of animal origin. d. is a vegetarian who occasionally eats poultry.

B) eats dairy products and eggs but no other animal products.

2. The term that refers to an adverse reaction to food that is caused by a nonimmunologic mechanism is a. food allergy. b. allergic reaction. c. food intolerance. d. food sensitivity.

B) food intolerance

3. The client with dysphagia has improved. The speech therapist has recommended moving the client to nectarlike liquids on the National Dysphagia Diet. Which liquids would this include? a. Jello b. Thin milkshakes c. Clear juices d. Watermelon

B) thin milk shake

3. In what types of foods are the most common food allergens found? a. High-simple-carbohydrate foods b. High-protein animal foods c. High-protein plant or marine foods d. High-saturated-fat foods

C) high protein plant or marine foods

Food Allergies 1. What are the most common antibodies involved in food allergies? a. IgG b. IgM c. T-cells d. IgE

D) IGE

3. Which of the following can affect medication absorption? a. Fiber b. Phytates c. Minerals d. a and b only e. a, b and c

E) fiber phytates and minerals

5. The RDN is working with a group of clients in a weight loss clinic. The RDN recognizes that the most successful diet plan is which of the following? a. Individualized to the client's preference and health status b. A low-fat diet (Ornish diet) c. Low-carbohydrate diet (Atkins type) d. Balanced diet (MyPlate)

a) Individualized to the clients preference and health status

4. Aerobic exercise is effective in weight management because it a. lowers glycogen stores and promotes the use of fat for fuel. b. decreases lean body mass in proportion to fat. c. increases resistance to insulin.

a) Lowers glycogen stores and promotes the use of fat for fuel

2. Which enzyme removes dietary triglyceride from the blood? a. Hormone-sensitive lipase b. Lipoprotein lipase c. Cholecystokinin d. Insulin

b) lipoprotein lipase

3. What methods of weight reduction have the highest rates of success? a. Diet combined with exercise b. Diet combined with lifestyle modification c. Diet, exercise, and lifestyle modification all combined d. Exercise combined with lifestyle modification

c) diet, exercise, and lifestyle modification all required

Weight Management 1. The rate of weight loss for men on energy-deficient diets is more rapid than for women because men a. generally have less fat to lose. b. are more successful at weight reduction programs. c. have higher resting metabolic rate and lean body mass than women. d. are more likely to exercise while trying to lose weight.

c) have higher resting metabolic rate and lean body mass than women

• What does the national institute of health (NIH) Recommend for weight loss

o .5lb-1b / week form BMI 27-35 o 1-2lb/week for BMI greater than 35 o These values are 5-10% of weight in 6 months

• How many people does adverse food reactions (arf) affect

o 1 and 5 people

• How is fluid calculated

o 1 ml per kcal

• What % of children have egg allergy

o 1.5%

• What is the fluid requirement for renal patients

o 1.5L/day

• What does good source mean

o 10-19% daily value

• What is the problem with very low calorie diet

o 10-25% obese people develop gallstones and gout

• What is the AMDR for proteins

o 10-35% of total kcal

• How many mg of phosphorous in the renal diet

o 1000 max

• What are the amount of calories in a full liquid diet

o 1000-1500 kcal

• How much carbs does a clear liquid diet contain

o 120-130 g carb

• What is the percentage of increased health risk if over weight (BMI 25-27)

o 13%

• What is considered heavy drinking for men

o 15 or more per week

• whats a healthy amount of storage body fat in men and women

o 15-25% in men o 20-30% in women o This is the fuel source for us low intensity and neat

• How many grams of carbohydrates is in a full liquid diet

o 150-170g

• How many kcal in a house diet

o 1600- 2200

• How many carbohydrates in a house diet

o 180- 300g of carbs

• How many people are obese

o 2 out of 3 or 60% of people are obese

• What % of children have milk allergies

o 2.5% under age 3 problems with baby formula

• What % of the population alters their diet because of ARF

o 20 %

• What does high mean

o 20% more or total calories

• What is the AMDR for total fat

o 20-35%

• How many calories in the renal diet

o 2000

• How many calories in a cardiac diet

o 2000 calories about

• How many mg of sodium in the renal diet

o 2000 mg

• How mg of potassium in the renal diet

o 2000 mg

• What is the atomic weight fo na (sodium)

o 23u or da (atomic units or daltons)

• What is fluid requirement for CHF patients

o 25ml/kg

• How long is a liquid diet administered

o 3 days tops

• Your patient needs 3 grams of sodium, how many teaspoons of salt should you give him

o 3-2 teaspoon

• For intervention what should be discussed for physical activity

o 30-60 minutes daily of moderate intensity

• What is the percentage of increased health risk for people in the obesity category

o 300% o Typically have knees, ankles, and back problems

• How many calories in 1 lb

o 3500 kcal

• What is in nutricia 24oz serving

o 360 calories o 90g carbs o Sodium and potassium

• What % of the population has food allergies

o 4%

• What is a very low calorie diet

o 400-800 kcal/day or less than 50% or predicter rmr o Use Mifflin st jeor o Decreases 15% of rmr 2 weeks at a time

