Vitamins and Minerals Nutrition. Blood-Forming Agents. Dermatologic, Ophthalmic and Otic Agents.

Vitamins and Minerals Nutrition.

Blood-Forming Agents. Dermatologic,

Ophthalmic and Otic Agents

Vitamins

• Organic substances necessary for metabolic functioning– Found in foods– Inadequate intake leads to deficiencies

Vitamins

• Organic substances necessary for metabolic functioning– Found in foods– Inadequate intake leads to deficiencies

• Most signs and symptoms of deficiencies can be corrected by administering the correct vitamin

Vitamin Deficiencies

• Keratomalacia– Vitamin A deficiency– Softens the cornea

• Rickets

• Beriberi

• Pallagra

• Scurvy


• Keratomalacia

• Rickets– Vitamin D deficiency– Causes bending of the bones

• Beriberi

• Pallagra

• Scurvy


• Keratomalacia• Rickets• Beriberi

– Vitamin B1 deficiency– Causes polyneuritis, edema, and cardiac

problems

• Pallagra• Scurvy


• Keratomalacia

• Rickets

• Beriberi

• Pallagra– Vitamin B3 deficiency

– Causes dermatitis and diarrhea

• Scurvy


• Keratomalacia• Rickets• Beriberi• Pallagra• Scurvy

– Vitamin C deficiency– Causes anemia, spongy gums, hemorrhages,

and brawny induration of calf and leg muscles

Classification of Vitamins

• Fat-Soluble – maintained in stores in the liver– Excessive amounts can collect and cause

toxicity

• Water-Soluble – readily excreted by the kidneys– Deficiency is quickly apparent, but overdose is

unlikely

Fat-Soluble Vitamins

• Vitamin A (Retinol)– Normal growth, bone formation, shedding of

epithelial tissue, retinal function, reproductive function, stability of cell membrane

• Vitamin D (ergocalciferol)

• Vitamin E (tocopherol)

• Vitamin K (phytonadione)


• Vitamin A (Retinol)

• Vitamin D (ergocalciferol)– Calcium and phosphate balance






• Vitamin E (tocopherol)– Antioxidant for unsaturated fatty acids






• Vitamin K (phytonadione)– Functions in the formation of prothrombin and

plays a role in blood clotting

Water-Soluble Vitamins

• Vitamin C (ascorbic acid)– Improves the ability of the immune system, has

anti-inflammatory activity and promotes wound healing

• Vitamin B1 (thiamine)

• Vitamin B2 (riboflavin)

• Vitamin B3 (nicotinic acid, niacin)


• Vitamin C (ascorbic acid)


– Acts as a coenzyme in carbohydrate metabolism







– Maintains the integrity of mucous membranes and metabolic energy pathways







– Involved in fat synthesis, electron transport, and protein metabolism


• Vitamin B5 (pantothenic acid)

– Forms part of the coenzyme system

• Vitamin B6 (pyridoxine)

• Vitamin B9 (folic acid)

• Vitamin B12 (cyanocobalamin)




– Coenzyme in amino acid and fatty acid metabolism







– Provides for production of healthy red blood cells and decreases the risk of birth defects







– Helps in the production of red blood cells

TPN Labeling

• Patient’s name

• Address or hospital unit

• Solution name, concentration, and volume

• Additives

• EXPIRATION DATE

Body Fluids

• Water is the major constituent of living cells

• Extracellular and intracellular fluids are largely water

• A loss of 25% of body water can lead to death

Electrolytes

• Compounds that form ions when dissolved in water

• Na+ - primary cation of extracellular fluid– Retains fluid in the body, generates and

transmits nerve impulses, maintains acid-base balance, regulates enzyme activities, and regulates osmolarity and electroneutrality

Electrolytes

• K+ - primary cation of intracellular fluid– Regulates acid-base and water balance,

important in protein synthesis, carbohydrate metabolism, muscle building, and the nervous system

• Ca++ – Important in bone formation, muscle

contraction, and blood coagulation

Electrolytes

• Cl- – Transports CO2, forms HCl in the stomach,

retains K+, maintains osmolarity

• H+

– Determines the acidity and alkalinity of body fluids

Electrolytes

• Mg++ - 2nd most abundant cation in intracellular fluids– Helps maintain normal nerve and muscular

function, transmission of impulses, and steady heart rhythms

Discussion

Why would a patient need an injection of B12?

Discussion

Why would a patient need an injection of B12?

