Final- Infant formulas, vitamins/minerals, colic, dry skin Flashcards
2 main starting points for infant formulas
1) cow milk, then modify to be as close to breast milk as possible (protein is cow based)
2) soy protein source (can’t take dairy for health, cultural or religious reasons)
which infant formalas have iron
all, some just lower
upgrade to a formula at this age
6 months; optional, not that big of a difference
use infant formula (as an alternative to breast milk) up until this age
9 to 12 months
when pasteurized whole milk can be introduced
9 to 12 months, continue until 2 years
when skim milk is appropriate for infants
after 2 years
iron in breastmilk
much more available than cow protein based formulas
follow up formulas- necessary?
in second 6 months of life, for when eating solid foods, not necessary very similar
when pasteurized whole milk can be introduced
9 to 12 months, continue until 2 years (full fat important)
follow up formulas- necessary?
in second 6 months of life, for when eating solid foods, not necessary very similar
infant formula with thickener
don’t recommend
natural vs synthetic vitamins
natural always better EXCEPT B12 and folate
kind of folic acid to use after age 50
synthetic- easier to breakdown, natural sources of it become hard for body to break down and use
single vitamin deficiencies are common?
no
vitamin D in infants
400-800 (if hardly any sun or months October to April-therefore recommend because babies shouldn’t be in sun anyway) IU if breastfed, 0-400 IU if formula (because already should be enriched with it).
**Standard 400 IUs
vitamin D in infants
400-800 (if hardly any sun or months October to April-therefore recommend because babies shouldn’t be in sun anyway) IU if breastfed, 0-400 IU if formula (because already should be enriched with it).
**Standard 400 IUs; D-Drops= good! Put on your finger to give, 400 IU/drop
Fe in infants
before 6 months, stores are enough. After, need supplementation (iron enriched cereals, etc)
Vitamin D age 1-13 years
1000-2000 IU (need more in winter). 600-800 is okay (health canada) because will get some from diet (very little) and sun
Iron in children
8-10 mg
multivitamin in children
chose most broad spectrum- vitamins AND minerals
mg of Ca per glass of milk
300 mg
difference between mens and womens vitamins
not much- if any change, not significant amount
vitamin D in adults
1000 IUs
- 400-1000 if less than 50 and healthy
- 800-2000 if over 50 and healthy
vitamin D pregnancy
consider 2000 IUs
Too much vitamin D bad?
yes, but high safety range. Don’t go above 2000 IUs. 5 min sun exposure enough vitamin D.
osteoporosis and vitamin D recommendations
-regardless of age 800-2000 IUs
difference between mens, womens and seniors vitamins
not much- if any change, not significant amount
-should add separate vitamin D and Ca (usually never enough Ca in multivitamin or pill would be huge) if needed
vitamin D in adults
1000 IUs
- 400-1000 if less than 50 and healthy
- 800-2000 if over 50 and healthy* (over 70)
osteoporosis and vitamin D recommendations
-regardless of age 800-2000 IUs
cod liver oil benefits
-too high vitamin A, too low vitamin D, not enough omega to make good
Ca age 31-50
1000 mg
Ca age 51-70
needs go up after 50 from 1000 to 1200 mg
Ca over 70
needs go up after 50 from 1000 to 1200 mg
B12 requirement adults
stays same age 30 and up; 2.4 ug
b12 safety
water soluble so very safe, even at 500x RNI, but don’t need
prenatal vitamins: iron
child bearing- 18mg
pregnancy- 27 mg (supplement with 16-20)
prenatal vitamins: folate
child bearing- 400 ug
pregnancy- 600 ug during and before in addition to food
prenatal vitamins: calcium
1000 mg, no change during pregnancy unless under 18 add 300 mg
prenatal vitamins: vitamin d
600 IUs, no change in pregnancy, but can consider up to 2000 IUs
natural folate sources
OJ, fruits, veg
natural iron
meat
prenatal vitamins: folate
child bearing- 400 ug
pregnancy- 600 ug during and before in addition to food….1mg*
-take at least 3 months ahead pregnancy
natural iron
meat
materna for pregnancy vitamin?
good, take before, during, and at least 6 weeks after pregnancy
spinal bifida/neural tube defects
- prevent with folic acid
- 3rd-4th week of development
- 50% pregnancies unplanned, for recommend multivitamin to all women of child bearing years
- 1 mg folic acid sufficient unless high risk- rx doctor 5mg
Ca age 4-8
1000 mg
Ca age 9-18
1300 mg
recommended Ca in vitamin
500 mg od, rest can come from diet. Rarely do you need bid, but if do only take 500 at once, this is all your body can absorb
Ca free of side effects up until
2500 mg
should Ca be given with food?