• How many grams of protein is in a full liquid diet

o 45-50

• What is the AMDR for carbohydrates

o 45-65% of total kcal

• What age of having obesity as a child is correlated having obesity as an adult

o 5 years old and older

• What percent of people who loos weight maintain there weight gain after 5 years

o 5%

• How much protein does a clear liquid diet contain

o 5-10g

• How many grams of fat is in a full liquid diet

o 50-65 g

• How much calories does a clear liquid diet provide

o 500-600 kcal

• What is the atomic weight of nacl

o 58u or da

• How many g of fat in a house diet

o 65 g

• What percentage of adult are overweight

o 68% and 35% of them are classified as obese

• How many grams of sodium is in a teaspoon

o 6g of salt in a teaspoon

• What is the amount of time for a food service diary to be recorded to determine the diagnosis of allergies

o 7-14 days

• How many g of protein is a house diet

o 70-80 g protein

• How many grams protein in the renal diet

o 75g

• What heavy drinking for women

o 8 or more per week

• Fat cells are cells that are limited in size what is its limit

o 8-10 times the original size o Once they reach max size they proliferate and divide (hyperplasia) o Cant get rid of fat cells they only get smaller o With maintenance for 5 years may be able to lose fat cells

• How people sensitive to peanuts are not actually allergic to peanuts

o 95%

• What is food drug interaction

o A broad term that includes drug nutrient interaction and the effect of a medication on nutritional status

• What is an agonist

o A chemical that binds to a receptor and activates the receptor to produce a biological response

• What is an example of drug food interaction

o A drug that causes chronic nausea or mouth pain may result in poor intake and weight loss

• What is pyy

o A hormone that decreases apatite

• What is the waist to hip ratio

o A ratio of waist to hip o Greater thatn .90cm in men is bad o Greater than .85 in women is bad

• What is the general affect of food on drugs

o A reduction in the drugs bio availability decreases effectiveness and absorption o Can alter drug clearance

• What makes up activity thermogenesis

o AT= exercise or physical activity + neat

• What are allergic symptoms of GI tract

o Abdominal pain o Nausea o Vomiting o Diarrhea

• What is the movement of drugs through the body

o Absorption o Distribution o Metabolism o Excretion

• What are the liquid diets used for

o Acute infection o Digestive problems o Replace fluids from vomiting and diarrhea o Before x rays of digestive tract

• Amdr

o Adequate macronutrient distribution range

• What is adsorption

o Adhesion to a food or food component fiber is known to do this

• What is side effect

o Adverse effect/ reaction of any undesirable effect of a drug

• What is food intolerance

o Adverse reaction to food that does not involve the immune system o Less severe than allergy or hypersensitivity o Occurs because of the way the body processes food

• What is food sensitivity

o Adverse reaction to food when it is not clear whether it is intolerance of food allergy

• What are the values in predictive equations

o Age o Gender o Weight o Height o Physical activity

• What is a cardiac diet

o Aka heart healthy o Aka fat restricted o Aka low cholesterol o Aka 2g sodium or lower

• What is the renal diet

o Aka low potassium o Aka potassium restricted o Aka low protein o Aka protein restricted o Aka 2gna/2gk diet

• What is oral allergy syndrome

o Aka pollen food allergy o The allergy is confined to the mouth and rarely affect the organs o Rapid onset o Symptoms include itching and irritation o Often coexists with seasonal allergy and caused by raw fruit (stone fruit) once it is cooked it is ok eat

• What is prospective

o All medical nutrition therapy offered when the patient firs starts a drug

• What are substitutions with wheat allergies

o Amaranth o Barley o Corn o Oat o Quinoa o Rice o Rye o Tapioca

• What protein in foods can raise blood pressure and cause hypertension

o Amines like tyramine, dopamine , and histamine o Aka the cheese reaction

• What is half life

o Amount of time it takes for the blood concentration of a drug to decrease by one half of its steady state level

• What is exercise induced food allergy

o An allergic reaction to a food triggered by exercise

• What is pollinosis

o An allergic reaction to pollen

• What is monoamine oxidase

o An enzyme the inactivates (break down) amines so they cannot raise the blood pressure by preventing them to increase concentration

• What diet should be the best to give some one

o An individualized diet

• What is the peanut allergy hygiene hypothesis

o Antibiotic treatment increased ease of peanut sensitization o Studies form many countries show that early exposure of viral infection may produce a proactive effect o Children born into families with several siblings tend to have reduced frequency of allergic sensitization (are we to clean)

week 7 october 13 food allergies • What is adverse food reaction

o Any undesired response to a food regardless of mechanism o Aka any unpleasant food experience

• What are drug side effect that affect nutritional status

o Appetite changes o Oral taste and smell o Nausea o Dry mouth o GI effects o Organ system toxicity o Glucose levels

• What are the types of mindful eating

o Arriving (notice the food and consider it) o Awakening (notice the food before during and after) o Tune in (notice every aspect of your body inside and out know level of hunger and when to stop eating) o Services (setting the table shopping etc)

• In intervention what should consist of a meal plan

o Assures nutritional adequacy o Provides structure o Satisfying o Culturally appropriate o Consider educational level and special needs o Can use exchanges o Defines serving sizes

• When does food allergies manifest

o At infancy peaking at age 1 and declines by 3

• In monitoring and evaluation how many scheduled visits should occur for weight loss

o At least 14 mnt encounters over a period of 6 months o If you increase the frequency it result with better weight loss o Can use telehealth and telenutrition

