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236 Cards in this Set
- Front
- Back
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Feeding provided through the gastrointestinal tract via a tube,catheter, or stoma that delivers nutrients distal to the oral cavity is?
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Enteral nutrition
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The intravenous administration of nutrients is?
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Parenteral nutrition
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Advantages such as more physiological, surgical, and improved outcomes are of what nutrition type?
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Enteral
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Advantages such as use in malnourished, fistula, short bowel syndrome, cancer, cystic fibrosis, and hyperemesis gravidarum are of what nutrition type?
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Parenteral
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PPN stands for? Given how?
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Partial parenteral nutrition; peripherally
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TPN stands for? Given how?
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Total parenteral nutrition; PICC, CVC, port
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At what level of dextrose and amino acids does a PICC line need to be used?
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Dextrose >10%
Amino acids >2.5% |
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What is contained in a 2 in 1 admixture? Advantage? Disadvantage?
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Contains dextrose and amino acids.
Advantage: Clear Disadvantage: More compounding and 2 bags must be hanged. |
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What is contained in a 3 in 1 admixture? Advantage? Disadvantage?
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Dextrose, amino acids, lipids.
Advantage: Only 1 bag to hang. Disadvantage: Milky color, cannot see precipitates, cannot use 0.22 micron filter. |
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What is the common used Dextrose products?
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70%
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How many Kcal/gram are in Dextrose?
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3.4 Kcal/gram
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What is the minimum amount of dextrose dosing in g/day?
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100-150g/day Dextrose
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What is the most commonly used amino acids product?
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10% amino acids
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How many Kcal/gram are in Amino acids?
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4 Kcal/gram
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What is the usual dosing of amino acids?
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1g/kg amino acids
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What is the most commonly used lipid emulsion product?
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20% lipid emulsion
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How many Kcal/mL are in lipid emulsion of a 20% product?
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2 Kcal/mL
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How many Kcal/gram are in a lipid emulsion?
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9 Kcal/gram Lipid
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What is the dosing for lipid emulsion? Not to exceed what amount?
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1g/kg/day not to exceed 2g/kg day
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Triglycerides should be lower than what value to be able to give PN?
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<400mg/dL
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Maintenance fluid is dosed at what mL/kg?
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30 mL/kg
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Fluid restriction is dosed at what mL/kg?
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20-25 mL/kg
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Increased loss, hypovolemic, is dosed at what mL/kg?
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35-40 mL/kg
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How many Kcals would a 20% 250mL lipid emulsion provide?
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500 Kcal. Remember there are 2 Kcal/mL in a 20% lipid emulsion. so 250ml x 2Kcal/1ml = 500 Kcal
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How many Kcals from 65 g of amino acids?
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260 Kcal. Remember there are 4 Kcal/gram in amino acids. So 65g x 4Kcal/1g = 260Kcal.
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How many g of dextrose will provide 1020 Kcals?
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300 g. Remember there are 3.4 Kcal/g in dextrose. So 1020 Kcals divided by 3.4Kcal/1g = 300 g
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What would your final concentration of dextrose and amino acids be in 2 L of a 2 in 1 TPN? If you have 300g dextrose and 65g amino acids?
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15% Dextrose, 3.3% amino acids.
(300g dextrose /2000mL bag) x100% =15% dextrose (65g amino acids/ 2000mL bag) x 100% = 3.3% amino acids |
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Normal Sodium lab values are?
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136-145 mEq/L
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Normal Potassium lab values are?
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3.5-5 mEq/L
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What infusion rate should be used for potassium? What should be monitored? What line should it be ran through?
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10 mEq/hr; monitor cardiac; CVC (central venous catheter)
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In hemodialysis patients, if the bath is set too high what can occur?
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hyperkalemia
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What medications can affect potassium levels?
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ACEI/ARB, K sparring diuretics
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When would you want to add chloride to a TPN?
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When vomiting or suction has occurred resulting in gastric loss.
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What is the normal lab values for chloride?
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96-106 mEq/L
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This should not be added in a TPN.
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bicarbonate
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What is converted to bicarbonate in patients with normal hepatic function?
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acetate
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When would you want to use acetate?
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metabolic acidosis
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What two micronutrients can precipitate in a TPN?