yes, helps cleave elemental Ca
vitamin A requirements
2000-3000 IUs, way too much may interact with Ca and have negative effects on bone health
forms of Ca
- carbonate (40% elemental, best)
- lactate (13%)
- gluconate (9%)
best bone health combo
vitamin D, Ca and weight bearing exercise
best bone health combo
vitamin D, Ca and weight bearing exercise
theory of adding mg to Ca
helps with leg cramps and reverses constipation (helps)- questionable, probably not
theory of adding mg to Ca
helps with leg cramps and reverses constipation (helps)- questionable, probably not
RDA protein
- 8 g/kg/day
1. 6 if strength training
during work out AAs lost
75% recylced into muscles, 25% lost
BCAAs in workout
theory is drive more muscle in to workouts because targeted- unlikely
BCAAs in workout
theory is drive more muscle in to workouts because targeted- unlikely
creatine
- body makes 2g/day, another 2 g from food
- reduces muscle breakdown during workouts, leads to more muscle mass
- no significant increase in performance, better from diet
creatine
- body makes 2g/day, another 2 g from food
- reduces muscle breakdown during workouts, leads to more muscle mass
- no significant increase in performance, better from diet
heme iron
most available form
RNA elemental iron in F
15-18 mg
ferrous fumarate (color and percent iron in salt)
blue, 33%, more iron faster
ferrous sulfate (color and percent iron in salt)
red, 20% (ex//, in 300 mg tablet, get 60 mg iron)
ferrous gluconate (color and percent iron in salt)
green, 12%, easiest tolerated in gut
vitamin c, food and iron
c helps absorbtion, food makes more tolerable
avoid with iron because decrease BA
coffee/tea, protein, Ca, antacids
slow release iron
no sense, immediate is better
discoloration in feces from Fe
fine if happens from start, if after or continuing could be blood see doc
pediatrics an iron
toxicity is big deal
pediatrics an iron
toxicity is big deal
upper limit of Fe
45 mg (60 will still be okay though)
reduce mortality, cancer, CV risk, stress, energy, fatigue, depression anxiety etc (vit)
NONE
niacin
- aka nicotinic acid
- nicotinamides or niacinamides decrease flush SE but no help with cholesterol (same with inositol)
- statins are most effective
- if use, must be in high doses but amp up slowly or could be very irritating
AMD (acute macular degeneration)
aging disease, see blurred central vision (faces, etc), cholesterol laying down in eyes
- dry type (cholesterol, 90%)
- wet type, more serious (10%)
- AREDs vitamins can potentially delay progression (intermediate to advanced, but can recommend at any stage)
- can’t reverse any stage, but might slow
smokes and AMD
take out beta carotene, vitalux s
smokes and AMD
take out beta carotene (lung cancer possibility), vitalux s
smokes and AMD
take out beta carotene (lung cancer possibility), vitalux s
magnesium amount
320-420 mg. Diarrhea at increased strength? Would need 30-60mL of 400mg/5ml.
Potassium amount
4700 mg, 2300 lowers BP by 3 points
Ensure vs pediasure
kids can take ensure too! meal supplement
glucerna
targetted to diabetics
drug interactions with vitamins
most not super significant
vitamin k amount
4700 mg
vitamin c amount
65-90 mg
Fe adult male
8mg
betacarotene is a source of
vitamin A (2000 beta is 200 A)
betacarotene is a source of
vitamin A (2000 beta is 200 A)
colic diagnosis
by exclusion; baby is fine between crying bouts, feeds well and gains weight. True colic is 3 hours 3 days a week for 3 weeks, baby inconsolable, usually in evening, disappears suddenly
-seems to be independent of breastfeeding vs formula
colic vs teething peaks
3 months vs 4 of age
types of lactose intolerance
1) normal= result of aging in some
2) result of illness (ex// stomach flu)
3) congenital
things to try with colic (non drug)
- no one way
- non drug= swaddle, reposition, stimulation (clothes dryer and music), change formulas
- drug:
simethicone (Oval)
for colic=defoaming agent, GI discomfort via trapped gas, give after each feeding, minimal effectiveness but no side effects. Zero value if not caused by gas. 1st recommended agent in colic
dicuclomine (bentylol)
antispasmodic for colic, better than placebo but doesn’t actually work for colic! Not for infants under 6 months, used for IBS, but SEs are drowsiness and constipation
Gripe water
sodium bicarbonate, almost no SEs, leap of faith for colic, GERD can cause colic so may have some effect…but unlikely
probiotics and colic
-third choice (gripe water and oval* are first), breastmilk has naturally, show promise, decent results in reducing crying,
cocyntal
useless homeopathic for colic
number of cigarettes to start step 2 at
10 cig (14 mg) (about 1 mg per cig, so 21, 14, 7 correspond)
eczema is
1) lack of filaggrin (skin protein)
2) dysfunction/deficiency in ceramide
3) lack of NMF (natural moisturizing factors like urea which reduces water loss by being hygroscopic, keratolytic by softening skin, is protective and antipruritic) (also lactic acids and amino acids
non pharm methods for dry skin
- cut back bath/shower
- use less hot water
