Lec 15: Drugs used in the management of Nutritional Disorders

Lec 15

What is the etiology of undernutrition?

Many causes!

• Low dietary intake

• Malabsorption disorders

• FAD diets

• Wasting disorders like cancer

• Chronic alcohol use

• Eating disorders

• GI disorders

• Chronic neurological disease

• Surgery

• Trauma

• Poverty

• Older age

What does the Recommended Dietary Allowances (RDAs) refer to?

Minimum amount of a vitamin needed to prevent symptoms of deficiency

Need for vitamins and minerals ____ among individuals

Vary

Supplements should _____ substitute for healthy diets

never

What do vitamins and minerals support in the body?

Numerous cellular functions

What is vitamin pharmacotherapy indicated for?

Prevent / Treat deficiency conditions

List some instances that vitamin deficiency might be a problem.

• Pregnancy

• Poor nutritional intake

• Chronic disease states

• Alcohol Abuse

What does this describe?

• Usually nonspecific + Occur over prolonged period

• Often present with multiple deficiencies

• Often result of certain factors

  • Poverty / FAD diets

  • Chronic alcohol / drug abuse

  • Prolonged parenteral feeding

General features of chronic vitamin deficiencies

What type of vitamins must be ingested with lipids to be absorbed in the small intestine?

Fat-soluble vitamins

What vitamins are stored in the liver and adipose tissue if there is excess? (These can then be removed from storage as needed. )

Fat-soluble vitamins

What vitamins does this describe?

Excessive intake can lead to dangerously high levels (Hypervitaminosis)

Fat-soluble vitamins (A, D, E, and K)

Which set of Vitamins are fat soluble?

A, D, E, K

Vitamin A is also known as…

Retinol / Retinyl 

What is Vitamin A required for?

Growth + Development of bones, VISION, reproduction, healthy skin, wound healing, mucous membranes, and cholesterol synthesis

What vitamin would you mainly use for these instances?

• Steatorrhea (presence of excessive fat in the stool)

• Severe biliary obstruction

• Liver cirrhosis (permanent scarring of the liver caused by long-term damage)

• Total gastrectomy (removes the entire stomach)

Vitamin A

Which vitamin can cause birth defects in pregnancy when taken in very high dose?

Vitamin A

Which vitamin do these toxicity symptoms indicate:

• Irritability

• Drowsiness

• Vertigo (spinning)

• Delirium

• Coma

Vitamin A

Vitamin D is also know as…

Cholecalciferol

“Sunshine vitamin refers to what vitamin?

Vitamin D

What does Vitamin D regulate?

Absorption/use of calcium, necessary for calcification of bones and teeth

Vitamin D2 (ergocalciferol) is obtained through…

Dietary sources like oily fish, egg yolk, mushroom, fortified foods

Vitamin D3 is produced by…

Skin by UV radiation

What vitamin would you mainly use for these instances?

• Treatment of deficiency

• Correction of long term deficiency

• Prevention of osteoporosis

Vitamin D

Which vitamin is contraindicated with hypercalcemia?

Vitamin D

Which vitamin should you monitor for signs of calcium alteration such as:

• Muscle twitching

• Cardiac arrhythmias

• Paraesthesia

Vitamin D

Which vitamin do these toxicity symptoms indicate:

• Weakness / Fatigue

• HA

• Anorexia

• Dry mouth

• Metallic Taste

• N/V

• Ataxia

• Bone pain

Vitamin D

Which vitamin in hgh doses can have blood thinning effects?

Vitamin E

Who is at highest risk for vitamin E deficiency?

Preterm infants

Which vitamin is needed for liver synthesis of prothrombin coagulation factors?

Vitamin K

Which vitamin has an interaction to Warfarin?

Vitamin K

Which vitamin is synthesized by normal flora in our gut?

Vitamin K

Which vitamin is given prophylactically to newborns after birth to prevent brain bleeds

Vitamin K

Which vitamins do these characteristics describe?

• Absorbed with water in digestive tract

• Easily dissolved in blood and body fluids

• Excess cannot be stored

Water-soluble vitamins

Which vitamins are excreted in the urine, so must be ingested daily?

Water-soluble vitamins

Water-soluble vitamins consist of…

Vitamins C and B complex

What is vitamin B₁ also known as?

Thiamine

Where does Vitamin B₁ come from?

Plant and animal products

What is Vitamin B₁ needed for?

Needed for carbohydrate metabolism/ATP creation in the Krebs cycle

A deficiency in this vitamin is most common with:

• Chronic alcohol use

• Bariatric surgery

• Chronic liver disease

• HIV infection

• Diabetes

Vitamin B1

What disorder is specifically correlated to severe vitamin B₁ deficiency?

Wernicke encephalopathy

Vitamin B₂ is also known as

Riboflavin

Vitamin B₂ comes from…

Plant and animal products

Vitamin B₂ is required to activate which vitamin?

Vitamin B6

Vitamin B₂ deficiency is most common with…

Chronic alcohol use

These symptoms describe which vitamin?

• Corneal vascularization

• Anemia

• Skin abnormality

Vitamin B2

Vitamin B₃ is also known as

Niacin

Vitamin B₃ is necessary to..

Breakdown glycogen into glucose

Where does Vitamin B₃ come from?

Plant and animal products

Which B vitamin is the only one with contraindications?

• Liver disease

• Severe hypotension

• Arterial hemorrhage

• Active peptic ulcer disease

Vitamin B3

A patient with pellagra is deficient in which vitamin?

