Vitamin and Mineral Replacement

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Pharmacology
Chapter 15
Chapter 15
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1

VITAMINS ARE?

ORGANIC CHEMICALS THAT ARE NECESSARY FOR NORMAL METABOLIC FUNCTIONS AND FOR TISSUE GROWTH AND HEALING.

2

HOW MUCH VITAMINS DO WE NEED?

THE BODY NEEDS ONLY A SMALL AMOUNT OF VITAMINS DAILY, WHICH CAN BE EASILY OBTAINED THROUGH ONES DIET.

3

INTAKE OF VITAMINS SHOULD BE INCREASED BY THOSE?

EXPERIENCING PERIODS OF RAPID BODY GROWTH, BY THOSE WHO ARE PREGNANT OR BREASTFEEDING, BY THOSE WITH A DEBILITATING ILLNESS, BY THOSE WITH MALABSORPTIVE ISSUES, AND BY THOSE WITH INADEQUATE DIETS. AND CHILDREN WHO ARE MALNOURISHED WILL NEED VITAMIN REPLACEMENT. PEOPLE ON "FAD" OR RESTRICTIVE DIETS FREQUENTLY HAVE VITAMIN DEFICIENCIES.

4

VITAMINS ARE NOT NEEDED WHEN?

IF THE INDIVIDUAL IS HEALTHY AND CONSUMES A WELL BALANCED DAILY DIET ON A REGULAR BASIS; HOWEVER MANY PEOPLE TAKE VITAMINS AS A SORT OF INSURANCE TO BE SURE THEY ARE GETTING WHAT THEY NEED.

5

THE 4 DRI NUTRIENT RECOMMENDATIONS INCLUDE:

1. ADEQUATE INTAKE (AI)
2. ESTIMATED AVERAGE REQUIREMENT (EAR)
3. RECOMMENDED DIETARY ALLOWANCE (RDA)
4. TOLERABLE UPPER INTAKE LEVEL (UL)

6

ADEQUATE INTAKE (AI) IS:

THE AMOUNT DETERMINED IN THE ABSENCE OF SCIENTIFIC INFORMATION THAT IS DEEMED TO BE SUFFICIENT. THE AI IS BASED ON DATA THAT SEEMS OT MAINTAIN A HEALTHY STATUS.

7

ESTIMATED AVERAGE REQUIREMENT (EAR) IS:

THE AMOUNT THOUGHT TO PROVIDE A SUFFICIENT INTAKE IN ONE HALF OF HEALTHY PERSONS IN A DEFINED GROUP.

8

RECOMMENDED DIETARY ALLOWANCE (RDA) IS:

THE AMOUNT THOUGHT TO PROVIDE THE NEEDS OF 98% OF WELL CHILDREN AND ADULTS OF SPECIFIC AGE GROUP AND GENDER. RDAs WERE DEVELOPED TO PREVENT DEFICIENCIES AND MAY NOT BE REFLECTIVE OF ALL GROUPS, SUCH AS OLDER ADULTS.

9

TOLERABLE UPPER INTAKE LEVEL (UL) IS:

THE MAXIMUM AMOUNT CONSIDERED NOT LIKELY TO BE A RISK FOR HEALTHY PERSONS IN A SPECIFIED GROUP. THIS IS NOT A RECOMMENDED LEVEL TO TAKE.

10

VITAMIN DEFICIENCIES CAN CAUSE?

CELLULAR AND ORGAN DYSFUNCTION THAT MAY RESULT IN SLOW RECOVERY FROM ILLNESS.

11

THE NATIONAL ACADEMY OF SCIENCES FOOD AND NUTRITION BOARD PUBLISHES THE U.S. RDA FOR

DAILY DOSE REQUIREMENTS OF EACH VITAMIN.

12

THE U.S. FOOD AND DRUG ADMINISTRATION (FDA) REQUIRES?

THAT ALL VITAMIN PRODUCTS BE LABELED ACCORDING TO THE AMOUNT OF VITAMIN CONTENT AND THE PROPORTION OF THE RDA PROVIDED BY THE VITAMIN PRODUCT. RDA MAY NEED TO BE MODIFIED FOR CLIENTS WHO ARE ILL.

13

MEGADOSE "FAD" OF VITAMINS INFORMATION:

CAN BE TOXIC; CLIENTS SHOULD BE ADVISED TO CONTACT THEIR HEALTH CARE PROVIDER BEFORE TAKING THESE PRODUCTS.
MEGADOSE OF FAT-SOLUBLE VITAMINS MAY CAUSE TOXIC EFFECTS.
MEGADOSE OF WATER-SOLUBLE ARE ELIMINATED VIA THE URINE AND ARE GENERALLY NOT TOXIC.

