Term
| What vitamins are water soluble? |
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Definition
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Term
| What vitamins are fat soluble? |
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Definition
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Term
| What are EAR, DRI, RDA, AI, and UL? |
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Definition
- DRI - Daily reference intake - sum of all values. Assesses diet of healthy ppl.
- EAR - Estimated Average Requirement - basis for RDA, intake meets needs of 50% of a group.
- RDA - recommended daily allowance - intake meets requirements of healthy ppl
- AI - adequate intake - RDA does not exist, will not help malnourishment
- UL - upper limit - highest intake that does not pose a threat. |
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Term
| What is the function of Vit A |
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Definition
Used for vision, epithelium
Embryonic neural development
Immune fxn - NK cells
Anemia prevention
** From retinoids/carotene |
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Term
| What are the forms of Vit A? |
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Definition
- Retinol - restores visual and reproductive fxn
- Retinoic Acid - promotes epithelium. Tretinoin and isotretinoin
- Beta Carotene - converts to both retinol and retinoic acid. Less toxic! |
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Term
| How are units of Vit A measured? |
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Definition
1 IU = 0.3 mcg retinol = 0.1 mcg beta carotene
**UL = 10,000 units or 3,000 mcg/day |
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Term
| What causes hypervitaminosis A? |
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Definition
Megadoses of retinol OVER 7.5 mg QD, retinoids for the skin
Sx: dry skin, anorexia, bone pain, liver change, teratogenic. |
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Term
| Can beta carotene be used for cancer? |
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Definition
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Term
| What is Vit K essential for? |
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Definition
Clotting factors 2,7,9,10, C/S.
Given IM to newborns. Deficiency in malabsorption |
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Term
| When is Vit K given to a warfarin patient? |
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Definition
- INR > 10, no bleed - Give 2.5 mg orally
- Serious bleeding at any elevation - give 5-10 mg IV
- Life-threatening bleed - give 5-10 mg IV w/ prothrombin complex
- moderate INR elevation w/ no bleed - always oral, not SQ |
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Term
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Definition
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Term
| What are the forms of Vit E? |
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Definition
Alpha tocopherol is active:
- Natural - 1 IU = 0.67 mg
- Synthetic - 1 IU = 0.45 mg |
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Term
| How is Vit E used by the body? |
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Definition
As an antioxidant!
Also used in reproduction and gene expression |
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Term
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Definition
Effects of Vit E and/or an aceI on CVD -- used Vit E 400 IU
Found NO DIFFERENCE between Vit E and rampiril.
**HOPE-TOO - Vit E showed HIGHER risk of CHF |
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Term
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Definition
Can anti-oxidant vitamins aid in cancer?
- Beta-carotene increased cancer
- Vit E increased death from stroke
**Risk of hemorrhage outweighs benefit. |
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Term
| What are effects of Vit D? |
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Definition
Decreases cancer risk, especially colorectal and breast cancer
Decreases both types of diabetes |
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Term
| What is a sign of Vit D deficiency? |
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Definition
Rickets
Increased PTH --> Osteoporosis
Muscle pain and weakness
Increased falls and fractures |
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Term
| What amounts of Vit D are recommended? |
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Definition
- RDA is normally 600 IU, UL is 4,000 IU
- National Osteoporosis foundation: 400-800 IU for adults < 50, 800-1000 IU for over 50.
- Vit D deficiency: 50,000 IU weekly |
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Term
| What is caused by Vit C deficiency? |
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Definition
Scurvy - Loose teeth, Anemia. Common in sailors, elderly
**Megadose - kidney stones, incr CV mortality. |
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Term
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Definition
B1: Thiamine
B2: Riboflavin - uv in newborns for incr bilirubin
B3: Niacin
B5: Pantothenic acid - no RDA, no deficiency
B6: Pyridoxine
B7: Biotin
B9:Folate
B12: Cyanocobalamin |
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Term
| What is caused by B1/Thiamine deficiency? |
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Definition
Beriberi - thiamine deficiency
- Wet - mimics CHF
- Dry - nervous defects
- Wernicke's encephalopathy - responds only to thiamine
- Korsakoff's syndrome - learning and memory impairment. May be irreversible. |
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Term
| What are the 2 sources of niacin/B3 |
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Definition
Nicotinic acid - helps hyperlipidemia
Nicotinamide
Found in grains and beans. Deficiency in corn-rich diet.
**Can be toxic in megadoses - flushing, hepatotoxicity |
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Term
| What is seen in Niacin/B3 deficiency? |
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Definition
3 D's - Dermatitis, Diarrhea, Dementia
Hartnup's disease - interferes w/ tryptophan absorption |
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Term
| When would Biotin/B7 need to be supplemented? |
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Definition
| Prolonged antibiotic therapy |
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Term
| What is Pyridoxine/B6 used for? |
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Definition
Synthesis of neurotransmitters and heme - very important.
Deficiency: Seizures, dermatitis. Supplement helps in PINV, but infants can be born dependent. |
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Term
| What is B12/Cyanocobalmin used for? |
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Definition
| Essential for utilization of folate. B12-folate (B9) complex necessary for purine/pyrimidine synthesis. |
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Term
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Definition
Found in veggies, liver, fruit, grains.
Used for conversion of homocysteine --> methionine and serine --> glycine.
Necessary for normal metabolism. |
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Term
| How is folate/B9 deficiency seen? |
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Definition
Megaloblastic anemia - Tx w/ B9-B12 complex.
Can lead to neural tube defects and homocysteine elevations.
