Calcium, Vitamin D and Vitamin D Deficiency
what are drug interactions with Ca+ an RPh should know?
- dec. Absorption / bioavailability of quinolones, tetracycline, levothyroxine, BPs, phenytoin, Fe -Absorption of calcium is dec with fiber/bulk laxative -Carbonate salts: dec. absorption w/PPIs, H2As
for Vitamin D Deficiency how much is given to patients to return to normal levels?
-1000 IU daily increases levels ~ 10ng/mL over 8 months -Check levels 2 months after starting high-dose supplementation; Once deficiency is corrected, continue maintenance dose -No identifiable harm in recommending supplementation at dosages <1000 IU/day
Adults between 19-30 yo need how much Ca+ and vitamin D?
-1000mg Ca+ -600 IU vitamin D
females 50-70 and all adults over 70 need how much Ca+ and vitamin D?
-1200mg Ca+ -800 IU vitamin D
how can Vitamin D Deficiency result as a person ages?
-Adults >70 do not effectively synthesize D3 due to Atrophic skin changes -Renal production of 1,25(OH)2D (active Vitamin D) dec b/c of decreased renal function with age
a Adolescents 14-18 yrs (because they are growing bones) how much Ca+ and Vitamin D are recommended?
-Ca+ 1300 -vitamin D 600 IU
what is the max amount of Ca+ absorbed, and what are AE of taking too much?
-Can only absorb ~500mg at a time (carbonate) divide between meals to increase absorption -Constipation, gas, upset stomach, kidney stones (if dehydrated and taking a bunch (Upper limits: 2000-2500mg/day)
what are two major causes of Vitamin D Deficiency?
-Causes reduced intestinal absorption of calcium & phosphorous: Early Vitamin D deficiency; Hypophosphatemia > hypocalcemia -Persistent Vitamin D deficiency: Hypocalcemia 2' hyperparathyroidism results in demineralization of bones = CKD
Vitamin D3 (cholecalciferol) is synthesized by the skin after 5-15 minutes of sunlight, why is it critical?
-Critical for absorption & homeostasis of Calcium -Few foods contain much vitamin D: Fortified foods - Milk, OJ contain Vitamin D2 (ergocalciferol), Fatty fish, Eggs
what are the Vitamin D Levels?
-Deficiency = <20 ng/ml -Preferred range = 30-60 ng/ml -Normal range = 20-100 ng/ml -Toxicity= >150 ng/ml
To prevent falls what is the RDA of vitamin D?
-Dose of at least 800 IU/day
Cholecalciferol (D3) may be more than 3x as effective as D2 in raising levels / maintaining levels, how much is recommended to fix defiencies?
-Dosing for Osteoporosis prevention/treatment 800 - 1000 IU/day
what are the available types of vitamin D?
-Ergocalciferol (D2): Plant sterols, Prescription product (insurance may cover), Effective for raising Vit D levels -Cholecalciferol (D3): Oily fish, cod liver oil, Synthesized in skin, OTC supplements, @ high doses more potent than D2, More effective at reducing fracture risk
what are foods high in Ca+
-Milk, yogurt, cheese, Fortified breakfast cereals, Breakfast bars, Calcium-fortified OJ, soy milk, cranberry juice, Salmon, sardines w/bones, Beans, broccoli, greens, almonds
what is the dose given for Ergocalciferol (D2) for OP?
-Osteoporosis prevention / treatment: 800 - 1000 IU qd -Deficiency: 50,000 IU/week x6-8 weeks, then 50,000 IU Q2-4 weeks maintenance -Rx: Drisdol: 50,000 IU caps, 8000 IU/ml drops, OTC: Calciferol: (drops) 8000 IU/ml -pediatrics: 400IU qd
when should the Carbonate salt for Ca+ be recommened?
-Poorly absorbed in achlorhydria (elderly, PPI, H2A use and-higher pH -take with food & cheeper
when should the citrate salt for Ca+ be recommended?
-Preferred choice if achlorhydria (older, PPI or H2A use) -take on empty stomach and more expensive