vitamins and minerals nutrition. blood-forming agents. dermatologic, ophthalmic and otic agents
Post on 25-Dec-2015
219 Views
Preview:
TRANSCRIPT
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
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– 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)
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 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
• 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
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!
top related