• Latex allergy has a cross reaction in what foods

o Avocado o Chestnut o Kiwi o Banana o IGe mediated response

• How do you cut back on sodium

o Avoid processed foods ( eat more fresh foods) o Eat less salt at the table and cooking o Be a smarter shopper use labels to read

• How is food allergies treated in medical nutrition therapy

o Avoid the food o Nutrition counseling o Retest for allergy every 1-3 months because children can out grow allergies

• What is the criteria for use for pharmacotherapy

o BMI greater than 27 if co morbidities are present o BMI greater than 30 if no co morbidity is present o Need for rapid weight loss due to impending surgery o Mechanism of weight loss drugs o Decreases food intake by altering neurochemicals o Not many options

Exam 2 medical nutrition therapy notes medical nutrition therapy therapeutic diets October 6 • What is a normal diet

o Balanced diet o Meets all the nutritional needs

• What is metabolism

o Biotransformation controlled mainly by the liver o CPTSO enzyme facilitates drug metabolism o Changes fat to water soluble

• What does food allergy herbal formula do

o Blocks anaphylactic symptoms o Tested on mice

• Set point is influenced largely by genetic factor and in influenced by

o Body type

• What does genetics have to do with obesity

o Both parents obese 80% chance child will become obese o If one parent is obese 40% chance child will be obese o Neither parents obese 7-10% chance child will be obese

• What is bariatrics

o Branch of medicine that is concerned with weight control

• What is mindful eating

o Bringing the same awareness and acceptance to the everyday activity of eating

• What are excipients

o Buffers o Binder o Coloring o Preservative in drugs o May cause allergic or health reaction

• What are some medical testing's for allergies To rule out non allergenic causes and symptoms

o CBC o Stool test o Hydrogen breath test

• What units of measurement do we not use when determining fluid requirement

o CC

• What cant you drink on a cardiac diet

o Caffeinated drinks

• What is the biggest food intolerance

o Carbohydrate inloerance and the biggest one is lactose intolerance

• What location of fat (fat distribution) is associated with increased health risk

o Central and upper body fat (additional health risk) o Android (up) (associated with increased health risk) o Gynecoid (lower) (associated with lower health risk)

• What affects do drugs have on absorption

o Change GI environment including pH o Damage GI mucosa o Affect intestinal transport o Fat adsorption

• How do you modify a normal diet

o Change consistency (liquid soft, low fib, high fiber) o Increase or decrease energy values o Increases or decrease type of food or nutrient o Eliminate specific foods o Adjust ratio of macros o Change number or frequency meals o Change rout and delivery of nutrients (enteral, parenteral)

• What is microbiota transplantation

o Characteristics of gut microbiota from fat people to skinny people o Fecal transplant in the university of Toronto

• Adverse food reaction is more prevalent in what population

o Children and it is also growing in prevalence

• What is the percentage of sodium in salt

o Cl/salt= 60% -> 6g cl /10g salt -> .6g cl X 100 =60%

• What are the types of liquid diets

o Clear liquid diet o Full liquid diet

• What are foods in a full liquid diet

o Clear liquid diet stuff o Strained soups o Strained cereals o Fruit juice o Vegies juice o Yogurt o Hot cocoa o Custard o Ice cream o Pudding o Sherbert o Egg nog

• In diagnosis for allergies what are major categories in the PES statement

o Clinical history o Early history o Physical examination o Food and symptom diary

• What are some hidden sources of egg

o Coffee drinks with foam topping o Pretzels o Pasta o Egg substitutes o Vaccines ( the influenza vaccine has eggs in them)

• What are cultural aspect of dietary planning

o Cultural awareness o Ethnic practices o Religious beliefs o Regional traditions

October 11th • Who is a cardiac diet used on

o Cvd patients o Hypertention o Chf o Aortic aneurysm o Cva o Renal failure o Liver failure

• What are examples of comparative reference standards

o DR's o Mediteranean diet o Professional organizations like American heart association

• What is associated with obesity

o Decreased quality of life and depression

• What is bioavailability

o Degree to which a drug or other substance reaches the circulation and becomes available to the target organ or tissue

• What are hidden sources of milk that can cause milk allergy

o Deli meats o Non dairy items o Canned tuna fish o Restaurants foods and sauces

• How do we determine weight gain weight maintenance and weight loss

o Determine how many calories in 1 lb o Determine to loose or gain a 1 lb a week o Divide that by per day ( divide by 7) - 500 kcal more or less per day form BMR

• How is weight management calculated overall

o Determine overall energy needs o Goal weight loss maintenance or gain o Macros o Micros o Fiber o Fluid

• Where does fat come from

o Dietary tryglycerides (long chain TG) that gets hit with bile put into chylimicrons travels through the lymph system and to the liver they come out of the liver as vldls to fat cells for storage the idl to ldl o Medium chains go right into the portal veins into the liver

• What is dysphagia

o Difficulty swallowing

• What is an intervention for exercised induced food allergy

o Don't eat a couple of hours before exercise

• What consist of involuntary pharyngeal phase

o Early : parasalstis force bollus-> between tonsillar pillard o Middle: soft pallat -> force up-> posterior nares close->no break down o Involuntary esophageal phase: relaxation of upper esophageal->parasaltive wave spincter

• What is the DASH diet

o Eating patterns that lowers high blood pressure (hypertension) o Low salt diet o Hi in minerals like potassium calcium and magnesium

