drugs for nutritional disorders rebecca...

Drugs for Nutritional Disorders Rebecca Baringhaus

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Vitamins

Organic substances needed in small amounts Promote growth Maintain health

Human cells cannot produce vitamins Exception: vitamin D Vitamins or provitamins (precursor to vitamins) must be

supplied in diet Deficiency will result in disease

Vitamins Serve Important Roles in Function of Body

Vitamin B complex: coenzymes essential to metabolic processes

Vitamin A: precursor of retinol, a pigment needed for normal vision

Vitamin D: regulates calcium metabolism Vitamin K: needed to produce prothrombin K = clotting

Lipid-Soluble Vitamins (A, D, E, K)

Must be ingested with lipids to be absorbed in small intestine

Excess stored in liver and adipose tissue Can be removed from storage areas and used as needed

Excessive intake can lead to dangerously high levels

Water-Soluble Vitamins (C, B Complex)

Absorbed with water in digestive tract Easily dissolved in blood and body fluids Excess cannot be stored Excreted in urine Must be ingested daily

Recommended Dietary Allowances (RDAs)

Minimum amount of a vitamin needed to prevent symptoms of deficiency

Need for vitamins and minerals varies among individuals

Supplements should never substitute for healthy diet Differs from Dietary Reference Intake (DRI)-optimal level of

nutrient needed

Vitamin Pharmacotherapy

Indicated for certain conditions Poor nutritional intake Pregnancy Chronic-disease states

***Most people who eat a normal, balanced diet obtain all the necessary nutrients without vitamin supplementation

Hypervitaminosis-toxic levels of vitamins

http://abcnews.go.com/WNT/video/daily-vitamins-good-14708219




Symptoms of Deficiency

Usually nonspecific; occur over prolonged period Often result of certain factors Poverty, fad diets Chronic alcohol or drug abuse Prolonged parenteral feeding

Clients often present with multiple deficiencies

Deficiencies in Lipid-Soluble Vitamins- Vitamin A

Vitamin A (retinol) Obtained from foods containing carotenes Vit. A sources: yellow and dark leafy veggies, carrots &

cantaloupe, butter, eggs, whole milk, and liver

Prototype drug: Vitamin A Mechanism of action: Essential for general growth and development Necessary for proper wound healing Essential for the biosynthesis of steroids One of the pigments required for night vision

Deficiencies in Lipid-Soluble Vitamins- Vitamin A

Primary use: pregnancy, lactation, or undernutrition, night blindness and slow wound healing

Topical forms are available for acne, psoriasis Adverse effects: Acute ingestion, produces serious CNS toxicity- headache,

irritability, drowsiness, delirium, and possible coma. Long-term ingestion of high amounts - drying and scaling of

the skin, alopecia, fatigue, anorexia, vomiting, and leukopenia

Deficiencies in Lipid-Soluble Vitamins- Vitamin D

Vitamin D Aids in absorption of calcium and in maintaining levels of

calcium and phosphorous Treats: rickets, osteomalacia, osteoporosis, hypocalcemia

New research shows may aid in prevention of osteoporosis, HTN, cancer, and several autoimmune diseases

A ) D2 (ergocalciferol)—from dairy products B) D3—formed in skin from UV light-we can produce it!

Deficiencies in Lipid-Soluble Vitamins Vitamin E

Vitamin E (tocopherols:8 chemicals that make up Vit. E) Found in plant-seed oils, whole-grain cereals, eggs, certain

organ meats Primary antioxidant:

Topical Vit. E available to treat dry, cracked skin

Deficiencies in Lipid-Soluble Vitamins- Vitamin K

Vitamin K—mixture of several chemicals K1 obtained from plant sources

Green leafy veggies, tomatoes, & cauliflower, and in egg yolks, liver, and cheeses

K2 obtained from microbial flora in colon Needed for clotting (necessary to form several clotting

factors) Used to treat those with clotting disorders & is antidote for

Coumadin OD Given to infants to promote clotting

Drug Therapy with Fat-Soluble Vitamins

Teach client that excessive vitamin intake can be harmful

Assess for deficiency Assess for impaired liver function Assess for chronic overdose of vitamins Consider socioeconomic status and culture of client Recommend foods that treat deficiency, are affordable &

liked by client

Deficiencies in Water-Soluble Vitamins- B1 Thiamine

B1/Thiamine-coenzyme needed for oxidation of carbohydrates Beriberi-thiamine/B1 deficiency Sx: paresthesia, neuralgia, & progressive loss of feeling and

reflexes Common amongst alcoholics and patients with chronic liver

disease Thiamine administered for hospitalized clients with severe

liver disease

Deficiencies in Water-Soluble Vitamins- B2/Riboflavin

B2/Riboflavin- coenzymes needed for different oxidation-reduction reactions Deficiency most common in alcoholics Sx: corneal vascularization, anemia, skin abnormalities

Deficiencies in Water-Soluble Vitamins- B3/Niacin

B3/Niacin-coenzyme for oxidative metabolism Deficiency can cause pellagra Sx: Early: fatigue, anorexia, drying of skin Late: dermatitis,

diarrhea, & dementia Sources: beans, wheat germ, nuts, meats Effects alcoholics & corn based diets Admin. of niacin may cause severe flushing (no harm, temp.

