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PHM 604- Nutrition and Cirrhosis > Vitamin Supplementation > Flashcards

Vitamin Supplementation Flashcards

1
Q

Water soluble vitamins

A

B1, B2, B3, B6, B12, folate/B9, C

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2
Q

Fat soluble vitamins

A

A, D, E, K

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3
Q

Energy-releasing vitamins

A

B1 (thiamine), B2 (riboflavin), B3 (niacin)

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4
Q

Hematopoiesis vitamins

A

B6 (pyridoxine), B12 (cyanocobalamin), B9 (folate)

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5
Q

Physiologic role of B1/thiamine

A

Coenzyme in the intermediary metabolism of multiple essential reactions

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6
Q

Physiologic role of B2/riboflavin

A

Plays a role in numerous respiratory systems

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7
Q

Physiologic role of B3/niacin

A

Component of two coenzymes

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8
Q

Physiologic role of B6/pyridoxine

A

Coenzyme in amino acid metabolism

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9
Q

Physiologic role of B12/cyanocobalamin

A

B12 coenzymes are essential for cell growth and replication

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10
Q

Physiologic role of B9/folic acid

A

DNA synthesis and hematopoiesis

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11
Q

Physiologic role of Vitamin C/ascorbic acid

A

Cofactor for electron transfer to enzymes, required for collagen synthesis and wound healing

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12
Q

Physiologic role of vitamin A

A

Essential in retinal function, growth and differentiation of epithelial tissue, enhances immune function, bone growth, reproduction, embryonic development

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13
Q

Physiologic role of vitamin E

A

Antioxidant

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14
Q

Physiologic role of vitamin D

A

Synthesized from cholesterol upon exposure to UVB; functions in the body as a steroid hormone

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15
Q

Recommended dietary allowance (RDA) definition

A

Average daily level of intake sufficient to meet the nutrient requirements of nearly all healthy individuals

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16
Q

Adequate intake (AI) definition

A

Established when evidence is insufficient to develop on RDA; intake of this level is assumed to ensure nutritional adequacy

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17
Q

Estimated average requirement (EAR) definition

A

Average daily level of intake estimated to meet the requirements of 50% of healthy individuals

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18
Q

Tolerable upper intake level (UL) definition

A

Maximum daily intake unlikely to cause adverse health effects

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19
Q

B1 deficiency is likely to happen in what population?

A

Alcoholics

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20
Q

Complications of B1 deficiency

A

Wernicke’s Encephalopathy, Korsakoff’s Psychosis

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21
Q

Symptoms of Wernicke’s Encephalopathy

A

Confusion, nystagmus, ataxia

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22
Q

Treatment for Wernicke’s Encephalopathy

A

50-100mg IV thiamine

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23
Q

How does Korsakoff’s Psychosis develop and what are the symptoms?

A

If Wernicke’s Encephalopathy is untreated, it can develop to Korsakoff’s Psychosis, a chronic state of irreversible damage and cognitive impairment

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24
Q

Symptoms of B2 deficiency

A

Glossitis, cheilosis, dermatitis, corneal vascularization, cataracts, anemia

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25
Q

Symptoms of B3 deficiency

A

Pellagra: diarrhea, dementia, dermatitis

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26
Q

B6 INH treatment

A

15-30mg/day for patients predisposed to neurotoxicity, 50-200mg/day in established neuropathy

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27
Q

DDIs with B6: levodopa

A

Enhances peripheral decarboxylation

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28
Q

DDIs with B6: phenobarbital, phenytoin

A

Decreased SDCs

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29
Q

B12 deficiency is likely to happen in what age group?

A

> 50 years old

30
Q

Complications of B12 deficiency

A

Macrocytic anemia, irreversible nervous system damage

31
Q

B12 DDIs

A

Possible DDIs with metformin, PPIs, H2RAs

32
Q

Cause of folic acid deficiency

A

Drug therapy may induce it and alcoholism impairs enterohepatic recycling of folic acid

33
Q

Folic acid deficiency DDI: methotrexate and trimethoprim

A

Inhibits DHFR

34
Q

Folic acid deficiency DDI: phenytoin and oral contraceptives

A

Impairs storage

35
Q

Vitamin C deficiency leads to what condition?

A

Scurvy

36
Q

Signs and symptoms of scurvy

A

Defect in collagen synthesis, failure in wound healing, defects in tooth formation, gingivitis

37
Q

Scurvy is seen in what populations?