14

ADVERSE REACTIONS (KIDNEY STONES AND NERVE DAMAGE, RESPECTIVELY) HAVE BEEN REPORTED WITH VITAMINS _____ AND ______.

C AND B6.

15

FAT-SOLUBLE VITAMINS ARE?

A, D, E, AND K

16

WHAT DO FAT-SOLUBLE VITAMINS DO?

THEY METABOLIZE SLOWLY, CAN BE STORED IN FATTY TISSUE, LIVER, AND MUSCLE IN SIGNIFICANT AMOUNTS, AND ARE EXCRETED IN THE URINE AT A SLOW RATE.

17

VITAMINS __ AND __ ARE TOXIC IF TAKEN IN EXCESSIVE AMOUNTS OVER TIME. VITAMIN __ TOXICITY IS RARE. VITAMINS __ AND __ WERE THOUGHT TO BE LESS TOXIC THEN VITAMINS __ AND __.

VITAMINS _A_ AND _D_ ARE TOXIC IF TAKEN IN EXCESSIVE AMOUNTS OVER TIME. VITAMIN _D_ TOXICITY IS RARE. VITAMINS _E_ AND _K_ WERE THOUGHT TO BE LESS TOXIC THEN VITAMINS _A_ AND _D_.

18

FOODS RICH IN VITAMIN A INCLUDE:

FRUITS, YELLOW AND GREEN VEGETABLES, FISH, AND DAIRY PRODUCTS.

19

FOODS RICH IN VITAMIN D INCLUDE:

DAIRY PRODUCTS AND NONHYDROGENATED MARGARINE

20

FOODS RICH IN VITAMIN E INCLUDE:

OILS, NONHYDROGENATED MARGARINE, MILK, GRAINS, AND MEATS.

21

FOODS RICH IN VITAMIN K INCLUDE:

GREEN LEAFY VEGETABLES, MEATS, EGGS, AND DAIRY PRODUCTS.

22

VITAMIN A INFORMATION:

ESSENTIAL FOR BONE GROWTH AND THE MAINTENANCE OF EPITHELIAL TISSUES, SKIN, EYES, AND HAIR. HAS BEEN USED TO TREAT SKIN DISORDERS (LIKE ACNE). EXCESS DOSAGES CAN BE TOXIC. DURING PREGNANCY EXCESS DOSAGE CAN CAUSE HARM TO FETUS. IM ADMINISTRATION IS USED ONLY IN THE ACUTELY ILL OR CLIENTS REFRACTORY TO THE ORAL ROUTE, LIKE THOSE WITH GI MAL-ABSORPTION SYNDROME.

23

VITAMIN A PHARMACOKINETICS:

IS ABSORBED FASTER WHEN THERE IS NO DEFICIENCY OR INTESTINAL OBSTRUCTION. PORTION IS STORED IN LIVE, THIS CAN BE INHIBITED WITH LIVER DISEASE. MASSIVE DOSES MAY CAUSE HYPERVITAMINOSIS (HAIR LOSS, PEELING SKIN, ANOREXIA, ABDOMINAL PAIN, LETHARGY, NAUSEA, AND VOMITING). UL FOR VITAMIN A IS 3000 MCG DAILY. EXCESSIVE USE SHOULD BE AVOIDED UNLESS WARRANTED BECAUSE VITAMIN IS STORED IN LIVER, KIDNEYS, AND FAT, AND IS SLOWLY EXCRETED FROM THE BODY. IS STORED IN THE LIVER FOR UP TO 2 YEARS. TO PREVENT TOXICITY THE DOSE FOR HEALTHY CLIENT SHOULD NOT BE GREATER THEN 7500 INTERNATIONAL UNITS. MINERAL OIL, CHOLESTYRAMINE, ALCOHOL AND ANTILIPEMIC DRUGS DECREASE THE ABSORPTION OF VITAMIN A. VITAMIN A IS EXCRETED THOUGH THE KIDNEYS AND FECES.

24

VITAMIN A PHARMACODYNAMICS:

VITAMIN A AIDS IN THE FORMATION OF THE VISUAL PIGMENT NEEDED FOR NIGHT VISION. NEEDED FOR BONE GROWTH AND DEVELOPMENT, PROMOTES THE INTEGRITY OF THE MUCOSAL AND EPITHELIAL TISSUES. EARLY SIGN OF VITAMIN A DEFICIENCY IS NIGHT BLINDNESS, CAN PROGRESS TO DRYNESS AND ULCERATION OF THE CORNEA AND TO BLINDNESS. CAN ALSO CAUSE DRY SKIN AND POOR TOOTH DEVELOPMENT.