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calcium and phosphorous
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If magnesium and potassium need corrected, which should be corrected first?
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Magnesium
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In magnesium dosing, patients with normal renal function usually start with what dose?
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8 mEq/day
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MVI-13 infuvite contains what vitamin?
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Vitamin K
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What are the five trace elements in a MTE-5?
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Selenium, zinc, copper, chromium, manganese
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When adding insulin to a TPN bag, how do you know how much to add?
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For every 10g dextrose, add 1 unit of insulin.
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If insulin is added to a TPN bag, how often should blood glucose be checked?
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Check every 6 hours.
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Can a PPI be added to a TPN bag?
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No, you may add H2RA such as famotidine, ranitidine. Or give PPI on the side.
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What lab monitoring should be done in regards to TPN?
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CHEM 7 +Ca, BMP, LFT, albumin, triglyceride.
Notes: BMP-basic metabolic panel, pre-albumin baseline levels taken. |
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Aside Lab test monitoring, what other monitoring should be done with TPN?
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X-ray of KUB (kidney, ureter, bladder)
Physical exam of bowel sounds, flatus, abdominal pain/tenderness |
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What treatment is recommended for cholestasis?
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Reduce glucose, cyclic TPN.
Notes: cholestasis is slow or blocked bile flow. Cyclic TPN means increase rate to give whole amount in less than 24 hours. |
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Refeeding syndrome is linked to what electrolyte disorders? Who is at risk for this syndrome?
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hypophosphatemia, hypokalemia
At risk: starved, severely malnourished. |
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When giving warfarin EN, tube feedings should be done how in relation to the dose of warfarin?
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Hold tube feedings for 1 hour prior and 1 hour after administration of dose.
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If tube feedings are stopped, what should be done with the warfarin dose?
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Dose reduction of warfarin
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When giving phenytoin EN, tube feedings should be done how in relation to the dose of phenytoin?
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Hold tube feedings for 1 hour prior and 1 hour after administration of dose.
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When giving fluoroquinolones EN, tube feedings should be done in relation to the dose of FQ?
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Hold tube feedings for 1 hour prior and 2 hours after administration of dose.
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This dosage form of this drug class may cause tube occlusion and should be avoided in EN.
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FQ- ciprofloxacin Suspensions
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Fluoroquinolones should not be administrated this way.
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Jejunal administration
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What PPIs may be added to EN?
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Delayed-release capsules with enteric coated granules; lansoprazole, omeprazole, esomeprazole
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When giving PPIs in EN, what needs to be done for the tube feedings?
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Hold tube feedings for 1 hour prior and 1 hour after administration of dose.
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This is the site where arterial blood is filtered
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Glomerulus
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This is the site where water and salts from the filtrate are reabsorbed.
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Renal tubule
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80% of water and electrolytes are reabsorbed in this area of the renal tubule.
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Proximal convoluted tubule
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This is the area where urine responds to antidiuretic hormone[ADH] and urine is concentrated.
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Collecting Duct
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This is related to the endocrine function of the kidney. What is it and what does it do?
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Renin; regulates blood pressure and organ perfusion.
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These are related to the metabolic functions of the kidney. What are they and what do they do?
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Erythropoietin; regulation of RBC production.
Vitamin D activation; regulation of calcium levels |
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Normal glomerular filtration rate is?
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120ml/min [90-140ml/min]
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Where are medications predominantly reabsorbed in the kidneys?
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along distal tubule and collecting duct
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Most sodium is reabsorbed where in the kidneys?
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65% PCT, 25% loop henle,
5% early DCT, 5% late DCT |
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These electrolytes are largely reabsorbed with sodium.
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Chloride, potassium
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This electrolyte is mostly reabsorbed in the loop.
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Magnesium
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These electrolytes are mostly reabsorbed in the PCT
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calcium and phosphorus
PCT- proximal convoluted tubule |
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These are reabsorbed via active transport.
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amino acids
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What responds to ADH in the late DCT and collecting ducts?
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water- osmotically reabsorbed except in collecting ducts.
DCT-distal convoluted tubule |
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Secretion predominantly takes place in the?
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proximal tubule
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This facilitates the elimination of compounds from renal circulation into the tubule.
