APPROVED Jeff Robins Trusted Resource - NCPA · Vitamin Supplementation Sponsored by Ortho...
Transcript of APPROVED Jeff Robins Trusted Resource - NCPA · Vitamin Supplementation Sponsored by Ortho...
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Counseling Your Patients On Drug Induced Nutritional Depletion and Vitamin SupplementationSponsored by Ortho Molecular Products, Inc.
Jeff Robins, RPh, FAAFRM
Jeff Robins, RPh, FAAFRM is the owner of Summit Functional Consulting. The conflict of interest was resolved by peer review of the slide content.
Disclosure
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• Apply course information to pharmacy patient database to identify patients with potential issues.
• Discuss prescription/OTC drug induced nutritional depletion with patients and recommend supplements.
• Create a plan to allow time, space, and manpower to counsel patients on their potential nutrient deficiencies.
• Counsel patients seeking wellness supplements on usage and interactions.
Learning Objectives
Courtesy of Linus Pauling Institute Oregon State University
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Courtesy of Linus Pauling Institute Oregon State University
• Patient presents with symptoms and is started on a medication.
• Medication helps with original symptoms• DIND starts to have effect on patients body-
insidious• Over weeks, months or years patient develops
another set of symptoms or out right disease state due to DIND.
• Patient returns to physician with new symptoms, and is started on another drug.
• Entire process may start all over again.
Etiology of A Drug-Induced Nutritional Deficiency
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• Inhibition of nutrient absorption.• Inhibition of nutrient synthesis.• Alterations in transport of nutrients across
membranes.• Increase or decrease in metabolism of
nutrients.• Increase or decrease in excretion of nutrients.• Alteration in the body’s ability to store nutrients.
How Drug-Induced Nutritional Deficiencies Develop
• Antacids• Antibiotics• Anticonvulsants• Antidiabetics• Antifungals• Anti-inflammatory drugs• Antivirals• Bronchodilators
Drug Classes that May Cause DIND
• Decongestants• Cardiovascular drugs• Cholesterol-Lowering drugs• Electrolyte Replacements• Female Hormones• Oral contraceptives• Laxatives• Psychotherapeutic drugs• Ulcer medications
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Cardiovascular Drugs
Medication Class and Name Example
Statins atorvastatin (Lipitor), Fluvastatin (Lescol), lovastatin (Mevacor, Altocor), pravastatin (Pravachol), rosuvastatin(Crestor), simvastatin (Zocor)
Nutrient Depleted
Co Enzyme Q10
Symptoms of Depletion
Congestive heart failure, high blood pressure, angina, mitral valve prolapse, cardiac, arrhythmias, lack of energy, muscle pain and weakness. Generalized weakening of the immune system.
Cardiovascular Drugs
Medication Class and Name Example
ACE Inhibitors captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril(Altace)
Nutrient Depleted
Zinc
Symptoms of Depletion
Acne, impaired sense of smell and taste, delayed wound healing, decreased immunity, frequent infections, depression, night blindness, problems with hair, skin and nails, component of insulin, needed for thyroid conversion of T4‐>T3.
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Cardiovascular DrugsMedication Class and Name Example
Beta Blockers atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), carvedilol (Coreg)
Nutrient Depleted
Co Enzyme Q10
Symptoms of Depletion
Congestive heart failure, high blood pressure, angina, mitral valve prolapse, cardiac arrhythmias ,lack of energy, muscle pain and weakness. Generalized weakening of the immune system.
Cardiovascular Drugs
Medication Class and Name Example
Calcium Channel Blockers amlodipine (Norvasc), felodipine (Plendil), nifedipine (Procardia, Adalat), nimodipine(Nimotop), nisoldipine (Sular)
Nutrient Depleted
Vitamin D
Symptoms of Depletion
Bone Loss, osteopenia, osteoporosis, muscle weakness, gradual loss of hearing, Leaky gut syndrome‐> allergies, and autoimmune problems.