Vitamin B3

• Alcohol use disorder

• Areas where corn is the primary food source

These are most common in which vitamin deficiency?

Vitamin B3

These symptoms are common with what B vitamin deficiency?

• Dermatitis

• Diarrhea

• Dementia

Vitamin B3

Which vitamin also has lipid lowering effects at high doses?

Vitamin B3

What is vitamin B₆ also called?

Pyridoxine

What is vitamin B₆ essential for?

To produce heme

Where are B₆ vitamins obtained from?

Animal products, Legumes, Fortified grains

Vitamin B₆ deficiency is most common with…

Alcohol use disorder, Uremia, Chronic kidney disease, Heart failure, Certain drugs (Isoniazid (TB), Hydralazine (HTN), Hormonal contraceptives)

Vitamin B₉ is also known as…

Folate / Folic acid

Vitamin B₉ is essential for…

Normal DNA synthesis + RBC production

Where is Vitamin B₉ obtained from?

Plant products only

Which vitamin is critical in pregnancy to prevent neural tube defect?

B9

What may decrease absorption of folic acid (B₉)

Oral contraceptives, Phenytoin, Barbiturates

Vitamin B₁₂ is also known as…

Cyanocobalamin

Which vitamin contains cobalt and is required for several metabolic processes like cell replication, erythrocyte maturation, myelin synthesis?

B12

Which vitamin is obtained from lead meat, seafood, liver and milk?

B12

Which vitamin deficiency is common with vegetarians?

B12

H2 blockers and proton pump inhibitors can lead to deficiency in what vitamin?

B12

Vitamin C is also known as…

Ascorbic acid

Which vitamin is a potent antioxidant and essential for collagen synthesis, tissue healing, maintenance of bone-teeth-epithelial tissue?

C

When talking about scurvy, what vitamin is deficient?

C

DIets lacking fruits + vegetables, Alcohol use disorder, Cigarette smokers, Cancer, Chronic kidney disease cause deficiencies in which vitamin?

C

Fatigue, Bleeding gums, Gingivitis, Poor wound healing are all symptoms of what vitamin deficiency?

C

Which vitamin interacts with ADHD stimulant meds?

C

True or False?

Excess minerals cannot be toxic to our body

False

True or False?

Very small amounts of minerals are needed to maintain normal metabolism

True

What are the 7 major (macro) minerals?

Calcium, Chlorine, Magnesium, Phosphorous, Potassium, Sodium, Sulfer

Macrominerals must be obtained daily from dietary sources in amounts of ___ mg or greater

100

Iron, Iodine, Fluorine, Zinc are which type of minerals?

Microminerals

Microminerals are required daily in amounts of __ mg or less

20

What is Calcium critical for?

Teeth + Skeletal bones, Nerve impulses, Muscle contractions

Which macromineral is indicated in pregnancy/lactation?

Calcium

Which macro mineral interacts with tetracyclines, quinolones, digoxin phenytoin?

Calcium

Which macro nutrient is indicated in pregnancy conditions such as preeclampsia and preterm labor?

Magnesium

Which macro nutrient interacts with several neuromuscular blocking drugs, CNS depressants, tetracyclines and quinolones

Magnesium

Which macro nutrient has toxicity symptoms like loss of tendon reflexes, CNS depression and respiratory distress?

Magnesium

Which statement about calcium supplements is correct? (SATA)

• A) Calcium can bind to tetracyclines and reduce absorption

• B) Take calcium supplements with dairy and antibiotics together

• C) Separate calcium and phenytoin by at least 2 hours

• D) Calcium toxicity can cause cardiac irregularities

• E) Calcium should always be taken on an empty stomach

A, C, D

Patient: 68 year old female on Warfarin, recently increased intake of kale spinach and started a supplement with vitamin K and E.

INR dropped from 2.5 to 1.6

Which nursing actions are appropriate? (SATA)

• A) Advise patient to completely avoid leafy greens

• B) Teach the patient to keep vitamin K intake consistent

• C) Explain that vitamin E may increase bleeding risk

• D) Instruct the patient to double vitamin K intake if feeling tired

• E) Recommend stopping warfarin immediately

B, C

Which type of nutrition still moves through the GI system?

Enteral

Which type of nutrition is delivered through a feeding tube?

Enteral

Which type of nutrition would you use for these instances?

• Abnormal esophageal/stomach peristalsis

• Altered anatomy secondary to surgery

• Depressed conscious

• Accelerated catabolic state

• Undernourishment

Enteral

Which part of the GI tract does absorption start?

Small intestine

What are the different formulations of enteral nutrition?

Polymeric, Elemental, Modular, Altered amino acid

Which enteral formulation does this describe?

• Closest to standard dietary intake

• Indicated for fully functional GI system

Polymeric

Which enteral formulation does this describe?

• Minimal digestion needed

• Indicated for pancreatitis, partial bowel obstruction, IBS, short bowel

Elemental

Which enteral formulation does this describe?

• Allows for specialized nutritional needs

• Ex) High fat diet needed

Modular

Which enteral formulation does this describe?

• Most common in metabolic disorders like PKU, Maple syrup urine disease

Altered amino acid

How long should enteral feedings be held for when known giving medication with known interaction?

2 hours

Enteral nutrition may inactivate some medications like…

Tetracycline, Nutrient formulations that contain calcium

Can enteral nutrition delay absorption of some medications?

Yes

Enteral nutrition can increase absorption rate resulting in increased therapeutic effects of what?

Corticosteroids or vitamins A / D