Lesson 7: PART 3 Vitamins, Minerals, and Nutritionals Activity

6 types of herbal supplements:

1. Aloe 2. St. John's Wort 3. Chamomile 4. Ginseng 5. Garlic 6. Shark Oil

A pharmacy technician named John, who has been working in this position for three years, goes to Seattle to visit his grandmother whom he hasn't seen for nearly ten years. While staying at her house, he notices that she has more than a dozen different types of vitamins and mineral supplements on her nightstand. He asks her if she takes all of these herself, and she answers, "Yes, I take all of them every day—they help me feel younger and give me more energy!" He finds out that she is also taking three to four different prescribed medications for hypertension and diabetes. 1. What should John's advice be to his grandmother? 2. Which vitamin or mineral supplements may have potential interactions with diabetes medications? 3. If John's grandmother were to take vitamins A and D in excess of the maximum daily require-ments, what would be the symptoms of over-dosage and toxicity from these vitamins?

1. John should tell his grandmother that excessive use of certain vitamins and minerals may cause toxicity. 2. Nicotinic acid and magnesium are examples of supplements that may have potential interactions with diabetes medications. 3. Excessive amounts of vitamin A can cause excessive peeling of the skin, hyperlipidemia, hypercalcemia, and hepatotoxicity, and can lead to death. Excessive amounts of vitamin D may lead to a toxicity syndrome that can result in hypercalcemia, malabsorption (which may lead to constipation), kidney stones, and calcium deposits on bones.

Electrolytes (ions)

1. sodium (Na) 2. potassium (K) 3. calcium (Ca) (chloride, bicarbonate)

Fill in the blank: 1. Vitamin K is an antagonist of _______________. 2. The only food that contains significant amounts of fluoride is _______________. 3. The drug penicillamine is able to remove _______________ from the tissues for excretion in treatment of _______________ disease. 4. Total parenteral nutrition may be administered through a(n) _______________ so that nutrition can be precisely monitored.

1. warfarin 2. tea 3. copper; Wilson's 4. infusion pump

Fat Soluble vitamins

A, D, E, K

Matching 4. vitamin B9

A. folic acid

3. Which of the following minerals should be restricted in patients who are complaining of weakness, dysrhythmias, and hypertension? A. magnesium B. aluminum C. sodium D. iron

A. magnesium

13. Which of the following vitamins may protect the body against infections or help heal wounds? A. vitamin C B. vitamin B12 C. vitamin K D. vitamin E

A. vitamin C

15. Which of the following is a food additive that occurs naturally? A. vitamin C B. aspartame C. partially hydrogenated vegetable oil D. mercury

A. vitamin C

Water-Soluble Vitamins

B vitamins (the B complex) and vitamin C (B1,B2,B3B5,B6,B7,B9,B12)

6. Which of the following types of feeding is more appropriate when a patient's gastrointestinal tract is not functioning? A. oral B. TPN C. enteral D. enema

B. TPN

12. Which of the following minerals is able to help in the formation of hemoglobin and the transportation of iron to bone marrow? A. fluoride (F) B. copper (Cu) C. zinc (Zn) D. iodine (I)

B. copper (Cu)

Matching 2. vitamin B3

B. nicotinamide

9. The Nutrition Labeling and Education Act of 1990 requires most packaged foods to list a specified set of: A. vitamin facts on the diet B. nutrition facts on the label C. mineral and vitamin facts on the diet D. nutritional deficiency data

B. nutrition facts on the label

5. Severe deficiency of niacin (vitamin B3) may result in: A. beriberi B. pellagra C. marasmus D. pernicious anemia

B. pellagra

10. All of the following describe the purposes of food additives, except: A. to make food more appealing B. to prevent misleading statements on the label C. to maintain nutritional value D. to main freshness in the food

B. to prevent misleading statements on the label

1. Which of the following vitamins is used for the patient with an overdose of warfarin? A. vitamin D B. vitamin K C. vitamin E D. vitamin A

B. vitamin K

Dietary Supplements

Because of this classification, guidelines are not as strict regarding quality controls and content. They must provide a minimal amount of information, similar to those required on food products. Items that must be included on a label are ingredients, nutritional information, and information stating that it's a dietary supplement. Additionally, the benefits listed must not be misleading.