VITAMIN A TAKEN ORALLY BEGINS TO TAKE EFFECT IN 1 TO 2 HOURS, PEAKS IN 4 TO 5 HOURS. DURATION OF ACTION IS UNKNOWN. BECAUSE IT IS STORED IN LIVER IT CAN BE AVAILABLE TO THE BODY FOR DAYS, WEEKS OR EVEN MONTHS.

25

VITAMIN A PROTOTYPE:

DRUG CLASS: FAT-SOLUBLE VITAMIN
TRADE NAME: ACON, AQUASOL A, DEL-VL-A
PREG. CATEGORY: A (X IF DOSE IS ABOVE RDA DOSE)
CONTRAINDICATIONS: HYPERVITAMINOSIS A, PREGNANCY
DOSAGE: IM AND PO
DRUG LAB-FOOD INTERACTIONS:
DRUG: MINERAL OIL DECREASES ABSORPTION.
LAB: MAY INCREASE BUN, CALCIUM, CHOLESTEROL, TRIGLYCERIDES, MAY LOWER ERYTHROCYTE, LEUKOCYTE COUNT.
ABSORPTION PO: 1 HOUR
DISTRIBUTION: UK
METABOLISM T1/2: WEEKS-MONTHS
EXCRETION: URINE
PO ONSET: 1-2 HOURS
PEAK: 4-5 HOURS

26

VITAMIN A PROTOTYPE CONTINUED:

THERAPEUTIC EFFECTS/USES: TO TREAT VITAMIN A DEFICIENCY (BILIARY TRACT OR PANCREATIC DISEASE, COLITIS, CIRRHOSIS, CELIAC DISEASE, SPRUE) PREVENT NIGHT BLINDNESS, TREAT SKIN DISORDERS, PROMOTE BONE DEVELOPMENT.
SIDE EFFECTS: HEADACHE, FATIGUE, DROWSINESS, IRRITABILITY, ANOREXIA, VOMITING, DIARRHEA, DRY SKIN, VISUAL CHANGES.
ADVERSE REACTIONS:
WITH TOXICITY- LEUKOPENIA, APLASTIC ANEMIA, PAPILL-EDEMA, INCREASED INTRACRANIAL PRESSURE, HYPERVITAMINOSIS A, BULGING FONTANELLES IN INFANTS JAUNDICE.

27

VITAMIN D:

MAJOR ROLE IN REGULATING CALCIUM AND PHOSPHORUS METABOLISM AND NEEDED FOR CALCIUM ABSORPTION FROM THE INTESTINES. DIETARY VITAMIN D IS ABSORBED IN THE SMALL INTESTINE AND REQUIRES BILE SALTS FOR ABSORPTION.

28

THERE ARE TWO COMPOUNDS OF VITAMIN D THEY ARE:

VITAMIN D2: ERGOCALCIFEROL (A SYNTHETIC FORTIFIED VITAMIN D)
VITAMIN D3: CHOLECALCIFEROL (A NATURAL FORM OF VITAMIN D INFLUENCED BY ULTRAVIOLET SUNLIGHT THROUGH THE SKIN)
OVER THE COUNTER VITAMIN D SUPPLEMENTS USUALLY CONTAIN D3.

29

MORE INFORMATION ON VITAMIN D:

ONCE ABSORBED IT IS CONVERTED TO CALCIFEDIOL IN THE LIVER. CALCIFEDIOL IS THEN CONVERTED TO ACTIVE FORM CALCITRIOL IN KIDNEYS. CALCITIOL FUNCTIONS AS A HORMONE AND WITH PARATHYROID HORMONE (PTH) AND CALCITRIOL REGULATES CALCIUM AND PHOSPHATE METABOLISM. THEY STIMULATE BONE REABSORPTION OF CALCIUM AND PHOSPHORUS.
EXCRETION IS PRIMARILY IN BILE AND JUST A TINY BIT IN URINE.
IF SERUM CALCIUM LEVELS ARE LOW MORE VITAMIN D ARE ACTIVATED, AND IF SERUM CALCIUM LEVELS ARE NORMAL ACTIVATION OF VITAMIN D IS DECREASED.
IF EXCESS VITAMIN D INGESTION OCCURS IT RESULTS IN HYPERVITAMINOSIS D, AND MAY CAUSE HYPERCALCEMIA. ANOREXIA, NAUSEA, AND VOMITING ARE EARLY SIGNS OF VITAMIN D TOXICITY.