Answer: low red blood cell count

IV Therapy

• Goal: provide sufficient water and electrolytes to maintain fluids and excrete waste products

• Solvent in IV solutions is water

IV Therapy

• Goal: provide sufficient water and electrolytes to maintain fluids and excrete waste products

• Solvent in IV solutions is water

• D5W = 5 g of Dextrose in 100 ml of water

• NS = 0.9 g of NaCl in 100 ml of water

Tonicity

• Measures the amount of dissolved particles in relation to body fluids

• Hypotonic – lower concentration of dissolved particles

Tonicity



• Hypertonic – higher concentration of dissolved particles

Tonicity



• Hypertonic – higher concentration of dissolved particles

• Isotonic – same concentration of dissolved particles (0.9% sodium chloride)

Enteral Nutrition

• Patients are fed through a tube leading to the GI system

• Preferred method over IV therapy

• Very important to label enteral nutrition separately than parenteral nutrition

Total Parenteral Nutrition

• Patient is fed through IV administration

• Can be lifesaving, but can be devastating if appropriate precautions are not taken

• Water, electrolyte, carbohydrate, and protein proportions must be calculated carefully

Malnutrition

• TPNs can help patients to avoid malnutrition

• 20% of all hospitalized patients have been shown to have malnutrition

2 Types of Protein Malnutrition

• Marasmus

• Kwashirokor


• Marasmus– Imbalance between protein and calorie intake– Causes growth retardation

• Kwashirokor


• Marasmus– Imbalance between protein and calorie intake– Causes growth retardation

• Kwashirokor– Lack of dietary protein or caused by stress of

infection, burns, traumatic injury, or disease

Indications for TPNs

• Poor wound healing

• Infections

• Anemia

• Specific GI disease

• Hypermetabolic states

• Patients who cannot tolerate enteral nutrition

Other Indications for TPNs

• AIDS

• Enterocutaneous fistulas

• Malignant disease

• Perioperative support

• Pregnancy

• Severe gastroparesis

Complications of TPNs

• Acid-base imbalance• Dehydration• Elevated serum

triglycerides• Failure to induce

anabolism• High serum lipid

concentrations

• Hyperammonemia• Hyperglycemia or

hypoglycemia (diabetic or not)

• Hypoalbuminemia• Imbalance of

electrolytes• Liver toxicity

Preparing TPN Solutions

• Two Types of TPN:– Solutions with lipids (3-in-1) = TNAs– Solutions without lipids (2-in-1) = TPN

• Advantages of TNAs– Lower cost of preparation– Less administration time for nurses– Potentially reduced risk of sepsis

Preparing TPN Solutions

• Disadvantages to TNAs– Precipitants cannot be seen– Not stable as long as TPNs without lipids

• Expiration date for 2-in-1 is 21 days

• Expiration date for 3-in-1 is 7 days– Can remain at room temperature for 24 hours

Mixing TPNs

• Phosphates injected first• Then add amino acids, dextrose, lipids, and

water• Then add the other electrolytes

– Phosphate must be separated from calcium and magnesium

• TPNs must be inspected after mixing to look for precipitates

Common Additions to TPNs

Electrolytes Daily Adult Dose

calcium 5 to 15 mEq

chloride 100 to 150 mEq

magnesium 8 to 30 mEq

phosphorus 15 to 45 mMol

potassium 80 to 100 mEq

sodium 100 to 150 mEq

Recommended Multivitamin Additions for TPN

• ascorbic acid (vitamin C)

• biotin• cyanocobalamin

(vitamin B12)

• ergocalciferol (vitamin D2)

• folic acid (vitamin B9)

• niacin (vitamin B3)

• pyridoxine (vitamin B6)

• retinol (vitamin A)

• riboflavin (vitamin B2)

• thiamine (vitamin B1)

• tocopherol (vitamin E)

Recommended Trace Element Additions for TPN

• chromium

• copper

• manganese

Standard per Liter Additions for TPN

• acetate• calcium• chloride• insulin, regular• magnesium• phosphate• potassium• sodium• zinc

TPN Labeling

• Patient’s name

• Address or hospital unit

• Solution name, concentration, and volume

• Additives

• EXPIRATION DATE

Ophthalmic AgentsAntibiotics

• bacitracin

• ciprofloxacin (Ciloxan, Cipro)

• gatifloxacin (Zymar)

• gentamicin (Gentak)

• levofloxacin (Iquix)

Drug List

Ophthalmic AgentsAntibiotics

• moxifloxacin (Vigamox)

• norfloxacin (Noroxin)

• ofloxacin (Ocuflox)

• sulfacetamide (Ak-Sulf, Bleph-10)

Drug List

Ophthalmic AgentsCorticosteroids

• bacitracin-neomycin-polymyxin B-hydrocortisone (Cortisporin Ointment)

• dexamethasone (AK-Dex)

• flurometholone (FML Forte)

• loteprednol (Alrex, Lotemax)

Drug List

Ophthalmic AgentsCorticosteroids

• neomycin-polymyxin B-dexamethasone (Maxitrol)

• sulfacetamide-prednisolone (Blephamide)

• tobramycin-dexamethasone (TobraDex)

Drug List

Ophthalmic Agents

Antifungal:

• natamycin (Natacyn)

Decongestant:

• naphazoline (AK-Con, Vasocon, Naphcon A)