8. Calcium deficiency may cause all of the following, except: A. rickets B. osteoporosis C. dwarfism D. osteomalacia

C. dwarfism

Matching 5. vitamin B12

C. hydroxycobalamin

7. An essential micronutrient of thyroid hormone (thyroxine) is: A. iron B. zinc C. iodine D. copper

C. iodine

14. All of the nutrition information on the label is based on which of the following? A. the amount of cholesterol B. the stated calories C. the stated serving size D. the amount of sodium

C. the stated serving size

Copper (Cu)

Copper is an important part of the synthesis of hemoglobin. It's also a component of several enzymes throughout the body and is essential to overall good health. Copper is concentrated primarily in the liver, heart, brain, and kidneys. Copper toxicity is seen in people with Wilson's disease (a rare, inherited disease) and those suffering from biliary cirrhosis. In these diseases, the copper builds up in the liver and can't be excreted. The drug penicillamine is used, because it has the ability to bind to the copper, allowing it to be removed from the body. Good sources of copper are liver, nuts, shellfish, and beans.

4. The proper intake and assimilation of nutrients is known as: A. parenteral nutrition B. excretion C. nutritional insufficiency D. nutritional care

D. nutritional care

Matching 3. vitamin B5

D. pantothenic acid

2. Physicians should prescribe vitamin B12 for patients in which of the following situations? A. inadequate exposure to sunlight B. liver disease C. hemophilia D. pernicious anemia

D. pernicious anemia

11. A system of nourishing through breathing is known as: A. volatile muesli B. immune activation C. saliva activator D. pharma food

D. pharma food

Matching 1. vitamin B

E. riboflavin

Fluorine (F)

Fluorine is added to many of the world's water supply and is still a controversial issue today. A benefit of fluorine is the strengthening of tooth enamel. It's a co-enzyme in several enzyme systems throughout the body. There's also evidence that it strengthens bones, which protects against osteoporosis. Excess fluorine can cause mottling of the teeth and can cause warts to become cancerous.

Nutritional Care

For certain patients, this process isn't working properly. Supplemental nutrition may be required to aid in the healing and maintenance of good health. While most of us can obtain our nutritional requirements by eating regular, healthy meals, others may need tube feedings, or hyperalimentation.

Natural Products

Herbal and botanical products have been used for thousands of years. Their therapeutic qualities have been documented, but the FDA considers them dietary supplements.

Hypercalcemia

Hypercalcemia is an increased level of calcium. This condition is seen in hyperparathyroidism, usually caused by tumor growths. Certain malignant cancers can also cause this.

Hypermagnesemia

Hypermagnesemia happens when the kidneys don't function properly. It's caused by an excess of magnesium. Respiratory distress and heart conditions are seen in patients with high magnesium levels. Calcium will help to reduce magnesium levels, along with the diuretic furosemide.

Hyperphosphoremia

Hyperphosphoremia can cause anemia, cachexia, bronchitis, and necrosis of the mandible bone. Phosphorus is essential for the metabolism of protein, calcium, and glucose. It aids in building strong teeth and bones. It can be found in dairy foods, meat, egg yolks, whole grains, and nuts.

Hypocalcemia (low calcium)

Hypocalcemia (low calcium) is seen in hypoparathyroidism. Tetany (hyperexcitability of nerves and muscles) is a major symptom of hypocalcemia. Heart conditions and cramping are also seen. Calcium supplements can be given orally for maintaining chronic conditions. Severe cases would utilize IV therapy.

Hypokalemia

Hypokalemia is low potassium. This is often due to dehydration caused by vomiting, diarrhea, and fever. Potassium supplements can be in oral or liquid form. For severe cases, IV therapy will be introduced. For conditions caused by lengthy illness, continual oral therapy is prescribed. Blood levels are monitored to assure hyperkalemia is not introduced.

Hypomagnesemia

Hypomagnesemia is seen in patients with poor absorption and excessive diuretic use. Depression and confusion are common symptoms of this condition. Heart conditions can also arise. IV therapy for severe cases is utilized and caution must be taken to dilute it so as not cause severe pain when infusing. If the condition is mild, oral therapy is effective.

Hypophosphoremia

Hypophosphoremia is rare and usually caused by secondary factors. People who overuse antacids containing aluminum are at risk. The aluminum combines with phosphates which render the phosphorus unable to be absorbed. Deficiency causes anemia, weight loss, muscular weakness, and bone pain.

