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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
**Drug levels** **AFFECTED by IRON**
***_DECREASES ALL OF THESE_*** Levo**dopa** + Methyl**dopa** **_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 Mg**, *but 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*
31
**Calcium Dosing** **for Corticosteroid-Induced Osteoporosis**
**1200-1500mg** **Elemental calcium** + **800 - 1200** units of **Vitamin D**
32
**Cholecalciferol**
**Vitamin _D3_** Derived from **ANIMALS** 400 / 1000 / 2000 / 3000 / 50k IU
33
**MAGNESIUM in** **DYSPEPIA TREATMENT**
Varies on **_ONSET OF ACTION_**: **_Trisilicate**_ \> _**Carbonate**_ \> _**Hydroxide_** TCH want to **treat it quicker**
34
**Iron FACTS**
Needed for **Hg production** for **Oxygen Transport + Metabolism** Involved in **NT Production** **15%** **stored** for use in situations of *inadequate dietary inake*
35
**Calcium Dosing** **for IOM** **- Osteoporosis / Fracture Prevention**
ALL Adults 19-50: **1000mg QD** in **2 divided doses** 1200mg in 2divdoses for women \>51 or men \>70
36
**Corticosteroids** Drug Related Vitamin Deficiency
***_DECREASED_*** Vitamins **A + D + C**
37
**Iron Supplementation INDICATION**
**Iron Deficiency ANEMIA** **ANEMIA of _Chronic Disease_**
38
**Vitamin D** **DOSING**
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
**Iron Dosing**
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
**Thiazide Diuretics** **Drug - Mineral INTERACTIONS​**
**HCTZ** / Chlorthalidone **_INCREASE_** in **CALCIUM** ***_decrease in:_*** Na / K / Mg + **P**
41
**Dietary Supplement CLAIMS**
_**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
**IRON Counseling Points**
* *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* **L****iquid --\> blacken teeth Oral --\> darken stool**
43
**What Mineral/Vitamin affects** **LEVOTHYROXINE?**
**_IRON_** will ***_decrease the efficacy / CHELATE_*** of levothyroxine **_SEPERATE by 4 HOURS_**
44
**Which Magnesium Salt is PREFERRED?**
**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
**Minerals**
**_In-Organic_** elements neded to **maintain life** Sources: **Soil & Water** absorbed by plants / eaten by animals
46
**Calcium Carbonate**
Requires **STOMACH ACID** for absorption should be taken **WITH FOOD** **Highest % of Elemental Calcium** cheaper
47
**Vitamins**
**_Organic_** Nutrients that are **_supplied by the DIET_** *generally NOT made _endogenously_ EXCEPT:* **Vitamin D / Niacin** from skin / from tryptophan
48
**Loop Diuretics** Drug Related Vitamin Deficiency​
**Thiamine *DEFICIENCY*** B1
49
**Risk Factors for** **MAGNESIUM deficiency**
**_GI Disease_** crohns disease --\> **chronic diarrhea** **_T2 Diabetes_** due to **INCREASED outpu**t secondary to **high glucose conc. in kidney** * *_Alcohol dependence_** * *GI - NVD** + **renal dysfunction** * *_Older age_** * decreased intake / absorption +* **increased renal loss**
50
**Risk Factors for** **Vitamin D Deficiency**
**Breastfed Infants** Individuals with **DARK SKIN** **Elderly** **OBESITY** **FAT-Malabsorption DISORDERS** H/O of **Gastric Bypass Surgery**
51
**Proton Pump Inhibitors** Drug Related Vitamin Deficiency​
**Vitamin B12 MALABSORPTION** *reduced ACID --\> impaired RELEASE of B12 from Food* same as H2RA's
52
**CITRACAL**
* *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
**MAGNESIUM Max Dose / ADR / CIP**
_**\<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 / MUSCLE**paralysis complete **HEART BLOCK**
54
**Magnesium Patient Counseling**
**TAKE WHOLE** some enteric coating to delay release **may be taken with food** * *_do NOT exceed 2 TABLETS DAILY_** * unless advised*
55
**Calcium Facts**
**MOST ABUNDANT MINERAL** 5th most common element in body Main roles: **Formation & metablism of BONE** **Intracellular messenger**
56
**Magnesium DOSING**
**Deficiency Treatment** **_200-400mg /day_** of oral elemential magnesium, divided **_BID to TID_** *to LIMIT side effects*
57
**VItamin D** **Max Dose / ADR**
**_\<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
**Histamine 2 Antagonist** Drug Related Vitamin Deficiency​
**Vitamin B12** **MALABSORPTION** *reduced ACID --\> impaired release of B12 from food* same as PPI's
59
**Loop Diuretics** **Drug - Mineral INTERACTIONS**
Furosemide / Torsemide / Bumetanide ***_DECREASE_*** in **Na / K / C / Mg**
60
**Iron Formulations**
**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
**Excess of WHAT Vitamin supplement causes** **KIDNEY STONES**
nephrolithiasis ## Footnote **_CALCIUM_**
62
**Magnesium FORMULATIONS**
**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
**What is CALCIUM's THRESHOLD ABSORPTION**
**_500 MG_** is the **maximum** **calcium** that we can **absorb @ 1 time** dose should be: **_1200mg**_ in _**2 DIVIDED DOSES_**
64
**Vitamin D** **Dietary Sources**
*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
**What Magnesium salt needs to be taken on a** **EMPTY STOMACH?**
**_Mg GLUCONATE_** better absorbed than chloride chloride = Enteric coating --\> delays absorption
66
**RDA for VITAMIN D**
19-50 y/o **_600 IU = 15 mcg_** FOR ALL Max \>4,000 IU (100mcg) for ALL
67
**SLOW-MAG**
* *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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