Vitamins

1

• Vitamins
• and
• Minerals
• Chapter 11
• Dr. Jay Shahed

2
Indications for vitamins and mineral supplements
include

• Inadequate diet
• Anorexia
• Weight reduction or other special diets
• Illness
• Alcoholism
• Poor eating habits.
• Malabsorption syndromes
• Chronic gastrointestinal disorders or surgery
  that result in chronic diarrhea.

3

• Increased need for certain nutrients
• Pregnancy and lactation
• Iron and Calcium.
• Infants
• adolescence
• Debilitation
• Illness
• Unusual physical activity
• Postmenopausal women (calcium).

4

• Deficiencies due to medication interactions
• Potassium deficiency
• Diuretic use.

5
The RDA

• Recommended Dietary Allowances
• Includes the amount from foods you eat as well as
  supplements.

6
Fat-Soluble Vitamins

• Vitamin A
• Vitamin D
• Vitamin E
• Vitamin K

7
Vitamin A( Retinol, Retinal, Beta Carotene)

• Functions
• Dim light vision
• Maintenance of mucous membranes
• Growth and development of bones
• Healing of wounds
• Resistance to infection
• Beta carotene is an antioxidant
• Blocks oxygen to combine with nutrient molecules
  ( Fat, Protein ).

8

• Deficiency
• Night Blindness
• Xerophthalmia
• Dry Cornea.
• Bone growth ceases
• Toxicity
• Irritability, lethargy
• Joint pain, myalgia, headache
• Stunted growth, fetal malformations
• Jaundice, nausea, diarrhea
• Dry skin and hair

9

• Food Sources
• Oily saltwater fish
• Whole milk
• Butter
• Cream
• Cod liver oil
• Dark green leafy vegetables
• Deep yellow or orange fruit
• Fortified margarine

10
Vitamin D (Calciferol, Cholecalciferol,
Ergocalciferol)

• Functions
• Healthy bones and teeth
• Muscle function
• Deficiency
• Rickets
• Osteomalacia
• Poorly developed teeth
• Muscle spasms

11

• Toxicity
• Hypercalcemia
• Kidney stones, kidney damage
• Muscle/bone pain
• GI distress
• Food Sources
• Fish oils
• Salmon, herring, mackerel, sardines
• Fortified milk
• Fortified cereals

12
Vitamin E (tocopherol)

• Functions
• Antioxidant
• Deficiency
• Destruction of RBCs, muscle weakness
• Toxicity
• Prolonged bleeding time
• Food Sources
• Meat, poultry eggs
• Vegetable oils
• Seeds, nuts

13
Vitamin K (Phytonadione)

• Functions
• Blood clotting
• Deficiency
• Prolonged blood clotting time
• Toxicity
• Jaundice in infants
• Food Sources
• Egg yolk,Milk,Vegetable oil,Green leafy
  vegetables, Cabbage, broccoli

14

• Water-Soluble Vitamins
• B-complex vitamins
• Vitamin C

15
Vitamin B1 (Thiamine)

• Functions
• Coenzyme carbohydrate metabolism Normal nervous
  and cardiovascular systems
• Deficiency
• GI upset
• Neuritis
• Mental disturbance
• Cardiovascular problems
• Muscle weakness, fatigue

16

• Food Sources
• Pork, beef, liver
• Oysters
• Eggs
• Fish
• Yeast
• Whole and enriched grains, wheat germ
• Legumes, collard greens, nuts

17
Vitamin B2 (Riboflavin)

• Functions
• Aids release of energy from food
• Deficiency
• Cheilosis
• Glossitis
• Photophobia, vision Problems
• Dermatitis

18

• Food Sources
• Milk
• Meat, liver
• Green vegetables
• Cereals
• Enriched bread
• Yeast

19
Vitamin B6 (Pyridoxine)

• Functions
• Synthesis of amino acids
• Antibody production
• Deficiency
• Cheilosis, Glossitis, dermatitis
• Neuritis, depression
• Toxicity
• Seizures in newborn

