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1

Magnesium

DRUG INTERACTIONS

Do not take supplements @ same time as:

QUINOLONE ABx /// TETRACYCLINES

BISPHOSPHONATES

Take supplement 2 HOURS AFTER taking the above medications

2

Dietary Sources of
IRON

Heme iron
Meat + Seafood + Poultry

 

Non-Heme
Nuts + Beans + Veggies + Fortified Grain

3

Magnesium 
FACTS

Important for BONE Structure

Involved in several BioChemical Processes / Reactions
muscle / nerve fxn
blood glucose control
HEART rhythem

Adults contain 25g of Mg
50-60% in bone
Rest in soft tissue

4

Vitamin D Facts

Fat Soluble Vitamin
that MAINTAINS CALCIUM levels in the body

Main role:
Promotes absorption of dietary calcium from small intestine

helps regulate calcium + phosphorus metabolism in BONE

Neuromuscular activity / cell growth / immune function

5

 Excess Calcium

ADR / CI / P

>2,500 mg for ALL ages

GI:
Upset stomach / Bloating / Belching / Flatulence / Diarrhea
Constipation

EXCESSIVE Supplementation
--> KIDNEY STONES

CV: INCREASED risk for MI in postmenopausal women / older adults

6

Indications for 
MAGNESIUM Supplementation

Mg DEFICIENCY

 

GERD / Dyspepsia
contained in ANTACIDS

Constipation
contained in LAXATIVES

7

Dietary Supplement Health & Educaion Act of 1994

Regulate Vitamins & Minerals
+ Herbs / Amino Acids / Enzymes

Should Clearly state that product is a dietary supplement

Should be taken by MOUTH

Intended to SUPPLEMENT Diet

8

Magnesium in

CONSTIPATION TREATMENT

Want to take account for DIARRHEA

Citrate / Sulfate / Hydroxide Salts

SULFATE salt
is the MOST POTENT in causing DIARRHEA

9

Dietary Sources of

MAGNESIUM

Legumes / Whole Grains
Brocolli / squash / green veggies / seeds / nuts

DAIRY / meats / chocolate / cofee

 

30%-40% of dietary Mg absorbed by body

10

SLOW-FE

142mg Ferrous Sulfate = IRON 45mg
ER

1T QD WF

Recommended is 8 males / 18mg females /
27mg Pregnancy / 9 mg Lactation

 

11

Calcium Citrate

Citrical

May be taken on an EMPTY STOMACH

21% elemental calcium

12

Daily Reference Intakes

Recommended Dietary Allowance = RDA
avg daily intate that meets needs of MOST healthy people

Adequate Intake = AI
level established when data lacking on nutrient requirements

Tolerable upper Intake level = UL
MAX daily intake, unlikely to cause adverse health effects

Estimated Average Requirement = EAR

13

RDA of

MAGNESIUM

Increased need w/ age
19-30 yo     
///     31-50 yo

Male = 400 /// 420 mg

Female = 310 /// 320 mg

Pregnancy = 350 /// 360 mg

Lactation = 310 /// 320 mg
same as regular female

MAX DOSE = 350mg for ALL >19 yo

 

14

Calcium Supplementation

INDICATIOn

Maintain normal calcium stores to
PREVENT Osteoporosis
&
Glucocorticoid-induced Osteoporosis

Treat hypoCalcemia

15

RDA of Calcium

&
MAX

19-50 years

1,000 mg for ALL
1,200 mg for females >51 yo

 

2,500 mg MAX for all

16

Diet Considerations

IRON

Seperate by 1-2 hours

Acidic Food/Beverage
INCREASES ABSORPTION

Dairy & Tea
DECREASE absorption

17

Vitamin D 
Counseling Points

DO NOT EXCEED > 4,000 IU
> 9 y/o limit

SUNLIGHT Exposure is KEY!

 

VERY LOW FAT DIET can lead to deficiency

18

Risk Factors for

IRON DEFICIENCY

Group @ Risk:
Pregnant women

Infants + Young children

Heavy Menstrual Bleeding

Frequent Blood Donors

Cancer / GI Surgery + Disorders

Heart failure

19

Iron

Max Dose / ADR / CI-P

< 45 mg / day

GI Upset:
ab pain / constipation / diarrhea / NV

Contraindications / Precautions
Existing GI Disease = PUD / Ulcers - AVOID IRON USE
Frequent Blood Transfusions
Elderly = risk of OD
Pediatric = accidental OD 
leading cause of fatal poisoning age <6

20

What Vitamins / Minerals have interactions with

LOOP DIURETICS
furosimide / torsemide / bumetanide

CALCIUM & MAGNESIUM
Decrease in these minerals

 

ALSO CAUSE:

THIAMINE DEFICIENCY
B1

21

Drugs that

DECREASE

Iron Absorption

H2RA / PPI

ANTACIDS with:
Al / Mg / Ca

Tetracycling + Doxycycline

Cholestyramine

22

Carbonyl Iron

100% Elemental Iron
NOT AN IRON SALT, highly purified iron

Dissolves in Gastric Secretion --> converted to HCL salt
--> SLOW RATE --> continued release of iron for 1-2 days

LESS TOXIC
in comparison to iron salts, need a much higher dose for toxicitiy

23

RDA of IRON

19-50 y/o

Male = 8

Female = 18 

Pregnancy =  27

Lactation = 9

ALL MAX = 45mg

24

Ergocalciferol

Vitamin D2

Derived from PLANTS

400 / 2k / 8k / 50k

25

Drug levels

AFFECTED by IRON

 

DECREASES ALL OF THESE

Levodopa + Methyldopa

Levothyroxine = chelates w/ iron - wait 3-4 hours

Penicillamine / Fluoroquinolones

Tatracycline + Doxycycline
wait 2 hours before iron admin

Mycophenolate

26

Magnesium
Formulation CONSIDERATIONS

GLUCONATE / CHLORIDE > Oxide
 due to less diarrhea

Sustained Release  > immediate release
due to slower absorption --> minimizes RENAL EXCRETION

Elemental Mg + BioAvailability
also must be considered

Chloride has high % elemental Mgbut it is only 20% absorbed

27

Indications for SUPPLEMENTATION of

VITAMIN D

Vit D Deficiency

Community Dwelling Adults

>65 y/o & at risk for falls
in combination with exercise + PT to prevent fractures
USPSTF recommendation

28

Calcium Deficiency
RISK FACTORS

Loop Diuretics + Corticosteroids

POST-menopausal women
Amenorrheic women
Female Athletes

Lactose Intolerance

Vegetarians
vegans eat no animal products

29

Alcoholism Affects Which Vitamins?

C / A  MAGNESIUM

B = 123 - 69

Thiamine = 1

Riboflavin = 2

Niacin = 3

Pyridoxine = 6

Folate = 9

30

What Vitamin/Mineral interacts with

Thiazide Diuretics = HCTZ / Chlorthalidone

CALCIUM
will cause an INCREASE in Calcium

 

but it will have a decrease in:
MAGNESIUM
sodium / potassium / phosphate