Iodine (I)

Iodine is an important micronutrient utilized of thyroxine (a thyroid hormone). The thyroid houses 80% of the iodine found in the body. Deficiency of iodine causes hypothyroidism, goiter, or cretinism. It's commonly found in seafood, iodized salt, and some dairy products. Iodine in high amounts can irritate acne, so those who suffer are told to stay away from iodized salt. Iodine is also used as a contrast medium to show blood vessels in CT scans. Isotopes of iodine are also used to diagnose and treat cancer of the thyroid.

Iron (Fe)

Iron is essential in the formation of hemoglobin and myoglobin. Its primary role is to transfer oxygen to tissues in the body. Absorption into the tissues is aided by antioxidants like ascorbic acid (vitamin C). A deficiency in iron can cause anemia. This can occur because of poor absorption in the digestive tract or chronic bleeding. Iron is found in our bodies in two different forms: ferrous (iron II) or ferric (iron III). Iron can be found in most meats, shellfish, legumes, and whole grains. If supplements are required, be aware that it can turn stools black. This is a harmless side effect. It's best to take them on an empty stomach to allow maximum absorption through the GI tract. It can also be given with orange juice (vitamin C source) to aid in the absorption and decrease any GI symptoms.

Hyperalimentation includes:

Sugar solution Protein solution Lipid solution (fat) Vitamins Electrolytes Minerals Insulin (These solutions are very stable and can be stored for up to 7 days (under refrigeration), depending on the concentrations of the ingredients.)

Vitamin A (retinol)

Vitamin A (retinol) is stored in the liver. It needs bile salts, pancreatic lipase, and fat to be adequately absorbed. Conditions such as Crohn's Disease, cirrhosis, and colitis can affect the absorption of vitamin A. Deficiencies cause growth retardation, insufficient night vision, and drying of the skin. Food sources include yellow and green vegetables, dairy products, organ foods, and shellfish. Liver has the highest content.

Vitamin B1 (thiamine)

Vitamin B1 (thiamine) is utilized in carbohydrate and sugar metabolism. Lack of this vitamin causes Beriberi, a condition that creates muscle weakness, anorexia, and cardiac arrhythmias. Alcoholics and diabetics are at the highest risk. Common food sources include wheat germ, pork, whole grains, and yeast.

Vitamin B12 (cyanocobalamin)

Vitamin B12 (cyanocobalamin) has a key role in cell reproduction, fat metabolism, and myelin and blood cell production. Deficiency causes anemia and peripheral nerve and spinal cord damage. People at highest risk are vegetarians. Food sources for this vitamin include seafood, dairy products, and meats.

Vitamin B2 (riboflavin)

Vitamin B2 (riboflavin) is converted to coenzymes, which aid in the production of energy through cellular respiration. Lack of this vitamin causes lesions in the mouth and on the tongue, and burning, itchy eyes. Food sources for this vitamin include dairy products, green leafy vegetables, organ meats, and whole grain cereals.

Vitamin B3 (niacin)

Vitamin B3 (niacin) is also called nicotinic acid. It plays a role in cellular oxidation and metabolism of fats, proteins, and carbohydrates. Pellagra is a disorder caused by insufficient B3 levels. Symptoms include insomnia, GI distress, dermatitis, dementia, and a swollen tongue in severe cases. Common food sources include lean meats, liver, green vegetables, bread, peanut butter, and potatoes.

Vitamin B5 (pantothenic acid)

Vitamin B5 (pantothenic acid) is part of the vitamin B complex. The primary role of pantothenic acid is the part it plays in many areas of cellular metabolism. This includes fatty acid metabolism, synthesis of sex hormones, and aiding in the functions of the nervous system and adrenal glands.

Vitamin B6 (pyridoxine)

Vitamin B6 (pyridoxine) is a coenzyme used in amino acid and fatty acid metabolism. Deficiency symptoms include fatigue, headache, nausea, muscle spasms, and GI pain. Common food sources include vegetables, cereals, yeast, and organ meats.

Vitamin B7 (biotin)

Vitamin B7 (biotin) is synthesized by the intestinal flora. It functions in metabolism by way of biotin-dependent enzymes. Deficiency is rare since it's naturally produced in the gut.

Vitamin B9 (folic acid)

Vitamin B9 (folic acid) is essential for cell growth and the reproduction of red blood cells. It's essential for fetal development. Deficiencies can cause spina bifida in a fetus.

