Vitamins Pt2 Flashcards
1
Q
What are tonics
A
- Old school remedys for seniors
- More phycological then anything
2
Q
Two types of iron
A
- Heme: meats and is the best
- Non heme: plants,
3
Q
RNI of iron and best way to reach this
A
- 15-18 mg for females (15 for teens, 18 for adults)
- best way to get this is through dietary measures if possible
4
Q
Do we hand out iron tablets (high iron supplements)
A
- No we don’t
- Try to increase it through dietary measures but if not possible use lab results
- Don’t prescribe them only dispense them
5
Q
Different salts iron is available in
A
- Ferrous fumarate: 33% iron (blue)
- Ferrous sulfate: 20% iron (red)
- Ferrous gluconate: 12% iron (green)
6
Q
What % of dietary iron (heme) is absorbed
A
- 10-15% is absorbed by the body from diet
- When in an iron deficiency about 20%
7
Q
Why are some people told to take iron supplements with orange juice
A
- Vitamin C causes a little better absorption of iron
8
Q
why do some iron supp say less/ no side effects
A
A lot of iron supplements have very little iron as only 10-20% is absorbed, also say less side effects but this usually just means less iron
9
Q
Absorption Interactions with iron (food, vit C, protein/calcium/antacids, coffee/tea)
A
- Increase: vit C
- Decrease: food (May have less then 50% of what you thought you had, but it is better to have it tolerable with food and not have any side effects), protein/calcium/antacids, coffee/ tea
10
Q
How long does it take for an iron deficiency to be under control
A
2-3 weeks, however prescription usually 3 months
11
Q
Tolerable Upper limit of iron
A
45 mg
12
Q
Side effects of iron
A
- Dyspepsia (heart burn)
- Nausea vomiting
- Constipation
- Dark stools (can be via unabsorbed iron and is harmless in this state)
13
Q
Do slow release formulations help?
A
- Iron is best absorbed quickly in the gut
- With a slow release product many of these may not be freed and may not even be available and goes through
- Slow release iron is more expensive and lower absorption
14
Q
If there is discoloration in the stool what do we do
A
- Most likely just the iron colour
- We cant tell if it is this or an actual bleed
- Needs to be checked out by a MD
15
Q
Is iron safe with kids?
A
- No it is not safe around kids as it can kill
Pediatric toxicity
16
Q
what vitamin has pediatric toxicity
A
iron, can cause death in kids
17
Q
Why do most people take vitamins
A
- Just in case 75% of people
- No value in reducing mortality, cancer, or almost any type of cardiovascular disease
18
Q
What are niacin used for
A
- Was used for cholesterol at the prescription level but now has less value now and has
barely any value at the OTC
19
Q
Flushing vs no flushing niacin
A
non flushing niacin means that it is deemed ineffective as the amide makes it useless (niacin/ nicotinic acid have some effect, niacinamide/ nicotinamide have no effect)
20
Q
Cancer with vitamins
A
- Antioxidants: When there is a mix of all antioxidants it is way better then just one at a time
- Foods vs supplements: supp not helpful
21
Q
Stress/ fatigue/ energy with vitamins
A
- B vitamins are critical just as proteins carbs… but it does not drive us to have less stress/ fatigue and more energy if you arent deficient
22
Q
Depression and anxiety with vitamins
A
- If you are deficient has some evidence for thiamine
- Thiamine’s(B1) RNA is 1 mg but the supplements come in at much higher then this
23
Q
AMD
A
- Age related macular degeneration: the flooding of blood and is basically high cholesterol in the eye (get fat deposits)
- Once you get it you cant reverse it (starts in the middle of the eye)
24
Q
Dry vs wet types of eye vitamins
A
- Dry: 90%: for high cholesterol
- Wet type: 10%, vascular type and get into your high
25
What are AREDS
- Age related eye disease studies
- Potentially delays progression of 1 in 4 cases that have intermediate AMD
- This level of agents cant be met by diet alone
- The only evidence based eye drops for AMD
- Must say AREDS or AREDS 2 on the package
26
RNI of magnesium
- 320-420 mg
27
2. What is magnesium most likely used for
- Heart health
- Leg cramps
- Bone health
- Depression
- Anti-constipation
28
Where do we want to get magnesium from
- Get majority with diet and then top up from supplements
29
