Vitamin and Mineral

1
Lecture 13

• Chapter 12
• Vitamin and Mineral
• Replacement

2
Vitamins

• Organic chemicals necessary for normal metabolic
  functions, tissue growth healing
• Body needs only a small amt. of vitamins daily
  easily obtained through a well-balanced diet
• Vitamin supplements not necessary if a
  well-balanced diet consumed -
• Vitamin deficiencies can cause cellular and organ
  dysfunction - may result in slow recovery from
  illness
• Most people use vitamins for inappropriate
  reasons relieve tiredness, improve general
  overall health, or prophylactic use

3
Vitamins

• Fat-Soluble Vitamins - A,D,E,K - they are
  metabolized slowly, can be stored in fatty
  tissue, liver, muscle - excreted in the urine
  at a slow rate - Can build up in the body
  become toxic
• - Vit. A - maintenance of epithelial tissues,
  skin, eyes, hair bone growth s/s of dec. in
  A? night blindness ? dryness of eyes and
  ulceration o the cornea ? blindness
• - Use - skin disorders (acne) excess doses
  ? toxic - s/s loss of hair peeling excess
  stored in the liver for up to 2 yrs.
  
  - Sources Beta carotene ? carrots,
  spinach, tomatoes, pumpkin Retinol
  (pre-formed A) only in foods of animal origin ?
  eggs, whole milk, butter liver

4
Vitamins
Vit. D assists in regulating calcium
phosphorus metabolism, needed for Ca absorption
from intestines -Excess vit. D results in
hypervitaminosis D and may cause hypercalcemia ?
elevated CA level early s/s D toxicity
anorexia, nausea, vomiting
- Sources milk, cereals sunlight

• Vit. E - antioxidant properties protecting
  cellular components from being oxidized RBCs
  from hemolysis - Lg. doses may prolong
  prothrombin time
  -Sources
  fresh greens, veggies, seeds oils wheat germ
  
• -400-800 IU /day dec. the number of non-fatal
  heart attack. E protects the heart arteries ?
  block free radicals s/s toxicity fatigue,
  weakness, nausea, GI upset, HA,

5
Vitamins

• - Vit. K - 4 forms Vit. K 2 not commercially
  available - stored primarily in the liver
• - needed for synthesis of prothrombin the
  clotting factors VII, IX, X
• Water-Soluble Vitamins C B complex - Not
  stored by the body readily excreted in the
  urine not usually toxic unless taken in extreme
  amts.
• - Vit. C ( ascorbic acid) - aids in absorption
  of Fe in the conversion of folic acid
• Does not cure or prevent the common cold
  Excess doses of C ? diarrhea
  GI upset

6
Vitamins
Absorbed thru GI tract, kidneys completely
excrete mostly unchanged.
Collagen syntheses
requires vit.C for tissue repair
Decrease effect of oral anticoagulants,
smoking decreases vit C level megadoses of vit
C taken with ASA or sulfonamides ? crystal
formation in the urine.
Found in citrus gruits green veggies
7
Vitamins

• -Vit. B complex - B1 (thiamine), B2 (riboflavin),
  B3 (niacin), B6 (pyridoxine)
• Uses improve nerve conduction d/t damage from
  ETOH ? (Thiamine) manage dermatologic problems
  (dermatitis, cracked sides of mouth) ?
  (riboflavin) dec. chol. (niacin) neuritis
  caused by INH tx for TB H2O soluble
• Large doses cause GI irritation vasodilation,
  resulting in a flushing sensation.

8
Vitamins

• Vitamin B12 - Essential for DNA synthesis (
  like folic acid), aids in conversion of folic
  acid to active form
• - needed in development of RBCs maintain
  nervous system integrity
• - B12 deficiency found in strict vegetarians
  (dont consume meat, fish, or dairy), crohns
  disease, malabsorption syndromes ? s/s numbness
  tingling in lower extremities, weakness,
  fatigue, anorexia, loss of taste, diarrhea to
  note a few

9
Vitamins

• Folic Acid (folate) - absorbed from sm.
  intestine, active form of folate circulated to
  all tissues stored in liver tissues.
  
