Nutritional%20Aspects%20of%20Pharmacology%20and%20Herbal%20Substances

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Nutritional Aspects of Pharmacology and Herbal
Substances
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Organizations are Structured to Provide Safe
Patient Care

• Chain of Command
• Interdisciplinary Team
• Rules and Policies

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Nutrition

• Nutrition how the body takes in and uses food
  and other sources of nutrients for growth and
  repair of tissues
• A five-part process intake, digestion,
  absorption, metabolism, elimination

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Nutrients

• Nutrient element or compound from diet that
  supports normal metabolism, growth, reproduction,
  or other functions
• Essential nutrient needed by body for normal
  functioning
• Nonessential nutrient can be synthesized by body
  from other compounds may also be derived from
  diet

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Seven Nutrients

• Proteins
• Fatty acids (also called lipids or fats)
• Carbohydrates
• Fiber
• Vitamins
• Minerals
• Water

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Macronutrients

• Needed by body in large amounts for energy
• Carbohydrates
• Fats
• Proteins
• Macrominerals (dietary minerals needed in high
  quantities grams)
• Water

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Macronutrients Are Energy

• Macronutrients interchangeable as sources of
  energy
• Fats yield 9 kilocalories of energy per 1 g
  consumed (9 kcal/g)
• Proteins and carbohydrates yield 4 kcal/g
• Water requirements 1 mL/kcal of energy expended
  or about 2,500 mL/day

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Essential Amino Acids

• Components of proteins that cannot be synthesized
  by the body and must be provided by diet
• Nine of the 20 amino acids are essential

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Essential Fatty Acids

• Required in amounts equaling 6 to 10 of fat
  intake (510 g/day)
• Appear to play a role in decreasing triglyceride
  levels and the growth rate of atherosclerotic
  plaque
• Required for the formation of prostaglandins and
  thromboxanes

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Types of Fatty Acids

• Saturated
• Dense, heavy, and solid at room temperature
• Found in dairy products and meats
• Unsaturated
• Usually liquid at room temperature
• From vegetables and legumes corn, soy, peanuts,
  safflower

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Cholesterol

• A natural lipid found in cell membranes
• Found in highest concentrations in animal muscles
  and organs
• Essential for certain cell structures
• Excess cholesterol can form atherosclerotic
  plaque, leading to cardiovascular disease

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Carbohydrates

• Provide about two-thirds of daily energy needs
• Aid in fat metabolism and help reserve protein
  for uses such as repairing and building tissues
• Daily requirement 50 to 60 of total caloric
  intake

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Two Types of Carbohydrates

• Simple sugars
• Quickly absorbed
• Found in fruits, some vegetables, milk, and table
  sugar
• Complex carbohydrates
• Must be processed by the body before absorption
• Found in grain, fruits, and vegetables

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Storage of Carbohydrates

• Glucose (a sugar) is stored in the liver and
  muscles as glycogen (starch).
• Available to supplement dietary supplies of
  carbohydrates
• Excess amounts of carbohydrates are stored in the
  body as adipose tissue (fat).

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Blood Glucose Levels

• The central nervous system (CNS) requires a
  constant supply of glucose to function properly.
• Sustained low blood glucose levels, which can be
  caused by an excessively low intake of
  carbohydrates, can result in brain damage and
  death.

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Lactose Sensitivity

• Lactose is a sugar in human and animal milk that
  must be broken down by the enzyme lactase to be
  digested.
• Many infants and children have trouble digesting
  foods that contain lactose.
• Lactose-free milk can be substituted.

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Fiber A Complex Carbohydrate

• Soluble fiber absorbs water and swells when
  eaten found in oats, fruits, and vegetables
• Insoluble fiber not absorbed by body found in
  bran of whole wheat and brown rice
• Provides stool bulk, which stimulates peristalsis

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Micronutrients

• Vitamins and essential trace nutrients needed in
  very small quantities.
• Insufficiencies cause biochemical alterations
  (such as changes in the structure and function of
  tissues and organs) and diseases.

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Vitamins

• Organic compounds needed for normal human growth,
  development, and maintenance of normal body
  function.
• Classified by solubility
• Water soluble B and C vitamins
• Fat soluble A, D, E, and K vitamins

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Table 9-1 Water-Soluble Vitamins
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Table 9-1 (continued) Water-Soluble Vitamins
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Table 9-1 (continued) Water-Soluble Vitamins
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Table 9-1 (continued) Water-Soluble Vitamins
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B Vitamins Thiamine (B1)

• Sources whole grains (especially wheat germ),
  lean meats, fish, soybeans, and other beans
• Important in carbohydrate metabolic processes
• Deficiency leads to beri-beri (edema,
  cardiovascular abnormalities, and neurologic
  symptoms).

