NFS 444 Lecture Notes - Lecture 40: Alcoholic Liver Disease, Peritoneal Dialysis, Blood Glucose Monitoring

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6 Feb 2017
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NFS 444: Review Outline for Final Exam 2016- Pharmacy
100 Questions (200 pts) - Multiple Choice, Matching, True/False
Approx 55 questions :
A. Obesity
i. BMI = weight (kg) / height (m2)
1. Underweight: < 18.5
2. Normal: 18.5 24.9
3. Overweight: 25.0 29.9 (increased risk)
4. Obese: 30.0 34.9
5. Class II Obesity: 35.0 39.9 (very high)
6. Extreme (morbid) obesity: >40 (extreme risk)
7. Limitations does not distinguish between fat and lean
tissue; does not indicate fat distribution.
8. Advantages standard for interpretation
ii. NIH guidelines
1. Who to treat: BMI > 25 + 2 or more risk factors
a. Risk factors:
i. Type 2 DM
ii. HTN
iii. Dyslipidemia
iv. Some cancers
v. Gallbladder disease
vi. Respiratory disease
vii. OA
viii. Surgery and pregnancy complications
2. Goals of treatment modest weight loss (5-10%, 1-2
lbs/wk)
3. Basic Principles of Weight Loss body fat is lost when
energy use exceeds energy intake
a. Diet: increase fruits, vegetables, and whole grains;
decrease fat. Goal: reduce energy intake by ~500
kcals/day
b. Exercise: moderate intensity, 30 mins. minimum
most days
c. Behavior therapy: making permanent changes in
eating and exercise patterns. There is also a
relationship between obesity and sleep (8 hours
being ideal)
iii. Medications
1. Orlistat
a. Lipase inhibitor: activity occurs in the small
intestine, inhibits gastric and pancreatic lipase so
that 30% of ingested fat is unabsorbed and excreted.
b. Minimal systemic absorption
c. Low fat diet (≤30%) required to minimize side
effects
d. Approved for longterm use
e. Weight loss: 2-10 kg (varies)
i. Most lost within first 6 months
f. Not meant as sole treatment
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2. Qsymia phentermine (appetite suppressant) and
topiramate (seizure/migraine medicine)
3. Belviq increases brain levels of serotonin
4. Effective?
a. Belviq: 47% treatment group vs. 23% placebo lost
at least 5% body weight
b. Qsymia (can’t compare b/c diff. study designs):
70% treatment group vs. 20% placebo lost at least
5% body weight
c. Orlistat: 57% treatment group vs. 31% placebo lost
at least 5% body weight
5. All are approved of BMI of ≥ 30 OR BMI of 27 + at least
one weight-related condition
iv. The best diet for weight loss is not clear
1. Low fat affects blood lipids; increase TG and decrease
HDL (opposite of what’s wanted). Hasn’t worked for
many people.
2. Low carb must ensure nutritional adequacy; high protein
and high fat may help decrease hunger.
v. Atkins Diet diet consists of pure proteins and fat with < 20
grams carbohydrates per day
1. < 20 grams carbs/day: insulin levels decrease
2. Low insulin/glucagon (IG) ratio fatty acid oxidation and
gluconeogenesis for energy
3. Goal: achieve ketosis/lipolysis
4. High protein diet needed to preserve lean body mass
(muscle protein) however there is always a state of low
protein synthesis due to low IG ratio.
5. Metabolic Effects of low CHO diets
a. Significant reduction in caloric intake
b. Significant reduction in B vitamins and fiber intake
c. Increased ketone formation if severe CHO
restriction
d. High saturated fat diet clearly shown to increase
serum LDL levels and risk of CVD
vi. Partial sleep deprivation alters circulating levels of hormones that
regulate hunger, which leads to increased appetite and preference
for high calorie, high fat/sugar foods.
1. Increase ghrelin (increases appetite)
2. Decreased leptin (controls appetite)
B. Kidney Disease
i. Nephrotic Syndrome:
1. Damage to glomerular basement membrane results in
increased permeability to protein; large quantities of
protein in the urine.
2. Management
a. Moderate protein restriction: 0.8-1.0 g/kg
b. Approx. 35 kcals/kg
c. Limit total saturated fat to <7% kcals, and limit chol
<200 mg/day
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d. Sodium < 2000 mg/day
e. Monitor potassium levels
f. May require vitamin D and Calcium supplements
ii. Acute Renal Failure
1. Characterized by sudden decline in GFR; due to infection,
exogenous nephrotoxins, trauma, dehydration, shock
resulting in ischemia
2. Management
a. Primary goal: prevent further damage to kidneys by
treating the underlying illness
i. Truma
ii. Intra-op blood loss
iii. Sepsis
iv. Hypotension
b. 35 kcals/kg/day
c. Protein restricted to 0.6-0.8 g/kg/day (unless on
dialysis)
d. Fluids individualized
e. Estimated fluid needs = urine output + 500 mL
f. Electrolytes sodium usually limited 2-3 g/day
iii. Chronic Renal Failure
1. Progressive, irreversible loss of kidney function; when ½-
2/3 of renal function lost, evidence of renal insufficiency
2. Urea/other waste products accumulate in the blood
3. Stages of kidney disease
a. 1: kidney damage w/normal or increased GFR (>90
mL/min)
b. 2: kidney damage with mildly decreased GFR (60-
89 mL/min)
c. 3: moderately decreased GFR (30-59 mL/min)
d. 4: severely decreased GFR (15-29 mL/min)
e. 5: kidney failure (GFR <15 mL/min)
4. Goals for stage 1-4
a. Slow rate of disease progression
i. Control blood pressure (limit Na)
ii. Control diabetes (controlled CHO
intake/NCS)
iii. Restrict protein intake (0.6-0.75 g/kg)
b. Decrease risk of CVD
i. Limit intake of saturated and trans fat
c. Prevent malnutrition (provide adequate energy
without exceeding limits for protein, potassium,
sodium, phosphorous and fluid)
5. Goals for stage 5
a. Control symptoms
b. Prevent malnutrition
c. Prevent complications (bone disease/CVD)
d. Control blood pressure and DM
iv. Osteodystrophy: nutritional concerns
1. Decrease serum Phosphate, before increase Ca
a. Phosphate binders: Phos-Lo, Amphogel
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