- try sponge
- pat dry don’t rub
- apply loting/cream while skil still damp
- water intake and humidifier won’t help much
danger of bath oil for dry skin
slip in tub (elderly), also only low level therapeutics but have no SEs
colloidal ointment treatment benefits
protective and water holding, slightly anti infla,. anti itch
what emollients and moisturizers try to do
mimic skin components (NMF, ceramide, etc)
NMFs
natural moisturizing factors (urea=hygroscopic, ketaolytic (softens), antipruretic, fillagrin, ceramide
o/w emollients/moisturizers
normal
w/o emollients/moisturizers
extra strength. Ointment would be next stage
benefits of ceramide products
not much over regular
straight vaseline (petrolatum) for dry skin
heaviest hitter, most occlusive
increased petrolatum for dry skin
increased occlusion, hydration, perfusion, but less is better for acne prone areas
young vs old skin
young= more fluid supplying upper layers of skin old= less glandular secretion and fluid delivery into upper levels makes more prone to dry skin
dry skin factors
excessive bathing and showering
- aging
- soaps
- mechanical rubbing
- low humidity
- medical conditions
dimethicone skin products
very smooth, silicone product, good for acne prone
low in eczematous skin
ceramide
dimethicone skin products
very smooth, silicone product, good for acne prone (decreased occlusion)
low in eczematous skin
ceramide
humectants and examples
- hygroscopic, attract and hold water to prevent fluid loss
- glycerin, prop glycol, phospholipids, urea
keratin softening agents: concentration needed
at least 5-10% for average person effect
20% keratin softening agents for-
not average dry skin person, it has more intense keratin dissolving effect and will be itchy and prickle when on. Give for more irritated/rough skin
examples of keratin softening agents
urea, AHA (alphahydroxy acid)
vitamins added to dry skin products to help sell better, some truth only
Vitamin C/A/E
- coenzyme Q
- nicacinamide
most products have __% in common with each other for dry skin ingredients, go for ____
- 80%
- glycerin, dimethicone and petrolatum
what to do for dry, cracked heels
-keep clean
-pare down keratin (debride- skin won’t heal if built up skin not removed)
-liquid bandaids=good option
-use ANY
moisturizer
-can use strapping (hold cracks together while heals), insoles to prevent thick skin development, heel cups to keep skin from expanding sideways
-podiatrists can glue tissue until healed
moisturizer to use on cracked heels
ANY
cause of dry cracked heels
prolonged standing
- mechanical factors
- overweight
- open back on shoes
- medical conditions (hypothyroid, diabetes)
- skin conditions
cause of dry cracked heels
prolonged standing
- mechanical factors
- overweight
- open back on shoes
- medical conditions (hypothyroid, diabetes)
- skin conditions
used to decrease age spots (hyperpigmentation aka liver spots)
- retinoids (can be around eyes or mouth), takes few months
- hydroquinone (5% rx, 2% cosmetics)/monobenzene can get rid of pigment in spot shooting depigmentation
- monobenzene is rx only and more potent
used to decrease age spots (hyperpigmentation aka liver spots)
- retinoids (can be around eyes or mouth), takes few months
- hydroquinone (5% rx, 2% cosmetics)/monobenzene can get rid of pigment in spot shooting depigmentation
- monobenzene is rx only and more potent
your complexion is based on
sun exposure, heredity, occupation, smoking
help with wrinkles
AHA (must be 5-10%) and retinoids, preventative with suncreens
presence or absence of rash with itch
rash and itch=skin disease
no rash and itch=systemic
will normal benedryl or claritin help with regular itch
no, won’t help with standard itch of dry skin
hives
-use antihistimines, 2nd gen in seniors. Use claritin-less SEs and more targetted
mosquito bites
use benedryl because of histimine release, for 1-2 bites can use a corticosteroid or tough it out
drugs that can induce itch
opioids
benedryl (oral) uses
histamine release only
more or less lanolins in dry skin lotion?
less
is eczema grade good for everyone?
yes
calamine for typical dry skin itch
NO- it will suck out moisture and increase loss leader to dryer skin
calamine for typical dry skin itch
NO- it will suck out moisture and increase loss leader to dryer skin
what can you use calamine for
first aid (insect bites, poison ivy)
menthol at low strength (less than 1%)
an antipruritic
-above this, it is a counter irritant and can make things worse
never recommend powder, anti itch or lotion for ___
a cut
should you use local anesthetics on dry skin?
no- can use for first aid (bites) and possibly minor cuts and burns
a large topical application of benedryl can
be harmful systemically
OTC topical steroids strength:
1= high potency, 7=low
occlusive ingredients in moisturizers
oils, petrolatum, dimethicone. All are emollients to protect skin
why is water first ingredient in dry skin lotions often
makes product easier to apply
can you absorb collagen and elastin from external sources?
no, must be made in body