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Secretion
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Urine for excretion is normally produced at a rate of?
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1 ml/min
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If there is a decline in renal function, leading to a decline in tubular secretion of K, what will happen to serum k?
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Serum K will increase.
If K is not secreted into the tubule, then it stays in the blood. |
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RAAS is composed of what?
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Renin, Angiotensin II, aldosterone
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This increases in response to decreased renal perfusion pressure.
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Renin
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This increases in response to renin.
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Angiotension II
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This increases in response to angiotension II.
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Aldosterone
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This is a potent vasoconstrictor of efferent arterioles and stimulates catecholamine release.
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Angiotension II
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This stimulates sodium and water reabsorption and promotes myocardial fibrosis and vascular dysfunction.
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Aldosterone
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90% of this endogenous hormone is produced by the kidneys.
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Erythropoietin
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What is the definition of AKI?
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Abrupt increase of SCr of more than 50% over 24-48hours.
OR Increase of 1mg/dL SCr in patient with pre-existing renal disease.[baseline SCr >2mg/dL] |
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Is acute renal disease reversible, irreversible, or both?
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Most cases is it reversible
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The definition for chronic kidney disease is?
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Proteinuria/albuminuria for at least 3 months
and/or GFR <90mL/min |
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This is used as a prediction model for outcomes of kidney injury.
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RIFLE
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The RIFLE classification of AKI uses what variables to predict kidney dysfunction?
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SCR/GFR and urine output
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What percentage of AKI cases in hospitalized patients are drug-induced?
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20%
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Dehydration is a common risk factor for what AKI?
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Community-Acquired AKI
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Low cardiac output is a common risk factor for what AKI?
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Hospital-Acquired AKI
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Sepsis/shock and low cardiac output are common risk factors for what AKI?
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ICU-Acquired AKI
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What are general risk factors for AKIs?
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>60 age, sepsis, pre-existing respiratory/cardiovascular disease, chronic kidney disease, dehydration, hypotension, exposure to nephrotoxins
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What are the 3 categories of AKI?
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Pre-renal(40-80%), intrinsic(10-50%), post-renal(<10%)
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What is the least common type of true AKI?
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Pseudorenal AKI
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An inadequate delivery of blood to the glomerulus results in this category of AKI.
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Prerenal AKI
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What does the nephron do in response to maintaining normal GFR to afferent and efferent arterioles?
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Afferent - vasodilation
Efferent - vasoconstriction |
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If prerenal AKI is severe and left untreated what will result?
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Tubular ischemia----->tubular necrosis
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In prerenal AKI, what lab values are elevated/low, FeNa%, and UA?
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Elevated: BUN,SCr, BUN:SCr(>20:1)
Low: urine sodium FeNa% <1% UA: dark color, hyaline casts, elevated sp.gravity, elevated urine osmolatity |
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To manage prerenal AKI, what should be done?
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Correct volume deficit, remove agent, correct electrolytes, monitor drugs that accumulate, emergent dialysis prn
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What drugs may induce prerenal AKI?
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NSAIDS, ARB,ACEI
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MOA: inhibit prostaglandin-mediated dilation of afferent arterioles.
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NSAIDS
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MOA: selectively dilate efferent arterioles.
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ACEI/ ARB
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This is when damage is within the kidney, categorized by the affected structure.
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Intrinsic AKI
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Is intrinsic AKI reversible, irreversible, or both?
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Both depends on the damage.
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This is caused by the necrosis of the proximal tubule epithelium and basement membrane.
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Acute tubular necrosis -ATN
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This is one of the most common causes of acute renal failure.
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ATN- acute tubular necrosis
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This may be described as oliguric or non-oliguric.
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ATN- acute tubular necrosis
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This is the most common cause of intrinsic renal failure.
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ATN- acute tubular necrosis
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What will the lab evaulation for ATN look like?
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UA: dark brown color urine; brown granular casts; epithelial cells
Elevated: urine Na, FeNa% Low: urine osmolality |
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Hypokalemia, hypophosphatemia, hypomagnesemia, and metabolic acidosis would occur in what injury to the kidneys?
