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PHARM 345 GI/NUTRITION > Lecture 17,18 Vitamins, Minerals And Other Supplements, Nutritional Deficiences > Flashcards

Lecture 17,18 Vitamins, Minerals And Other Supplements, Nutritional Deficiences Flashcards

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1
Q

Roles of vitamins and minerals in health

A

Essential for maintaining various physiological functions, supporting metabolism and ensuring overall health and well being

Bone health
Immune function
Blood health and oxygen transport
Nerve fx
Antioxidant protection

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2
Q

What are the water soluble vitamins

A

Vitamin B1 (thiamine)
Vitamin B2 (Riboflavin)
Vitamin B3 (Niacin)
Vitamin B6 (Pyridoxine)
Vitamin B7 (Biotin)
Vitamin B12 (Cyanocobalamin)
Folic Acid (Folate)
Vitamin C (Ascorbic acid)

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3
Q

What are the Fat Soluble Vitamins

A

Vitamin A,D,E,K

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4
Q

What are the 5 main Minerals

A

Calcium,iron,zinc,selenium,magnesium

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5
Q

Functions and sources of vitamin B1 (thiamine)

A

Fx: Needed for energy, metabolism and nerve function

Source: pork, whole grains, cereals

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6
Q

Functions and sources of vitamin B2 (Riboflavin)

A

Fx : energy needed for metabolism, normal vision and skin health

Source: milk, vegetables, whole grains

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7
Q

Function and source of vitamin B3 (niacin)

A

Fx: required to produce hemoglobin, maintain blood glucose

Sources: meat, fish, whole grain, cereals, vegetables

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8
Q

Function an sources of Vitamin B5 (panthothenic acid)

A

Fx: coenzyme for energy metabolism

Source: liver,kidney,egg yolk, legumes, broccoli

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9
Q

Function and source of Vitamin B6 (Pyridoxine)

A

Fx: coenzyme needed for protein metabolism, red blood cell production

Source; Meat, fish, poultry, legumes etc..

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10
Q

Function and sources of Vitamin B7 (Biotin)

A

Fx: coenzyme needed for energy metabolism

Sources: egg yolk, liver, yeast, bananas, grapefruit

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11
Q

Function and source of Vitamin B12 (Cyanocobalamin)

A

Fx: required for red blood cell formation, DNA synthesis, neurological function

Source: meat, fish, shellfish, eggs

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12
Q

Function and source of Folic acid

A

Fx: coenzyme needed for making DNA and new cell growth

Source: legumes, green leafy veggies, liver, breakfast cereals

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13
Q

Function and source of VitaminC (Ascorbic acid)

A

Fx: antioxidant; coenzyme for protein metabolism, immune system health, aids in iron absorption

Source: citrus fruits and vegetables

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14
Q

Vitamin A function and sources

A

Fx: vision, health skin, mucous membrane, bone and tooth growth

Source : milk, cheese, cream, butter,

beta carotene ( from plant source): leafy, dark green vegetables

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15
Q

Function and source of Vitamin D

A

Fx: calcium metabolism, cell differentiation, immunity, insulin secretion

Source: salmon, sardines, tuna and fish oils, milk products

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16
Q

Vitamin E function and sources

A

Fx: antioxidant protection from free radicals

Source: nuts, seeds, vegetable oils, egg yolk

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17
Q

Vitamin K function and sources

A

Fx: blood clotting, bone formation

Sources broccoli, soybeans, dark green leafy veggies

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18
Q

Calcium function and sources

A

Fx: mineralization of bones and teeth, contraction and dilation, blood clotting

Source: diary, kale, broccoli

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19
Q

Function and sources of Iron

A

Fx: component of hemoglobin, muscle metabolism, healthy connective tissue

Source: meat, poultry, fish, legumes, nuts and seeds

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20
Q

Function and sources of Zinc

A

Fx: involved in cellular metabolism, catalytic activity, immune fx, protein and DNA synthesis

Sources: meat, fish, seafood

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21
Q

Function and sources of Selenium

A

Fx: thyroid hormone fx, DNA synthesis, reproduction

Sources: organ meats, seafood, plant sources

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22
Q

Magnesium function and sources

A

Function: cofactor in more than 300 enzyme systems involved in protein synthesis, muscle and nerve function

Sources: Green leafy veggies, nuts, seeds, whole grains

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23
Q

What are the 6 stages of food processing

A

Ingestion
Digestion
Absorption
Transport
Metabolism
Excretion

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24
Q

Risk factors for vitamin deficiencies

A

Dietary factors
Malabsorption conditions
Increased nutrient requirements
Medication use
Chronic medical conditions
Alcohol and substance use
Lifestyle and environmental factors
Genetic and physiological factors
Cultural and social influences

