A
What is the clinical use of drugs to prevent and threat diseases; defines principles of drug actions (the cellular processes that change in response to the presence of drug molecules)?
Pharmacotherapeutics
What is the Food and Drug Administrations's primary purpose?
To protect patients and ensure drug efficacy
Most medication errors occur because of _____ as opposed to _____.
Breakdown in the medication use system
Being the fault of the individual
Ethnopharmacology is _____.
Why is ther some lack of clarity in this field? (Give an example.)
The body of knowledge for understanding the specific impact of cultural factors on patient drug responses
Lack of clarity in terms: race, ethnicity, and culture
The term 'hispanic' is used differently by many people in different ways (i.e. Spanish speaking, Spanish nationality, or belonging to a Spanish-speaking country).
Order the following into most broad to most narrow:
- Adverse drug reactions
- Adverse drug events
- Allergic reactions
- Idiosyncratic reactions
- Medication errors
Hint: more than 1 term can be on the same level
Adverse drug events
Medication errors and adverse drug reactions
Allergic reaction and idiosyncratic reactions
Which disease of peripheral nerves is caused by deficiency of thiamine (b1) and has the symptoms of fatigue, diarrhea, weight loss, edema, heart failure, disturbed nerve function?
Beriberi
Supplemental amounts of which vitamins can be synthesized by normal bacterial flora in the gi tract?
b complex and k vitmains
Is an excess amount of one or more nutrient resulting in deficiencies of other nutrient(s), as a result of megadosing, more likely in vitamins or minerals?
Megadosing which types of vitamins is particularly risky?
Megadosing minerals is more likely to cause deficiencies in other nuterient(s).
Megadosing vitamins can lead to hypervitaminosis, especially in fat soluble vitamins.
While megadosing water soluble vitamins is safer than megadosing fat soluble vitamins, it can still be unsafe.
At what dose can soluble vitamin b6 cause nerve damage?
50-100x the DRI
Which disease results from niacin deficiency or metabolic defect and interferes w/ the conversion of tryptophan to niacin (B3)?
Pellegra
Medications are regulated by 3 main bodies
- Food and Drug administration
- Drug Enforcement Agency
- Individual state laws
Which fat soluble vitamin is the safest in large doses?
It remains safe at doses _____x the recommended DRI.
- Vitamin E is the safest fat soluble vitamin.
- It remains safe at doses 10-20x recommended DRI.
Medication reconciliation occurs _____.
At each stage of healthcare delivery and any time their their health status changes; at all points of entry and exit to or from a health care entity (and ideally when their care team within the facility changes)
Other than in cases of inadequate dietary intake, vitamin a supplementation is indicated in which populations?
Vitamin A supplementation is indicated for the following patient populations:
4 keys to preventing errors
- Reporting errors
- Reporting potential errors
- Non-punitive approach to error reporting or "just culture"
- QSEN initiatives
What b vitamin is needed by coenzyme A for energy production?
Explain.
Vitamin b5 or pantothenic acid completes coA, allowing it to function within the citric acid cycle
It helps generate the energy needed for anabolic tissue building processes.
DRI vs RDA
RDA stands for recommend daily allowances; were first used in 1941 by the FDA to establish minimum nutrient requirements
Dietary reference intakes (DRI) represent optimal nutrient amounts; percentages on nutrition label represent proportion of the DRI is in the product
What is the American Dietetic Association’s definition of a megadose?
Preventative or therapeutic use of vitamins at medadoses are referred to as?
Doses of a nutrient that are 10x or more the recommended amount
Orthomolecular medicine; coined in 1968 by chemist Linus Pauling
Long-term isoniazid drug therapy can cause low vitamin _____; thus, concurrent _____ of this vitamin would be indicated.
B6 or pyridoxine
megadosing
Vitamin a comes in 3 forms; name them.
Medications containing vitamin a require what?
Vitamin a comes in 3 forms:
Medications containing vitamin a require a prescription but otc products with vitamin a do not.
Explain how megadosing can interfere with chemotherapy drugs and radiation treatments.
Megadosing can interfere with chemotherapy drugs and radiation treatments.
Both therapies work to destroy cnacer cells through the oxidation process.
Antioxidant supplementation may impead this.
How are D2 and D3 vitamins biotransformed into active metabolites?
D2 and D3 vitamins are biotransformed into active metabolites in the liver by the actions of the PTH, becoming calcifediol.
Calcifediol gets transported to kidney and is converted into calcitriol (most physiologically active form of vitamin d).
Ingestion of excess vitamin a occurs most commonly in which PT population?
Symptoms can occur _____.
What effect to the skin will be seen over several weeks?
Ingestion of excess vitamin a occurs most commonly in children
A few hours after
Over several weeks, generalized peeling of the skin and erythema may occur.
What vitamin d analogue is used primarily in hypocalcemia management for pts with chronic renal failure and are undergoing hemodialysis?
It can also be used for signs of what other disease?
It is only available in what form?
Calcifediol or calderol
It can also be used for signs of hyperparathyroid disease.
It is only available in oral use.
Nutrient megadosing is known to be helpful in which situations?
Give examples.
Nutrient megadosing is known to be helpful when concurrent long-term drug therapy depletes vitamin stores or interfere’s with vitamin function
Examples:
For gi malabsorption syndrome pts, like in those w/ severe colitis and/or cystic fibrosis (all macro- & micronutrient classes)
To treat pernicious anemia resulting from cyanocobalamin or B12 deficiency (B12)
When a vitamin behaves like a drug at megadose levels (e.g. niacin or b6 functions as a vitamin up to 20 mg daily; reduces blood triglyceride and ldl cholesterol at doses 50-100x higher)