*VITAMIN D TAKEN WITH CALCIUM REDUCED INCIDENCE OF FRACTURES.

30

VITAMIN E:

HAS ANTIOXIDANT PROPERTIES THAT PROTECT CELLULAR COMPONENTS FROM BEING OXIDIZED AND RED BLOOD CELLS FROM HEMOLYSIS. DEPENDS ON BILE SALTS, PANCREATIC SECRETION, AND FAT FOR ITS ABSORPTION. VITAMIN E IS STORED IN ALL TISSUES, ESPECIALLY THE LIVER, MUSCLE, AND FATTY TISSUE. ABOUT 75% OF VITAMIN E IS EXCRETED IN BILE.

31

WHAT VITAMIN E IS USED FOR: (A FEW MENTIONED)

REDUCES THE NUMBER OF NONFATAL MYOCARDIAL INFARCTIONS (MIs). REDUCE THE RISK OF CORONARY ARTERY DISEASE (CAD). PROTECTS THE HEART AND ARTERIES AND AIDS IN THE PREVENTION OF MACULAR DEGENERATION BECAUSE OF ITS ANTIOXIDANT EFFECTS (E.G. IT INHIBITS THE OXIDATION OF OTHER COMPOUNDS BY BLOCKING A GROUP OF HARMFUL CHEMICALS CALLED FREE RADICALS) CLIENTS WITH ALZHEIMER'S OR PARKINSON'S DISEASE TAKE VITAMIN E FOR ITS ANTIOXIDANT EFFECT.

32

SIDE EFFECTS OF LARGE DOSES OF VITAMIN E:

MAY INCLUDE FATIGUE, WEAKNESS, NAUSEA, GI UPSET, HEADACHE, AND BREAST TENDERNESS. MAY PROLONG THE PROTHROMBIN TIME. PERSONS TAKING WARFARIN SHOULD NOT BE TAKEN TOGETHER BECAUSE IRON CAN INTERFERE WITH THE BODY'S ABSORPTION AND USE OF VITAMIN E.

33

VITAMIN K OCCURS IN 4 FORMS:

VITAMIN K1: PHYTONADIONE; IS THE MOST ACTIVE FORM.; ABSORBED IN THE PRESENCE OF BILE SALTS.
VITAMIN K2: MENAQUINONE; IS SYNTHESIZED BY INTESTINAL FLORA.; NOT COMMERCIALLY AVAILABLE; ABSORBED IN THE PRESENCE OF BILE SALTS.
VITAMIN K3: MENADIONE; HAVE BEEN PRODUCED SYNTHETICALLY. DO NOT NEED BILE SALTS TO BE ABSORBED.
VITAMIN K4: MENADIOL; HAVE BEEN PRODUCED SYNTHETICALLY. DO NOT NEED BILE SALTS TO BE ABSORBED.

34

AFTER VITAMIN K ABSORPTION:

IT IS STORED PRIMARILY IN THE LIVER AND IN OTHER TISSUES. HALF OF VITAMIN K COMES FROM THE INTESTINAL FLORA, AND THE REMAINING PORTION COMES FROM ONES DIET.

35

VITAMIN K IS NEEDED FOR?

SYNTHESIS OF PROTHROMBIN AND THE CLOTTING FACTORS VII, IX, AND X. FOR ORAL ANTICOAGULANT OVERDOSE.

VITAMIN K1: IS THE ONLY FORM AVAILABLE FOR THERAPEUTIC USE AND IS THE MOST EFFECTIVE IN PREVENTING HEMORRHAGE.

36

THE COMMERCIAL DRUGS FOR VITAMIN K1 ARE ____ AND ___.

MEPHYTON AND AQUAMEPHYTON

37

VITAMIN K IS USED FOR TWO REASONS:

1. AS AN ANTIDOTE FOR ORAL ANTICOAGULANT OVERDOSE
2. TO PREVENT AND TREAT THE HYPOPROTHROMBINEMIA OF VITAMIN K DEFICIENCY DUE TO LACK OF BILE SALTS AND MALABSORPTION SYNDROMES THAT INTERFERE WITH VITAMIN K UPTAKE.

38

NEWBORNS ARE VITAMIN ___ DEFICIENT.

K; THUS A SINGLE DOSE OF PHYTONADIONE IS RECOMMENDED IMMEDIATELY AFTER DELIVERY. THIS PRACTICE IS COMMON IN THE U.S. BUT CONTROVERSIAL IN OTHER COUNTRIES. THIS CAN ELEVATE THE BILIRUBIN LEVEL AND CAUSE HYPERBILIRUBINEMIA WITH A RISK OF KERNICTERUS. THERE ARE ORAL AND PARENTERAL FORMS OF PHYTONADIONE; IV ADMINISTRATION IS DANGEROUS AND MAY CAUSE DEATH.