• What are the different type of body types

o Ectomorph (slow twitch lots of mitochondira small) o Mesomorph (more fast twitch muscle fluctuates in weight) o Endomorph (fast twitch weight gain)

• What is food elimination in intervention of allergies

o Eliminate all forms of suspected food o Sometimes use elemental diet o Gradually introduce foods back into diet

• Slide 40 evidence on what works with weight loss

o Energy restriction

• What is eras

o Enhances recovery after surgery o Nutrition provided in this method attenuates physiological stress response to surgery o Insert picture o Normal diet day before surgery + 24oz of carbohydrate drink (nutricia) o Morning before surgery drink nutricia 12oz o Drink liquids right after surgery o Normal meal offered and eaten the next day

• What is retrospective

o Evaluation of symptoms to determine if medical problems might be the result of food drug interactions o Nep and diet hidtoy : include questions about OTC, alcohol, supplements, and herbals Weight management week 9 october 25th

• What is the dietary guidelines for americans 2015

o Evidence base nutritional guidance o Favor of physical activity o Federal government funded

• What is the most reliable predictor of weight loss

o Exercise

• What does exercise do for weight loss

o Exercise lowers lean body mass (lbm) so it increases the basal metabolic rate (BMR) o Metabolism increases during exercise and 90 minutes after wards but longer for more intense workouts

• What are some topics for early history in diagnosis for allergies

o Exposure during pregnancy o Lactation or early child hood

• What do obese people have a taste for

o Fat

• What are the signs and symptoms of exercised induced food allergy

o Feel itchy and light headed soon after they start exercising

• What is material in the colon

o Fiber o Intestinal secretion o Bacteria o Cells shedded material ( intestinal mucosa)

• When does milk allergy develop

o First year of life

• What are the dietary guidelines for American's 5 recommendations

o Follow a healthy eating pattern across the life spand o Focus on variety , nutrient density, and amount o Limit calories form added sugars and saturated fats and reduce sodium intake o Shift to healthier food and beverage choices o Support healthy eating patterns for all

• What are thing related to food intolerance

o Food additives (food coloring ) o Sulfites ( found in wine) o Msg o Food toxins and microbial contaminants ( there are certain levels allowed)

• What does adverse food reaction encompass

o Food allergy o Food intolerance

• What Chinese herbal medicine is used for treating allergies

o Food allergy herbal formula (FAHF) ( consist of 9 different herbs put together

• What do dietitians translate food, nutrition, and health, information into

o Food choices o Diet patterns for groups and individuals

• What are the interventions for food allergies or adverse reactions to food

o Food elimination o Food challenge

• What can interfere with drug absorption

o Food in the intestinal tract o Uncessary supplemental use minerals and vitamins o Hi GI ph is lower absorption

• What do you want to know in assessment

o Food nutrition related history o Weight history o Physical finding o Biochemical data o Determine energy need with Mifflin st jeor formula eal recommends this one o Medications o Activity frequency and intensity o Family history o Asses knowledge level, motivation, and readiness to change

• What is a clear liquid diet

o Foods that are clear and liquid at room temperature o Inadequate in all nutrients

• What is a full liquid diet

o Foods that are semi liquid at room temperature o Adequate in nutrient except in fiber

• What is the FODMAPS diet

o For people who have an intolerance with fructose o This is a carbohydrate intolerance diet o IBS (alteration of enzyme microbiome )

• What is the difference between free and low

o Free means no or none at all o Low means can be eaten frequently without exceeding limit

• What are the foods for the dash diet

o Fruits and vegetables canned and uncanned o Whole grains o Omega 3 fatty fish o Low fat dairy

• What are the allergic reaction caused by soy

o GI distress no respiratory problems children tend to out grow it

• What is the regular house diet

o General standard diet o Includes all foods o Meet nutrient need for a normal diet/ healthy person o This is the goal of the patient status to be reached before discharge

• Why are some people not hungry after an intense work out

o Glucose and lipid enters the blood stream and takes a little while to clear out

• What is an exchange list

o Goods are grouped according to type, nutrients, and calories o Pts are allowed a certain number of items from each exchange list according to individual needs o 15g of carbs in an exchange list

• What units should sodium be prescribed in

o Grams o Miligrams o Milliequivalent

• What kind of juice inhibits the intestinal metabolism

o Grape fruit juice that contains compounds of furancoumailins which inactivates metabolizing intestinal enzymes

• What is the waist circumference that is a health risk for men and women (NHLBI)

o Greater than 40 inches in men o Greater than 35 inches in women o These are triggers for health risk

• What foods are high in vitamin K

o Green leafy vegetables

• What are some topics for physical examination in diagnosis for food allergies

o Growth o Malnutrition o Eczema o Rhinitis o Asthma

• How does urinary pH affect drug metabolism

o Half life of drugs can greatly be change from this o Half life of acidic drugs in acidic urine is extended because it is in it unionized form o Half life in alkaline drugs in acidic urine is reduced because it is in its ionized form

• What are the steps on how to counsel/ educate a patient who is trying to lose weight

o Have the first visit with patient o Take notice of the expectations o Go through assessment o Diagnosis o Intervention o Monitoring and evaluation

• What are the side effects of rapid weight loss

o Head aches o Fatigue o Nausea o Cold intolerance o Constipation o Increased uric acid levels which compete with ketones for excretion by the kidney leading to gout in those predisposed o Hypocholesteremia from mobilization fo fat store o Gallstones