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proximal tubular injury
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Hyperkalemia, metabolic acidosis, and polyuria would occur in what injury to the kidneys?
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Distal tubular injury
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What drugs can cause a drug-induced ATN?
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Aminoglycoside, amphotericin B, cisplatin, contrast media
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MOA: Absorbed in the proximal tubule cells and stored in lysosomes; when lysosomes burst, a large concentration of this drug is released into the nephron.
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Aminoglycoside (AG)
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MOA: in distal tubule, alters cell permeability creating pores in cell membrane; further damage and necrosis.
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Amphotericin B (AmB)
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MOA: By creating reactive species, impairs cellular energy function and causes apoptosis.
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Cisplatin (C)
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MOA: direct toxicity to proximal tubule cells. Vasoconstriction reducing intrarenal perfusion.
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Contrast media
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MOA: renal artery vasoconstriction
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Amphotericin B(AmB)
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If giving aminoglycoside, what management is done to prevent a drug-induced ATN?
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Drug level monitoring
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If giving amphotericin B, what management is done to prevent a drug-induced ATN?
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Lipid formulation delivered to site of infection to avoid exposure to tubular cells
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If giving cisplatin, what management is done to prevent drug-induced ATN?
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Amifostine - chelates cisplatin in normal tissue, limiting chance to develop toxicities.
Give hypertonic saline administration. |
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When giving contrast media, what management can be done to prevent drug-induced ATN?
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Hydration pre & post-administration, Sodium bicarbonate hydration, renal vasodilators, N-Acetylcysteine, use lowest volume of contrast media.
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When the glomerulus is damaged and allows large proteins, blood, and charged molecules to pass into the renal tubule; it is called this? what type of AKI?
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Glomerulonephritis; intrinsic AKI
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What would glomerulonephritis evaluation look like; UA and tests?
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UA: elevated protein, presence of RBC/casts.
24hr urine: elevated protein, protein:Cr Biopsy Test for antibodies [ANCA, complement] |
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Glomerulonephritis is classified as this when no inflammation is present and proteinuria is >3.5g/day.
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Nephrotic syndrome
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Glomerulonephritis is classified as this when inflammation is present, pus is in the urine, and cellular/granular casts are present.
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Nephritic syndrome
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The general approach in management of glomerulonephritis is?
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Immunosuppressive agents [corticosteroids, cytotoxic, cyclosporine/mycophenolate]
Restriction of dietary protein, sodium, cholesterol. Manage hypertension, edema, hyperlipidemia |
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What is the major difference between nephritic and nephrotic syndrome?
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The amount of proteinuria is higher in nephrotic syndrome.
Hint: nephROTic =pROTeinuria |
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When the interstitial tissue and surrounding tubules becomes inflamed and hypersensitivity occurs, this is called?
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Interstitial nephritis- intrinsic AKI
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If a patient experiences fever, rash, and arthralgias; an AKI is in question what type would it be?
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Interstitial nephritis - intrinsic AKI
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What would lab evaluation for interstitial nephritis look like?
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Eosinophils in peripheral blood smear.
UA: WBC, casts, eosinophils |
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Which of the following is most specific for interstitial nephritis?
Normal BUN:Cr, UA eosinophils, Elevated uNa, presence of hyaline casts. |
UA eosinophils
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This AKI is due to the obstruction of urinary outflow and can lead to fluid accumulation and increased glomerular pressures.
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Postrenal AKI
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What are the risk factors for nephrolithiasis?
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1.poor hydration
2. higher doses, longer treatment of [sulfonamides, allopurinol, acyclovir, methotrexate, etc] |
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What can be done as management for postrenal AKI?
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1. increase fluid intake [nephrolithiasis]
2. Stenting for obstruction 3. Pain management |
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What would the UA for postrenal AKI present like?
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UA: little to no proteinuria
Elevated: urine osmolality, BUN:SCr >20:1, FeNa% Low urine Na at first, with progression to high urine Na. |
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How do you confirm postrenal AKI diagnosis?
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Ultrasound
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What is the most common measure of overall kidney function?
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GFR
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What is the relationship between BUN reabsorption and GFR?
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When GFR slows, BUN reabsorbs easily.
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Specific gravity will correlate with what other lab?