39

WATER-SOLUBLE VITAMINS ARE THE ___ AND ___ VITAMINS.

B-COMPLEX AND C VITAMINS

40

WATER-SOLUBLE VITAMINS ARE?

NOT USUALLY TOXIC UNLESS TAKEN IN EXTREMELY EXCESSIVE AMOUNTS. NOT STORED BY THE BODY, SO CONSISTENT, STEADY SUPPLEMENTATION IS REQUIRED. ARE READILY EXCRETED IN THE URINE. PROTEIN VITAMIN IS MINIMAL.

41

FOODS THAT ARE HIGH IN VITAMIN B ARE WHAT, AND VITAMIN B IS GOOD FOR WHAT?

GRAINS, CEREAL, BREAD, AND MEATS;
VITAMIN B MAY PROMOTE A SENSE OF WELL-BEING AND INCREASED ENERGY AS WELL AS DECREASED ANGER, TENSION, AND IRRITABILITY.

42

FOODS THAT ARE HIGH IN VITAMIN C ARE?

CITRUS FRUITS AND GREEN VEGETABLES. IF THE FRUITS AND VEGETABLES ARE CUT, WASHED, OR COOKED, A LARGE AMOUNT OF VITAMIN C IS LOST.

43

VITAMIN B COMPLEX HAS 4 VITAMIN B COMPLEX MEMBERS LIST THEM:

VITAMIN B1 (THIAMINE)
VITAMIN B2 (RIBOFLAVIN)
VITAMIN B3 (NICOTINIC ACID, OR NIACIN)
VITAMIN B6 (PYRIDOXINE)

44

VITAMIN B1 (THIAMINE):

THIAMINE DEFICIENCY CAN LEAD TO THE POLY-NEURITIS AND CARDIAC PATHOLOGY SEEN IN BERIBERI OR TO WERNICKE ENCEPHALOPATHY THAT PROGRESSES TO KORSAKOFF SYNDROME, CONDITIONS MOST COMMONLY ASSOCIATED WITH ALCOHOL ABUSE.

45

WERNICKE-KORSAKOFF SYNDROME IS?

A SIGNIFICANT CENTRAL NERVOUS SYSTEM DISORDER CHARACTERIZED BY CONFUSION, NYSTAGMUS, DIPLOPIA, ATAXIA, AND LOSS OF RECENT MEMORY. IF NOT TREATED, IT MAY CAUSE IRREVERSIBLE BRAIN DAMAGE. IV ADMINISTRATION OF THIAMINE IS RECOMMENDED FOR TREATMENT OF WERNICKE-KORSAKOFF SYNDROME. THIAMINE MUST BE GIVEN BEFORE GIVING ANY GLUCOSE TO AVOID AGGRAVATION OF SYMPTOMS.

46

VITAMIN B2 (RIBOFLAVIN):

CAN BE GIVEN TO MANAGE DERMATOLOGIC PROBLEMS SUCH AS SCALY DERMATITIS, CRACKED CORNERS OF THE MOUTH, AND INFLAMMATION OF THE SKIN AND TONGUE. TO TREAT MIGRAINE HEADACHE, RIBOFLAVIN IS GIVEN IN LARGER DOSES THAN FOR DERMATOLOGIC CONCERNS.

47

VITAMIN B3 (NICOTINIC ACID, NIACIN)

IS GIVEN TO ALLEVIATE PELLAGRA AND HYPERLIPIDEMIA, FOR WHICH LARGE DOSES ARE REQUIRED. LARGE DOSES MAY CAUSE GI IRRITATION AND VASODILATION, RESULTING IN A FLUSHING SENSATION.

48

VITAMIN B6 (PYRIDOXINE):

GIVEN TO: CORRECT VITAMIN B6 DEFICIENCY CAUSED BY LACK OF ADEQUATE DIET, INBORN ERROR OF METABOLISM, OR DRUG-INDUCED DEFICIENCIES SECONDARY TO INH, PENICILLAMINE, OR CYCLOSPORINE (OR HYDRALAZINE) THERAPY. HELP ALLEVIATE THE SYMPTOMS OF NEURITIS CAUSED BY ISONIAZID (INH) THERAPY FOR TUBERCULOSIS.
ARE: ESSENTIAL BUILDING BLOCKS OF NUCLEIC ACIDS, RED BLOOD CELL FORMATION, AND SYNTHESIS OF HEMOGLOBIN.