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B Vitamins Riboflavin (B2)

• Sources dairy, yeast, and liver
• Important in metabolism of fats, carbohydrates,
  and proteins
• Deficiency causes cheilosis, stomatitis,
  glossitis, and seborrheic dermatitis.
• No danger of excessive consumption

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B Vitamins Nicotinamide (B3)

• Also called niacin
• Sources liver, yeast products, peanuts, whole
  grain cereals, and fish
• Large doses lower cholesterol, triglycerides,
  free fatty acids
• Deficiency causes pellagra (dementia, dermatitis,
  diarrhea, and death).

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B Vitamins Nicotinamide (B3)

• Toxicity includes hepatic impairment, severe
  hypotension, and various skin conditions.

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Pharmacologic Doses of Niacin

• At high doses, niacin decreases blood levels of
  low-density lipoprotein (LDL) cholesterol and
  triglyceride levels, which are linked to
  cardiovascular disease, and increases
  high-density lipoprotein levels (good
  cholesterol).
• Niacin is used under physician's supervision for
  this purpose.

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B Vitamins Pantothenic Acid (B5)

• Sources whole grain cereals, legumes, meat, eggs
• Needed for formation of coenzyme A
• Deficiency is rare

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B Vitamins Pyridoxine (B6)

• Sources animal and plant products
• Used to prevent neuritis in patients on isoniazid
  (INH) therapy and to treat hyperemesis gravidarum
  (nausea during pregnancy)
• Deficiency is rare

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B Vitamins Biotin

• Sources widely available in foods and made by
  natural flora in intestines
• Deficiency is almost unknown
• No known toxicities

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B Vitamins Folate

• Sources dark green, leafy vegetables
• Aids creation of DNA essential to hemoglobin
  formation and amino acid synthesis
• Deficiency causes anemia
• Increased folic acid recommended in pregnancy to
  prevent spina bifida.
• No known toxicity

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B Vitamins Cobalamin (B12)

• Sources fish, dairy, organ meats, eggs
• Promotes normal cell function, especially blood
  formation and nerve cell function

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B Vitamins Cobalamin (B12)

• Lack of intrinsic factor in GI tract (caused by
  certain GI disorders) can block absorption of
  B12, leading to pernicious anemia
• More common in elderly patients
• No known toxicity

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Vitamin B Factors (Choline)

• Sources milk, eggs, liver, and peanuts
• Needed to produce acetylcholine (neurotransmitter
  involved in memory and muscle control)
• Deficiency linked to Huntingtons chorea,
  Parkinsons disease, and Alzheimers disease

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Vitamin B Factors (Choline)

• Excess doses may lower blood pressure cause
  fishy body odor, sweating, and excessive
  salivation and reduce growth rate.

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Vitamin C Ascorbic Acid

• Sources capsicums, guavas, kiwi, citrus
• Aids wound healing, tissue repair, infection
  resistance, iron bioavailability, and calcium
  absorption

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Vitamin C Ascorbic Acid

• Antioxidant role may reduce cancer risk and
  lower cholesterol levels
• Deficiency causes scurvy
• Excess may cause diarrhea and gastritis.

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Vitamin C and Cataracts

• Vitamin C may protect against cataracts because
  the body concentrates it in the lenses of the
  eye.
• The use of vitamin C for 10 or more years is
  associated with 77 to 83 lower prevalence of
  early to moderate cataracts.

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Fat-Soluble Vitamins

• Vitamin A (retinol)
• Vitamin D3 (cholecalciferol)
• Vitamin D2 (ergocalciferol)
• Vitamin E (alpha tocopherol)
• Vitamin K1 (phylloquinone)
• Vitamin K2 (menaquinone)

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Retinol (Vitamin A)

• Sources fish-liver oils, butter, egg yolk, liver
• All milk is fortified with vitamin A
• Carotene is converted to vitamin A in body
• Aids tissue maintenance, skeletal and soft-tissue
  growth, protein synthesis, vision

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Retinol (Vitamin A)

• Mild deficiency may cause night blindness
• Toxicity (hypervitaminosis A) marked by hair
  loss, jaundice, joint pain, liver injury, ascites

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Vitamin A Deficiency

• Dietary vitamin A deficiency is the number one
  cause of blindness in children worldwide.

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Overconsumption of Vitamins or Minerals

• If overconsumption of vitamin or mineral occurs,
  patients should cut back, but not stop
  immediately, to allow the body to adjust.
• Stopping immediately can trigger a deficiency.

