Common Vitamins and Minerals

Question 1

What is the percentage of elemental calcium is in each of the three types of calcium? (carbonate, citrate, lactate, gluconate)

Answer 1

carbonate: 40%
citrate: 21%
lactate: 18%
gluconate: 9%

Question 2

For optimal absorption, calcium doses should not exceed ____ of elemental calcium?

Answer 2

500 mg

Question 3

What should be done if there is a higher amount of calcium needed than 500 mg?

Answer 3

you should divide the doses throughout the day (bid to tid dosing)

Question 4

What is considered to be elemental calcium?

Answer 4

the amount of calcium that the body is able to absorb - the body is able to absorb most of the calcium carbonate because it has the most elemental calcium

Question 5

What is the most effective calcium supplement?

Answer 5

• calcium carbonate

Question 6

Describe calcium carbonate

Answer 6

• best calcium absorption occurs in an acid environment, and therefore should be taken with meals
• cheapest option
• often first line
• well tolerated

Question 7

When is calcium citrate generally needed?

Answer 7

• needed when there is an increased gastric pH (in patients that are on H2 blockers, IBS or absorption disorders)
• may be taken on an empty stomach
• • has less elemental calcium vs carbonate, therefore more doses may be needed

Question 8

What other element can natural calcium supplements from oyster shells or bone meal contain?

Answer 8

• contains some lead - not likely an issue as calcium blocks lead absorption

Question 9

What is the purpose of having magnesium as part of a calcium supplement?

Answer 9

• has a laxative effect- helps to decrease the effect of constipation from the calcium supplement

Question 10

What can excess ingestion of calcium potentially lead to?

Answer 10

• ingestion of calcium can potentially cause kidney stones, milk-alkali syndrome or renal insufficiency

Question 11

Preparations containing more than ____ of elemental iron are considered NAPRA schedule 2

Answer 11

30 mg

Question 12

What must all dietary iron be reduced to?

Answer 12

the ferrous form - therefore ferrous iron is absorbed more readily than the ferric form

Question 13

Where does most iron absorption occur?

Answer 13

• in the detail duodenum and proximal jejunum

Question 14

What is the effect of EC or sustained release iron?

Answer 14

• iron release occurs further down the intestinal tract – means that they are ineffective supplement options as they release past the duodenum which is the sire of absorption

Question 15

When is the only time that iron supplementation should occur?

Answer 15

• known or suspected iron deficiency

- increased need for iron

Question 16

What can happen when there is excess iron stored in tissues and organs?

Answer 16

• may lead to cirrhosis, or heart failure - does this when there is excessive iron because a lot of iron storage is in the liver

Question 17

What is the amount of elemental iron that is in different formulations?

Answer 17

gluconate: 12%
sulfate: 20%
fumarate: 33%

Question 18

What are the newer formulations of iron that are used?

Answer 18

1. heme iron polypeptide (proferrin)
   - hemaglobin from bovine red blood cells
2. polysaccharide iron complex (FeraMAX)
   - ferric iron complex with hydrolyzed starch
   - unproven claim that it causes GI irritation

Question 19

Various forms of iron all have the same ________

Answer 19

clinical efficacy

Question 20

How should iron salts be taken?

Answer 20

• should be taken on an empty stomach

Question 21

What should a person do if they experience some stomach irritation when taking iron salts?

Answer 21

• can be administered with food— start taking the iron with a little bit of food and then can gradually stop taking it with food
• can start the dose of iron low and then gradually increase to the recommended dose

Question 22

What are some of the drug interactions with iron supplements?

Answer 22

• antacids, PPIs, calcium supplements and antibiotics (quinolone and tetracyclines)

Question 23

What are the typical side effects that would be associated with taking iron?

Answer 23

• abdominal discomfort
• nausea and vomiting
• diarrhea and constipation
  (these SE are directly related to the amount of elemental iron ingested)

Question 24

Do B vitamins help to relieve stress and increase energy?

Answer 24

• high amounts of B vitamins are found in energy drinks and supplements
• B vitamins are helpful to release energy from foods
• diet supplies all required B vitamins, extra is flushed out of the body

Question 25

What are some non-pharms we can suggest to patients to relieve stress?