• What do you want to know in physical findings and assessment

o Height , weight and BMI o Waist circumference o Bp. Pulse, respiration

• What is brown adipose tissue

o Helps regulate the body temperature by regulating heat in adult it si fround mainly in the scapular and subscapular areas

• What are the topics you would go over in nutrition counseling to avoid food allergies

o Hidden forms of foods o Reading labels o Replace nutrients missing o Nutrition car manual client ED handouts

• What kind of diet enhances metabolism of drugs

o High protein and low carbohydrate diet

• If patient need to be on a clear liquid diet longer than 3 days what should you do

o High protein broth and gelatin

• What causes anaphylactic shock symptoms

o Histamine

• What are some question to ask during diet history

o How often o What o Where o What seasoning o Who grocery shops o What medications do they use o Do you drink heavily

• What do you do for behavior change in intervention

o Identify and interrupt cues to inappropriate eating behaviors (environmental and emotional) o Build a network of support for the patient o Integrate meal plan and physical activity into lifestyle so they can maintain weight loss o Personalized feedback electronic modalities

• What is food allergy or hypersensitivity

o Immune mediated reaction to food, usually protein

• What are treatment options for food allergies

o Immunotherapy o Chinese herbal medicine o Medical nutrition therapy

• What is hyperplasia obesity

o Increased number of fat cells o Typically doubles from infancy to puberty o Can also increase in adulthood during weight gain o Plasia means number cells

• What is the drug action of caffeine

o Increases adverse effects of stimulants such as amphetamines, methyl phenidate, throphylline

• What is ghrelin

o Increases apatite and comes from your gut

• How is TEF calculated or overall energy needs is determined

o Indirect calorimetry o Predicative equations

• What kind of diet is the best diet

o Individualized

• Allergy chart for oral allergy syndrome

o Insert picture

• Classification of obesity chart (BMI)

o Insert picture

• How do you convert salt to sodium

o Insert picture

• How do you convert sodium to salt

o Insert picture

• How would you do the math to find out the milligrams of sodium in a teaspoon of salt

o Insert picture

• Medical complications of obesity picture

o Insert picture

• Regulation of body weight picture

o Insert picture

• Role of diet, lifestyle, environment and genetics picture

o Insert picture

• Show the chart on arf

o Insert picture

• What is IOM

o Institute of medicine

• What do you do on your first visit with your patient

o Introduce yourself ( have a feel for the patients create small talk) o Sit down and talk with the patient before weighing o Professional environment (have toilets for heavy weight) o Provide business cards and contact information

• What is leptin

o It comes from fat cells and it decreases intake

• What is the adipoq gene

o It is an adiponectin gene associated with metabolic syndrome o This gene is seen in metabolic syndrome

• Highly processed oils have no detectable protein should the patient avoid them or not

o It is generally advised that peanut allergic patients avoid all peanut oils

• What is absorption

o It is the movement of the drug form the site of administration to the blood stream

• What is pharmacogenetics

o It is the role of genetics in drug response o A genetically determined variations revealed only by effect of drugs brings to life drug response genotyping to predict drug response

• What is pharmacodynamics

o It is what the drug does to the body o The physiological and biochemical effects of a drug or combination of drugs

• What is pharmacokinetics

o It is what thebody does to the drug o Includes the movement of drugs through the body including absorption, distribution , metabolism , excretion

• What is an antagonist

o It's a chemical that blocks the action of the antagonist

• What are the symptoms of the allergic reaction

o Itching in the mouth o Hives - eczema o Diarrhea o Bp may drop o Vomiting o Throat tightness and swelling o Breathing difficulty o Anaphylactic shock o Swelling angioedema

• What are allergic symptoms of the respiratory tract

o Itching or tightness of throat o Shortness of breath o Dry and rasp cough o Runny nose o Wheezing

• What do you want to know in biochemical data in assessment

o Lab values of fasting triglycerides, ldl and hdl cholesterol fasting glucose

• Who should not be on a full liquid diet

o Lactose intolerance o Those who cannot tolerate thin liquids

• What is endomorph

o Large frame, fast twitch fibers and efficient storage of fat; significant, continouse weight gain through out life Weight management October 27

• What is hypertrophic obesity

o Larger adipose cells typical in adult onset obesity o Cells get bigger

• What is lean and extra lean

o Lean is less than 10g o Extra lean is less than 5g

• What is OB gene associated with

o Leptin (associated with leptin or leptin receptor) o Mutation in the gene or the lepton receptor can cause obesity

• How many levels of dysphagia

o Level 1 - most sever ( puree food texture) o Level 2- moderate dysphagia (mechanicall altered or ground) o Level 3- mild or dysphagia advanced ( advanced, mechanically soft these are cut to small pieces they are not crushed)

• How should a regular house diet visually look like

o Look good o Taste good

• What si the effect on drugs for the malnourished patients

o Low albumin increases drug potentcy o Obese or elderly people have higher amounts of adipose tissue so fat soluble drugs may accumulate in the body increasing the risk of toxicity

• What are some low carb , low fat, high protein diets

o Low fat diet o Volumetric diet o Paleo diet

• What should many obese people do for their weight loss

o Low intensity 5-10 minutes per session and gradually increase their frequency intensity and time

• What do you want to know in a patients weight history

o Lowest adult weight o Highest adult weight o Goal weight and why that number o How long ago at goal weight o What led to your weight gain

