Vitamins, Minerals + Electrolytes Flashcards
Which vitamin should be avoided in pregnancy, what is It found in?
Vitamin A- found in liver products, fish liver oils, carrots, eggs
Vitamin A helps with eye sight
What is vitamin B1, and what do we need it for?
Thiamine
Need it for nerves (hence why lack of it can cause Wernickes encephalopathy- biochemical lesions of the central nervous system causing memory loss and confusion)
What is vitamin B6, what do we need it for?
Pyridoxine
Key role in the nervous system- decreases the risk of Neuropathy associated with Isoniazid use (TB drug)
Itself can cause neuropathy if used for long time at high doses!
What is vitamin B12 and what does it cause in deficiency?
B12= Cobalamin
Deficiency = Pernicious Anaemia (a type of Megaloblastic anaemia- MCV high, Heamoglobin low)
Replacement= Hydroxycobalamin
What is Ascorbic acid? What is it used to treat?
Vitamin C- in oranges, peppers, broccoli
Used to treat scurvy (bleeding and inflamed gums and opening of wounds)
Name some of the Vitamin D analogues we give for vitamin D deficiency? What kind of conditions do you see these in?
For prevention of osteoporosis
Hypocalceamia
Rickets
They help promote calcium absorption
Ergocalciferol (vit D2 + calciferol)
Colecalciferol (Vit D3)
alfacalcidol (hydroxylated vit D)
Calcitriol (hydroxylated vit D)
What forms of Vitamin D should be given in renal impairment, and why?
Vitamin D requires hydroxylation by the kidney into its active form. Therefore in renal impairment, hydroxylated vitamin D is given in the form of:
Alfacalcidol
Calcitriol
If not renally impaired, standard Egocalciferol or Colecalciferol (Non hydroxylated) can be used.
What is the main function of Vitamin K? What foods is it found in?
Blood clotting- used for major bleeds with warfarin
It is found in green leafy vegetables- broccoli and spinach
What is the name of the Vitamin K used to reverse warfarin overdose bleeding? When should a patient stop taking warfarin and receive this?
Phytomenadione by Slow IV injection
INR > 8, or any major bleeding: Stop taking- A & E- phytomenadione + dried prothrombin complex
INR > 8, minor bleeding: stop taking, A & E: Phytomenadione injection
INR > 8, No bleeding: stop taking, A & E, phytomenadione BY MOUTH
INR > 5: minor bleeding: stop warfarin, A & E: Phytomenadione BY MOUTH
INR > 5: no bleeding: Miss 1 or 2 doses of warfarin, reduce maintenance dose
What are the synthetic derivatives of folate, and when do we use these?
Folic acid- used for prevention of NTD’s
Folic acid 400mcg in women of low risk
Folic acid 5mg for those at high risk
Folic acid 5mg for Megaloblastic anaemias
Folinic acid- given with methotrexate treatment to reduce methotrexates side effects
What drugs can produce a folate deficiency? (4)
Methotrexate
Phenytoin
trimethoprim-sulfamethoxazole
sulfasalazine
What kind of anaemia does folate deficiency cause?
Megaloblastic anaemia
High Mean Cell Volume, Low Heamoglobin level
Can Vitamins be prescribed on NHS Rx’s as dietary supplements?
No- only for deficiency states
What is the risk of injectable Iron?
Serious Hypersensitivity Reaction with injections
What would be the signs of Magnesium deficiency?
Apathy (lack of enthusiasm) and muscle weakness
Symptoms of Low potassium?
Usually when potassium falls below 2.5 mmol/ L
Weakness, drowsiness Muscle cramps Low BP (dizziness) Palpitations (arrhythmias) tingling/ numbness Confusion Constipation!!
Symptoms of Low sodium (Hyponatreamia)?
CONFUSION drowsiness Nausea & Vomiting Personality changes Muscle cramps Weakness
What is a benefit of using potassium sparing diuretics over potassium salts to correct potassium levels?
Potassium salts can cause nausea and vomitting
What is the normal potassium range?
What is classed as severe Hyperkaleamia?
3.5 - 5.3 mmol/ L
Severe: > 6.5 mmol/ L (risk of cardiac arrest- treat with calcium gluconate then insulin or bicarbonate)
Symptoms of Hyperkaleamia?
V similar to Hypokaleamia: Arrhythmias muscle weakness, tingling sensations, nausea
What is the normal sodium range?
133 - 146 mmol/L
What drugs may cause Hypernatreamia? (3)
Corticosteroids
Phenytoin
Lithium
What drugs may cause Hyponatreamia? (5)
Diuretics- thiazide & Loop SSRI's Vasopressin (used in diabetes insipidus) Carbamazepine Sulfonylureas
What is the rationale behind Oral Rehydration salts?
Intestinal absorption of sodium and water is enhanced by Glucose.
There ORT contains sodium, potassium and glucose/ another carbohydrate (RICE) to replenish electrolytes lost in diarrhoea.
What can too rapid injection of Calcium salts cause?
Arrhythimas
What can magnesium salts cause and therefore be used as?
Diarrhoea
Used as osmotic laxative
Also used for seizures in pre-eclampsia and eclampsia (hypertension in pregnancy (pre-eclampsia) leading to convulsions- eclampsia)
What are acute prophoryias?
A hereditary disorder of Haem biosynthesis- list of drugs in the BNF that are unsafe in this condition eg HRT, COC’s, POP’s
Drugs causing Hypokaleamia (4)?
Thiazide & related diuretics
Loop diuretics (e.g. furosemide)
Beta 2 agonists (e.g. salbutamol)
Insulin
Drugs causing Hyperkaleamia (5)?
K sparing diuretics (e.g. amiloride, Triamterene) + Aldosterone agonists (e.g. spironolactone, eplerenone)
ACE inhibitors confusion, muscle twitching or spasms,
NSAIDs
Heparin
Drugs causing Hypermagnesaemia?
Antacids
Mg supplements
Remember Mg may cause diarrhoea
Drugs cause Hypomagnesaemia? (4)
Thiazide and related diuretics
Loop diuretics (e.g. furosemide)
Digoxin
Aminoglycosides (e.g. gent, vanc)
Hypernatreamia- symptoms?
Major symptom= thirst
confusion
muscle twitching/ spasms,
What electrolyte disturbance can long term PPI therapy (3 months- 1 year) cause ?
HypoMAGNESAEMIA
What can we use to correct Hypercalcaemia?
Bisphosphonates- they bind calcium! e.g. pamidronate
Vitamin C deficiency signs?
swollen gums, bleeding gums, gum hyperplasia
Vitamin B12 deficiency signs?
Cracked mouth
Mouth sores
Extreme tiredness
Headaches
