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PDAT1 > 14 - Vitamins & Minerals > Flashcards

14 - Vitamins & Minerals Flashcards

1
Q

Magnesium

DRUG INTERACTIONS

A

Do not take supplements @ same time as:

QUINOLONE ABx** /// **TETRACYCLINES

BISPHOSPHONATES

Take supplement 2 HOURS AFTER taking the above medications

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2
Q

Dietary Sources of
IRON

A
  • *Heme iron**
  • *Meat + Seafood + Poultry**
  • *Non-Heme**
  • *Nuts + Beans + Veggies + Fortified Grain**
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3
Q

Magnesium
FACTS

A

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

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4
Q

Vitamin D Facts

A

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

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5
Q

Excess Calcium

ADR / CI / P

A

>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

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6
Q

Indications for
MAGNESIUM Supplementation

A

Mg DEFICIENCY

  • *GERD / Dyspepsia**
  • *contained in** ANTACIDS

Constipation
contained in LAXATIVES

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7
Q

Dietary Supplement Health & Educaion Act of 1994

A

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

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8
Q

Magnesium in

CONSTIPATION TREATMENT

A

Want to take account for DIARRHEA

Citrate / Sulfate / Hydroxide Salts

SULFATE salt
is the MOST POTENT** in causing **DIARRHEA

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9
Q

Dietary Sources of

MAGNESIUM

A

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

DAIRY / meats / chocolate / cofee

30%-40% of dietary Mg absorbed by body

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10
Q

SLOW-FE

A

142mg Ferrous Sulfate = IRON 45mg
ER

1T QD WF

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

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11
Q

Calcium Citrate

A

Citrical

May be taken on an EMPTY STOMACH

21% elemental calcium

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12
Q

Daily Reference Intakes

A

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

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13
Q

RDA of

MAGNESIUM

A

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

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14
Q

Calcium Supplementation

INDICATIOn

A

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

Treat hypoCalcemia

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15
Q

RDA of Calcium

&
MAX

A

19-50 years

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

2,500 mg MAX for all

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16
Q

Diet Considerations

IRON

A

Seperate by 1-2 hours

Acidic Food/Beverage
INCREASES ABSORPTION

  • *Dairy & Tea**
  • DECREASE absorption*
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17
Q

Vitamin D
Counseling Points

A

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

SUNLIGHT Exposure is KEY!

VERY LOW FAT DIET can lead to deficiency

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18
Q

Risk Factors for

IRON DEFICIENCY

A

Group @ Risk:
Pregnant women

Infants + Young children

Heavy Menstrual Bleeding

Frequent Blood Donors

Cancer / GI Surgery + Disorders

Heart failure

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19
Q

Iron

Max Dose / ADR / CI-P

A

< 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

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20
Q

What Vitamins / Minerals have interactions with

LOOP DIURETICS
furosimide / torsemide / bumetanide

A
  • *CALCIUM & MAGNESIUM**
  • Decrease in these minerals*

ALSO CAUSE:

THIAMINE DEFICIENCY
B1

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21
Q

Drugs that

DECREASE

Iron Absorption

A

H2RA / PPI

  • *ANTACIDS** with:
  • *Al / Mg / Ca**

Tetracycling + Doxycycline

Cholestyramine

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22
Q

Carbonyl Iron

A
  • *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

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23
Q

RDA of IRON

A

19-50 y/o

Male = 8

Female = 18

Pregnancy = 27

Lactation = 9

ALL MAX = 45mg

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24
Q

Ergocalciferol

A

Vitamin D2

Derived from PLANTS

400 / 2k / 8k / 50k

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25
Q

Drug levels

AFFECTED by IRON

A

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

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26
Q

Magnesium
Formulation CONSIDERATIONS

A

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 Mg, but it is only _20% absorbed_

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27
Q

Indications for SUPPLEMENTATION of

VITAMIN D

A

Vit D Deficiency

Community Dwelling Adults

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

28
Q

Calcium Deficiency
RISK FACTORS

A

Loop Diuretics + Corticosteroids

  • *POST-menopausal** women
  • *Amenorrheic** women
  • *Female Athletes**

Lactose Intolerance

Vegetarians
vegans eat no animal products

29
Q

Alcoholism Affects Which Vitamins?