• What are all the nutritional needs for

o Maintenance o Repair o Living process o Growth o Development

• Why is it hard to have a soy allergy

o Major ingredient in food product so hard to avoid

• What is amu and Dalton equivalent to in units of measure

o Mass o 1 amu ( or single nucleon/ proton/ neutron) = 1g/mol

• What is residue

o Material in colon ( a low residue diet is a low fiber diet)

• Why don't you mix drugs and enteral feeding

o May cause diarrhea o Drug nutrient binding o Blocked tube o So don't add to formula ever

• What are the three main components that must be part of a weight loss plan in intervention

o Meal plan o Physical activity of moderate intensity for 30 to 60 minutes daily o Behavior change

• What kind of foods can acidify the urine

o Meats o Fish o Cheeses o Eggs

• What is the benefit for minimizing food drug interactions

o Medications achieve their intended effects o Improved compliance with medications o Less need fo additional medication or higher dosages o Fewer caloric or nutrient supplements are required o Adverse side effects are avoided o Disease complications are minimized o The cost of helath care services is reduced o There is less professional liability o Licensing agency requirements are met

• What is mesomorph

o Medium frame, fast twitch muscle fibers (sprinting) weight fluctuates

• What kind of food can alkalinize the urein

o Milk o Vegetables o And citrus fruits

• What are the 8 foods included in food allergy labeling required by the FDA

o Milk o Egg o Peanuts o Treenuts o Fish o Soy (may contain soy almost everything to cover ass) o Wheat Week 8 drug nutrient interaction on October 20th on October 18th is FNCE no class

• What are the most frequently allergenic foods in young children

o Milk, o eggs, o wheat, o soy, o peanuts, o treenuts, o shellfish

• What is the process of excretion for patients on a high sodium diet

o More lithium is excreted

• What causes a brand to have a higher allergenic protein content

o More mature , larger kernels (more protein) o Drying or curing at higher temps (concentration of protein increase) o Roasting (increased concentration of proteins) o Whipped or emulsified peanut butter

• How do chemist find out that na + is 40% of nacl

o Na amu/nacl amu -> 23 amu/ 58 amu -> .3965 X 100 - 39.6 -> round to 40% in ratio to cl

• What is the symbol for sodium

o Na+

• What is the salt symbol

o Nacl

• How do chemist find the grams salt in 1 amu

o Nacl amu / na or cl -> 58 amu / 23 amu-> 2.5 amu -> 2.5g permole-> 2.5 g permole salt

• What are some signs of intolerance to diet

o Nausea o Vomiting o Cramping o Gi distress

• Is there a cure for food allergies

o No ( just tells you what foods to avoid)

• What is neat

o Non exercise activity thermogenesis

• Whats a wheat allergy

o Not celiac disease (different but lumped together has GI issues not respiratory ) o IGE mediated response to wheat protein

• What do you do after calculating the math for weight management

o Numbers are turned into meal plans o Reference standards are used

• Where do you get info on the therapeutic diets

o Nutrition care manual o Eat right. Org o Aha o Aspen

• What does reduced mean

o Nutritionally altered product contain 25% less total calories

• What are 3 genes associated with obesity

o Ob gene o Adipoqgene o Thrifty gene (pima Indians)

• What is food challenge in intervention of allergies of ARF

o One food at a time on different days (micro dosing) o Open food challenge; single - blind food challenge o Double- blind , placebo - controlled food challenge o Be prepared for emergency treatment of reactions

• Renal diet is prescribed to what kind of patients

o Patients with a decreased kidney function

• Who are the patients at risk for drug nutrient interactions

o Patients with chronic disease o Elderly o Fetus o Infant o Pregnant women o Malnourished patients o Allergies or intolerance

• What is the consistent carb diet what patients is it used on

o Patients with diabetes mellitus (body does not produce enough insulin to metabolize carbohydrates) consist of an exchange list

• What are some major food allergens

o Peanut allergies o Milk allergies o Egg allergies o Tree nut allergies o Fish and shellfish allergies o Wheat allergies o Soy allergies o Latex allergies o Exercise induced food allergies

• What allergy is one of the leading causes of deaths

o Peanuts o Treenuts o Fish o All these are typically life long allergies

• What is aspiration

o Penetration of foreign matter into the respiratory tract below the true vocal cords

• What are options for pharmacotherapy

o Phentermine o Belvia o Contrive o Qysemia o Metformin

• How to motivate someone to become more active

o Planned activities o Lifestyle changes less tv take stairs no elevator

• What are the drugs in the blood stream often bound to

o Plasma protein

• What is monoamine oxidase inhibitor (MAOI)

o Prevent the break down of amines inactivating mao drugs so have to change diet

• What is excretion

o Process of when drugs are eliminated form the body as an unchanged drug or metabolite o Usually through renal and some through bile and other sources