  - essential for body growth
  -
  needed for DNA syntheses, lack ? disruption cell
  division
  - deficiency
  during 1st trimester of preg. affects level. of
  CNS in fetus ? neural tubal deficets (spina
  bifida or anencephaly)
  - s/s
  deficiency ? anorexia, nausea, stomatitis,
  diarrhea, anemia, leukopenia,
  -Sources
  Added to grains, pasta, rice, grits, flours.

10
Minerals

• Iron (ferrous sulfate, gluconate, or funarate)
  - vital for Hemoglobin
  regeneration, 1 cause of anemia is iron
  deficiency.
• - Sources liver, lean meats, egg yolks, dried
  beans, green veggies fruit

• Copper needed for formation of RBCS
  connective tissue, also imp. in the production of
  NE dopamine

• Zinc may alleviate common cold

• Chromium may help to normalize blood glucose
  by inc the effects of insulin on cells
• Selenium antioxidant works with vit. E , may
  dec. risk of lung, prostate, colorectal CA

11
Vitamins

• Hyperalimentation - Total Parenteral Nutrition
  (TPN)
• - Administered through a central line
  (delivers nutrient into the superior vena cava ?
  empties into the R atrium of the heart)
• - Used to feed clients when unable to
  tolerate PO nutrition or GI system needs a rest
• - Most important ingredients dextrose (10),
  amino acids
• - May also include electrolytes, vitamins and
  minerals depending on clients lab values. Ordered
  daily per the MD

12
Chapter 45

• Endocrine System
• Endocrine Pharmacology

13
Endocrine System
Hormones chemical substances synthesized
from amino acids cholesterol that act on body
tissues organs and affect cell activity.

• 2 categories
• Proteins or small peptides
• Steroids hormones from the adrenal glands
  gonads are steroids all others are PRO.

14
Endocrine System
Endocrine glands include pituitary or
(hypophysis), thyroid, parathyroid, adrenal,
gonads, and pancreas
Hypothalamus Pituitary are closely related
both anatomically and functionally, together they
help regulate all bodily processes by using at
least 15 hormones both lobes of pituitary are
under control of the hypothalamus, the
hypothalamus communicates w/ ant. pit by
release-reg factors ? portal blood vessels comm
w/post. pit. is neuronal
15
Endocrine System

• Pituitary Gland - Located at base of brain, 2
  lobes
• - Anterior (adenohypophysis) - master gland -
  secretes hormones that stimulate the release of
  other hormones
• - Posterior (neurohypophysis) - secretes
  antidiuretic hormone (ADH, vasopressin)
  oxytocin
• Anterior Pituitary Gland secretes 6 various
  hormones targeting glands tissues controlled
  by hypothalamus
• 1) growth hormone (GH) - stimulates growth of
  tissue/bone
• 2) thyroid-stimulating hormone (TSH) - acts on
  thyroid gland to promote synthesis and release of
  thyroid hormones.
• 3) adrenocorticotropic hormone (ACTH) -
  stimulates adrenal cortex to release
  adrenocortical hormones

16
Endocrine System

• 4) follicle-stimulating hormone acts on ovary
  to promote follicular growth development In
  testes, FSH promotes spermatogenesis.
• 5) luteinizing hormone (LH) promotes
  ovulation in women, in men acts on the testes to
  promote androgen production
• 6) prolactin stimulates milk production
• Growth hormone (GH) - Somatrem
  (Protropin) somatropin (Humatrope) - If GH
  deficiency diagnosed and dwarfism can result -
  these drugs may be used. Very expensive therapy
• Posterior Pituitary Gland secretes 2
  hormones 1) antidiuretic hormone (ADH,
  vasopressin) 2) oxytocin (ch. 47)
• - ADH promotes H2O rebsorption from the renal
  tubules to maintain H2O balance Dec. ADH? lg.
  amts. H2O excreted called diabetes insipidus (DI)
  ? fluid vol. dec electrolyte imbalance