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Cholecalciferol (Vitamin D3)

• Sources yeast, fish-liver oils
• Cholecalciferol (vitamin D3), made by the body in
  response to UV light then activated by
  cholesterol to become calcitriol.
• Stimulates calcium and phosphorus absorption

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Cholecalciferol (Vitamin D3)

• Deficiency causes rickets, osteomalacia,
  osteoporosis.
• Toxicity can occur, especially in children.

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Tocopherol (Vitamin E)

• Sources vegetable oils, nuts, fortified cereals
• Protects breakdown of red blood cells (RBCs)
• Deficiency can occur in premature infants who
  miss final 1-2 months of gestation.

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Tocopherol (Vitamin E)

• Deficiency in adults disrupts myelin production,
  affecting physical activity and vision.
• Excess intake may interfere with vitamin K and
  blood clotting.

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Vitamin K

• Phylloquinone (K1) is dietary form menaquinone
  (K2) is synthesized by intestinal bacteria.
• Sources green leafy vegetables
• Aids blood clotting and bone development
• Antidote for overdose of anticoagulants
• Deficiency is rare.
• No known toxicity

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Vitamin K

• Phylloquinone is routinely given to newborns to
  prevent hemorrhage when the umbilical cord is
  cut.
• Trade names of this vitamin K shot are
  AquaMephyton, Mephyton, or Phytonadione.

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Mineral and Vitamin Interactions

• Insufficient vitamin D intake hinders the uptake
  of calcium.
• High amounts of supplemental vitamin C reduce
  copper levels.
• Vitamin C can increase iron absorption as much as
  30.

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Mineral and Vitamin Interactions

• Excessive amounts of vitamin E interfere with
  iron absorption.
• Vitamin B6 is required to metabolize magnesium
  and zinc.

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Proper Dosage of Vitamins

• Advise patients about the proper dose of vitamins
  that are needed to maintain metabolic control and
  prevent disease.a
• Warn patients that certain health problems are
  related to inadequate or excessive intake.

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Minerals

• Major daily requirements more than 100 mg/day
• Calcium, phosphorus, sodium, potassium,
  magnesium, and chlorine
• Minor (essential trade minerals) daily
  requirements less than 100 mg/day
• Iron, iodine, fluoride, zinc, chromium, selenium,
  manganese, molybdenum, and copper

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Calcium

• Sources milk, cheese, salmon, green leafy
  vegetables, whole grains
• Aids bone formation, nerve conduction, myocardial
  and skeletal muscle contractions
• Absorption dependent on vitamin D.
• Deficiency causes rickets, osteomalacia,
  osteoporosis.

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Calcium

• Excess may cause constipation, nausea,
  hypotension, vomiting, kidney stones, cardiac
  arrhythmias.

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Phosphorus

• Sources milk, cheese, legumes, beef, fish, pork
• Needed for bone and tooth formation, energy,
  storage of fats, metabolism of other nutrients
• Deficiency can cause anemia, bone brittleness,
  confusion, and weakness.
• Toxicity may cause hypocalcemia and kidney stones.

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Sodium

• Source table salt
• Needed for body fluid balance and acid-base
  balance regulates nerve transmission and cell
  membrane irritability.

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Sodium

• Deficiency may cause headache, confusion, nausea,
  weakness, anxiety, muscle spasms, hypotension.
• Toxicity produces hypertension and edema.

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Potassium

• Sources oranges, bananas, red meats, vegetables,
  yams, milk products, coffee
• Helps maintain normal cardiac and muscle function
  
• Deficiency can cause weakness, paralysis, cardiac
  arrhythmias, digitalis toxicity.

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Potassium

• Excessive intake may produce muscle weakness,
  diarrhea, severe dehydration, abdominal pain,
  hypotension, cardiac arrest.

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Magnesium

• Magnesium is required to form proteins.
• It stimulates muscle contraction and nerve
  transmission, activates enzymes, and aids in bone
  formation.
• Sources green leafy vegetables, whole grains,
  and legumes
• Excess or deficit may cause tetany, convulsions,
  or muscle spasms.

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Chlorine

• Sources table salt, meat, milk, processed foods
• Major electrolyte that aids acidbase balance and
  fluid balance
• Deficiency is rare.
• No known toxicity

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Essential Trace Minerals

• Essential trace minerals are also called
  microminerals.
• Less than 100 mg per day are required
• They include iron, iodine, fluoride, zinc,
  chromium, selenium, manganese, molybdenum, and
  copper.

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Iron

• Sources meat, eggs, vegetables, cereals
• Aids in synthesis of hemoglobin and general
  metabolism
• Deficiency causes anemia.
• Toxicity can be fatal.

