Pharmacology week 9.docx

Pharmacology week 9 OTC- vitamins and minerals Vitamins Organic molecules needed in small quantities for normal metabolism and other biochemical functions, such as growth or repair of tissue Natural sources from both plants and animals Attach to enzymes or coenzymes and help activate anabolic (tissu...

Pharmacology week 9 OTC- vitamins and minerals Vitamins Organic molecules needed in small quantities for normal metabolism and other biochemical functions, such as growth or repair of tissue Natural sources from both plants and animals Attach to enzymes or coenzymes and help activate anabolic (tissue building) processes Water-soluble vitamins B-complex group and vitamin C Easily secreted in the urine Daily intake required to prevent deficiencies Can be dissolved in water Cannot be stored by the body over long periods of time Fat-soluble vitamins Vitamins A, D, E and K Stored in the liver and fatty tissues Deficiencies occur only after prolonged and deprivation from an adequate supply or from disorders that prevent their absorption Daily intake not required unless one is deficient Vitamins: other issues Nutrient mega dosing- strategy for health promotion and maintenance for treatment of various illnesses (ex: Vitamin C for the flu) ( mega dosing is 10x the regular dose) Recommended daily allowances Toxic accumulation “hypervitaminosis” – fat-soluble Dietary reference intakes (DRIs) – nutrition values for nutrients Vitamin A Fat soluble Vitamin A (retinol) food sources: liver, fish, dairy products, egg yolks, dark green leafy vegetables, and yellow-orange vegetables and fruits Vitamin A comes from carotenes, which are found in plants (green and yellow vegetables and yellow fruits Different types of names: retinol, retinyl palmitate and retinyl acetate Function: required for growth and development of bones and teeth, essential for night and normal vision and necessary for reproduction and integrity of mucosal and epithelial surfaces Indications for use: dietary supplement (infants and pregnant nursing women) deficiency states, hyperkeratosis of the skin (thickening of the outside of the skin and night blindness) used to treat skin conditions such as acne, psoriasis, keratosis follicularis used in Accutane (can result in possible toxicity) Toxicity: ingestion of excessive amounts causes toxicity which can lead to irritability, drowsiness, vertigo, delirium, coma, vomiting, diarrhea, increased intracranial pressure infants. Generalized peeling of the skin and erythema over several weeks. Vitamin D fat soluble sunshine vitamin (regular dose 1000-4000) responsible for proper utilization of calcium and phosphorus vitamin D2 (plant vitamin, obtained through food such as fish liver oils, saltwater fish) vitamin D3 (produced in the skin by ultraviolet irradiation; they give children born in Alaska or dark places vitamin D shots as they don’t see the sun as often. Functions: works with parathyroid hormone to regulate absorption and use of calcium and phosphorus. Necessary for normal calcification of bone and teeth. Indications for use: dietary supplement treatment of vitamin D deficiency treatment and correction of conditions related to long-term deficiency such as rickets (weak bone development in children), tetany (involuntary facial twitching) and osteomalacia prevention of osteoporosis Toxicity: symptoms same as most therefore last to be ruled out. Hypertension, dysrhythmias, weakness, fatigue, headaches, and drowsiness. Forms of vitamin D: calcifediol, calcitriol, dihydrotachysterol and ergocalciferol. Vitamin E Fat soluble, antioxidant Four forms Very few acute adverse effects Treatment of deficiency (highest risk of deficiency in premature infants) Dietary plant sources: fruits, grains, fortified cereals, vegetable oils, wheat germ, nuts Animal sources: eggs, chicken, meats, and fish Functions: unknown, believed to be an antioxidant. False theory beneficial effects for cancer, heart disease, Alzheimer’s disease, premenstrual syndrome, and sexual dysfunction. Vitamin K Fat soluble Three types Body does not store large amounts of vitamin K Synthesised by intestinal flora Best source: dark leafy greens (asparagus, broccoli, cucumbers, salad greens) Indications for use: Improves bone health and regulates blood clotting Fights cancer and supports brain function Reduces menstrual pain and heavy bleeding Supports heart health Dietary supplement (deficiency is rare) Given prophylactically to newborn infants (helps with blood flow, helps their gut health) Reverses effects of warfarin approx. 