Answer 25

- reducing caffeine, alcohol and smoking - exercise - sufficient sleep - relaxation techniques (medication, guided imagery)

Question 26

Will B vitamins decrease the risk of skin cancer?

Answer 26

- niacinamide is found to help HIGH risk patients who have already had non-melanoma skin cancer - found to decrease the risk of skin cancer by 23% - benefit is not demonstrated in those without skin cancer -

Question 27

What is age related macular degeneration?

Answer 27

- leading cause of poor vision and adult blindness in those over 60 years old - result of deterioration of the macula - the loss of vision is central yet the peripheral vision if unaffected

Question 28

What is the macula?

Answer 28

- small area at the centre of the retina in the back of the eye, the purpose is to permit seeing fine details clearly

Question 29

What are the other visual symptoms of age related macular degeneration?

Answer 29

- decrease in sharp, straight ahead vision needed for driving, reading, recognizing faces and looking at detail

Question 30

What are the two types of AMD?

Answer 30

Dry and Wet

Question 31

What is dry macular degeneration?

Answer 31

atrophic macular degeneration - results in the thinning of the macula - more common form (90%) - development occurs over many years, leading to gradual vision loss - there are 3 stages: early, intermediate and advanced

Question 32

What is wet macular degeneration?

Answer 32

- less common but more serious | - quickly progresses, leading to severe vision loss or blindness

Question 33

What are the treatment options for wet AMD?

Answer 33

1. anti-vascular endothelial growth factor (anti-VEGF) injections 2. photodynamic therapy

Question 34

What is the treatment for dry AMD?

Answer 34

- no proven effective treatment

Question 35

What was found in the study that looked at antioxidants and progression to advanced stage dry AMD? (AREDS)

Answer 35

- it was found that a unique high dose of antioxidant vitamins and zinc lowered the profession risk to advanced stage (and further vision loss) - original formula is high doses of vitamin A, C and beta carotene as well as zinc - beta carotene however is associated with a higher risk of lung cancer in those who have smoked before (only non smokers should use this original formulation)

Question 36

What is AREDS2?

Answer 36

- new formulation of the antioxidant vitamin that is without beta-carotene, added lutein and zeaxanthin - found to be equally as effective

Question 37

When should AREDS2 be recommended to an individual?

Answer 37

- when they have intermediate AMD in both eyes | - have advanced dry AMD in one eye

Question 38

What will smoking do in those with AMD?

Answer 38

- will quicken the progression to AMD

Question 39

What is the effect of orlistat on an individual's nutrients?

Answer 39

- decrease in the levels of some fat soluble vitamins (A,D,E, and K) and beta carotene - should recommend that these individuals take a multivitamin (should separate the vitamin from the orlistat dose by 2 hours) - does this by blocking the absorption of the fat soluble vitamins in the small intestine

Question 40

What is the effect of metformin on an individual's nutrient state?

Answer 40

- may lead to a decrease in folate (B9) and vitamin b12 in some patients - vitamin B12 and homocysteine levels should be monitored yearly - supplements may be required in some patients

Question 41

What is the effect of corticosteroids on an individual's nutrient state? (oral only)

Answer 41

- corticosteroids with high mineralocorticoid activity can cause steroid induced osteoporosis - supplements with calcium and vitamin D are needed in patients taking over 7.5 mg of prednisone daily (or equivalent) - in long term treatment, need to monitor levels every 6 months (bone mineral density and calcium levels)

Question 42

What are the drug interactions that vitamin A and beta carotene has?

Answer 42

- should avoid this combination with any retinoids -- there is an additive toxic effect - avoid this combination with hepatotoxic medications (acetaminophen, carbamazepine, methotrexate) as well as may increase risk of liver disease - avoid combination with warfarin due to an increased risk of vitamin A toxicity and bleeding

Question 43

What are the drug interactions that you must be aware of when a patient is taking vitamin E?

Answer 43

- when combined with warfarin, ASA or NSAIDs may increase the risk of bleeding - management: restrict vitamin E dose to less than 200 IU per day and monitor the INR (if the patient is on warfarin)