20

• Food Sources
• Pork
• Eggs
• Whole grain cereals, wheat germ
• Legumes, peanuts, soybeans
• Potatoes

21
Vitamin B12 (Cyanocobalamin)

• Functions
• Synthesis of RBCs
• Maintenance of nervous system
• Deficiency
• Nerve, muscle, mental problems
• Pernicious anemia

22
Niacin (nicotinic acid)

• Functions
• Lipid metabolism
• Nerve functioning
• Deficiency
• Pellagra
• Toxicity
• Vasodilatation of blood vessels

23

• Food Sources
• Milk
• Eggs
• Fish
• Poultry
• Legumes, nuts

24
Folate (folic acid)

• Functions
• Synthesis of RBCs
• Deficiency
• Glossitis
• Macrocytic anemia
• Irritability, behavior disorders

25

• Food Sources
• Organ meats
• Green leafy vegetables
• Avocado, beets
• Broccoli
• Orange juice

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Vitamin C (ascorbic acid)

• Functions
• Prevention of scurvy
• Formation of collagen
• Healing of wounds
• Absorption of iron
• Antioxidant

27

• Deficiency
• Scurvy
• Poor healing
• Muscle cramps/weakness
• Ulcerated gums/mouth
• Capillary fragility

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• Toxicity
• Raise uric acid level
• GI distress
• Kidney stones
• Rebound scurvy in neonates

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• Food Sources
• All citrus
• Broccoli
• Tomatoes
• Brussels sprouts
• Cabbage
• Green peppers

30
Minerals

• Sodium ( Na )
• Chloride ( Cl )
• Potassium ( K )
• Calcium ( Ca )
• Iron ( Fe )

31
Calcium (Ca)

• Functions
• Development of bones and teeth
• Permeability of cell membranes
• Transmission of nerve impulses
• Blood Clotting

32

• Deficiency
• Osteoporosis
• Osteomalacia
• Rickets
• Food Sources
• Milk, cheese
• Sardines
• Salmon
• Green vegetables

33
Potassium (K)

• Functions
• Contraction of muscles
• Transmission of nerve impulses
• Carbohydrate and protein metabolism
• Maintaining water balance

34

• Deficiency
• Hypokalemia
• Toxicity
• Hyperkalemia
• Food Sources
• Oranges
• Bananas
• Dried fruits
• Tomatoes

35
Sodium (Na)

• Functions
• Maintaining water balance in blood
• Deficiency
• Hyponatremia
• Toxicity
• Increase in blood pressure

36
Chlorine (Cl)

• Functions
• Gastric acidity
• Regulation of osmotic pressure
• Activation of salivary amylase
• Deficiency
• Imbalance in gastric acidity
• Toxicity
• Diarrhea
• Food Sources
• Table salt

37
Magnesium (Mg)

• Functions
• Synthesis of ATP (adenosine triphosphosphate)
• Transmission of nerve impulses
• Relaxation of skeletal muscles
• Deficiency
• Imbalance
• Weakness

38

• Toxicity
• Diarrhea
• Food Sources
• Green vegetables
• Whole grains

39
Iron (Fe)

• Function
• Hemoglobin formation
• Resistance to infection
• Deficiency
• Pale, Weak, Lethargy
• Vertigo
• Air hunger

40

• Toxicity
• Vomiting/ Diarrhea
• Erosion of GI tract
• Food Sources
• Liver
• Eggs
• Poultry
• Spinach
• Dried Fruits

41
Iodine (I)

• Functions
• Major component of thyroid hormones
• Regulating rate of metabolism
• Growth, reproduction
• Nerve and muscle function
• Protein synthesis
• Skin and hair growth

42

• Deficiency
• Goiter
• Hypothyroidism
• Toxicity
• Iodine goiter
• Hyperactive, enlarged goiter
• Food Sources
• Freshwater shellfish and seafood
• Iodide salt