& expected)

Deficiencies in Water-Soluble Vitamins- B6/Pyridoxine

B6/Pyridoxine- necessary for heme synthesis/RBC production & coenzyme in metabolism of amino acids Deficiency Sx: skin abnormalities, cheilosis, fatigue, &

irritability Admin. of pyridoxine may cause severe flushing (no harm,

temp. & expected)

Deficiencies in Water-Soluble Vitamins B9/Folic Acid

B9/Folic Acid/Folate-essential for DNA synthesis & RBC production Deficiency Sx: anemia Sources: green leafy veggies & citrus fruits & fortified grains ***Promotes fetal growth -given before and during

pregnancy-helps prevent birth defects and neural tube defects Assess women of childbearing age for folic acid deficiency Prior to attempting or during pregnancy

Folic Acid Drug Info.

Prototype drug: Folic Acid ( Folacin) Mechanism of action: administered to reverse

symptoms of folate deficiency 1 mg/day of oral folic acid often reverses the deficiency

symptoms within 5 to 7 days

Folic Acid Pharm. Info. Primary use: during pregnancy to promote normal

fetal growth Patients with inadequate intake, such as with chronic

alcohol abuse.

Adverse effects: uncommon but Patients may feel flushed following IV injections. Allergic hypersensitivity to folic acid by the IV route is

possible

Deficiencies in Water-Soluble Vitamins- B12/Cyanocobalamin

B12/Cyanocobalamin-coenzyme for metabolism & RBC formation Deficiency can cause pernicious or megaloblastic anemia

Decrease in RBC’s that occurs when body can’t properly absorb B12 from the GI tract

Megablastic- anemia with larger than normal RBC’s

Deficiencies in Water-Soluble Vitamins- Vitamin C/Ascorbic Acid

Vitamin C/Ascorbic acid-potent antioxidant, collagen synthesis, tissue healing, & maintenance of bone, teeth, and epithelial tissue Deficiency can cause scurvy

Sx: fatigue, bleeding gums, gingivitis, & poor wound healing

Caution clients with history of kidney stones against using vitamin C

Advise clients taking vitamin C to increase fluid intake

Water-Soluble Vitamin Therapy

Recommend multivitamin to avoid overdose Water-soluble vitamins are not stored in the body Must be replenished daily

Minerals

Inorganic substances- very small amounts needed to maintain normal metabolism

1) Macrominerals-must ingest larger amounts 2) Microminerals Constitute 4% of body weight Can be obtained from normal diet Excess minerals can be toxic

Macrominerals

Seven major (macro) minerals Calcium, chlorine, magnesium, phosphorous, potassium,

sodium, sulfur

Must be obtained daily from dietary sources in amounts of 100 mg or greater

Macromineral Therapy

For mineral deficiencies or eclampsia Large doses can cause life-threatening adverse

effects Encourage well-balanced diet Eliminates or reduces need for supplements

Macrominerals-Calcium

Calcium-nerve conduction, muscular contraction, bony matrix, & hemostasis

If calcium prescribed Avoid zinc-rich foods, which impair calcium absorption Inform health-care provider of use of glucocorticoids,

thiazide diuretics, tetracyclines

Macrominerals-Phosphorous

Phosphorous-forms bony matrix, part of ATP and nucleic acids

If phosphorus prescribed Inform health-care provider if on sodium- or potassium-

restricted diet Immediately report seizure activity; stop drug Avoid antacids

Macromineral Therapy-Magnesium Sulfate

Magnesium sulfate-nerve conduction and muscle contraction

Prototype drug: Magnesium Sulfate Mechanism of action: Essential for proper neuromuscular function. Also serves a metabolic role in activating certain enzymes in

the breakdown of carbohydrates and proteins

Macromineral Therapy-Magnesium Sulfate (continued)

Primary use: Severe hypomagnesemia-use of magnesium sulfate is

restricted to severe magnesium deficiency To prevent or terminate seizures associated with eclampsia Oral forms used as cathartics for complete evacuation of the

colon

Macromineral Therapy-Magnesium Sulfate (continued)

Adverse effects: Early signs of overdose include

Flushing of the skin, sedation, confusion, change of consciousness, intense thirst and muscle weakness/change in deep tendon reflexes

Extreme levels cause neuromuscular blockade leading to respiratory paralysis, heart block, and circulatory collapse.

