Vitamins and Minerals 2029.pdf

Decarboxylation of α-ketoacids and branched-chain amino acids

What is the primary function of Thiamine in energy generation?

Transketolase

Thiamine pyrophosphate acts as a coenzyme for which reaction involving hexose and pentose phosphates?

Yeast, organ meat, pork, legumes, beef, whole grains, and nuts

List the primary food sources of Thiamine.

Pork and liver

Which specific meats are particularly high in thiamine?

Milled rice and highly processed crops

Which types of grains have little to no thiamine?

Raw fish, shellfish, and tannins (coffee/tea)

Which dietary items are known to decrease thiamine levels in the body?

Wet beriberi

Which condition is characterized by high-output heart failure, cardiomegaly, tachycardia, and edema?

Dry beriberi

Which thiamine deficiency condition involves symmetric peripheral neuropathy and muscle wasting?

Wernicke-Korsakoff syndrome

What neurologic disorder is associated with alcoholism and thiamine deficiency?

Confusion, ophthalmoplegia/nystagmus, and ataxia

What is the clinical triad of Wernicke encephalopathy?

Memory impairment and confabulation

What are the hallmark symptoms of Korsakoff syndrome?

Infantile thiamine deficiency

What thiamine-related condition occurs in infants of deficient mothers at 3–4 weeks of age?

Alcohol use disorder, hyperemesis gravidarum, post-bariatric surgery, and chronic diuretic therapy

List four high-risk populations for thiamine deficiency.

Parenteral glucose without supplementation

What hospital treatment can trigger thiamine deficiency in high-risk patients?

Sulbutiamine, Benfothiamine, and Fursulthiamine

Name three thiamine-related drugs or derivatives mentioned in the source.

Arcalion or Enerion

What is the brand name for Sulbutiamine?

Diabetic neuropathy and peripheral nerve disorders

What are the primary indications for Benfothiamine?

Asthenia

What condition is Sulbutiamine specifically indicated for?

Headache, nausea, GI discomfort, and skin rash

What are the common adverse effects of thiamine supplements?

FMN and FAD

Vitamin B2 is a precursor to which two essential coenzymes?

Breaking down carbohydrates, fats, and proteins

What is the role of riboflavin in generating energy?

Regenerating glutathione

What is the antioxidant role of Vitamin B2?

Vitamin B6 and Tryptophan

Vitamin B2 is required for the conversion of which vitamin and which amino acid to functional forms?

Dairy, eggs, chicken breast, salmon, almonds, and spinach

List the major natural food sources of riboflavin.

Ariboflavinosis

What is the clinical term for Vitamin B2 deficiency?

Oral-ocular-genital syndrome

What is the non-pathognomonic clinical presentation of Vitamin B2 deficiency called?

1.3 mg

What is the Recommended Daily Intake of riboflavin for males age 19+?

1.1 mg

What is the Recommended Daily Intake of riboflavin for females age 19+?

Take with meals

How should riboflavin supplements be administered to increase absorption?

Corneal cross-linking for corneal ectasia or progressive keratoconus

What is the recent ophthalmic use for riboflavin?

Migraine prophylaxis

Besides deficiency, why is oral riboflavin supplementation indicated?

Vegetarian athletes and lactating women

Name two groups at high risk for riboflavin deficiency.

Brown-Valetto-Van Laere or Fazio-Londe syndrome

Name the syndromes associated with riboflavin transporter deficiency.

None established

What is the established Tolerable Upper Intake Level for Riboflavin?

Flavinuria

What is the term for the bright yellow or orange urine caused by excess riboflavin?

NAD+ and NADP+

Vitamin B3 is a precursor to which coenzymes required for glycolysis and the TCA cycle?

PARP (Poly ADP-Ribose Polymerase)

NAD+ acts as a substrate for which enzyme involved in DNA strand break repair?

Sirtuin deacetylase

NAD+ acts as a substrate for which enzyme involved in gene expression?

Regenerating reduced glutathione

How does NADPH protect cells from reactive oxygen species?

Tryptophan

Which amino acid can the liver convert into niacin?

Muscle weakness and poor glandular secretion

What are the signs of early niacin deficiency?

Pellagra

What is the name for severe niacin deficiency?

Dermatitis, Diarrhea, Dementia, and Death

What are the "4 Ds" of Pellagra?

Glossitis, abdominal pain, vomiting, and hemorrhage

List the GI findings associated with niacin deficiency.

Casal’s necklace

What is the term for the pigmented, scaly neck rash seen in niacin deficiency?

Chronic alcoholism and corn-based/protein-poor diets

Name two dietary/lifestyle risk factors for niacin deficiency.

Carcinoid and Hartnup syndromes

Which two medical syndromes are associated with B3 deficiency?

Isoniazid, anticonvulsants, and 5-fluorouracil

Name three drugs that can induce niacin deficiency.

Stresstabs

Which multivitamin formulation has the highest B3 dose?