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Urine osmolality
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When ADH is released will urine osmolality increase or decrease?
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increase
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When renal tubule is damage and doesn't respond to ADH, will urine osmolality increase or decrease?
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decrease
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What is the equation for FeNa%?
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[Urine Na/ Serum Na] / [Urine Cr/ serum Cr]
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If FeNa% is >2% what does this tell you?
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renal tubule damage, decrease in reabsorption of Na
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If FeNa% is <1% what does this tell you?
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Pre-renal dysfunction, increase in reabsorption of Na
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If a patient is taking this drug, you cannot use the FeNa % because it will give an unreliable number.
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Furosemide
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If a patient is taking furosemide, what would you use to determine if its a prerenal or intrinsic AKI?
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FeUrea%
<35% prerenal >50% intrinsic |
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This reabsorption rate is dependent upon water reabsorption.
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BUN
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What is the normal value for SCr?
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0.7 -1.5 mg/dL Females/Males
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As the GFR decreases, does SCR increase or decrease?
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increase
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What are the surrogate markers within the blood?
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Inulin, Cystatin C, BUN, SCr
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What measures the clearance of the surrogate markers in the blood?
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CrCl
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Nonoliguric urine output is what value?
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>500 mL/24hr
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Oliguric urine output is what value?
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<500 mL/24hr
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Anuric urine output is what value?
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<50ml mL/24hr
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More severe AKI and increased mortality is seen with what type of urine output?
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Reduced UO; anuric
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What is currently the only equation used to determine doses of drugs that need to be adjusted based on renal function?
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Cockcroft-Gault
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In elderly patients, if SCr is < 1mg/dL; what value for SCr should be used?
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SCr of 0.8mg/dL in elderly. (unless value is 0.9mg/dL then use 0.9)
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Does Cockcroft-Gault overestimate or underestimate CrCl in patients with an unstable renal function?
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overestimate CrCl
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What factors affect SCr?
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1.Gender: decrease females
2.Race: increase blacks 3.Diet: increase meat; decrease plant-based 4. muscular body 5. malnutrition, amputation, muscle wasting disease |
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What is the Cockcroft-Gault equation for adults?
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CrCl (ml/min)= (140 - age) x (BW) (x 0.85 females) / (SCr x 72)
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For males: how do you figure out the IBW?
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Males: 50kg +/- 2.3 for every inch above/below 60 inches
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For females: how to you figure out the IBW?
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Females: 45.5kg +/- 2.3 for every inch above/below 60 inches
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If you need to use ABW, what equation do you use?
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ABW= [0.4 x (TBW-IBW)] + IBW
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This equation is used in patients with CKD risk factors and GFR <60 mL/min
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MDRD - modification of diet in renal disease
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How often should monitoring of fluids in/out and hemodynamics be done?
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Every shift or every 8 hours
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How often should monitoring of Blood chemistries, blood glucose, drug/dosing regimens, nutritional regimens, times of administered doses, and RRTs be done?
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Daily
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How often should serum concentration data for drugs, urinalysis, Calculations of FeNa/ CrCl be done?
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After regimen change/RRT for serum conc. After measured urine collection of urinalysis and calculations.
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For a CKD(chronic kidney disease), what is the definition?
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Presence of structural kidney damage and/or
GFR <90mL/min for 3 months or more. |
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End-stage renal disease is reserved for what stages?
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Stage 4 & 5
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What factors can cause loss of nephron mass?
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Diabetes (increase sugar) and hypertension
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What factors can cause glomerular capillary hypertension?
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Increase in angiotension II
Increase in glomerular pressure |
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What factor causes proteinuria?
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Increase glomerular permeability allowing larger proteins to pass directly injuring interstitial/tubular
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What are the 3 major risk factors for the development of CKD?
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1. Initiating factors
2. Susceptibility factors 3. Progression factors. |
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What are the initiating factors that cause direct kidney damage and nephrosclerosis?
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1.Diabetes mellitus
2. Hypertension 3. Glomerulonephritis |
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What are the susceptibility factors useful in identifying at-risk patients?
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1. >60 age
2. Racial/ethnic minority 3. Low birth rate/reduced renal mass 4. Family history of CKD 5. Low income/education ??? 6. systemic inflammation 7. hyperlipidemia |
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What are the progression factors that can hasten the functional decline and increase the risk of ESRD?