17
Endocrine System

• Thyroid Gland - Located anterior to the trachea,
  has 2 lobes (butterfly like), secretes 2
  hormones Thyroxine (T4), triiodothyronine (T3)
  thyroid hormones have 3 actions
• 1) stimulation of energy use? inc. basal
  metabolism rate
• 2) stimulation of the heart?leads to inc rate
  force of contraction ? inc cardiac output
• 3) promotion of growth and development(brain
  skeletal muscle).- Can be either a thyroid
  deficiency (hypothyroidism), or an overabundance
  (Hyperthyroidism)
• Hypothyroidism a dec. in thyroid hormone
  secretion
• -primary cause is thyroid gland disorder or
  secondary cause is lack of TSH secretion slow
  metabolic rate - s/s (lethargic, weak, edema,
  slow pulse, constipation, wt. gain, emotional
  changes)
• - Drugs containing T4 T3 are used to treat
  this

18
Endocrine System

• Levothyroxine sodium (Levothroid, Synthroid) -
  drug of choice for replacement therapy, Used to
  treat simple goiter chronic lymphocytic
  thyroiditis
• - Action inc. T3 T 4, inc. metabolic
  rate, inc. cardiac output, PRO synthesis,
  glycogen usage, O2 consumption, body growth
• - SE - N V, diarrhea, cramps, nervousness
• - DI - Many increase effects of oral
  anticoagulants, with adrenergic agents
  (decongestant or vasopressor) cardiac CNS
  effects increase.
• Liothyronine (Cytomel) a synthetic T3 not for
  maintenance but for initial tx. of Myxedema,
  because of its rapid onset of action

19
Endocrine System
Hyperthyroidism - inc. circulating T3 T4
from overactive thyroid gland - s/s rapid
metabolic rate (Inc. HR, palpitations,
nervousness) - symptoms mild to severe (Thyroid
storm can cause death from vascular collapse).
--Graves disease or thyrotoxicosis most common
due to Inc. function of thyroid -Rx surgical
removal of part of gland, radioactive iodine
therapy or antithyroid drugs - s/s rapid
pulse, palpitations, excessive perspiration, heat
intolerance, nervousness, irritability, bulging
eyes, and weight loss
20
Endocrine

• Purpose of Pharm tx reduction of thyroid
  hormones T3 T4 by inhibiting thyroid secretion
• Propylthiouracid (PTU), methylthiouracil
  (Tapazole) are affective thiomide antithyroid
  drugs
• - Use hyperthyroidism (thyrotoxic crisis)
  and in prep for subtotal thyroidectomy
• - Action - Blocks synthesis of T3 T4 - does
  not destroy, but prevents oxidation of iodide
• Usually takes a period of a few days to 3
  wks before symptoms improve
• Ask MD about using iodized salt eating
  shellfish - contain iodine and may alter the
  effectiveness of drug

21
Endocrine System

• Adrenal Glands - located at the top of each
  kidney composed of 2 sections adrenal medulla
  (inner section) adrenal corex (surrounds the
  adrenal medulla)
• - adrenal medulla releases epi. norepi. is
  linked to the sympathetic nervous system
• - adrenal cortex ? 2 major types of hormones
  called (corticosteroids) 1) glucocorticoids 2)
  mineralocorticoids
• - main glucocorticoid cortisol
• - main mineralocorticoid aldosterone

22
Endocrine System

• Corticosteroids promote Na retention K
  excretion. A Na ion is reabsorbed from the renal
  tubules in exchange for a K ion K ion then
  excreted.
• - Influences electrolytes, carbohydrates,
  protein fat metabolism - deficiency ? serious
  illness or death
• - in corticosteroid secretion Addisons
  disease
• - in cotricosteroid secretion Cushings
  Syndrome

23
Endocrine System

• Glucocorticoids - influenced by ACTH, released
  from the ant. pituitary gland. Affect
  carbohydrate, protein, fat metabolism
• - can cause Na absorption from the kidney
  H2O retention, K loss inc. BP
• - Cortisol - main glucocorticoid
  antiinflammatory, antiallergic antistress
  effects
• - Indications for therapy trauma, surgery,
  infections, emotional upsets, anxiety
• - Most of the wide variety of glucocorticoid
  drugs called cortisone drugs - synthetic