Vitamin D (calciferol)

Vitamin D (calciferol) regulates calcium metabolism and absorption. It's most commonly used to treat rickets. Some say that vitamin D also aids in blood clotting and heart functions. Common food sources are cod liver, oil, fish (salmon, tuna and sardines), milk, and egg yolks. Sunlight is also a major source of this vitamin.

Vitamin E (tocopherols)

Vitamin E (tocopherols) is said to be great anti-oxidant. Vitamin E aids in the relief of leg cramps and cystic breast disease and promotes the healing of wounds. Food sources include wheat germ, almond oil, sunflower seeds, and nuts. It's fragile to temperature. Freezing destroys it, and heat decreases its effectiveness.

Vitamin K (phytonadione)

Vitamin K (phytonadione) is essential in the blood clotting process. Clotting factors II, VII, IX, and X rely on this vitamin to be activated. It's also used as an antidote for overdoses of warfarin. Symptoms of vitamin K deficiency are nosebleeds, bloody urine, and bruising. Intestinal bacteria produce Vitamin K naturally. Food sources include cheddar cheese, Brussels sprouts, liver, and egg yolks.

Vitamins

Vitamins can be provided by the foods we consume. Medical conditions, age, and activity can affect the balance of vitamins we consume or retain through our diet. (Compounds found in food that help regulate many body processes)

Zinc (Zn)

Zinc is essential for the activity of enzymes, growth, glucose tolerance, wound healing, and taste acuity. The immune system is adversely affected when zinc is deficient. Deficiencies can be spotted by prolonged healing of wounds, abnormal fatigue, retarded growth, and poor appetite. An overdose of zinc can be dangerous. It can cause copper deficiency by allowing too much copper to be excreted. It can also cause atherosclerosis by allowing a rise in cholesterol and triglycerides. Zinc is found in foods high in protein.

Some vitamins can affect the __________________ or effectiveness of some medications. Some are _____ -soluble, and others are water-soluble.

absorption, fat

Electrolytes

are compounds, particularly salts, that when dissolved in water or another solvent dissociate into ions and are able to conduct an electric current. The concentrations of electrolytes differ in blood plasma and other tissues. Sodium, potassium, and chloride ions are electrolytes.

Minerals

are inorganic substances occurring naturally in the earth's crust that the body needs to help build and maintain body tissues for life functions. They are classified as major and trace elements.

Trace Elements

are no less important than vitamins or electrolytes. Only very small amounts are needed to be effective. Trace elements are defined as needing 100mg/day or less to maintain homeostasis.

Minerals help keep the body's water and electrolytes in ___________.

balance

Chamomile

comes from a plant. The oil from this plant has been used for nervousness, GI upset, bladder infections, and menstrual cramps. Topical applications help with inflammation of skin disorders, joints, and hemorrhoids. It is found in teas (oral), oils (oral or topical), or tinctures (topical).

Vitamins are classified according to their _____ or water solubility, their physiological effects, or their __________ structures. They are designated by alphabetic _________ and chemical or other specific names.

fat, chemical, letters

Supplements may be necessary to meet the daily requirements for adequate _________.

health

Trace Elements include:

iron, iodine, copper, fluoride, and zinc.

Hypernatremia

is a high level of sodium. Sodium affects fluid movement throughout the body. Too much sodium can be caused by dehydration (without loss of electrolytes) or severe illness (diabetes). Treatment would be to increase fluid intake and decrease sodium levels slowly. Seizures can occur if levels are decreased too quickly. Infusing dextrose solutions to alter the sodium balance and increase fluid volume is most common.

Hyperkalemia

is a high potassium condition. Potassium affects the heart as well as other muscles. Cardiac arrhythmias are common in patients with abnormal potassium levels. Muscle cramping, twitching, and paralysis are signs of high potassium. Treatments for high potassium levels include infusing dextrose solutions, sodium bicarbonate, or drinking sodium polystyrene sulfonate (SPS). SPS "grabs" onto potassium and eliminates it from the body.

Hyponatremia

is a low sodium condition. This is often seen with severe vomiting or excessive use of diuretics (agents used to reduce fluid within the body). Cardiac patients are often prescribed diuretics, so their electrolytes levels must be monitored. Seizures and coma are seen in patients with low sodium levels. Sodium can be given orally, or in IV form. Increasing fluids with sodium-containing solutions (0.9%NS) is usually the prescribed therapy.