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1. Hyperglycemia
2. Hypertension 3. Proteinuria 4. Obesity 5. Smoking 6. Hyperlididemia |
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What is the most common cause of CKD?
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Diabetes mellitus
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CKD should be suspected in patients with what conditions?
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1. Diabetes meillitus
2. Hypertension 3. GU abnormalities 4. Autoimmune diseases |
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What screenings can be done for patients at risk for CKD?
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1. SCr
2. MDRD - estimate GFR 3. UA - protein in urine 4. KUB |
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When considering protein or albumin quantification of proteinuria, what is the value?
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>= to 300
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What is the GFR for stage 1 CKD?
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>=90
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What is the GFR for stage 2 CKD?
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60-89
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What is the GFR for stage 3 CKD?
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30-59
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What is the GFR for stage 4 CKD?
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15-29
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What is the GFR for stage 5 CKD?
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<15
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The patient enters full-blown uremia as toxins accumulate in what stage?
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Stage 5
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Fatigue, cold intolerance, shortness of breath, palpitations, cramping/muscle pain, depression adn sexual dysfunction are all symptoms of?
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CKD
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Elevated BUN, Elevated SCr, eletrolytes disturbances, HyperMg, hyperPhos, HypoCa, oliguria, acidosis, weight loss are signs of?
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CKI
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Decreased hgb, hyperparathyroidism, decreased vitamin D activation, peripheral edema, rales or rhonichi are all signs of?
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CKI
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What are the goals for treatment of CKD?
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1. Delay progression to ESRD
2. Initiate disease-modifying therapies 3. Avoid/minimize exposure to nephrotoxic agents |
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What are the non-pharmacological therapies for CKD?
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1.Dietary protein restriction
2. Smoking cessation |
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What are the NFK guidelines for protein restriction in patients with a GFR <25mL/min?
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0.6g/kg/day of protein
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What drugs are used in treatment of CKD?
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ACEI and ARBs
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What do ACEIs and ARBs do?
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Reduce blood pressure and lower proteinuria
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What are the goals in CKD for BP and proteinuria?
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BP <130/80 mmHg
Reduce proteinuria by 30-50% |
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What are the proposed hemodynamic factors in treating CKD with ACEI/ARBs?
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Decreased Angiotension II, Decreased blood pressure,
Vasodilation of Efferent arterioles, Decreased capillary pressure |
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What are the proposed non-hemodynamic factors in treating CKD with ACEI/ARBs?
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Decreased angiotension II,
Slowed progression to proteinuria Decreased transforming growth factor B, Renal blood flow maintained |
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All ACEIs except fosinopril, have this? How does this affect dosing?
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Reduced clearance in renal insufficieny
Dosing: start at half the usual starting dose |
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What are the ADRs associated with ACEI/ARBs in renal insufficiency?
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Transient, acute worsening of renal function
HyperKalemia |
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What should be monitored when giving ACEI/ARBs in renal insufficieny?
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Serum K (for hyperkalemia)
Blood pressure SCr (a rise >30% over 24-48h = DC drug) |
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When monitoring ACEI/ARBs in renal insufficieny, if SCr increases when should a drug be discontinued?
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if SCr rises >30% over 24-48hours
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What are the ACEIs used for CKD? List Brand And Generic names.
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1. lisinopril [zestril, prinivil]
2. captopril [capoten] 3. ramipril [Altace] 4. enalapril [Vasotec] |
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What are the ARBs used for CKD? list Brand and Generic names
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1. irbesartan [Avapro]
2. candesartan [Atacand] 3. losartan [Cozaar] 4. valsartan [Diovan] |
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Drug class and Brand name for: Lisinopril
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Class: ACEI
Zestril, Prinivil |
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Drug class and Brand name for: captopril
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Class: ACEI
Capoten |
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Drug class and Brand name for:
Ramipril |
Class: ACEI
Altace |
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Drug class and Brand name for: enalapril
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Class: ACEI
Vasotec |
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Drug class and Brand name for: irbesartan
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Class: ARB
Avapro |
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Drug class and Brand name for: candesartan
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Class ARB
Atacand |
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Drug class and Brand name for: losartan
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Class ARB
Cozaar |
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Drug class and Brand name for: valsartan
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Class ARB
Diovan |
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If you use ACEI and ARB in combination for CKD, what occurs?