• What foods have MAOI

o Processed meats and cheese o Chocolates

• What does allergenic protein content depend on

o Processing and processing varies by brand

• Who would have a low fiber diet

o Prones disease o Diverticulitis o Ulcer colitis o Surgery to gi tract o Ulcer

• When planning to loose or gain weight you have to determine the amount of macronutrient needed what are the macronutrients

o Protein o Carbohydrates o Fat o Water o Cholesterol

• The renal diet controls what nutrient

o Protein o Sodium o Potassium o Phosphorous o Fluids

• What is the purpose of a clear liquid diet

o Provide fluids and electrolytes to prevent dehydration

• How is micronutrients calculated

o RDA

• What do patient like about very low calorie diet

o Rapid weight loss about 3-8 lbs per week o Average 3 lb perweek

• What is the Mediterranean diet

o Reduces CVD o Has healthy out comes o 35% fat higher than us guideline

• What are the different health care diets

o Regular/ house diet ( many calorie level) o Liquid diet (clear and full liquid diet ) o Cardiac diet ( limits sodium and fat ) o Renal diet ( limits protein sodium potassium phosphorous and liquids ) o Consistent carb ( patients with stress response for diabetics) o Consistency modification (liquids and solids)

• Compared to the reported allergy trends chart what is the most allergies from greatest to least

o Respiratory allergy o Skin allergy o Food allergy

• What are the components of total energy expenditure (TEE)

o Resting energy expenditure (REE) aka RMR resting metabolic rate o Thermic affect of food (TEF) o Activity thermogenesis (AT)

• How much cholesterol in a cardiac diet

o Restricted 200mg or less

• What are some hidden sources of tree nuts

o Salads o Salad dressings o Barbecue sauce o Breading for chicken o Pancakes o Meat free burgers o Pasta o Honey o Fish dishes o Pie crust o Mandelonas o Mortadella

• When doing the diagnosis of your patient what do you want to use

o Sample pes statement o Problems rt etiology aeb signs and symptoms

• What does a healthy eating pattern limit?

o Saturated fats o Trans fats (less thant 10% of calories per day) o Sugar (< 10% calories per day) o Sodium ( less than 2300 mg/ per day = 6 teaspoon women and 9 for men)

• Where is brown adipose tissue found in adults

o Scapular and subscapular areas

• When are signs and symptoms from an allergic reaction noticed

o Seconds to hours after ingestion of the allergen

• How long can a patient be on a liquid diet

o Short periods of time o Nutritionally inadequate

• What is a low carb , low fat, high protein diet used for

o Short term strategy in losing weight o Associated with greater weight loss than low calorie diets in the first 6 months o Low carb diets creates ketosis which suppresses apatite

• What are the characteristics of patients following eras

o Shorter hospital stay b/c faster return of normal functioning o Decreased rates of complication o Improved satisfaction scores

• What are some immunological tests

o Skin prick test o Rat and E lisa (new blood test take blood sample and it contains extracted proteins of allergens put together and measured IGE) o CAP- FEIA (approved for only 6 foods)

• Why do you want to know about a patients sleep patterns

o Sleep is linked to altering the endocrine regulation of hunger and apatite no sleep increases ghrelin and make people choose more simple carbohydrates

• What is ectomorph

o Small frame slow twitch muscle fibers (endurance) rich in mitochondria and weight is stable through out life

• What causes a brand to have a lower /less allergenic protein content

o Small kernels o Raw peanuts

• How does the world health organization (WHO) measure waist circumference

o Smallest area below the ribs above the belly button o Greater than 40 men is bad o Greater than 35 wemon is bad o Don't work for people under 5 feet

• If a drug must be given through a tube what should you do

o Stop feeding ,Flush tube ,Give drug o Use liquid form of nutrient o Avoid crushing tablets

• What is whit adipose tissue

o Stores energy as a respiratory for trigylcerides, cusions abdominal organs and insulates the body to preserve heat !o Looks kind of yellow due to carotene

• Why do you want to know about the patients level of stress

o Stress releases corticol and it releases insulin for fight or flight. It increases apatite and ghrelin and decreases leptin

• What are the different forms of immunotherapy

o Sublingual immunotherapy (SLIT) o Oral immunotherapy (OIT) o Both consider minute amount of allergen administered over time and increase quantity which induces tolerance

• What are the most common symptoms to allergens

o Swelling o Sneezing o Nausea o Gi distress

• What are allergic symptoms of the skin

o Swelling of the lips tongue and face o Itchy eyes o Hives o Rash

• What are some topics for clinical history in diagnosis for allergies

o Symptoms o Timing o Recent reactions o Suspected foods o Quantity

• What does light mean

o Terms of texture o Reduced 50% of total calories

• What is an example of drug food interaction

o Tetracyline and diary product decreases drug absorption

• What is the process or the idea of immunotherapy

o The contact of an antigen induces intolerance so patients are given increasing amounts of the allergen (micro dosing) o May be affecting for egg and milk but no evidence for long term tolerance

• What type of patients do we focus on the most for drug nutrient interactions and why

o The elderly o The bodies ability to metabolize decreases

• What is lactose intolerance

o The inability to digest milk sugar and they have 75% decrease lactose enzyme

• What is drug nutrient interaction

o The result of the action between a drug and a nutrient that would not happen with the nutrient or the drug alone

• What does absorption depend on

o The route of administration o The chemistry of the drug and its ability to cross membranes o The rate of gastric emptying (for oral drugs) and GI movement o The quality of the product formulation

• What does most allergic reactions with egg involve

o The skin

• Does peanut allergy develop in utero

o Their no evidence for that

• Why would you know what kind of medication a patient may be taking

o There medication can be associated with weight gain

• What are the consistency liquids are thickened to

o Thin liquids o Nectar o Honey o Pudding

• What is the therapeutic importance of drugs

o Thos that alter the intended response to the medication that causes drug toxicity o Those that alter normal nutritional status