49

VITAMIN B6 DEFICIENCIES MAY OCCUR?

IN ALCOHOLICS ALONE WITH DEFICIENCIES OF OTHER B-COMPLEX VITAMINS. ALCOHOLICS AND PEOPLE WITH DIABETES MAY BENEFIT FROM DAILY SUPPLEMENTATION. IS READILY ABSORBED IN THE JEJUNUM AND STORED IN THE LIVER, MUSCLE, AND BRAIN. IT IS METABOLIZED IN THE LIVER AND EXCRETED IN THE URINE.

50

VITAMIN C (ASCORBIC ACID):

IS ABSORBED FROM THE SMALL INTESTINE. AIDS IN ABSORPTION OF IRON AND IN THE CONVERSION OF FOLIC ACID. IT IS NOT STORED IN THE BODY AND IS EXCRETED READILY IN THE URINE.
A HIGH SERUM VITAMIN C LEVEL THAT RESULTS FROM EXCESSIVE DOSING OF VITAMIN C IS EXCRETED BY THE KIDNEYS UNCHANGED.
RECOMMENDED DAILY DOSE OF VITAMIN C FOR ADULTS IS 50 TO 100 MG/DAY. SOME PEOPLE TAKE HIGHER AMOUNTS TO TREAT A UPPER RESPIRATORY INFECTIONS, CANCER, OR HYPERCHOLESTEROLEMIA. MASSIVE DOSES CAN CAUSE DIARRHEA AND GI UPSET.

51

VITAMIN C PHARMACOKINETICS:

ABSORBED READILY THROUGH GI TRACT AND IS DISTRIBUTED THROUGHOUT THE BODY FLUIDS. THEY KIDNEYS COMPLETELY EXCRETE VITAMIN C, MOSTLY UNCHANGED.
ABSORPTION: PO: QUICKLY
DSITRIBUTION: pb: 25%
MATABOLISM: UK
EXCRETION: IN THE URINE, UNCHANGED WITH HIGH DOSES

52

VITAMIN C PHARMACODYNAMICS:

IS NEEDED FOR CARBOHYDRATE METABOLISM AND PROTEIN AND LIPID SYNTHESIS AND COLLAGEN SYNTHESIS (FOR CAPILLARY ENDOTHELIUM), CONNECTIVE TISSUE, AND TISSUE REPAIR, AND OSTEOID TISSUE OF THE BONE. LARGE DOSES OF VITAMIN C DECREASES THE EFFECT OF ORAL ANTICOAGULANTS. SMOKING DECREASES SERUM VITAMIN C LEVELS. AND AIDS IN IRON ABSORPTION.

53

MEGAVITAMIN THERAPY (MASSIVE DOSAGES OF VITAMINS):

(VITAMIN C) CAN BE TOXIC AND MIGHT RESULT IN MINIMAL DESIRED EFFECT. MANY BELIEVE VITAMIN C DOES NOT CURE THE COMMON COLD BUT GIVES IT A PLACEBO EFFECT. MEGA-DOSE OF VITAMIN C TAKEN WITH ASPIRIN OR SULFONAMIDES MAY CAUSE CRYSTAL FORMATION IN THE RUNE, CAUSE A FALSE-NEGATIVE OCCULT (BLOOD) STOOL RESULT AND FALSE-POSITIVE SUGAR RESULT IN THE URINE WHEN TESTED BY THE CLINITEST METHOD. IF MEGA VITAMIN THERAPY IS TO BE DISCONTINUED, IT IS REQUIRED THAT A PERSON GRADUALLY REDUCE THE DOSE TO AVOID VITAMIN DEFICIENCY.

54

VITAMIN C (CONTRAINDICATIONS, SIDE EFFECTS, ADVERSE REACTIONS)

CONTRAINDICATIONS: CAUTION: RENAL CALCULI, GOUT, ANEMIA, SICKLE CELL, SIDEROBLASTIC, THALASSEMIA.

SIDE EFFECTS: ORAL: NAUSEA, VOMITING, DIARRHEA, HEARTBURN, HEADACHE.
PARENTERAL: FLUSHING, HEADACHE, DIZZINESS, SORENESS AT INJECTION SITE.

ADVERSE REACTIONS: KIDNEY STONES, CRYSTALLURIA, HYPERURICEMIA. HEMOLYTIC ANEMIA WITH CLIENTS WITH G6PD.
LIFE-THREATENING: SICKLE CELL CRISIS, DEEP VEIN THROMBOSIS

55

FOLIC ACID (FOLATE):

FOLIC ACID IS ABSORBED FROM THE SMALL INTESTINE, AND THE ACTIVE FORM OF FOLIC ACID (FOLATE) IS CIRCULATED TO ALL TISSUES. ONE-THRID SI STORED IN THE LIVER, AND THE REST IS STORED IN TISSUES. 80% EXCRETED IN BILE, 20% IN URINE.