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May reduce proteinuria beyond maximum doses of each agent alone
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This is the art and science of safeguarding and improving community health through prevention of disease, control communicable disease, sanitary measures, health education, monitoring environmental hazards.
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Public health
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There are 10 major public health achievements: How many can you name?
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1. Vaccinations
2. Motor vehicle safety 3. Safer workplaces 4. Infectious diseases 5. Heart disease and stroke 6.Safer, healthier food 7. Healthier mothers and babies 8. Family planning 9. Fluoridation of drinking water 10. Tobacco use |
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There has been several public health legislature over the past few decades: How many acts can you name?
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1. National Mental Health Act
2. Clean Air act 3. Clean water act 4. Comprehensice drug abuse prevention and control act 5. Worker right-to-know act 6. Omnibus budget reconciliation act 7. Health insurance portability and accountability act(HIPAA) 8. Medicare prescriptioon drug, improvement, and modernization act 9. Patient protection and affordable care act |
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Who are the players in public health system in the public sector?
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Government- federal, state, and local
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Who are the players in public health system in the private sector?
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Businesses- for profit and nonprofit
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What is HP {healthy people) 2020?
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A vision where in a society all people live long, healthy lives
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What is the difference between focus/topic areas and health indicators?
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They are synonymous. The leading health indicators are considered high-priority.
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What roles does APhA recommend the the pharmacist take in public health?
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1. Track and analyze trends, medication errors, ADRs
2. Evidence-based protocols and disease management programs 3. Plan and execute emergency preparedness initiatives 4.Contribute to policy development 5. Work within the public health services 6. Counsel patients 7. Educate other HCPs 8. Vaccinate and dispense accurately and safely |
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How can pharmacists contribute to the 10 major public health achivevements?
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1. Administer/encourage vaccines
2. Promote use of antimicrobials/stewardship 3. Counsel on healthy lifestyle, medication adherence, physical activity, prenatal care, teratogenic drugs, smoking cessation. |
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There are 5 steps in the MAP-IT; what are they?
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1. Mobilize people of your community into a coalition
2. Assess areas of greatest need. 3. Plan your approach 4. Implement your plan. 5. Track your progress. |
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A person is classified as Obesity II between what BMIs?
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35-39.9
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Can genetic factors have an affect on obesity, if yes how?
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Yes, may predispose an individual to become obese but still may require outside factors to be expressed
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What environmental factors affect obesity?
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1. sedentary lifestyle
2. unhealthy food choices 3. large portion size 4. socioeconomic status 5. cultural factors |
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What medical conditions are associated with weight gain?
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1.Cushing's disease
2. Growth hormone deficiency 3. Insulinoma 4. Leptin deficiency 5. Psychiatric disorders |
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What medications are associated with weight gain?
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1. pschotropic agents [TCA, mirtazapine, antipsychotics]
2. anticonvulsants 3. steroid hormones 4. insulin and most oral hypoglycemia agents [except metformin] |
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What is the BMI of a 37 year old female with a weight of 155lbs and a height of 5'5''. Classify her BMI.
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BMI 25.79 Overweight
BMI=(155lbs/4225inchesSquared) x 703 = 25.79 |
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A person is classified as underweight at what BMI?
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<18.5
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A person is classifed as normal between what BMIs?
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18.2 - 24.9
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A person is classified as overweight between what BMIs?
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25 - 29.9
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A person is classified as Obesity I between what BMIs?
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30 - 34.9
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A person is classified with Extreme obesity or obesity III over what
BMI? |
> or equal to 40
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A waist circumference larger than what for males and females is associated with increased risks?
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Males: > or equal to 40
Females: > or equal to 35 |
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A 58 year old female weighs 182lbs and is 5'5'' ; what is her BMI and classify it?
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BMI=30.28 Obesity I
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If a patient has a BMI of 31 without any risk factors but is motivated to lose or maintain; What therapy is given?
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Weight loss Drug therapy
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