A

C / A MAGNESIUM

B = 123 - 69

Thiamine = 1

Riboflavin = 2

Niacin = 3

Pyridoxine = 6

Folate = 9

30
Q

What Vitamin/Mineral interacts with

Thiazide Diuretics = HCTZ / Chlorthalidone

A

CALCIUM
will cause an INCREASE in Calcium

  • but it will have a decrease in:*
  • MAGNESIUM*
  • sodium / potassium / phosphate*
31
Q

Calcium Dosing

for Corticosteroid-Induced Osteoporosis

A

1200-1500mg Elemental calcium

+

800 - 1200 units of Vitamin D

32
Q

Cholecalciferol

A

Vitamin D3

Derived from ANIMALS

400 / 1000 / 2000 / 3000 / 50k IU

33
Q

MAGNESIUM in

DYSPEPIA TREATMENT

A

Varies on ONSET OF ACTION:

Trisilicate** > **Carbonate** > **Hydroxide

TCH

want to treat it quicker

34
Q

Iron
FACTS

A

Needed for Hg production for
Oxygen Transport + Metabolism

Involved in NT Production

15% stored for use in situations of inadequate dietary inake

35
Q

Calcium Dosing

for IOM - Osteoporosis / Fracture Prevention

A

ALL Adults 19-50:
1000mg QD in 2 divided doses

1200mg in 2divdoses for women >51 or men >70

36
Q

Corticosteroids

Drug Related Vitamin Deficiency

A

DECREASED

Vitamins A + D + C

37
Q

Iron Supplementation
INDICATION

A

Iron Deficiency ANEMIA

ANEMIA of Chronic Disease

38
Q

Vitamin D

DOSING

A

For Vitamin D *DEFICIENCY:*
1000-2000 IU
QD for maintanance

for Corticosteroid-Induced Osteoporosis:
800-1200 IU units of Vitamin D
+
1200-1500 mg Elemental CALCIUM

39
Q

Iron Dosing

A

Deficiency Treatment:
150-300mg elemental iron daily
in 2-3 divided doses
to maximize tolerability

Onset after treatment:
TAKES TIME: HgB levels should should increase by
1g/dl q 2-3 weeks
after HGB levels are normal, may take up to
~4months to replensih iron stores

40
Q

Thiazide Diuretics

Drug - Mineral
INTERACTIONS​

A

HCTZ / Chlorthalidone

INCREASE in CALCIUM

decrease in:
Na / K / Mg + P

41
Q

Dietary Supplement CLAIMS

A

Health Claims
will reduce risk of disease / condition

Structure/Function Claims
may affect organs/systems of body = can NOT mention disease state

Nutrient Claims
fortified / high / rich in / excellent source of / high potency / good source

“This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”

42
Q

IRON
Counseling Points

A
  • *Seperate from DAIRY + ANTACIDS**
  • *2 hours**!

Keep away from children

  • *Acid food/beverages –> INCREASE**
  • *Milk / Tea** –> DECREASE

GI SE associated w/ DOSE, not formulation/salt

EC / Controlled release –> decrease nausea
but have LOWER absorption rate
Liquid –> blacken teeth
Oral –> darken stool

43
Q

What Mineral/Vitamin affects

LEVOTHYROXINE?

A

IRON

will decrease the efficacy / CHELATE of levothyroxine

SEPERATE by 4 HOURS

44
Q

Which Magnesium Salt is PREFERRED?

A

CHLORIDE & GLUCONATE
CL= Enteric coating/poorly absorbed, but higher % elemental Mg
Gluconate = better absorbed but TAKE ON EMPTY STOMACH

better than OXIDE due to less diarrhea

Sulfate = most potent though

45
Q

Minerals

A

In-Organic elements neded to maintain life

Sources:
Soil & Water
absorbed by plants / eaten by animals

46
Q

Calcium Carbonate

A

Requires STOMACH ACID for absorption

should be taken WITH FOOD

Highest % of Elemental Calcium
cheaper

47
Q

Vitamins

A

Organic Nutrients that are supplied by the DIET

generally NOT made endogenously EXCEPT:
Vitamin D / Niacin
from skin / from tryptophan

48
Q

Loop Diuretics

Drug Related Vitamin Deficiency​

A

Thiamine DEFICIENCY
B1

49
Q

Risk Factors for

MAGNESIUM deficiency

A

GI Disease
crohns disease –> chronic diarrhea

T2 Diabetes
due to INCREASED output secondary to high glucose conc. in kidney

  • *Alcohol dependence**
  • *GI - NVD** + renal dysfunction
  • *Older age**
  • decreased intake / absorption +* increased renal loss
50
Q