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25
Risk factors for vitamin deficiencies Dietary factors, examples
Poor dietary habits Restricted diets (vegan) Food insecurity Elderly population Unbalanced diets
26
Risk factors for vitamin deficiencies Malabsorption conditions
Gastrointestinal disorders ( celiac disease, IBD, chronic diarrhea) Postbariatric surgery ( reduced absorption of iron, calcium, vitamin B12) Chronic pancreatitis ( reduce A,D,E,K)
27
Risk factors for vitamin deficiencies Increase nutrient requirements
Pregnancy and lactation Infancy and adolescence Aging Chronic diseases
28
Risk factors for vitamin deficiencies Medication use Effects of PPI,Metformin,Diuretics,Anticonvulsants,Corticosteroids
PPI- reduce stomach acid (B12,calcium,magnesium) Metformin - B12 deficiency Diuretics - pottasium, magnesium, calcium depletion Anticonvulsants - Vitamin D Corticosteroids- deplete calcium and potassium
29
Risk factors for vitamin deficiencies Chronic medical conditions - effects of liver disease, kidney disease, heart failure
Liver disease- impaired vitamin storage and metabolism (A,D,E,K) Kidney disease - loss of water soluble vitamins due to dialysis Heart failure - potential for increased nutrient needs due to medication use and fluid balance issues
30
Risk factors for vitamin deficiencies Alcohol and substance use disorders
Chronic alcohol consumption - reduced absorption - especially Thamine Substance use disorders, vitaminC, B vitamins, iron, calcium, and magnesium
31
Risk factors for vitamin deficiencies Lifestyle and environment Effects of Smoking, Sunlight exposure, physical activity
Smoking - potential higher vitamin C requirements, and potential deficiencies in folate and Vitamin E Sunlight exposure- vitamin D deficiency Physical Activity levels - increase nutrient demand
32
Risk factors for vitamin deficiencies Genetic and physiological factors
Genetic disorders - hemochromatosis, phenylketonuria Obesity- altered metabolism and nutrient distribution
33
Risk factors for vitamin deficiencies Cultural and social influences
Cultural and dietary practices -may exclude specific food groups Religious dietary restrictions- fasting or food restriction
34
Patient assessment for vitamin supplementation Collecting- patient history
Dietary habits Lifestyle factors Social determinants of health Medication history Past medical history Symptoms suggestive of deficiencies
35
Collecting dietary history from patients
24 hours dietary recall Food frequency questionnaire Typical day diet assessment Food group inquiry Patterns and restrictions ( vegan, vegetarian, gluten free, lactose free, allergies) Cooking skills and knowledge
36
Collecting lifestyle factors from patients
Smoking Alcohol use Physical activity
37
Collecting past medical history and medication history
Conditions like Celiac disease, IBD, Gastric bypass surgery Medications: PPI,Diuretics,Anticonvulsants, vitamins, minerals
38
What are some symptoms of deficiencies
Fatigue Hair loss Brittle nails Dental issues Mood changes Abnormal bruising or bleeding
39
Follow up and monitor for patients
Repeat lab tests if needed to assess improvement in nutrient levels Evaluation of symptom resolution Adherence assessment to dietary supplementation plans
40
What are the magnesium salts used for supplementation
Magnesium aspartate Magnesium bisglycinate Magnesium carbonate Magnesium Chloride Magnesium glucoheptonate Magnesium Gluconate
41
What is the indications for supplementation (magnesium) and the potential causes of deficiency
- Average health adult does not need supplementation with magnesium - malnutrition, chronic diarrhea, IBD, Diuretics, Critically ill
42
Adverse effects of magnesium supplementation
Diarrhea Nausea Toxicity: Hypotension,N/V, facial flushing, muscle weakness, arrhythmia, cardiac arrest
43
Measuring Vitamin D levels
25-hydroxyvitamin D - best biomarker of nutritional vitamin D status (Half -life of 2 weeks) Generally not required prior to or after intitating vitamin D supplementation Indicated in high risk pt: malabsorption syndromes, significant liver disease, CKD, unexplained bone pain, unusual fractures
44
What is the preferred test for Vitamin D levels and numbers associated
25-hydroxyvitamin D is preferred test <30 nmol/l- risk of deficiency 30-50 nmol/l clinical features of inadequacy in some individuals > 50nmol/l - adequate for bone health in practically all individuals >125nmol/l- potential for adverse effects
45
What are some Vitamin D sources
Food sources: Fatty fish, egg yolks, fortified foods Exposure to sunlight, BUT increased risk of skin cancer
46
On average, Canadian adults do not obtain sufficient vitamin D from dietary sources to meet the RDA of …..
RDA: 600-800IU TUL : 4000IU
47
What are the vitamin D dosage forms
Vitamin D2 - Ergocalciferol Vitamin D3 - cholecalciferol Vitamin D3 is recommended over vitamin D2 as it has been show to be 3x more effective than D2 at increasing 25-hydroxyvitamin D levels High dose vitamin D once/year not recommended- increase risk of fracture
48
What are some potential indication for higher doses of D2/D3