UL of diarrhea and side effects of magnesium
- Tolerable upper limit it 350 mg
- At 500 mg can cause diarrhea
- Cant say no side effects but need a lot of mg to cause diarrhea
30
Potassium
Important aspect of DASH diet (For hypertension and lifts potassium levels up and seems to help heart health)
31
RNI of potassium
- 4700 mg
- A banana has 470 mg
32
What does high levels of supplemented potassium do in relation to BP
- 2300 mg of supp lowered BP by 3 points
- Not to mess around in the OTC world rather prescription
33
What can we expect If a person starts taking multi-vitamin, calcium, iron, AMD product
- Not going to feel different unless they are maybe iron deficient
Preventative more
34
How long will I be on iron, calcium, AMD product
- Iron: about 3 months if iron deficient
- Calcium: for life
- AMD product: lifelong
35
Enteral products
- Complete nutrition has all the carbs, fats, proteins vitamins and minerals to keep you sustained as possible
- If worried about vitamins you can take them to this as this gives them everything
-Boost, ensure
36
Why would a person take an extra fat enteral product
The plus is more fats thrown in, can drink 50% less of liquid
37
what are other uses for enteral products
Also used for tube feeding, nursing home, jaw wired shut
38
Diabetic(glucerna) enteral product
- Slower carb release
- Marketed to diabetics
- Only difference is the carbs are a bit more Complex in glucerna
Gives less spike for diabetics
39
kid vs adult enteral product
basically same thing with different labelling
40
Vitamin C
Essential vitamin
41
Vitamin C Needed for 19+
- Male: 90 mg
- Female: 75 mg
- Need very little amount while Most tablets are at about 500 mg
42
Vitamin E
- Mostly used for scar prevention
- May help
Vaseline works just as good
43
Needed vitamin E: 14+
- Males: 15 mg (22.4 IU)
- Females: 15 mg
- However most products have 400 IU
44
Vitamin K
- Generally not a self medication scenario (it affects coagulation)
- Low levels of vitamin K can raise the risk of uncontrolled bleedings but deficiencies are rare in adults
- Clotting vitamin
May have an influence on bone mineral density and osteoporosis
45
RNI of vitamin K
- Around 100 ug
46
Types of vitamin K
a) K1: phylloquinone
- Dietary form, found in plants like green vegetables, low toxicity
b) K2: menaquinone
- Created in body by intestinal flora and found in fermented foods
c) K3: menadione
- Created in body by intestinal flora and found in fermented foods
-concern for toxicity
47
which vitamin K is preferred usually
K1 usually preferred as lower concern for toxicity and works faster but some claim for K2 being better for boen
48
Fat soluble vitamins and mineral oil interactions
- Mineral oil is hard on gut, no constipation patient is taking mineral oil, fat soluble vitamins could leak into mineral oil taken out of body.
49
Vitamin E and anticoagulation interactions
- It is not linked to any cardiovascular value at 400IU
- It could have an effect if you had upwards of 1000 IU
50
Fe (not at multivitamin levels, TUL of iron is 45 mg)with antacids, coffee/tea/wine, tetracyclines, any drug with GI irritation potential, any drug with potential for constipation
a) Antacids
- PPIs can make less Acid and make iron Less absorbed
b) Coffee, tea, wine
- Could make it a little less Absorbed, not to worry about
c) Tetracyclines
- Big one (could be on for acne), Iron could make tetracycline less effective
d) Any drug with GI irritation potential, any drug with potential for constipation
- Unless your taking the TUL not an issue
Ibuprofen
51
Calcium with tetracyclines, corticosteroids, chronic PPI use, any drug with potential for constipation
a) Corticosteroids
- Chronic steroids can leach Ca out of the bones
- Ca would be a good thing with chronic steroids
b) Potential for constipation
- Not going to cause (at 2500mg it could) but you only have about 200mg in a multivitamin
c) Vitamin A and retinoids (oral and topical) interactions
- Retinoids (vitamin a derivatives for acne), if have both then multiple sources of vit A
- No multivitamin will interact with retinoids, vit a will not help with acne orally
d) Potassium and diuretics interactions
- Can lose a bit of potassium with diuretics
- Multivitamin will not increase K levels (not enough in them)
