Vitamins and Minerals Flashcards by Joshua Borkosky

Differentiate vitamins obtained through the diet from vitamins obtained through a supplement.

The body does not differentiate one from the other. The only difference is the dietary form likely has additional nutrients.

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What determines whether or not a patient should take a vitamin supplement?

Individual choice based on how balanced their diet is

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What is the primary use of vitamins and minerals in our body?

Used as cofactors in metabolism

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In what type of vitamins do we worry about toxicity?

Fat soluble - A, D, E, K

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Describe Nephrocaps and state what type of patients should take them.

Multivitamin fortified with higher concentration of water soluble vitamins. Taken by patients on dialysis because dialysis removes a lot of water soluble vitamins.

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What substances are pre-natal vitamins fortified with?

Folate and iron

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What is the name for vitamin A and its analogues?

Retinol / retinoids

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Describe the functions of vitamin A in the body.

Skin development
Formation of retinal photochemicals
Enhance immune function
Protective effect against certain cancers

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What are the indications for prescription vitamin A supplementation?

Psoriasis, acne (most common), some leukemias

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What are the AEs of taking vitamin A supplements?

Teratogenicity, GI upset, hyperglycemia, hyperlipidemia, dry/chafed skin, elevated LFTs

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What are the signs and symptoms of vitamin A toxicity?

Headache, N/V, drowsiness, pain in long bones

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List and name the B vitamins discussed in class and describe what they are primarily known for.

B1: Thiamine - deficiency in chronic alcoholics
B3: Niacin - increase HDL
B6: Pyridoxine - supplemented in patients taking isoniazid for TB
B9: Folate - deficiency causes anemia
B12: Cyanocobalamin - deficiency causes pernicious anemia

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Describe the mechanism by which B12 is absorbed in the stomach

B12 is known as extrinsic factor. To be absorbed you need intrinsic factor absorbed by the stomach.

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Other than anemia, what else can result from long term B12 deficiency?

Neurological and psychiatric symptoms, ex = depression

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What drug can mask signs and symptoms of B12 deficiency/pernicious anemia?

Folate –> can return CBC values to normal but still result in further neuronal destruction and misdiagnosis. Pernicious anemia requires replacement of B12.

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How may B12 be administered?

PO or by injection

What is the name for vitamin C?

Ascorbic Acid

What is the indication a person is getting too much vitamin C?

Urine turns yellow

What is the name of the condition caused by vitamin C deficiency?

Scurvy - petechial hemorrhages, hematomas, gum bleeding, anemia

What processes in the body requires vitamin C?

Collagen production and reduction/neutralization of free radicals

What supplement is often co-formulated with vitamin C and why?

Iron because vitamin C is acidic and iron requires acid for absorption.

What condition should cause caution in recommending supplementation with vitamin C and why?

Kidney stones –> acidification of the urine may promote stone formation

What condition results from vitamin D deficiency?

Rickets –> softening of the bones

What is the name of vitamin E and what are its uses in the body?

Tocopherol –> reduction/neutralization of free radicals and some anti-coagulant properties

What are the signs and symptoms of vitamin E toxicity?

GI distress and bleeding disorders

What are the vitamin K dependent pro-coagulant and anti-coagulant clotting factors?

Pro-coagulant: II, VII, IX, and X | Anti-coagulant: Proteins C and S

What medications may hinder the absorption of vitamin K in the colon?

Drugs that block fat absorption --> orlistat for ex.

What patients require folate supplementation and why?

Pregnant women --> fetus requires folate for neural tube formation

What drugs interfere with folate processing and activation?

Bactrim interferes with folate in bacteria | Methotrexate interferes with folate in humans

Deficiency of what vitamin can ultimately lead to folate deficiency anemia and why?

Vitamin C protects stores of tetrahydrofolic acid (active form of folate). Vitamin C deficiency can lead to depletion of active folate and ultimately folate deficiency anemia.

Compare the dose of folate recommended for a pregnant person to that recommended for a non-pregnant person.

Typical Dose = 50-100 mcg | Pregnancy = 300-400 mcg

What is the most significant AE of iron supplementation and how is it mitigated?

GI upset --> take with food

Why is iron necessary in the body?

Required in formation of hemoglobin

How is iron stored and transported in the body?

Storage: ferritin Transport: transferrin

By what routes can iron supplementation be administered?

PO or parenterally (IV, etc.) --> several different formulations

In what two conditions is iron supplementation required?

Pregnancy and anyone taking erythropoietin

With what medications might iron interact and why?

All heavy metals chelate --> space from fluoroquinolones and tetracyclines

What patients most commonly overdose on iron and why?

Young children because iron tablets look like M&Ms

What is the antidote for iron toxicity and how do you measure its effect?

Deferoxamine --> turns urine pink. When urine returns to normal all iron has been detoxified.