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Iron Toxicity

• In the United States, iron overdose from
  supplements is leading cause of poisoning in
  young children.
• Symptoms nausea, vomiting, diarrhea
• If not treated immediately, can result in brain,
  kidney, liver, and heart damage

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Iodine

• Sources iodized table salt, seafood
• Helps synthesize thyroxine to control bodys
  basal metabolic rate
• Deficiency can cause goiter, cretinism, and
  myxedema.
• Excess intake causes acne-like skin lesions or
  worsen acne.

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Cretinism

• Cretinism occurs in children born to mothers who
  had limited iodine intake during adolescence and
  pregnancy.
• Children with cretinism have retarded physical
  and mental development.

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Zinc

• Source meat
• Important during growth periods
• Deficiency may cause retarded physical growth
  (such as dwarfism) and retarded sexual
  maturation, poor wound healing, hair loss,
  diarrhea, skin irritation.

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Zinc

• Excess intake can inhibit copper absorption or
  cause nausea, vomiting, and decreased immune
  function.

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Fluoride

• Sources fish, tea
• Prevents dental caries by strengthening tooth's
  ability to withstand bacterial erosion

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Copper

• Sources organ meats (liver), seafood, nuts,
  seeds, legumes, grains
• Aid energy production and hemoglobin synthesis
• Deficiency is rare increased intake is
  recommended for pregnant or lactating women to
  meet increased needs.

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Copper

• Toxicity Wilsons disease is genetic disorder
  causing excess storage of copper in body that can
  result in liver and nerve damage.

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Nutritional Requirements

• Nutritional needs of infants in 1st year of life
  are increased.
• Breast milk and commercially prepared formula
  contain the correct balance of nutrients.
• Cows milk does not meet these standards.

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Nutritional Requirements

• Food and Nutrition Board issues recommended
  dietary allowances (RDAs) every 5 years.
• Body composition requires balancing energy intake
  with energy expenditure.
• Nutrition during pregnancy 2530 pound weight
  gain recommended.

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Cachexia

• A profound syndrome caused by malnutrition and a
  disturbance in glucose and fat metabolism.
• Occurs in patients with terminal cancer or AIDS
  and in patients who are in generally poor health

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Nutritional Support

• Enteral nutrition used in patients with a
  functioning GI tract to supplement or completely
  replace oral feeding administered through a tube
  
• Parenteral nutrition indicated for patients who
  require intensive protein and caloric support and
  who are unable or unwilling to take oral
  supplementation administered IV

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NutrientDrug Interactions

• Food affects drug absorption by slowing gastric
  emptying, by binding with a drug, decreasing the
  access of drugs to sites of absorption, altering
  the dissolution rate of drugs, or altering the pH
  of the GI contents.
• Drugs can affect mineral or vitamin metabolism or
  absorption, and also suppress appetite.

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Table 9-2 Drugs That Affect Appetite,
Absorption, and Tissue Metabolism
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Food Additives and Contaminants

• Benefits of additives
• Facilitate food processing and preservation
• Enhance restorative or stimulating properties of
  foods
• Control natural contaminants
• Additives are strictly regulated.
• Reported health problems related to additives
  have been trivial and largely anecdotal

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Herbal Supplements

• An herbal supplement may be defined as any
  mixture of ingredients based on plant sources and
  designed for the improvement of health or
  treatment of certain conditions.
• They are considered by the FDA to be food
  products, and not drugs.

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Use of Herbal Supplements

• Patients must understand that the taking of
  herbal supplements should not occur without
  consulting their physician.
• These substances are not regulated by the FDA and
  there is no verification of their quality,
  effectiveness, or quantity of ingredients they
  contain.

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Complementary and Alternative Medicine (CAM)

• CAM involves different healing systems and
  therapies, which include
• Herbal therapies
• Nutritional supplements
• Special diets

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The Dietary Supplement Health and Education Act

• DSHEA (1994) attempted to regulate herbal
  supplements.
• This act requires manufacturers to label these
  products as dietary supplements.
• Dietary supplements are defined as products that
  are intended to enhance or supplement the diet.

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The Dietary Supplement and Nonprescription Drug
Consumer Protection Act

• This 2007 act required that manufacturers must
  include contact information on product labels for
  consumers so that they can report adverse effects
  of products.
• Manufacturers must inform the FDA of such
  occurrences within 15 days after receiving a
  consumer complaint.

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Table 9-3 Top-Selling Herbal Supplements
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Table 9-3 (continued) Top-Selling Herbal
Supplements
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Table 9-3 (continued) Top-Selling Herbal
Supplements
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Table 9-3 (continued) Top-Selling Herbal
Supplements