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Cardiovascular Drugs
Medication Class and Name Example
Cardiac Glycosides digoxin (Lanoxin, Digitek)
Nutrient Depleted
Magnesium, Potassium
Symptoms of Depletion
Magnesium is used in over 300 enzymatic processes in the body, muscle cramps, weakness, insomnia, loss of appetite, GI disorders, kidney stones, osteoporosis, nervousness, restlessness, depression, anxiety, confusion, fatigue, HBPPotassium‐Irregular heart beat, edema, muscle weakness, fatigue, dizziness, confusion
Cardiovascular Drugs
Medication Class and Name Example
Potassium Supplements potassium chloride (Klor‐Con)
Nutrient Depleted
Vitamin B12
Symptoms of Depletion
Fatigue, Peripheral neuropathy, tongue and mouth irregularities, macrocytic anemia, depression, confusion, memory loss, easy bruising, dermatitis, loss of appetite
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Diuretic DrugsMedication Class and Name ExampleLoop Diuretics bumetanide (Bumex), furosemide (Lasix)Thiazide Diuretics chlorthalidone indapamide(Lozol), hydrochlorothiazide methyclothiazidePotassium Sparing Diuretics Amiloride hydrochloride, spironolactone (Aldactone), triamterene (Dyrenium)
Nutrient Depleted
B1, B6, Vitamin C, Calcium, Magnesium, Zinc, Potassium Magnesium, B1, B6, Phosphorous, Potassium, Zinc, Coenzyme Q10
Calcium, Magnesium
Symptoms of DepletionPhosphorous is essential for building soft tissue (phospholipids), creating cellular energy (ATP), coenzyme for enzymatic processes, acts as buffer, needed for cellular and protein synthesisVit B1‐ depression, memory loss, muscle weakness, confusion, fatigue, nerve inflammation, rapid pulse rate
Antidiabetic Drugs
Medication Class and Name Example
Biguanidesmetformin (Glucophage)
Nutrient Depleted
Folic Acid, Vit B12
Symptoms of Depletion
Folic‐Megaloblastic anemia, birth defects, cervical dysplasia, elevated homocysteine, headache, fatigue, hair loss, increased infections.B12‐Fatigue, Peripheral neuropathy, tongue and mouth irregularities, macrocytic anemia, depression, confusion, memory loss, easy bruising, dermatitis, loss of appetite
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Antidiabetic DrugsMedication Class and Name Example
Sulfonylureas glyburide (Diabeta, Glynase, Micronase),glipizide (GlipiZIDE XL, Glucotrol), glimepiride (Amaryl)
Nutrient
Healthy Intestinal Bacteria, Coenzyme Q10
Symptoms of Depletion
Healthy bacteria‐ Gas, bloating, constipation, diarrhea, chronic yeast infections, bad breath, decrease immune response, depression, anxiety.CoQ10‐Congestive heart failure, high blood pressure, angina, mitral valve prolapse, cardiac, arrhythmias, lack of energy, muscle pain and weakness. Generalized weakening of the immune system.
Antacids/ Antiulcerative DrugsMedication Class and Name Example
H2 Inhibitors famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac) Proton‐pump inhibitors omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), esomeprazole (Nexium), rabeprazole(Aciphex) Antacids Amphojel, Basaljel, Aluminum Hydroxide plus Magnesium, (Gaviscon‐2, Gelusil, Maalox, Mylanta)
Nutrient
Folic Acid, B12, Vitamin D, Calcium, Iron, Zinc
Beta‐Carotene, B12, Folic Acid, Calcium, Zinc, Iron
Folic Acid, Vitamin D, Zinc, Calcium, Magnesium, Chromium, Iron
Symptoms of Depletion
Iron‐ Anemia, thyroid disorder, weakness, fatigue, hair loss, brittle nails, frequent infections.
Beta‐carotene‐Weaker immune system, increase risk of cancer, night blindness, Xerophthalmia, dry rough skin.