56

FOLIC ACID (FOLATE) IS NEEDED FOR?

ESSENTIAL FOR BODY GROWTH, DNA SYNTHESIS, WITHOUT FOLIC ACID THERE IS A DISRUPTION IN CELLULAR DIVISION. CHRONIC ALCOHOLISM, POOR NUTRITIONAL INTAKE, MALABSORPTION SYNDROMES, PREGNANCY, AND DRUGS THAT CAUSE INADEQUATE ABSORPTION OR FOLIC ACID ANTAGONISTS ARE CAUSES OF FOLIC ACID DEFICIENCIES. SYMPTOMS OF FOLIC ACID DEFICIENCIES INCLUDE: ANOREXIA, NAUSEA, STOMATITIS, DIARRHEA, FATIGUE, ALOPECIA, AND BLOOD DYSCRASIAS. THESE ARE NOTE NOTED UNTIL 2 TO 4 MONTHS AFTER FOLIC ACID IS DEPLETED.

57

FOLIC ACID DEFICIENCY DURING PREGNANCY:

DEFICIENCY DURING FIRST TRIMESTER CAN EFFECT THE CNS DEVELOPMENT OF FETUS. CAN CAUSE NEURAL TUBE DEFECTS (SPINA BIFIDA, ANENCEPHALY)
RECOMMENDED THAT PREGNANT WOMEN TAKE 400 MCG OF SUPLIMENT FOLIC ACID DAILY.

58

FOLIC ACID INFORMATION:

SOME EVIDENCE SUGGEST THAT 400 TO 800 MCG PER DAY CAN DECREASE THE INCIDENCE OF CORONARY ARTERY DISEASE (CAD). IT ALSO DECREASES THE AMINO ACID HOMOCYSTEINE IN THE BLOOD, WHICH MAY CONTRIBUTE TO HEART DISEASE. ALSO OFFERS SOME PROTECTION FROM COLORECTAL CANCER. EXCESSIVE DOSES OF FOLIC ACID MAY MASK SIGNS OF VITAMIN B12 DEFICIENCY. CLIENTS TAKING DILANTIN TO CONTROL SEIZURES SHOULD BE CAUTIOUS ABOUT TAKING FOLIC ACID, CAN LOWER THE SERUM PHENYTOIN THAT CAN INCREASE THE RISK OF SEIZURES. PHENYTOIN DOSES SHOULD BE ADJUSTED.

59

VITAMIN B12 IS NEEDED FOR:

ESSENTIAL FOR DNA SYNTHESIS, AIDS IN CONVERSION OF FOLIC ACID TO ITS ACTIVE FORM. WITH FOLIC ACIDS IT PROMOTES CELLULAR DIVISION. NEEDED FOR NORMAL HEMATOPOIESIS, AND TO MAINTAIN NERVOUS SYSTEM INTEGRITY, ESPECIALLY THE MYELIN.

60

VITAMIN B12 ADSORPTION:

THE GASTRIC PARIETAL CELLS PRODUCE AN INTRINSIC FACTOR THAT IS NECESSARY FOR THE ABSORPTION OF VITAMIN B12 THROUGH THE INTESTINAL WALL. WITHOUT THE INTRINSIC FACTOR, LITTLE OR NO VITAMIN B12 IS ABSORBED. AFTER ABSORPTION IT BINDS TO THE PROTEIN TRANSCOBALAMIN II AND IT TRANSFERRED TO THE TISSUES. MOST IS STORED IN THE LIVER, AND IS SLOWLY EXCRETED IT CAN TAKE UP TO 2 OR 3 YEARS FOR STORED B12 TO BE DEPLETED AND A DEFICIT NOTED.

61

VITAMIN B12 DEFICIENCY:

UNCOMMON UNLESS THERE IS A DISTURBANCE OF THE INTRINSIC FACTOR AND INTESTINAL ABSORPTION. PERNICIOUS ANEMIA IS A MAJOR CAUSE. CAN ALSO DEVELOP IN STRICT VEGETARIANS WHO DO NOT CONSUME MEAT, FISH OR DAIRY PRODUCTS. OTHER REASONS IS MALABSORPTION SYNDROME, GASTRECTOMY, CROHN'S DISEASE, AND LIVER AND KIDNEY DISEASE. COMMONLY SEEN WITH METFORMIN AND PROTON PUMP INHIBITORS.

