Common Vitamins and Minerals Flashcards
What is the percentage of elemental calcium is in each of the three types of calcium? (carbonate, citrate, lactate, gluconate)
carbonate: 40%
citrate: 21%
lactate: 18%
gluconate: 9%
For optimal absorption, calcium doses should not exceed ____ of elemental calcium?
500 mg
What should be done if there is a higher amount of calcium needed than 500 mg?
you should divide the doses throughout the day (bid to tid dosing)
What is considered to be elemental calcium?
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
What is the most effective calcium supplement?
- calcium carbonate
Describe calcium carbonate
- best calcium absorption occurs in an acid environment, and therefore should be taken with meals
- cheapest option
- often first line
- well tolerated
When is calcium citrate generally needed?
- 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
What other element can natural calcium supplements from oyster shells or bone meal contain?
- contains some lead - not likely an issue as calcium blocks lead absorption
What is the purpose of having magnesium as part of a calcium supplement?
- has a laxative effect- helps to decrease the effect of constipation from the calcium supplement
What can excess ingestion of calcium potentially lead to?
- ingestion of calcium can potentially cause kidney stones, milk-alkali syndrome or renal insufficiency
Preparations containing more than ____ of elemental iron are considered NAPRA schedule 2
30 mg
What must all dietary iron be reduced to?
the ferrous form - therefore ferrous iron is absorbed more readily than the ferric form
Where does most iron absorption occur?
- in the detail duodenum and proximal jejunum
What is the effect of EC or sustained release iron?
- 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
When is the only time that iron supplementation should occur?
- known or suspected iron deficiency
- increased need for iron
What can happen when there is excess iron stored in tissues and organs?
- may lead to cirrhosis, or heart failure - does this when there is excessive iron because a lot of iron storage is in the liver
What is the amount of elemental iron that is in different formulations?
gluconate: 12%
sulfate: 20%
fumarate: 33%
What are the newer formulations of iron that are used?
- heme iron polypeptide (proferrin)
- hemaglobin from bovine red blood cells - polysaccharide iron complex (FeraMAX)
- ferric iron complex with hydrolyzed starch
- unproven claim that it causes GI irritation
Various forms of iron all have the same ________
clinical efficacy
How should iron salts be taken?
- should be taken on an empty stomach
What should a person do if they experience some stomach irritation when taking iron salts?
- 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
What are some of the drug interactions with iron supplements?
- antacids, PPIs, calcium supplements and antibiotics (quinolone and tetracyclines)
What are the typical side effects that would be associated with taking iron?
- abdominal discomfort
- nausea and vomiting
- diarrhea and constipation
(these SE are directly related to the amount of elemental iron ingested)
Do B vitamins help to relieve stress and increase energy?
- 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
What are some non-pharms we can suggest to patients to relieve stress?
- reducing caffeine, alcohol and smoking
- exercise
- sufficient sleep
- relaxation techniques (medication, guided imagery)
Will B vitamins decrease the risk of skin cancer?
- 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
What is age related macular degeneration?
- 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
What is the macula?
- small area at the centre of the retina in the back of the eye, the purpose is to permit seeing fine details clearly
What are the other visual symptoms of age related macular degeneration?
- decrease in sharp, straight ahead vision needed for driving, reading, recognizing faces and looking at detail
What are the two types of AMD?
Dry and Wet
What is dry macular degeneration?
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
What is wet macular degeneration?
- less common but more serious
- quickly progresses, leading to severe vision loss or blindness
What are the treatment options for wet AMD?
- anti-vascular endothelial growth factor (anti-VEGF) injections
- photodynamic therapy
What is the treatment for dry AMD?
- no proven effective treatment
What was found in the study that looked at antioxidants and progression to advanced stage dry AMD? (AREDS)
- 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)
What is AREDS2?
- new formulation of the antioxidant vitamin that is without beta-carotene, added lutein and zeaxanthin
- found to be equally as effective
When should AREDS2 be recommended to an individual?
- when they have intermediate AMD in both eyes
- have advanced dry AMD in one eye
What will smoking do in those with AMD?
- will quicken the progression to AMD
What is the effect of orlistat on an individual’s nutrients?
- 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
What is the effect of metformin on an individual’s nutrient state?
- 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
What is the effect of corticosteroids on an individual’s nutrient state? (oral only)
- 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)
What are the drug interactions that vitamin A and beta carotene has?
- 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
What are the drug interactions that you must be aware of when a patient is taking vitamin E?
- 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)