Calcium‐ muscle cramps, heart palpitations, HBP, brittle and soft bones, insomnia, leg and back pain.
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Osteoporosis DrugMedication Class and Name Example
Bisphosphonates alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), etidronate (Didronel), zoledronic Acid (Reclast)
Nutrient
Calcium, Magnesium
Symptoms of Depletion
Calcium‐muscle cramps, heart palpitations, HBP, brittle and soft bones, insomnia, leg and back pain. Magnesium is used in over 300 enzymatic processes in the body, muscle cramps, weakness, insomnia, loss of appetite, GI disorders, kidney stones, osteoporosis, nervousness, restlessness, depression, anxiety, confusion, fatigue, HBP
Antibiotic DrugsMedication Class and Name Example
Antibiotics Levaquin, Avelox, Ciprofloxacin, Noroxin, Trovan, Amoxicillin, Amoxil, Trimox, Penicillin, Erythromycin, Azithromycin, Biaxin, Zithromax
Nutrient
Biotin, B1, B2, B3, B6, B12, Zinc, Calcium, Magnesium, Potassium, Vitamin K, Healthy Intestinal Bacteria
Symptoms of Depletion
Biotin ‐Hair loss, B1‐depression, irritability, confusion, muscle weakness, nerve inflammation, numbness, memory loss, B2‐ dry itchy skin, cheilosis, reddening tearing burning of eyes,B6‐Depression, insomnia, PMS, Elevated homocysteine, lethargy
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Hormone DrugsMedication Class and Name Example
Conjugated Estrogens Premarin, Prempro, Estrace
Bio‐Identical Hormones Estradiol, Estriol, Estrone
Oral Contraceptives
Nutrient
B6, B12, Vitamin D, Calcium, Magnesium, Zinc, Folic Acid
Symptoms of Depletion
Depression, low energy, low libido, osteopenia, osteoporosis, insomnia, more illnesses, low blood count, heart palpitations, weight gain
Narcotic/Analgesic DrugsMedication Class and Name Example
NSAIDS aspirin, celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin), ketorolac (Toradol), naproxen (Aleve, Naprosyn) Opiates hydrocodone (Vicodin), morphine (MS Contin, Kadian), oxycodone (Oxycontin, Percocet)
Nutrient
Folic Acid, Vitamin C, Iron, Potassium
Symptoms of Depletion
Vitamin C‐Capillary fragility, muscle weakness, tender swollen joints, easy bruising, gums that bleed easily
Folic‐Megaloblastic anemia, birth defects, cervical dysplasia, elevated homocysteine, headache, fatigue, hair loss, increased infections. Potassium‐Irregular heart beat, edema, muscle weakness, fatigue, dizziness, confusion
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Order in product
Make space and time to talk to your patients
How to Get Started with your Patients?
Use product lines that are exclusive to professional practices.
Use products that have a track record of safety.
Use products that are proven to be efficacious.
What Kind of Products to Order?
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Which Products to Order?
Multivitamin‐ Capsule form take twice daily, activated forms of vitamins
CoEnzyme Q 10‐ Bioavailable form.
B‐complex‐ Acitvated form of B vitamins
Probiotics‐Minimum of 10 billion cultures per capsule. Saccharomyces boulardii
Vitamin D3 5000U‐ proven potency
Multi‐mineral supplement‐Bioavailable thru chelating mineral to an amino acid
Pharmacists should be behind the counter only to:
Check prescriptions
Talk to patients on the phone
Talk to other healthcare providers
Create the Time to Talk to Your Patients
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Drug –induced nutritional depletions are real.
Body functions start to break down without vitamins
Replacing nutrient depletions is easy and inexpensive.
Set your pharmacy apart from your competition by meeting your patient’s needs.
Remember
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Thank You!
Jeff Robins RPh, FAAFRMSummit Functional Consulting
[email protected]#309-453-4660