62

VITAMIN B12 DEFICIENCY SYMPTOMS:

NUMBNESS AND TINGLING IN THE LOWER EXTREMITIES, WEAKNESS, FATIGUE, ANOREXIA, LOSS OF TASTE, DIARRHEA, MEMORY LOSS, MOOD CHANGES, DEMENTIA, PSYCHOSIS, MEGALOBLASTIC ANEMIA WITH MACROCYTES IN BLOOD, AND MEGALOBLASTS IN BONE MARROW.

63

CORRECTION OF B12 DEFICIENCY:

CYANOCOBALAMIN IN CRYSTALLINE FORM CAN BE GIVEN INTRAMUSCULARLY FOR SEVERE DEFICITS. CANT BE GIVEN IV BECAUSE OF POSSIBLE HYPERSENSITIVE REACTIONS. CAN BE GIVEN ORALLY AND IS COMMONLY FOUND IN MULTIVITAMIN PREPARATIONS. CAN ALSO BE GIVEN SUBQ INJECTION.

64

MINERALS NEEDED FOR BODY FUNCTION ARE:

IRON, COPPER, ZINC, CHROMIUM AND SELENIUM.

65

IRON (FERROUS, SULFATE, GLUCONATE OR FUMARATE) IS VITAL FOR AND SOURCES ARE?

IT VITAL FOR HEMOGLOBIN REGENERATION. 60% IS FOUND IN HEMOGLOBIN. CAUSES ANEMIA WHEN IRON IS DEFICIENT. NORMAL DIET HAS 5 - 20 MG OF IRON. FOODS RICH IN IRON ARE LIVER, LEAN MEATS, EGG YOLKS, DRIED BEANS, GREEN VEGETABLES, AND FRUIT. FOODS, TETRACYCLINE, QUINOLONE ANTIBIOTICS AND ANTACIDS SLOW THE ABSORPTION OF IRON, VITAMIN C INCREASES ABSORPTION.

66

IRON IN PREGNANT WOMEN:

INCREASED AMOUNT DURING PREGNANCY IS NEEDED. IN FIRST TRIMESTER MEGA-DOSE IS CONTRAINDICATED, LARGER DOSES ARE NEEDED IN SECOND AND THIRD TRIMESTER.

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IRON PHARMACOKINETICS:

ABSORBED IN INTESTINES AN ENTERS THE PLASMA AS HEME, OR IT MAY BE STORED AS FERRITIN. ALTHOUGH FOOD DECREASED ABSORPTION BY 25-50% IT IS NECESSARY TO TAKE WITH FOOD TO AVOID GI DISCOMFORT.

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IRON PHARMACODYNAMICS:

IRON DEFICIENCY IS GIVEN USUALLY TO CORRECT OR CONTROL IRON-DEFICIENCY ANEMIA. THIS IS DIAGNOSED BY A LABORATORY BLOOD SMEAR. CLINICAL SIGNS INCLUDE FATIGUE, WEAKNESS, SHORTNESS OF BREATH, PALLOR, AND IN CASES OF SEVERE ANEMIA, INCREASED GI BLEEDING.
ONSET OF ACTION: TAKES DAYS
PEAK: DAYS OR WEEKS

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IRON TOXICITY:

A SERIOUS CAUSE OF POISONING IN CHILDREN. AS FEW AS TEN TABLETS TAKEN AT ONCE CAN BE FATAL WITHIN 12 TO 48 HOURS. HEMORRHAGE BECAUSE OF ULCEROGENIC EFFECTS OF UNBOUND IRON LEADS TO SHOCK. PARENTS SHOULD BE CAUTIOUS IN LEAVING IRON PRODUCTS OR MULTIVITAMINS (ESPECIALLY THOSE WITH IRON) WHERE CHILDREN CAN GET A HOLD OF.

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IRON SIDE EFFECTS AND ADVERSE REACTIONS:

SIDE EFFECTS: NAUSEA, VOMITING, DIARRHEA, CONSTIPATION, EPIGASTRIC PAIN, **ELIXIR MAY STAIN TEETH**
ADVERSE REACTIONS: EXISTING GI CONDITIONS MAY BE AGGRAVATED, DROWSINESS.
LIFE-THREATENING: IRON POISONING AND MAY RESULT IN CARDIOVASCULAR COLLAPSE, METABOLIC ACIDOSIS.
TOXICITY: NAUSEA, VOMITING, DIARRHEA, **GREEN TARRY STOOL**, HEMATEMESIS, PALLOR, CYANOSIS, SHOCK AND COMA.

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COPPER (REASON WE NEED COPPER):

NEEDED FOR