A

Elderly, alcoholics, drug addicts, patients with inadequate diets

38
Q

Vitamin A deficiency consequences

A

Involve all epithelium, can lead to blindness and hypervitaminosis A with excessive intake

39
Q

Vitamin E deficiency consequences

A

There’s no unequivocal evidence that exists to show that vitamin E is even necessary for humans to take

40
Q

Factors that go into Vitamin D deficiency

A

Age, skin color, geography, sun exposure

41
Q

Benefits of taking Vitamin D

A

Helps with:

General health and deficiency, CVD risk, diabetes, respiratory diseases, eye diseases, infectious diseases, neurologic disease, colon and breast cancer

42
Q

Vitamin D toxicity

A

Hypercalcemia from consuming >10,000 units/day

43
Q

Vitamin D toxicity symptoms

A

Anorexia, diarrhea, constipation, vague aches, depression, hallucinations, amnesia, impaired renal function, widespread tissue calcification, decline in growth rate in children, death

44
Q

Vitamin D toxicity treatment

A

Withdraw vitamin, administer fluids, very low calcium diet

45
Q

Vitamin D levels for deficiency

A

<30 nmol/ml, 12 ng/ml

46
Q

Vitamin D levels for inadequate intake

A

30-50 nmol/ml, 12-20 ng/ml

47
Q

Vitamin D levels for adequate intake

A

≥50 nmol/ml, ≥20 ng/ml

48
Q

Vitamin D levels that cause adverse effects

A

> 125 nmol/ml, >50 ng/ml

49
Q

Best indicator of immediate vitamin D status

A

Cholecalciferol (D3 levels); half-life is one day and represents day-to-day exposure

50
Q

Best indicator of vitamin D exposure

A

Calcidiol (25(OH)D) levels; half-life is 15 DAYS and represents vitamin D produced by the skin and consumed over a longer period

51
Q

Worst indicator of vitamin D status

A

Calcitriol (1,25(OH)2D) levels; half-life is 15 HOURS and levels don’t decrease until deficiency is severe

52
Q

Vitamin D replacement

A

Expected change in blood concentration of calcidiol with daily dosing for 2-3 months; then use maintenance doses once level is achieved

53
Q

Which form of vitamin D is more efficient? (D3 or D2)

A

D3

54
Q

Intermittent vs. daily dosing of Vitamin D

A

The PK of vitamin D allows for intermittent high doses but increases fall risk in the elderly and increased risk and duration of URIs

55
Q

Patient factors that contribute to increased vitamin requirements

A 
Weight reduction and fad diets
Malabsorptive states/bariatric surgery
Pregnancy
Alcohol consumption
Drug-nutrient interactions
Osteodystrophy
Elderly
Refugees/immigrants
56
Q

Recommendations for patients where supplementation is beneficial: deficiency, “at risk”

A

Malnutrition, age, DDIs, malabsorption

57
Q

What vitamins to use if a patient is taking metformin or a PPI

A

B12, calcium, magnesium

58
Q

Recommendations for patients where supplementation is beneficial: maintaining bone health

A

Take vitamin D per DRI in conjunction with calcium (get at least 50% of calcium from diet)

59
Q

Recommendations for patients where supplementation is beneficial: pregnancy

A

FOLIC ACID! Iron if anemic

60
Q

Recommendations for patients where supplementation is beneficial: macular degeneration

A

Antioxidant/mineral combination products

61
Q

Cancer and CV protection and prevention: what would increase harm to these patients?

A

High dose supplements of beta-carotene, vitamin E, selenium, vitamin C, and folic acid aren’t recommended

62
Q

Increased harm of Vitamin E

A

Excessive bleeding with higher doses in conjunction with anticoagulant therapy

63
Q

Increased harm of Vitamin A

A

Smokers have increased mortality

64
Q

Primary literature: Vitamin D and CVD risk

A

Higher concentrations of Vitamin D, lower risk of CVD

65
Q

Primary literature: Vitamin D intake in invasive cancer and CVD events

A

No difference between the placebo and Vitamin D treatment group

66
Q

Primary literature: vitamin intake in healthy adults without special nutritional needs for primary prevention of CVD and cancer

A

No recommendations for multivitamins, single-or-paired nutrient supplements, beta-carotene, or vitamin E

67
Q

Primary literature: there is an increased risk of mortality in patients taking what vitamins?

A

Beta-carotene/Vitamin A, Vitamin E

68
Q

Primary literature: what shouldn’t be used in women <65 for CVD prevention

A

Menopausal therapy, antioxidant supplements, folic acid, and ASA

69
Q

Where are AREDS supplements used?

A

Age-related macular degeneration

70
Q

Which formulation of AREDS can you use in smokers? (AREDS or AREDS-2)

A

AREDS-2! Doesn’t contain beta-carotene

PHM 604- Nutrition and Cirrhosis (6 decks)

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