**Megadose folic acid increases cognitive decline in the elderly as well as prostate cancer. |
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Term
| Where is B12/Cyanocobalmin NOT found? |
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Definition
| In vegetables! Vegans must take supplements. |
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Term
| How is B12/cyanocobalmin deficiency seen? |
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Definition
Pernicious anemia - decr intrinsic factor = no absorption
Neurologic damage
Tx of pernicious anemia: 1000 mcg IM daily x7 days, then QW for one month, then once monthly. FOREVER. |
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Term
| How do homocysteine levels affect CHD? |
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Definition
| lowering homocysteine levels actually increased risk of a CV event and increases GFR. DOES NOT WORK. |
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Term
| What is Zinc dosing used for? |
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Definition
May decrease duration of the common cold. Avoid intranasal dosing.
**Toxicity - copper deficiency, renal failure, loss of sense of smell |
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Term
| What are the differences in calcium supplements? |
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Definition
- Calcium carbonate - 40%, the highest. take with meals
- Calcium Citrate - 21%. Better absorption, good w/ PPIs
- Calcium Acetate - 25% - for hyperphosphatemia
- Calcium Phosphate - 38% - low solubility
- CaCl - 27% - IV
- Ca gluconate - 9% - less irritating. |
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Term
| What are signs of iron toxicity? |
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Definition
- Leading cause of children unintentional poisoning
- GI, liver, CNS, CV toxicity
**Antidote: DFO, a chelator |
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Term
| What is magnesium used for? |
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Definition
- First line Tx for Torsades
- As a laxative, for bones, PMS
Tx of toxicity w/ IV calcium |
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Term
| What is selenium used for? |
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Definition
An antioxidant at high levels, major role in synthesis of TSH
Toxicity similar to ARSENIC poisoning |
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Term
| What is the SELECT trial? |
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Definition
| Selenium +/- Vit E for prostate cancer prevention: no decrease, higher rate of prostate CA in Vit E group, higher rate of diabetes in Se group. |
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Term
| Does selenium help diabetes? |
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Definition
| No! Increased risk seen with selenium supplementation. |
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Term
| What is Chromium used for? |
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Definition
Cr3 is found in foods while Cr4 is toxic. Used in GTF for normal insulin sensitivity - deficiency leads to glucose tolerance
**No RDA |
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Term
| What effect do thiazide diuretics have on nutrients? |
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Definition
- K/Mg/thiamine wasting. May need supplements
- Calcium retention. Caution w/ supplements |
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Term
| What effects do loop diuretics have on nutrients? |
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Definition
| - HIGHER loss of K/Mg/Ca/Thiamine. May need supplements. |
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Term
| What electrolyte deficiencies can exacerbate dig toxicity? |
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Definition
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Term
| How do bile acid sequestrants affect vitamins and minerals? |
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Definition
Decrease absorption of A, D, E, K, B12, Folate, Fe, Ca, and Mg.
Decreases Intrinsic factor binding to B12 |
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Term
| What antibiotics can affect mineral supplements? |
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Definition
| Tetracyclines and Fluoroquinolones. Take 2 hours before or 6 hours after supplements. |
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Term
| How does bactrim affect vitamins and minerals? |
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Definition
| TMP inhibits Folate and decreases K excretion -- hyperkalemia |
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Term
| How does INH/Isonaizid affect B6? |
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Definition
| Inhibits activation of B6 |
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Term
| How does MTX affect folate? |
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Definition
| binds to DHFR and antagonizes folate. Must be supplemented for RA. |
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Term
| How do corticosteroids affect supplements? |
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Definition
| Increased excretion and decreased absorption of Vit D and calcium -- induced osteoporosis |
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Term
| How do PPIs affect supplements? |
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Definition
Increase pH, decreasing absorption of calcium and iron, and decreasing binding of IF-B12.
Calcium Citrate preferred. |
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Term
| How do anticonvulsants (carbamazepine, phenytoin, phenobarb, primidone, fos-phenytoin) affect supplements? |
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Definition
- Increased Vit D metabolism
- Increased Vit K metabolism. Pregnant women should supplement.
- Folate may decrease PHT lvls, monitor. |
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Term
| How do NSAIDs and Plavix/Warfarin affect supplements? |
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Definition
| When used w/ Vit E -- increased risk of bleeding |
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Term
| What does iron interact with? |
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Definition
| Levothyroxine - forms insoluble complex, separate by 2 hours |
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Term
| How does folate interact with B12? |
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Definition
| Folate can mask B12 deficiency in megaloblastic anemia - check before starting folate tx |
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Term
| What supplement does Metformin interact with? |
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Definition
| B12 - malabsorption, monitor levels |
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Term
| What supplement does hydralazine interact with? |
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Definition
| B6/pyridoxine - makes B6 inactive and can lead to deficiency -- neuropathy. |
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Term
| What Vitamins in the ICU actually decrease mortality? |
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Definition
| - Vit A - was thought to be helpful in sepsis, is NOT |
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Term
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Definition
Take mg of Iron and divide by corresponding # to get % iron:
Ferrous Fumarate: 3
Ferrous Sulfate: 5
Ferrous Gluconate: 9 |
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Term
| What vitamins should be supplemented in the critically ill? |
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Definition
- B1/Thiamine. ALWAYS
- B12/Cyanocobalmin
- Vit C - helps with wound healing if deficient
- Vit D/Calcium - monitor
- Selenium - whenever possible, an antioxidant. Vit E is also an antioxidant.
- Zinc - gets sequestered, decreases mortality if supplemented |
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Term
| How is iron affected in critical illness? |
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Definition
Sequestering of iron is a defense mechanism. Ferritin stores are HIGH.
**Give iron only if ferritin is low, indicating anemia |
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Term
| What is Wilson's disease and how is it treated? |
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Definition
An autosomal recessive disorder leading to copper deposition
Tx: copper restriction, Penicillamine, maintenance w/ Zn salts which prevent copper absorption |
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