Macromineral Therapy-Potassium

Potassium-nerve conduction & muscle contraction, acid-base balance

***NEVER PUSH K!

Microminerals

Nine trace (micro) minerals Include iron, iodine, fluorine, and zinc, chromium, cobalt,

copper, manganese, molybdenum, & selenium

Required daily amount is 20 mg or less

Microminerals

Iron-component of Hgb Iron deficiency anemia-most common nutritional d/o in the

world & common indication for iron supplements Sources: meat, shellfish, nuts, legumes

Iodine-component of thyroid hormone Source: iodized salt Deficient Sx: goiter (enlarged thyroid gland)

Fluorine-tooth structure Closely monitor use in children as high amounts are very

toxic

Zinc-wound healing, normal growth, lozenges

Undernutrition

Many causes Low dietary intake

Poverty, depression, difficulty eating Malabsorption disorders Fad diets Wasting disorders such as cancer or AIDS

Get dietary consult

Role of the Nurse

Monitor client’s condition Provide client education Obtain medical, surgical, drug history Assess lifestyle and dietary habits Obtain description of symptomology and current

therapies

Enteral Nutrition

Via GI tract Provided orally or through feeding tube Means of meeting client’s nutritional needs

Classification of Enteral Products

Oligomeric (Vivonex, T.E.N., Peptamen) “Few”-basic forms of free amino acids, & peptide combos.

that require little digestion & easily absorbed

Polymeric—most common type (Compleat, Sustacal, Ensure) “Many”-mix of proteins, carbs, and lipids

Modular—given to supplement single nutrient (Casec, Polycose, Microlipid, MCT Oil)

Specialized—given for special disease states (Amin-Aid, Hepatic-Aid II, Pulmocare)

Total Parenteral Nutrition (TPN)

Also known as “hyperalimentation” Means of supplying nutrition to clients Peripheral vein (short term) Central vein (long term)

Administered through infusion pump for precise monitoring

Hypertonic soln. provides amino acids, lipids, carbs, electrolytes, vitamins, & minerals

Patients Receiving Vitamin and Mineral Pharmacotherapy

Assessment Obtain complete health history and complete physical

examination Obtain a history of vitamin deficiencies or hypervitaminosis Obtain drug history including allergies Obtain a dietary history noting adequacy of essential

vitamins, minerals and nutrients

Patients Receiving Vitamin and Mineral Pharmacotherapy

Assessment Note sunscreen use and amount of sun exposure-Vit. D. Obtain weight, height and vital signs Evaluate., CBC, electrolytes, hepatic and renal function

studies, ferritin and iron levels, glucose, BUN, total protein, serum albumin, lipid profile, serum iron levels

Assess for and promptly report adverse effects

Patients Receiving Vitamin and Mineral Pharmacotherapy (continued)

Nursing diagnoses Imbalanced nutrition: less than body requirements Impaired Health Maintenance, (related to dietary habits,

deficient knowledge); Deficient knowledge, related to drug therapy Readiness for Enhanced Therapeutic Regimen Management Risk for Injury (related to adverse drug effects,

hypervitaminosis) Risk for infection Risk for imbalanced fluid volume


Planning—patient will Experience maintenance of overall health, symptoms of

previous deficiency are absent. Be free from, or experience minimal adverse effects Verbalize an understanding of the drug’s use, adverse effects

and required precautions Demonstrate proper self-administration of the medication

(e.g., dose, timing, when to notify provider)


Implementation-Tube Feeds Treat the cause: correct the deficiency Monitor the use of fat-soluble vitamins [A, D, E, and K] for

possible toxic effects Monitor liver function Assess for appropriate enteral tube placement before administering any feeding.


Implementation-Tube Feeds Encourage adequate intake of vitamin and folic-acid rich

foods prior to conception Ensure adequate hydration if large doses of water-soluble

vitamins are taken. Instruct patient to keep pre-natal vitamins out of reach of

children

Patients ReceivingVitamin and Mineral Pharmacotherapy (continued)

Implementation-TPN Monitor vital signs

Observe for signs of infection, such as elevated temperature Assess all access sites (e.g., gastric tube site, I.V. or port

sites) frequently for redness, streaking, swelling, or drainage Assess patient’s ability to take oral nutrition and encourage

small oral feedings if allowed


Implementation-TPN Monitor for signs of fluid overload Observe for signs of hyperglycemia or hypoglycemia

Monitor blood-glucose levels Monitor renal status – intake and output, daily weight,

serum creatinine and BUN Maintain accurate infusion rate with infusion pump

make rate changes gradually avoid abruptly discontinuing TPN feeding

Patients Receiving Parenteral Nutrition (continued)

Implementation -TPN Report any fever, chills, malaise, or changes in mental status

immediately Use strict aseptic technique with all I.V. tubing or bag

changes, site dressing changes Instruct patient and/or family in proper self-administration

of drug Refrigerate TPN solution until 30 minutes before using


Evaluation Experiences maintenance of overall health, symptoms of

previous deficiency are absent Is free from, or experiences minimal adverse effects Verbalizes an understanding of the drug’s use, adverse

effects and required precautions Demonstrates proper self-administration of the medication

(e.g., dose, timing, when to notify provider)

Any Questions?

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