24
Endocrine System

• - Cortisone drugs can be given orally,
  parenteral (IM, IV), topical (creams, ointments),
  aerosol (inhaler)
• - Uses - inflammatory conditions (MS,
  rheumatoid arthritis, MG, ulcerative colitis),
  shock, head trauma, asthma, contact dermatitis,
  anaphylaxis, debilitating conditions
  (malignancies), organ transplant recipients
• - Many glucocorticoids - some more potent than
  others
• - SE - TONS!! - fluid retention, muscle
  weakness, CV problems, hard on GI system ,
  headache, inc. ICP, masks signs of infection,
  susceptibility to infection

25
Endocrine System

• Dexamethasone (Decadron) - PO, IV, IM
• Action - Not clearly defined. Decreases
  inflammation, suppresses immune response,
  stimulates bone marrow
• Use - Cerebral edema, inflammatory conditions,
  allergic rxns, neoplasias
• SE - Can effect all systems
• Do not D/C drug abruptly - rebound
  inflammation poss.
• Teach - take w/ food or milk, SS of early
  adrenal insufficiency (fatigue, weakness, joint
  pain), warn about long term therapy cushing
  symptoms (moon face)

26
Endocrine System

• Prednisone (Deltasone, Orasone) - PO
• Action - Suppression of inflammation adrenal
  function
• Use Dec. severe inflammation,
  immunosuppression, dermatologic disorders
• SE N, V, diarrhea, inc. appetite, sweating,
  depression, mood changes, HA, flushing
• Teaching - do not d/c abruptly - Best to start
  medication at lowest effective dose
• CI psychosis, fungal infection, Caution w/
  diabetes
• Hydrocortisone (Cortef) - PO, IV, IM, enema
• Action - Decreases inflammation
• Use - Inflammation, adrenal insufficiency,
  ulcerative colitis

27
Endocrine System

• Glucocorticoid Inhibitors - Ketoconazole
  (Nizoral) - an antifungal drug, aminoglutethimide
  (Cytadren) - an antineoplastic hormone antagonist
• - inhibit glucocorticoid synthesis
• - Nizoral - Rx Cushings syndrome adjunct to
  surgery or radiation
• - high doses can cause fatal vent.
  dysrhythmias
• - Cytadren temporary RX of selected clients
  w/ Cushings syndrome, esp. clients w/ adrenal
  adenoma, carcinoma, adrenal hyperplasia

28
Endocrine System

• Mineralocorticoids - secrete aldosterone
• - maintains fluid balance by promoting
  reabsorption of Na from the renal tubules
• - Na attracts H2O H2O retention
• - hypovolemia ( in circulating fluid) ?
  more aldosterone secreted to Na and H2O
  retention ? restore fluid balance
• - W/ Na reabsorption K lost hypokalemia
• - severe in aldosterone ? hypotension
  vascular collapse - Addisons disease

29
Endocrine System

• Fludrocortisone (Florinef) - an oral
  mineralocorticoid given w/ a glucocorticoid
• Action - Increases Na reabsorption K
  secretion
• Use - Addisons disease (adrenocortical
  insufficiency)
• SE - hypertension, Na H2O retention
• Alert - monitor clients BP electrolytes (
  esp. K)
• Can cause a neg. nitrogen balance - a
  high-protein diet indicated

30
Chapter 43

• Disorders of the Eye

31
Eye Disorders

• Diagnostic Aids Used to locate leisions or
  foreign objects to provide anesthesia.
  Fluorescein sodium a dye turns scratches green
  circle foreign objects in green.
• Topical Anesthetics - used for exams removal
  foreign objects - proparacaine HCL (Ophthaine,
  Ophthetic), tetracaine HCL (Pontocaine) -
  anesthesia in 1min. lasts about 15 min. blink
  reflex temporarily lost - patch the eye
• Antiinfectives - frequently used for eye
  infections
• - Conjunctivitis (inflammation of the membrane
  covering the eyeball lining the eyelid) -SE
  ?local skin/eye irritation, allergy to med.

