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Clinical Pharmacy 1 - Term 1 > 12 - Common Vitamins & Minerals > Flashcards

12 - Common Vitamins & Minerals Flashcards

1
Q

Which calcium has the highest percentage of elemental calcium?

A

Calcium carbonate

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2
Q

For optimal absorption, calcium doses should not exceed ___ mg of elemental calcium

A

500

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3
Q

What should be done if more than 500 mg of calcium supplementation is needed?

A

Divide it throughout the day (BID or TID)

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4
Q

Where does the best calcium absorption occur?

A

Acidic environment, so should be taken w/ meals

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5
Q

What should calcium supplements not be taken w/?

A

High fiber meals and foods like spinach, nuts, beans, seeds, and wheat bran b/c may decrease absorption

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6
Q

Which type of calcium is first line?

A

Calcium carbonate

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7
Q

What is a potential side effect of calcium supplements?

A

Constipation, so fiber can help this, just don’t consume fiber and calcium together

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8
Q

When is calcium citrate recommended?

A

Px on PPI’s or H2 blockers, inflammatory bowel disease, or absorption disorders

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9
Q

Does calcium citrate need to be taken w/ food?

A

No, can be taken on an empty stomach

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10
Q

What is an advantage to calcium citrate over calcium carbonate?

A

Calcium citrate has increased absorption, especially in px w/ high gastric pH

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11
Q

Are natural preparations of calcium from oyster shells or bone meal safe?

A

May contain lead, but calcium blocks lead absorption

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12
Q

What are some consequences of calcium overdose?

A
  • Kidney stones
  • Milk-alkali syndrome
  • Renal insufficiency
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13
Q

Iron supplements containing more than ___ mg of elemental iron are schedule 2

A

30 mg

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14
Q

Which type of iron is more readily absorbed?

A

Ferrous iron (not ferric)

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15
Q

Where does majority of iron absorption occur?

A

Distal duodenum and proximal jejunum

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16
Q

Are enteric coated or sustained release iron supplements effective?

A

Not if iron is released past the duodenum or jejunum

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17
Q

Where is excess iron stored and what can this lead to?

A
  • Tissues and organs

- Cirrhosis, heart failure

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18
Q

What are the different formulations of iron from least to most elemental iron?

A
  • Least = ferrous gluconate
  • Ferrous sulfate
  • Ferrous fumarate
19
Q

Should iron salts be taken w/ food or on an empty stomach?

A

Empty stomach

20
Q

Which foods can impair iron absorption?

A
  • Cereals
  • Dietary fiber
  • Tea, coffee
  • Eggs
  • Milk
21
Q

What can be done if iron salts cause stomach irritation?

A
  • Take w/ food
  • Switch to product w/ less elemental iron
  • Smaller, less frequent doses
  • Switch to liquid formulation for smaller titrations (however not very palatable)
22
Q

Which medications can decrease absorption of iron?

A
  • Antacids, PPI’s, H2 blockers

- Take iron 2 hours before or 4 hours after antacids

23
Q

What can be done if px on PPI’s need iron supplementation?

A
  • Changing timing of dosing won’t help

- Want to choose a product that won’t interact or doesn’t require acid

24
Q

What are some GI side effects of iron?

A
  • Abdominal discomfort
  • N/V
  • Diarrhea, constipation
  • Dark stools
25
Q

What effect does vitamin C have on iron absorption?

A

Increases iron absorption

26
Q

What effect do B vitamins have on energy?

A

Help to release energy from food

27
Q

What should be done if a px asks for a B vitamin to relieve stress?

A
  • Suggest non-pharms
  • Reduce caffeine, alcohol, and smoking
  • Exercise
  • Sufficient sleep
  • Relaxation techniques
28
Q

Do B vitamins decrease risk of skin cancer?

A
  • No effect in px w/o skin cancer, so not a replacement for current recommendations for sun protection
  • Niacinamide was shown to help high-risk px who already have nonmelanoma skin cancer
29
Q

What is the leading cause of poor vision in adults over 60 y/o and of adult blindness?

A

Age-related macular degeneration

30
Q

What is macular degeneration?

A
  • Deterioration of macula
  • Macula is small area at center of retina in the back of the eye, purpose is to permit seeing fine details clearly
  • Loss of central vision yet peripheral vision unaffected
31
Q

What are some non-modifiable risk factors for age-related macular degeneration?

A
  • Older age (usually over 50 y/o)
  • Ethnicity (caucasian and asian)
  • Genetics
32
Q

What are some modifiable risk factors for age-related macular degeneration?

A
  • History of smoking
  • Obesity
  • Diet w/ high saturated fat
  • Diet w/ low omega-3 fatty acids
  • Diet w/ low antioxidants and zinc
33
Q

What are signs and symptoms of age-related macular degeneration?

A
  • Blurred center of vision
  • Vision impairment
  • Dark adaptation decreased
  • Vision distortion (straight lines look wavy)
  • Blank areas in vision / partial loss of vision
  • Flashes of light
34
Q

What is dry age-related macular degeneration?

A
  • Result of thinning of macula
  • More common form
  • Development occurs over many years
  • 3 stages – early, intermediate, and advanced
35
Q

What is wet age-related macular degeneration?

A
  • Result of abnormal blood vessels growing under retina
  • Less common, but more serious
  • Quickly progresses, leading to severe vision loss or blindness
36
Q

What is the tx for wet AMD?

A
  • Anti-vascular endothelial growth factor injections

- Photodynamic therapy

37
Q

What is the tx for dry AMD?

A
  • No proven effective tx
  • Current recommendation for px w/ intermediate to advanced stages of dry AMD is AREDS2 formulation (vitamin A, C, lutein, and zeaxanthin) to reduce further progression
38
Q

Potential nutrient depletion caused by Orlistat

A
  • May be a decrease in levels of some fat soluble vitamins and beta-carotene
  • Recommended for px to take multivitamin supplement at least 2 hours before/after Orlistat
39
Q

Potential nutrient depletion caused by metformin

A
  • Decrease in folate and vitamin B12 in some px
  • Monitor vitamin B12 yearly
  • Some px may require supplements
40
Q

Potential nutrient depletion caused by corticosteroids

A
  • Oral corticosteroids w/ high mineralocorticoid activity can cause steroid-induced osteoporosis
  • Supplements w/ calcium and vitamin D needed in px taking > 7.5 mg prednisone daily (or equivalent)
41
Q

Which oral corticosteroids have high mineralocorticoid activity?

A
  • Hydrocortisone
  • Cortisone
  • Prednisone
  • Prednisolone
42
Q

Which drugs does vitamin A (beta-carotene) interact w/?

A
  • Retinoids (avoid combination)
  • Hepatoxic medications, acetaminophen, carbamazepine, methotrexate (avoid combination)
  • Warfarin (avoid combination)
43
Q

What drugs does vitamin E interact w/ and what should be done for management?

A
  • When combinated w/ warfarin, ASA, or NSAIDs may increase risk of bleeding
  • Restrict vitamin E to less than 200 IU per day and monitor INR for warfarin

Clinical Pharmacy 1 - Term 1 (18 decks)

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