Malabsorption, obesity, meds that affect metabolisms of VitD - 5000U daily or 50,000u weekly - maintancene: 1500-2000u/day Vitamin D-resistant rickets - 12,000-500,000U daily Hypoparathyrodism -50,000-200,000 daily
49
Vitamin D toxicity (>250nmol/l)
Hypercalceima -Confusion, depression, psychosis -vomiting, abdominal pain, anorexia, constipation -hypertension, arrhythmias,
50
Vitamin B12 testing Recommend?
Not recommended 1150-220pmol/l Test if clinically symptomatic patient with specific features of B12 deficiency
52
What is the recommendation in all Canadians over the age of 50 in terms of vitamin D
Take 400IU of vitamin D per day in addition to consuming vitamin D rich food
53
Risk factors for Vitamin B12 low levels Diet Medical hx Medications
Diet: Vegetarian, vegan, chronic excessive alcohol use Medical Hx: increasing age, pernicious anemia, crohns, celiac disease Medications: Metformin, PPI, H2 receptor antagonists
54
Treatment recommendations for vitamin B12 deficiency 1.Adults with normal absorption 2.Adult with impaired absorption 3.Adults with dietary deficiency 4.Pernicious anemia 5.Altered GI anatomy 6.Adults anemia or neurological symptoms or pregnancy
1 - 1000mcg daily orally 2- high doses 1000-2000mcg daily 3- 500-2000 mcg orally 4- IM/deep SC, 1000mcg once per week for 4 weeks, then once per month. Can do high dose oral 5- IM/Deep SC, 1000mcg once per week x4 then once per month 6. IM/Deep SC, 1000mcg daily or every other day for 1-2 weeks then once month. Trial oral 1000-2000 mcg based on preference
55
Following and monitor for VitaminB12
Hematologic parameters should resolve within weeks Neurological/neuropsychaitric within months B12 levels every 3-6 months
56
Celiac disease Deficient nutrients and supplement recommendation
- iron, folate, B12, Fat-soluble vitamin, calcium - iron 325mg daily, folate 1mg, B12 1000mcg, vitamin D 1000-2000 IU daily
57
Crohn’s disease, deficient nutrients and supplement recommendations
- Deficient nutrient - B12, Iron, Zinc, Fat soluble vitamins - B12 1000mcg IM monthly, zinc 10-40mg daily, iron 325 mg daily
58
Short bowel syndrome deficient nutrients and supplement recommendations
B12, Fat soluble vitamins, iron, calcium, Zinc B12 1000mcg IM monthly, High dose fat soluble vitamins, zinc 10-40 mg daily
59
Chronic pancreatitis deficient nutrients and supplement recommendations
Deficient nutrients- Fat soluble vitamins, B12, Calcium Enzyme replacement, vitamin B12 1000mcg daily, Calcium 1000-1500 mg daily
60
Thiamine- Alcohol disorder Increased risk of ……. Treatment dose
Increased risk of wernicke-korsakoff syndrome 200-500mg IM/IV 3 times daily for 2-7 days, followed by 250mg once daily for 3-5 days
61
Thiamine Deficiency = Beriberi
“Wet”- high output cardiac failure Dry - peripheral neuropathy, absent knee jerk and deep tendon reflexes, progressive weakness and muscle atrophy Thiamine supplementation, initial - IM/IV, or oral : 100-200mg 3x daily for 2-3 days. Maintenance : 5-100mg once daily until no longer at risk of deficiency
62
Cancer prevention Breast cancer
B vitamins- limit supplementation for primary prevention of breast cancer Vitamin D- Not recommended for prevention Vitamin E - Limit or avoid Vitamine E supplementation
63
Cardiovasculate disease prevention ( primary)
Limit supplementation of the following - Vitamin C, Multivitamins - Vitamin D - Omega-3-fatty acids
64
CVD- secondary prevention
Avoid routine use of - antioxidants Omega-3fatty acids - unlikely benefit, but minimal risk - high dose supplementation with icosapent ethyl may reduce elevated triglycerides
65
Absorption Interactions
Mechanism : Chelation, PH changes, alterations in gastrointestinal motility or enzyme activity Examples: calcium, iron, zinc, magnesium ( bind to tetracyclines and fluoroquinolones reducing absorption). Antacids ( calcium carbonate, aluminum hydroxide), reduce absorption of iron and B12 due to increased gastric PH Management: separate administration times
66
Metabolism interaction
Mechanism: enzyme inhibition or induction, nutrients affecting drug metabolism Examples: Vitamin K + warfarin = reduce effectiveness of warfarin. Grapefruit inhibits CYP3A4 - potential to increase concentration of some statin and CCB Management: patient education on consistent vitamin K intake, avoidance of grapefruit with certain medication
67
Distribution and protein binding
Mechanism : completion between drug and nutrient for plasma protein binding sites Examples: vitamin A and warfarin - displacement of warfarin from protein binding sites, increasing bleeding risk Management: monitor INR and adjust doses as necessary
68
Symptoms of low Vitamin B12
Fatigue, weakness, pallor, numbness tingling, cognitive difficulties, depression
69
What are some nutrient deficiency induced by drugs
Vitamin B12 - long term use of PPI or Metformin Folic acids - methotrexate,phenytoin Calcium and Vitamin D - corticosteroids
70
What are some nutrient affecting drug efficacy and monitoring and management
Iron and calcium- reduces efficacy of levothyroxine Managementz; adjust timing, seperate administration
71
T/F loop diuretics may increase excretion of potassium,magnesium,calcium
True
72

PHARM 345 GI/NUTRITION (34 decks)

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