Drug List

Ophthalmic AgentsAntivirals

• fomivirsen (Vitravene)

• trifluridine (Viroptic)

Drug List

Ophthalmic AgentsMast Cell Stabalizer

• cromolyn sodium (Crolom)

• pemirolast (Alamast)

Drug List

Ophthalmic AgentsAntihistamines

• epinastine (Elestat)

• ketotifen (Zaditor)

• olopatadine (Patanol)

Drug List

Ophthalmic AgentsNSAIDs

• diclofenac (Voltaren)

• flurbiprofen (Ocufen)

• ketorolac (Acular)

Drug List

Ophthalmic AgentsOthers

• cyclosporine (Restasis)

• verteporfin (Visudyne)

• vitamin C-vitamin E-zinc-beta carotene (Ocuvite PreserVision)

Drug List

CMV Retinitis

• Inflammation of the retina caused by cytomegalovirus (CMV)

• Treated with antivirals

fomivirsen (Vitravene)

• Intravitreal injection

• Blocks the replication of CMV

• Should not be used as a 1st line agent

Age-Related Macular Degeneration (AMD)

• The macula has the highest concentration of photoreceptors in the retina

• Dry AMD – cells in the macula slowly breakdown and vision is slowly lost

• Wet AMD – new blood vessels in the retina grow toward the macula; damage occurs rapidly and vision is lost rapidly

AMD

• Neither form causes pain

• The cause in unknown

• Age is the greatest risk factor

AMD

• Neither form causes pain

• The cause in unknown

• Age is the greatest risk factor

• Wet AMD can be treated with surgery

• Dry AMD does not have a treatment

Chronic Dry Eye

• Eye is unable to produce sufficient tears to lubricate and nourish the eye

• Can be treated with Restasis

cyclosporine (Restasis)

• For chronic dry eye

• Increases tear production

• Decreases immune function in the eye, but is not absorbed systemically

Conjunctivitis

• Known as “pink eye”

• Common, very contagious if infected, eye disorder

• Signs and symptoms:– Increased tearing, itching, conjunctival

swelling, redness

olopatadine (Patanol)

• Antihistamine used for allergic conjunctivitis

Glaucoma

• The most commonly occurring eye disease

• No cure for this chronic disorder

• Characterized by abnormally high internal eye pressure that destroys the optic nerve

• Pressure is due to an imbalance with the aqueous humor

Goals of Treatment for Glaucoma

• Prompt reduction of intraocular pressure

• Stabilization of eye status for corrective surgery

• Gradual reduction of pressure

• Long-term normalization

• Prevention of optic nerve damage

• Preservation of eyesight

Glaucoma AgentsEyedrops

• apraclonidine (Lopidine)

• betaxolol (Betoptic)

• bimatoprost (Lumigan)

• brimonidine (Alphagan P)

• brinzolamide (Azopt)

Drug List


• carbachol (Carbastat, Miostat)

• dipivefrin (Propine)

• dorzolamide (Trusopt)

• echothiophate iodide (Phospholine Iodide)

• latanoprost (Xalatan)

Drug List


• pilocarpine (Isopto Carpine)• timolol (Timoptic)• travoprost (Travatan)• unoprostone (Rescula)

Oral Agent:• acetazolamide (Diamox)

Drug List

brimonidine (Alphagan P)

• Lowers intraocular pressure by reducing fluid production and increasing outflow

• Effectiveness may diminish over time

latanoprost (Xalatan)

• Slows production of aqueous humor

• Increases drainage

• Causes light-colored eyes to turn brown

• Should be stored in the refrigerator

Otics

• Otalgia is usually treated with a prescription

• OTC products:– Ear wax solvents– Products to dry water in the ear canal

Otic Agents

Analgesic:• antipyrine-benzocaine (Auralgan)Antibiotics:• ciprofloxacin-dexamethasone (Ciprodex)• neomycin-polymixin B-hydrocortisone

(Cortisporin Otic)

Drug List

Otic Agents

Wax Dissolvers:

• carbamide peroxide (Debrox)

• triethanolamine polypeptide-oleate condensate (Cerumenex)

Drug List

Otics Dispensing Issues

• Suspension should be used if– There are tubes in the ears– The eardrum is ruptured

• Ophthlamics can be used in the ear and is a common practice (eardrops cannot be used in the eye)

Warning!

Otics Dispensing Issues

• Be careful not to confuse eyedrops and eardrops

• They look very similar

Warning!

Discussion

Why can eyedrops be used in the ear, but eardrops cannot be used in the eye?

Discussion

Why can eyedrops be used in the ear, but eardrops cannot be used in the eye?

Answer: eyedrops must be sterile, eardrops do not

Vitamins and Minerals Nutrition. Blood-Forming Agents. Dermatologic, Ophthalmic and Otic Agents.

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Transcript of Vitamins and Minerals Nutrition. Blood-Forming Agents. Dermatologic, Ophthalmic and Otic Agents.