Dyslipidemia

Nicotinic acid is used to treat which condition by reducing LDL and increasing HDL?

Hyperphosphatemia

Low-dose nicotinic acid is used to treat which mineral imbalance?

Acne vulgaris, hyperpigmentation, and melasma

What are the topical indications for Vitamin B3?

Cutaneous flushing

What is the most common adverse effect of oral niacin?

Hepatotoxicity

What toxic effect can occur with niacin ingestion of more than 3g per day?

Glucose intolerance and hyperuricemia

Name two metabolic toxicities associated with high-dose niacin.

Protein and amino acid metabolism

What is the primary role of Vitamin B6 in tissue repair?

RBC and hemoglobin formation

What is the role of Vitamin B6 in blood health?

Starchy vegetables (potatoes) and non-citrus fruits (bananas/papayas)

What are the plant-based sources of Vitamin B6?

Microcytic/sideroblastic anemia

Which type of anemia is associated with Vitamin B6 deficiency?

PLP cofactor for d-ALA synthase

What is the biochemical mechanism leading to sideroblastic anemia in B6 deficiency?

Peripheral neuropathy, seizures, and cheilosis

List three clinical signs of B6 deficiency.

Dialysis patients

Which specific group of chronic kidney disease patients is at risk for B6 deficiency?

Isoniazid and Penicillamine

Name two drugs that act as PLP inactivators.

Isoniazid (tuberculosis) therapy

In which infectious disease treatment is Vitamin B6 supplementation mandatory?

GABA synthesis

A decrease in which neurotransmitter leads to seizures and neuropathy in B6 deficiency?

Nausea and vomiting in pregnancy

What is the first-line indication for a combination of Vitamin B6 and doxylamine?

Premenstrual syndrome and homocystinuria

Name two other conditions managed with Vitamin B6 adjunct therapy.

Photosensitivity and ataxia

Name two adverse effects of excessive Vitamin B6 intake.

Levodopa, barbiturates, and anticonvulsants

Name three drugs that interact with Vitamin B6.

Carboxylases

Biotin is a crucial coenzyme for which class of enzymes?

Gluconeogenesis, amino acid metabolism, and fatty acid synthesis

Name three metabolic processes mediated by biotin.

Liver, red meat, and egg yolk

List three animal-based sources of biotin.

Thinning hair and scaly red rash

What are the gradual signs of biotin deficiency?

Ketolactic acidosis

What metabolic state occurs in biotin deficiency when lactate production exceeds clearance?

Biotin deficiency facies

What is the term for the rash and unusual distribution of facial fat in deficient individuals?

Appearex and Wolvit

Name two specific oral biotin supplements mentioned in the source.

Anticonvulsants and Lipoic acid

Which two substances interfere with biotin uptake or binding?

Tetrahydrofolate (THF)

What is the active form of Vitamin B9?

Purines and thymidylate (dTMP)

THF provides one-carbon units for the synthesis of which DNA components?

Spinach, broccoli, lettuce, and watercress

Name four leafy greens rich in folate.

Tropical fruits (passionfruit and plum)

Which types of fruits are the highest sources of folate?

Megaloblastic (macrocytic) anemia

What type of anemia results from folate deficiency?

Folate may mask anemia while B12-induced neurological damage continues

Why must clinicians distinguish between folate and B12 deficiency?

Neural Tube Defects (NTDs)

Folate deficiency is a major risk factor for which congenital condition?

1 month prior to conception

When should women begin taking 400 mcg of folic acid to reduce NTD risk?

Leucovorin (folinic acid)

Which form of folate is used as a rescue agent during high-dose methotrexate regimens?

Trimethoprim and Sulfonamides

Name two antibiotics that should not be taken with folic acid.

Antiepileptic drugs (AEDs)

Which drug class requires folate supplementation due to interference?

Myelin synthesis

Vitamin B12 is essential for the nervous system because of its role in what?

Succinyl-CoA

Vitamin B12 is needed to convert Methylmalonyl-CoA into what?

Homocysteine to methionine

The enzyme methionine synthase uses B12 to convert which amino acid?

Animal products only (meat, shellfish, dairy, eggs)

Where is Vitamin B12 found naturally?

Paresthesia, ataxia, and loss of proprioception

List the primary neurologic symptoms of B12 deficiency.

Cyanocobalamin, Hydroxocobalamin, and Methylcobalamin

Name the three main forms of B12 available as supplements.

Pernicious Anemia

What condition involves a lack of intrinsic factor preventing B12 absorption?

Metformin

Which long-term medication affects B12 absorption in the ileum?

Hypokalemia

What rare side effect can occur during a rapid hematopoietic response to B12 therapy?

Prolyl and lysyl hydroxylase

Vitamin C acts as a cofactor for which enzymes in collagen synthesis?

Wound healing

Vitamin C promotes fibroblast function and capillary formation, making it critical for what?

Ferric (Fe³⁺) to ferrous (Fe²⁺)

Vitamin C reduces iron to which form to improve absorption?