43
Zinc (Zn)

• Functions
• Wound healing
• Mineralization of bone
• Insulin glucose regulation
• Normal taste
• Deficiency
• Poor wound healing
• Reduced taste perception
• Alcohol/glucose intolerance

44

• Toxicity
• GI distress
• Impaired immune system
• Food Sources
• Liver
• Oysters
• Poultry
• Fish
• Whole-grain bread and cereal

45

• Skin Medications
• CHAPTER 12
• Dr. Jay Shahed

46
Anti-pruritics

• Indication
• Itching
• short term treatment of dermatitis
• Hives and insect bites.
• Types
• Local Anesthestitic
• Benzocaine
• Drying agents
• Calamine.
• Side effect
• Hypersensitivity
• Antihistaminic effect when dry

47
Anti-inflammatory

• Corticosteroids.
• Example Cortaid
• Side effect
• Reduces resistance to infection, impairs healing
  and possible hypersensitivity.
• Antihistamines
• To relieve histamine based reactions (allergy).
• Example - Benadryl

48
Emollients and Demulcents

• Indications
• Irritation
• Used for minor dermatological lesions only
• Diaper rash, abrasions and minor burns
• Example.
• Vitamins A and D

49
Keratolytic agents

• Coal Tar
• Dandruff
• Seborrheic dermatitis
• Psoriasis
• Podophylim
• Congenital warts
• Salicylic acid
• Warts, acne, dandruff, psoriasis, corns and
  calluses.
• Sulfur
• Acne, dandruff and scabies.

50

• Indications
• Dandruff
• Seborrhea
• Dermatitis
• Psoriasis
• Peeling of skin
• Acne
• Calluses
• Warts ( skin and genital).

51

• Side effects
• Pruritis,
• Skin irritation
• photosensitivity
• Cephalgia
• GI disturbance
• Contraindications
• Pregnant, Lactating or young children.

52
Scabicides and Pediculocides

• Examples
• Lindane (Kwell) for scabies
• Pyrethrins (Rid) for lice
• Indication
• Scabies( Mites )
• Pediculosis ( lice ).
• Contraindication
• Should not be applied to open or bleeding wounds.
• Side effects
• Irritation,
• Rash
• Dermatitis
• Conjunctivitis.

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Antifungals

• Indications
• Fungi infections.
• All areas must be clean and dry.
• Lose fitting clothing and foot wear that promotes
  UV penetration should be used.
• Contraindication
• Causes fetal abnormalities if used whilst
  pregnant.
• Side effects
• Contact dermatitis
• Pruritis, burning
• Irritation.

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• Example
• Nystatin - (Mycostatin)
• Candida, Tinea pedis, Tinea cruex and diaper
  rash.
• Clotrimazole (Lotrimin/Mycelex)
• Candida vaginalis
• Butoconazole (Femstat)
• Candida vaginalis
• Tolfinate (Tinactin)
• Tinea pedis, Tinea cruex
• Zinc undecylenate (Cruex/ Desenex) -
• Tinea pedis, Tinea cruex Indication

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Anti-Viral

• Acyclovir Zovirax
• Indication
• Herpes Simplex
• Herpes Zoster
• Varicella zoster (chicken pox).
• Side effects
• Irritation, rash

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Local Anti- Infective

• Antiseptics
• Indication
• local treatment of infection.
• Types
• Bacteriostatic
• Bacteriolytic (bactericidal).

57

• Hexachlorophene
• Septisol - Bacteriostatic
• Side effects
• Dermatitis
• Erythema,
• Photosensitivity
• CNS irritability, seizures an death.

58

• Iodine
• Betadine - bactericidal
• Side effects
• Skin irritation
• Burns
• Allergic reaction

59
Burn Medications

• Types
• Nitrofurazone Furacin
• Silver sulfurdiazine Silvadene
• Side effects
• Pain
• Burning
• Itching
• Allergy.

60

• Contraindication
• Newborns
• Renal or Hepatic impairment
• Always use sterile equipment and precautions to
  prevent unnecessary infection.