Ginseng

is a root that dates back centuries in China. It's used to treat depression, fatigue, and the common cold. It's available as a tea, tablet, powders, capsules, and rock candy. Side effects include hypertension, asthma, and diabetes.

Garlic

is a spice used for allicin, its active ingredient. It's been used in the treatment of colds, high cholesterol, blood pressure, arthritis, and food poisoning. It can be applied topically or taken internally. Garlic has been noted to cause increased clotting time, which may cause increased bleeding.

Aloe

is a tropical herb used for analgesic and antihistamine-like effects. It relieves skin irritations, insect bites, allergies, and constipation. It also acts as an emollient.

Vitamin C (ascorbic acid)

is also called ascorbic acid. Lack of vitamin C in the diet can cause scurvy. This was a common ailment in our history seen in sailors who were out to sea for extended periods. Vitamin C therapy is used in post-surgical healing, prevention of cold sores and bedsores, and some argue, the common cold. Common food sources include oranges, spinach, watercress, strawberries, green peppers, broccoli, and Brussels sprouts. Vitamin C is excreted in the urine.

Hyperalimentation

is also called total parenteral nutrition. It's the feeding of a patient through an IV line. The exact nutritional requirements are placed in one IV bag, placed on an infusion pump, and administered slowly over 10 to 12 hours on average.

Phosphorus (P)

is essential for the metabolism of protein, calcium, and glucose. It aids in building strong bones and teeth, and helps in the regulation of the body's acid-base balance. Nutritional sources are dairy foods, meat, egg yolks, whole grains, and nuts. A nutritional deficiency of phosphorus is rare, and is usually due to secondary factors.

St. John's Wort

is from a flower. It has been used as an anti-inflammatory and an anti-depressant. The major chemical found in this flower is a flavonoid. It's been noted to positively affect the immune system. High doses can cause nausea, vomiting, and high blood pressure.

Magnesium (Mg)

is important for the function of many enzyme systems and is the second-most abundant ion of the intracellular fluids in the body. It helps to build strong bones and teeth, and aids in regulating the heartbeat. It is stored in the bone and is excreted mainly by the kidneys.

Chloride (Cl)

is involved in the maintenance of fluid and the body's acid-base balance. The most common metal chloride is sodium chloride (table salt). Chloride ions are needed for the production of hydrochloric acid in the stomach. Chloride is normally associated with sodium and potassium, which are involved in helping to maintain pressure balances between the various body compartments.

Shark Oil

is noted for its use in cancer, with claims that its properties decrease the vascularization (growth of blood vessels) of tumors, preventing the growth of the tumor cell. It's also been used as an antihemorrhoidal agent.

Sodium (Na)

is one of the most important elements in the extracellular fluids. Sodium ions are involved in acid-base balance, water balance, transmission of nerve impulses, and contraction of muscles. Major dietary sources of sodium are table salt (sodium chloride), ketchup, mustard, cured meats and fish, cheese, and potato chips.

Calcium (Ca)

is the fifth-most abundant element in the human body and is present mainly in the bones. The body requires calcium ions for the trans-mission of nerve impulses, muscle contraction, blood coagulation, and cardiac functions. It is a component of extracellular fluid and of soft tissue cells.

Potassium (K)

is the major electrolyte in intracellular fluids, helping to regulate neuromuscular excitability and muscle contraction. Sources of potassium in the diet are whole grains, meat, legumes, fruit, and vegetables. Potassium is important in glycogen formation, protein synthesis, and the correction of imbalances of acid-base metabolism, especially in association with the action of sodium and hydrogen ions. Potassium is also used to temporarily stop the heart in certain types of cardiac surgery. The kidney plays an important role in controlling secretion and absorption of potassium by the body tissues, especially in the muscles and the liver.

The definition of nutritional care is the proper intake and assimilation of ____________.

nutrients

Vitamins are __________ compounds essential in small quantities for physiological and ____________ functioning of the body.

organic, metabolic

Chloride is an ion that commonly attaches itself to ________ (table salt) or potassium. This attachment to sodium and potassium aids in the function of the sodium/potassium _____ that exchanges these electrolytes between body compartments to maintain ___________ balance. Chloride is also needed for the production of hydrochloric acid in the stomach.

sodium, pump, pressure

Electrolytes are ________ -soluble minerals within our body fluids. They are electrically charged and flow through our ________, intra- and extracellular fluids, and _______ tissues. An imbalance of these agents can cause ________, organ dysfunction, and even death.

water, blood, muscle, illness