Risk Factors for

Vitamin D Deficiency

A

Breastfed Infants

Individuals with DARK SKIN

Elderly

OBESITY

FAT-Malabsorption DISORDERS

H/O of Gastric Bypass Surgery

51
Q

Proton Pump Inhibitors

Drug Related Vitamin Deficiency​

A

Vitamin B12 MALABSORPTION

reduced ACID –> impaired RELEASE of B12 from Food

same as H2RA’s

52
Q

CITRACAL

A
  • *CALCIUM** CITRATE
  • sometimes with Vitamin D + other minerals*

Help reduce the risk of Osteoporosis

  • *1T QD/BID**
  • can DISREGARD MEALS*

1000mg QD

>2500mg QD –> may lead to KIDNEY STONES

53
Q

MAGNESIUM
Max Dose / ADR / CIP

A

<350 mg / dose for all >19 yo

ADR:
Diarrhea / Nausea / Ab Cramps
Excess magnesium –> eliminated by KIDNEYS
can accumulate and have risk in person with RENAL DYSFUNCTION

Contraindication / Precaution:
Excessive intake –> HYPERmagnesemia
RESPIRATORY / MUSCLEparalysis
complete HEART BLOCK

54
Q

Magnesium Patient Counseling

A

TAKE WHOLE
some enteric coating to delay release

may be taken with food

  • *do NOT exceed 2 TABLETS DAILY**
  • unless advised*
55
Q

Calcium Facts

A

MOST ABUNDANT MINERAL
5th most common element in body

Main roles:
Formation & metablism of BONE

Intracellular messenger

56
Q

Magnesium DOSING

A

Deficiency Treatment

200-400mg /day
of oral elemential magnesium, divided
BID to TID
to LIMIT side effects

57
Q

VItamin D

Max Dose / ADR

A

<4,000 IU for ALL > 9y/o

Well tolerated

OVER SUPPLEMENTATION can lead to:
anorexia / urination / weight loss
+ INCREASED CALCIUM levels
–> vascular / renal / cardiac calcification

Women’s Health Initiative:
increase risk of kidney stones with calcium + vitamin D
women should AIM to get CALCIUM + VITAMIN D from DIET

(100mcg)

58
Q

Histamine 2 Antagonist

Drug Related Vitamin Deficiency​

A

Vitamin B12 MALABSORPTION

reduced ACID –> impaired release of B12 from food

same as PPI’s

59
Q

Loop Diuretics

Drug - Mineral
INTERACTIONS

A

Furosemide / Torsemide / Bumetanide

DECREASE in

Na / K / C / Mg

60
Q

Iron Formulations

A

Best = CARBONYL IRON (not a salt )

SIMILAR absorption between salts
Ferrous Sulfate/Gluconate/Citrate
is more soluble than Ferric (Fe3+)
ferric has the LEAST risk of Poisoning

addition of Cu/Co/Mb/ other minerals
has NO ADVANTAGE, just INCREASED COST

Ferrous Sulfate = Preferred supplement:
due to tolerability / efficacy / cost
CITRATE is the most common though

61
Q

Excess of WHAT Vitamin supplement causes

KIDNEY STONES

A

nephrolithiasis

CALCIUM

62
Q

Magnesium
FORMULATIONS

A

Absorption VARIES between SALT forms

CHLORIDE
enteric coating delays absorption

GLUCONATE
take on an empty stomach

L-Lactate / Aspartate
take with food / can be granules

63
Q

What is CALCIUM’s
THRESHOLD ABSORPTION

A

500 MG
is the maximum calcium that we can absorb @ 1 time

dose should be:
1200mg** in **2 DIVIDED DOSES

64
Q

Vitamin D

Dietary Sources

A

few foods contain enough VITAMIN D
most American Diet is FORTIFIED

  • *Flesh of Fatty Fish**
  • *Fish Liver Oil**

Beef LIVER / Cheese / Egg yoks : TRACE levels

65
Q

What Magnesium salt needs to be taken on a

EMPTY STOMACH?

A

Mg GLUCONATE

better absorbed than chloride

chloride = Enteric coating –> delays absorption

66
Q

RDA for VITAMIN D

A

19-50 y/o

600 IU = 15 mcg
FOR ALL

Max >4,000 IU (100mcg) for ALL

67
Q

SLOW-MAG

A
  • *Magesium Chloride** + Calcium Carbonate
  • *Enteric Coated**
  • *2 Tabs = 1 Serving**
  • *143mg Mg** + 238mg Calcium

Recommended doses:
400mg Males / 310mg Females+lactation
350mg Pregnancy

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