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Clinical Pharmacy > Common Vitamins and Minerals > Flashcards

Common Vitamins and Minerals Flashcards

1
Q

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

A

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

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2
Q

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

A

500 mg

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3
Q

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

A

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

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4
Q

What is considered to be elemental calcium?

A

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

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5
Q

What is the most effective calcium supplement?

A
  • calcium carbonate
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6
Q

Describe calcium carbonate

A
  • best calcium absorption occurs in an acid environment, and therefore should be taken with meals
  • cheapest option
  • often first line
  • well tolerated
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7
Q

When is calcium citrate generally needed?

A
  • 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
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8
Q

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

A
  • contains some lead - not likely an issue as calcium blocks lead absorption
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9
Q

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

A
  • has a laxative effect- helps to decrease the effect of constipation from the calcium supplement
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10
Q

What can excess ingestion of calcium potentially lead to?

A
  • ingestion of calcium can potentially cause kidney stones, milk-alkali syndrome or renal insufficiency
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11
Q

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

A

30 mg

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12
Q

What must all dietary iron be reduced to?

A

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

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13
Q

Where does most iron absorption occur?

A
  • in the detail duodenum and proximal jejunum
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14
Q

What is the effect of EC or sustained release iron?

A
  • 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
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15
Q

When is the only time that iron supplementation should occur?

A
  • known or suspected iron deficiency

- increased need for iron

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16
Q

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

A
  • may lead to cirrhosis, or heart failure - does this when there is excessive iron because a lot of iron storage is in the liver
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17
Q

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

A

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

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18
Q

What are the newer formulations of iron that are used?

A
  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
19
Q

Various forms of iron all have the same ________

A

clinical efficacy

20
Q

How should iron salts be taken?

A
  • should be taken on an empty stomach
21
Q

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

A
  • 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
22
Q

What are some of the drug interactions with iron supplements?

A
  • antacids, PPIs, calcium supplements and antibiotics (quinolone and tetracyclines)
23
Q

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

A
  • abdominal discomfort
  • nausea and vomiting
  • diarrhea and constipation
    (these SE are directly related to the amount of elemental iron ingested)
24
Q

Do B vitamins help to relieve stress and increase energy?

A
  • 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
25
Q

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

A
  • reducing caffeine, alcohol and smoking
  • exercise
  • sufficient sleep
  • relaxation techniques (medication, guided imagery)
26
Q

Will B vitamins decrease the risk of skin cancer?

A
  • 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
27
Q

What is age related macular degeneration?

A
  • 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
28
Q

What is the macula?

A
  • small area at the centre of the retina in the back of the eye, the purpose is to permit seeing fine details clearly
29
Q

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

A
  • decrease in sharp, straight ahead vision needed for driving, reading, recognizing faces and looking at detail
30
Q

What are the two types of AMD?

A

Dry and Wet

31
Q

What is dry macular degeneration?

A

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
32
Q

What is wet macular degeneration?

A
  • less common but more serious

- quickly progresses, leading to severe vision loss or blindness

33
Q

What are the treatment options for wet AMD?

A
  1. anti-vascular endothelial growth factor (anti-VEGF) injections
  2. photodynamic therapy
34
Q

What is the treatment for dry AMD?

A
  • no proven effective treatment
35
Q

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

A
  • 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)
36
Q

What is AREDS2?

A
  • new formulation of the antioxidant vitamin that is without beta-carotene, added lutein and zeaxanthin
  • found to be equally as effective
37
Q

When should AREDS2 be recommended to an individual?

A
  • when they have intermediate AMD in both eyes

- have advanced dry AMD in one eye

38
Q

What will smoking do in those with AMD?

A
  • will quicken the progression to AMD
39
Q

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

A
  • 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
40
Q

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

A
  • 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
41
Q

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

A
  • 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)
42
Q

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

A
  • 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
43
Q

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

A
  • 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)

Clinical Pharmacy (24 decks)

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