61

• Eye Medications
• CHAPTER 18
• Dr. Jay Shahed

62
Anti-Infective

• Antibiotics
• Erythromycin
• Gentamycin
• Neomycin
• Polymoxin B
• Side effects
• Hypersensitivity
• Conjunctivitis
• Urticaria.
• Burning rash
• Interactions
• Corticosteroids.

63

• Antiviral
• Vidabrine ( Viral A )
• Indications
• Herpes simplex
• Keratitis
• Conjunctivitis

64
Anti-Inflammatory Agents

• Corticosteroids
• Prednisolone
• Dexamethasone.
• Indications
• Conjunctiva
• Burns
• Irritation.

65

• Side effects
• Reduced resistance to bacteria
• Increased introccular pressure
• Delayed wound healing
• Stinging
• Burning.
• Contraindications
• Infections
• Glaucoma
• Pregnancy.
• Diabetes
• Abuse

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Anti-Glaucoma Agents

• Increased Intraoccular Pressure
• Acute (Angle closure) Glaucoma
• S S
• Sudden pain, blurred vision, pupil dilation,
  blindness within days.
• Treatment
• Pilocarpine (miotics)
• mannitol (osmotic agent)
• Diamox (carbonic inhibitor)
• Surgery

67

• Chronic ( Open - angle ) Glaucoma
• S S
• Gradual bilateral blurred vision
• Treatment
• Pilocarpine (miotics)
• Carbonic Inhibitors
• Beta - Adrenergic blocker ( Timoptic )
• Epinephrine ( contraindicated in closed angle).

68
Carbonic Anhydrase Inhibitors

• Acetazolamide (Diamox)
• Mechanism
• This medication acts by reducing the amount of
  hydrogen and bicarbonate ions and a diuretic
  effect.
• Indication
• Open angle

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• Side effects
• GI disturbance
• Vertigo
• Fatigue
• Blood dyscriasis
• Hepatic
• Renal disorders.
• Contraindications
• COPD
• Pregnancy
• Hepatic
• Renal disorders.

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• Interactions
• Decrease effect
• Lithium
• Phenobarbital
• Salicylates
• Oral Diabetics
• Increase effect
• Procaine
• Quinidine
• Amphetamines
• Hypokalemia
• Thiazides
• Corticosteroids

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Miotics

• Pilocarpine (Isoptocarpine)
• Mechanism
• Reduce Intraoccular pressure
• increasing the aqueous outflow which is done by
  the contraction of ciliary muscles. This causes
  an effect of pupil constriction.
• Contraindication
• Patients on pilocarpine are advised not to drive
  at night.

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• Side effects
• Blurred vision
• Ocular pain
• GI disturbance
• Headache
• Photophobia.
• Interactions
• Anesthetics.
• Increased effect with Timolol

73
Beta Adrenergic Blockers

• Timolol (Timoptic)
• Indications
• Open angle glaucoma.
• Side effects
• Ocular irritation
• Conjunctivitis
• Diplopia
• Vertigo
• Cardiovascular diseases
• Pulmonary disorders.

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• Contraindications
• Bradycardia
• COPD.
• Interactions
• Oral B - Blockers
• Other anti glaucoma medications.

75
Sympathomimetics

• Epinephrine
• Dipivefrin (Propine).
• Mechanism
• Mydriatic effect.
• Indication
• Open angle glaucoma patients only.

76

• Side effects
• Blurred vision
• Photophobia
• Cephalgia
• Tachycardia.
• Contraindications
• Diabetes
• Hypertension
• Cardiac disorders.

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Mydriatics

• Atropine (Atropine)
• Indication
• Dilate the pupil for Ophthalmic examination
• Paralyze the muscles of accommodation.
• Side effects
• Increased introccular pressure
• Local irritation
• Blurred vision is common
• Contraindications
• Angle closure glaucoma
• Infants.

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Local Anesthetics

• Tetracaine (Pontocaine)
• Indication
• Minor surgery.
• Side effects
• Anaphylaxis ( Hypersensitivity ).
• Contraindications
• Corneal erosions.