1 week after vitamin K administration Very few drugs have reversals for this, so it is important and can prevent subdural hematoma Vitamin B6 pyridoxine Water soluble Sources: whole grains, wheat germ, yeast, fortified cereals, fish, organ meats, eggs Function: necessary for many metabolic functions, integrity of skin, nerves, mucous membranes, hematopoietic systems of organs and tissues, including bone marrow and spleen. Cause of deficiency: inadequate intake, poor absorption Uremia: increased level of urea in blood Alcoholism and heart failure Cirrhosis and hyperthyroidism Drug induced: hydralazine- high blood pressure med can cause B6 deficiency. Indications for use: Deficiency Seizures that are unresponsive to usual therapy Morning sickness during pregnancy Vitamin B12 (cyanocobalamin) Water soluble Oral absorption (extrinsic factors require presence of intrinsic factor (glycoprotein secreted from the gastric parietal cells) Synthesized by microorganism in body Food sources: liver, kidney, fish, shellfish, milk, poultry, eggs Function: required for many metabolic pathways: fat & carbohydrate metabolism, protein synthesis, growth, cell replication and hematopoiesis Deficiency: most common is pernicious anemia. Vitamin b12 shots can fix this to create RBCs. Can lead to neurological damage, megaloblastic anemia (immature and large RBCs) Vitamin C (ascorbic acid) Water soluble Natural sources: citrus fruits, tomatoes, green peppers, livers Functions: acts in oxidation-reduction reactions and required for several metabolic activities; collagen synthesis, C.T repair, folic acid, erythropoiesis Enhances absorption of iron and required for synthesis of lipids, proteins, steroids, cellular respirations and infections. Deficiency: prolonged deficiency results in scurvy Weakness, gingivitis and bleeding gums, anemia, loss of teeth, delayed healing of soft tissues and bones Indications of use: deficiency supplement Prevention and treatment of scurvy Most large, controlled studies have shown that ascorbic acid has little or no value as a prophylactic for the common cold Mega-dosing: can cause N/V, headache, and abdominal cramps (discontinuing mega dosing may result in scurvy like symptoms. Calcium Most abundant mineral element in the body Accounts for 2% of body weight Highest concentration in bones and teeth Efficient absorption requires adequate amounts of vitamin D Needed for: growing children, women who are pregnant Food sources: Found in many foods (milk and dairy products, fortified cereals, sardines, salmon) Function: essential for normal maintenance and function of nervous, muscular, and skeletal systems. (lock and key method for the catalyst point and free enzyme binds to the substrate). Contraction of cardiac, smooth, skeletal muscles Deficiency: calcium deficiency (hypocalcaemia) (infantile rickets and osteoporosis). Toxicity: anorexia, N/T, constipation, delirium and coma. Drug interactions: chelation – calcium salts will bind with tetracyclines to produce an insoluble complex. Magnesium Essential for enzyme systems associated with energy metabolism (required for: nerve function and muscle contraction) Dietary sources: green leafy vegetables, meats, and seafood, required for higher amounts for diets high in protein-rich foods Deficiency: hypomagnesemia (malabsorption) Indications of use: nutritional supplement, magnesium deficiency, anti-convulsant, eclampsia (magnesium sulphate) Adverse effects: tendon reflex loss, change in bowel movements, CNS depression Phosphorus widely distributed in foods (dairy products, meats, fish and eggs dietary deficiency is rare functions: required precursor for the synthesis of essential body chemicals, building block for body structures. Deficiency: malabsorption, extensive D/V, hyperthyroidism Functions: responsible for cellular energy transfer, necessary for the development and maintenance of the skeletal system and teeth (increased phosphorus level = muscle spasms, weak bones, chronic kidney disease) Indications: treatment of deficiency, supplement in several multivitamin formulations Adverse effects: diarrhea, N/V, confusion, confusion, weakness, breathing difficulties Zinc trace element essential in metabolic reactions of proteins and carbohydrates, important for normal tissue growth and repair. Found in liver, red meats, oysters, milk products. Minerals inorganic compounds bind with enzymes to help regulate many bodily functions required for intracellular and extracellular body fluid electrolytes include: macrominerals, microminerals or trace elements Water soluble vitamins: vitamin B and C Can dissolve in water Excessive amounts excreted in the urine Toxic reactions very rare Act as coenzymes or oxidation-reduction agents Nursing implications Assess for nutritional status, history and medication history, contraindications, baseline lab values. Follow specific guidelines for administration Provide nutritional counselling about necessary foods to include in diet Monitor for therapeutic responses Monitor for adverse effects