Vitamins and Minerals Nutrition. Blood-Forming Agents. Dermatologic, Ophthalmic and Otic Agents
-
Upload
octavia-stevens -
Category
Documents
-
view
28 -
download
0
description
Transcript of 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
Vitamin Deficiencies
• Keratomalacia
• Rickets– Vitamin D deficiency– Causes bending of the bones
• Beriberi
• Pallagra
• Scurvy
Vitamin Deficiencies
• Keratomalacia• Rickets• Beriberi
– Vitamin B1 deficiency– Causes polyneuritis, edema, and cardiac
problems
• Pallagra• Scurvy
Vitamin Deficiencies
• Keratomalacia
• Rickets
• Beriberi
• Pallagra– Vitamin B3 deficiency
– Causes dermatitis and diarrhea
• Scurvy
Vitamin Deficiencies
• 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)
Fat-Soluble Vitamins
• Vitamin A (Retinol)
• Vitamin D (ergocalciferol)– Calcium and phosphate balance
• Vitamin E (tocopherol)
• Vitamin K (phytonadione)
Fat-Soluble Vitamins
• Vitamin A (Retinol)
• Vitamin D (ergocalciferol)
• Vitamin E (tocopherol)– Antioxidant for unsaturated fatty acids
• Vitamin K (phytonadione)
Fat-Soluble Vitamins
• Vitamin A (Retinol)
• Vitamin D (ergocalciferol)
• Vitamin E (tocopherol)
• 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)
Water-Soluble Vitamins
• Vitamin C (ascorbic acid)
• Vitamin B1 (thiamine)
– Acts as a coenzyme in carbohydrate metabolism
• Vitamin B2 (riboflavin)
• Vitamin B3 (nicotinic acid, niacin)
Water-Soluble Vitamins
• Vitamin C (ascorbic acid)
• Vitamin B1 (thiamine)
• Vitamin B2 (riboflavin)
– Maintains the integrity of mucous membranes and metabolic energy pathways
• Vitamin B3 (nicotinic acid, niacin)
Water-Soluble Vitamins
• Vitamin C (ascorbic acid)
• Vitamin B1 (thiamine)
• Vitamin B2 (riboflavin)
• Vitamin B3 (nicotinic acid, niacin)
– Involved in fat synthesis, electron transport, and protein metabolism
Water-Soluble Vitamins
• Vitamin B5 (pantothenic acid)
– Forms part of the coenzyme system
• Vitamin B6 (pyridoxine)
• Vitamin B9 (folic acid)
• Vitamin B12 (cyanocobalamin)
Water-Soluble Vitamins
• Vitamin B5 (pantothenic acid)
• Vitamin B6 (pyridoxine)
– Coenzyme in amino acid and fatty acid metabolism
• Vitamin B9 (folic acid)
• Vitamin B12 (cyanocobalamin)
Water-Soluble Vitamins
• Vitamin B5 (pantothenic acid)
• Vitamin B6 (pyridoxine)
• Vitamin B9 (folic acid)
– Provides for production of healthy red blood cells and decreases the risk of birth defects
• Vitamin B12 (cyanocobalamin)
Water-Soluble Vitamins
• Vitamin B5 (pantothenic acid)
• Vitamin B6 (pyridoxine)
• Vitamin B9 (folic acid)
• Vitamin B12 (cyanocobalamin)
– 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
• Measures the amount of dissolved particles in relation to body fluids
• Hypotonic – lower concentration of dissolved particles
• Hypertonic – higher concentration of dissolved particles
Tonicity
• Measures the amount of dissolved particles in relation to body fluids
• Hypotonic – lower concentration of dissolved particles
• 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
2 Types of Protein Malnutrition
• Marasmus– Imbalance between protein and calorie intake– Causes growth retardation
• Kwashirokor
2 Types of Protein Malnutrition
• 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
Glaucoma AgentsEyedrops
• carbachol (Carbastat, Miostat)
• dipivefrin (Propine)
• dorzolamide (Trusopt)
• echothiophate iodide (Phospholine Iodide)
• latanoprost (Xalatan)
Drug List
Glaucoma AgentsEyedrops
• 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