• What type of drugs can leave the blood stream and affect target organs

o Those who are unbound from the plasma proteins

• What is the purpose for medical testing and treatment for allergies

o To rule out non allergenic causes of symptoms

• What consist of the voluntary oral phase

o Tongue -> hard palate-> into pharynx

• How are the macronutrients needed measured

o Total g o g/kg (only protein and water) o % of total energy intake o Mg (only cholesterol)

• What response is associated with treenut allergies

o Treenuts an IGE mediated response where it hook on to the mast cells and release histamine strict airway and causes anaphylaxis

• Who are full liquid diets used for o People unable to chew

o Unable to digest solid foods o Transition step promotion clear to full to soft diet following gi surgery

• What is visceral adipose tissue

o Under the skin in the mesenteries (intestinal abdominal wall) and omentum (cover and supports membranes) and behind the peritoneum o These are abdominal cavity membranes

• How do you get patients to increase food intake

o Use color temperature and texture o Imagination visually appealing o Work with chef for good meal

• What are the different forms of adipose or lipid tissue

o Visceral adipose tissue VAT o White adipose tissue WAT o Brown adipose tissue BAT

• What are the three phases of swallowing

o Voluntary or oral phase o Involuntary pharyngeal phase o Involuntary esophageal phase

• What a treenut

o Walnuts o Almonds o Hazelnuts o Coconuts o Cashews o Pistachios o Brazil nuts

• What is the drug action of warfarin

o Warfarin is an anticoagulant so it prevents these conversion of vitamin k to a usable form

• What are some foods in a clear liquid diet

o Water o Clear juice o Apple or cranberry juice o Fat free broth o Jello o Popsicles o Ginger ale o Tea o Coffee

• What are the dietary concerns of dysphagia

o Weight loss o Dehydration

• What is discussed when evaluating expectations

o What would they like out of the visit o Explain you can provide structure or goal setting o Explain that first visit is information gathering o Inform patient you would like to see them and follow up to monitor progress

• What are therapeutic or modified diets

o When modifying a diet to provide requirements for relief from disease process or to adjust digestive absorptive capacity

• What is the set point theory

o When the body has a biological preferred weight o Loss or gain of weight snaps back to original weight o Achieved by changes in satiety, hormonal action and rmr o Standard weight body wants to have

• What is distribution

o When the drug leaves the systemic circulation and moves to various parts of the body

• What are the key recommendations for healthy eating patterns

o Whole grains o Colorful fruits and vegetables o Low fat diary o Lean meats o Meat the physical activity for America

• Do diabetics drink nutricia

o Yes

• Do people out grow milk allergy

o Yes most children (starts to recognize allergen in baby formula)

• What is an example of drug nutrient interaction

o Zantac (ranitidine ) and vitamin B12 decreases nutrient absorption

• what age group has the most anaphylactic shock

o age 19 or younger o peanuts and tree nuts are the top killer

• what are classification of allergies

o allergic reactions are classified into non IGE mediated, IGE mediated or mixed response

• what is a food allergy / hypersensitivity

o an immune response in the body (reaction) occurs after eating a certain food ( protein) releases antibodies to fight allergen/ antigen o insert picture from book

• what is non ige mediated response

o antibodies are slower in onset and is primarily gastrointestinal reaction o gluten allergies and milk allergies

• what is IGE mediated response

o antibodies that causes histamine and other chemicals to be released which triggers allergy symptoms o the reaction is rapid in onset, symptoms include anaphalaxis and urticaria

• who are typically overweight but not over fat

o athletes

• what is obesity

o condition that is excessive fatness that either generalized or localized

• what is storage body fat

o energy reserve under the skin, primarily triglycerides in adipose tissue o protect internal organs

• what is included in fatmass

o essential body fat o storage body fat

• what is sarcopenia

o excessive fatness but not over weight

• what are the body weight components

o fat free mass (FFM) (lean body mass(lbm) ) o fat mass

• How is fiber calculated

o g/day o 14g/1000 kcal o 25g females o 35g male

• what are the causes of overweight and obesity

o heredity and nutritional genomics o inadequate physical activiy o inflammation o sleep, stress, and circadian rhythm o taste, satiety , and portion size o obeseogenes o viruses and pathogens o gut microflora and diet

• what is the process in forming IGE mediated antibodies

o it is an inheredited predisposition (immunoglobulin protein) o you first have to be exposed to the food (eat the food) o as food is digested, it triggers certain cells to produce IGE in large amounts o IGE's are then released and hooks to mast cells o Next time person eats the food it interacts with specific IGE and triggers the mast cell to release chemicals such as histamine

• who has higher fat mass

o men

• what allergies children usually grow out of

o milk o egg o wheat o soy

• what allergies people usually have for the rest of their life

o peanuts o tree nuts o shell fish

• what is essential body fat for

o physiological function (minimal amount of fat for normal function located on organs)

• what are usually allergens

o proteins

• fat free mass ffm is a major determinant of

o resting metabolic rate (its where it comes from)

• what is overweight

o state in which weight exceeds a standard based on height

• what is included in fat free mass

o water o protein o mineral component o basically everything except fat

• what is autoimmune disease

o when the body elecit an abnormal immune response to a harmless food substance and the bodies antibodies are released to fight the allergen o allergens are usually proteins

• who has more essential body fat

o women (12%) roughly o men (3%) roughly