• Lubricants - Used for dryness of the eyes -
  artificial tears, contact lens wearers, CNS
  disorders that result in unconsciousness or dec.
  blinking - most are OTC

32
Eye Disorders
Glaucoma characterized by visual field loss 2nd
ary to optic nerve damage, due to increase
intraocular pressure, caused by an increase in
production of aqueous humor this circulates
around the iris and then in the anterior chamber,
it exits to the trabecular mesh work and the
canal of Schlemm. If outflow is impeded, back
pressure will develop and the IOP will rise. 2
types 1) Primary Open Angle Glaucoma
2) Acult Angle Closure
33
Eye Disorders

• Pharm tx reduces IOP by 1) facilitating aqueous
  humor outflow or 2) reducing aqueous humor
  production
• Miotics - used in open-angle glaucoma to lower
  the intraocular pressure increasing aqueous
  outflow ? decrease retinal damage loss of
  vision.
• - Direct-acting cholinergics cholinesterase
  inhibitors 2 types of miotics
• - cause a contraction of the ciliary muscle
  widening of trabecular meshwork
• - Systemic absorption poss. but not common

34
Eye Disorders

• Pilocarpine (Isopto Carpine, Pilocar)
• - Action - produces miosis (contracts pupil)
  which widens angle, allows outflow of aqueous
  humor dec. intraocular pressure Onset 10-30
  min duration 4-8 hrs
• - SE - headache, eye pain, decreased vision.
  Systemic absorption N V, frequent urination,
  inc. salivation
• --Ocusert is a disk with time release
  pilocarpine, replaced q 7 d.
• -CI retinal detachment, adhesions,
  infection(eye), Many illness caution asthma,
  HTN, CVD, UT obstruction, GI obstruction

35
Eye Disorders

• Beta Adrenergic Blocking Agents Timolol
  maleate (timoptic), Carteolo (cartrol), betaxolo
  (betoptic)

- 1st line drugs for glaucoma these cause
less disturbance of vision the pilocarpine.
Basic pharm discussed previously
- Action dec IOP in glaucoma by dec
production of aqueous humor ? increase outflow
- Used in initial tx maintenance eye drops
- SE locally ?stinging, conjunctivitis
blurred vision, dry eyes can be absorbed
systemically ? effect on heart lung These
effects are the greatest concern. Can produce
AV block, bronchospasm . CI in heart failure.
36
Eye Disorders

• Carbonic Anhydrase Inhibitors - interfere w/
  production of carbonic acid ? dec. aqueous humor
  formation dec. IOP
• - used for long term Rx of open-angle glaucoma

• - used only when other agents not effective
• - drugs developed as diuretics
• Acetazolamide (Diamox) - PO
• SE - lethargy, anorexia, drowsiness,
  polyuria, hypokalemia - clients frequently d/c
  from side effects
• - do not use w/ clients allergic to
  sulfonamides
• - can cause photosensitivity

37
Eye Disorders

• Osmotics - generally used pre-op and post-op to
  dec. vitreous humor volume ? dec. IOP
• - Use - in the emergency Rx of acute
  closed-angle glaucoma d/t ability to rapidly
  reduce IOP
• Mannitol (Osmitrol) - IV
• - SE - headache, nausea, N V, diarrhea,
  electrolyte dist.
• - also used to dec. ICP in head trauma
• Anticholinergic Mydriatics Cycloplegics -
• - Mydriatics dilate the pupils

38
Eye Disorders

• - cycloplegics - paralyze the muscles of
  accommodation
• - both are used in diagnostic procedures
  ophthalmic surgery
• - relax the ciliary dilator muscles of the
  iris by blocking acetylcholine
• Atropine sulfate (Atropisol) - cycloplegic
• SE - tachycardia, photophobia, dryness of the
  mouth
• s/s toxicity dry mouth, blurred vision,
  photophobia, constipation tachycardia, confusion
  hallucinations
• Beta-Adrenergic Blockers - used to dec. elevated
  IOP in chronic open-angle glaucoma. Dec. aqueous
  production and inc. outflow

39
Eye Disorders

• Other Ophthalmic Products
• - Antifungal - Natamycin (Natacyn) - (Soln)
• - Antiviral - Vidarabine (Vira-A) - (Oint)
  inhibits viral replication
• - Corticosteroids - Dexamethasone (Maxitrol) -
  (Oint.) dec. inflammatory/redness - corneal
  abrasions
• - Antibiotics - Tobramycin (Tobrex) - (Oint. or
  Soln) inhibits or kills organisms causing
  infection - eye infections, corneal abrasions