Vitamins

• Vital - elements
• essential micronutrients, required by the body in small amounts.
• They are either
• Fat soluble—A, D, E, and K or
• Water soluble— B vitamins and vitamin C.
• Fat-soluble vitamins (mainly A and E) are stored in the body.
• Vitamins D and K are stored in tiny amounts.
• more than 10 times the daily allowance, vitamins A and D are toxic,
but E and K are not.
• Niacin, vitamin B6, and vitamin C are toxic when taken in high doses,
but the other water-soluble vitamins are not.
Vitamin A (Retinol)
• Retinol is found mainly in fish liver oils, liver, egg yolk, butter, and cream.
• Green leafy and yellow vegetables contain carotenoids, such as beta-
carotene, which the body slowly converts to vitamin A. Most of the body's
vitamin A is stored in the liver.
• Several forms of Vit A.
• Retinaldehyde - a component of the photoreceptors
• Retinoic acid - keeps the skin and the lining of the lungs, intestine, and
urinary tract healthy.
• Retinoids - drugs related to vitamin A - used to treat severe acne, and
psoriasis.
• Bio needs:
1. To maintain normal epithilia – (caugh ?)
2. Vision
3. Immunity
4. Protect against some cancers
• Vitamin A deficiency
1. Night blindness; later, a deposit (Bitot's spot) may appear in the
white of the eye (sclera), and the cornea may harden and scar—a
condition called xerophthalmia—
2. Hyperkeratosis (dermatitis)
3. More infections

Clinical uses:
1. In the deficiency
2. Psoriasis
3. Acne
• Preparations:
• Vit A capsules, 25,00IU
• Vit A Inj: 100,000IU/ 2mL U.S. recommended dietary
• Vit A&D caps – 4000IU/ 400IU
• Halibet Liver oil allowance (RDA):
1. 900 mcg daily (3,000 IU)
• Retinoids – Tretinoin, Isotretinoin for men and 700
mcg daily (2,300 IU) for
Side effects – occur with prolonged high doses women;
1. Painfull swelling in long bones 2. for pregnant women 19
2. Peeling off of skin outer layer
years old and older, 770
3. Birth defects if used in pregnancy in high doses
mcg daily (2,600 IU);
Vitamin D
exists in two forms
• Vitamin D2 (ergocalciferol) found in yeast
• vitamin D3 (cholecalciferol) is found in fish liver oils and egg yolk.
1 alpha hydroxycalciferol
(Alfacalcidol)

1,25
dihydroxycholecalciferol
(Calcitriol)
• main function is to increase calcium absorption
from the intestine and facilitate normal bone
formation.
• In vitamin D deficiency, the calcium and
phosphate levels in the blood decrease, resulting
in bone disease because not enough calcium and
phosphate are available to maintain healthy
bones.
• This condition is called
1. Rickets in children
2. Osteomalasia in adults.
Vitamin E (Tocoferol)
• an antioxidant that protects the body's cells against damage by
reactive chemical compounds - free radicals.
• only the following indications are allowed – MEC Decisions .
1. For noctural muscle cramps
2. Malabsorption in cystic fibrosis
3. Malabsorption in chronic cholestasis
Cystic Fibrosis –
a hereditary disorder affecting the
exocrine glands. It causes the production
of abnormally thick mucus, leading to
the blockage of the pancreatic ducts,
intestines, and bronchi and often
resulting in respiratory infection.
Vitamin K (Phytomenadione)
• Vitamin K is a generic name for several related substances necessary for
the formation of blood clotting factors II (prothrombin), VII, IX and X
• Principal form is vitamin K1 (Phytomenadione / Phytonadione), found in
plants, particularly green leafy vegetables.
• Bacteria in the colon produce vitamin K2 (menaquinone)
• Because vitamin K is fat soluble, disorders that interfere with fat absorption
can cause a vitamin K deficiency.
• Taking excessive amounts of mineral oil may also prevent the absorption of
vitamin K.
• deficiency can also develop in people who take anticoagulant drugs to
prevent blood clots.
Vitamin B
Vit. B1 (Thiamine)
• Deficiency – : “beri-beri” (oedema, neuropathy, heart failure)
• Common with “polished rise” consumers + alcoholics
• Daily requirement: 2mg
• Preps - Tabs 10mg & available in B Complex preps + Inj 100mg
Vit. B2 (Riboflavin)
• Essential for oxidation reactions of the body
• Deficiency - angular stomatitis, ulceration of mucus membranes,
magenta tougue
• Daily requirement: 2mg
• Found in milk, green vegetables
Vit B3 (Niacin)
• Two chemicals ; Nicotinamide & Nicotinic acid
• Involve in oxidation reactions
• Deficiency – Pellagra *(3D – diarrhoea + dermatitis + diamentia)
• Reasons for deficiency – maize is the only food, alcohol, Drugs
(Isoniazid)
• Daily need 20mg
• produced by bacteria in Gut
Vit B6 (Pyridoxin)
• Deficiency is very rare
• Involve in amino acid metabolism
• Drugs that block pyridoxin action can cause deficiency; Isoniazid
• Deficiency leads to – Peripheral neuropathy.
• Preps – Tabs 10mg, 50mg
Cobalamin (Vit B12)
• Synthesis by micro-organisms in the Gut
• Found in meat, fish, eggs, milk Not destroyed by cooking
• Not in plant food
• Stores in liver adequate for 2 –5 years
• Combine with intrinsic factor for absorption
• Causes of deficiency:-
1. No intrinsic factor
2. Strict vegetarians
3. GIT disease
In deficiency:
1. Megaloblastic anaemia
2. Degeneration of brain & spinal code.

Preps:
• Hydroxycobalamine (Inj)
• Cyanocobalamine (Inj: + in B Co tabs)
• Daily requirement 1mcg
 Folic acid is also used
1. for the prevention of
Folic Acid methotrexate-induced side-
effects
• Vit B group Vitamin. 2. severe Crohn’s disease
• Active form tetrahydrofolic acid 3. rheumatic disease
• Involved in DNA/ AA synthesis 4. severe psoriasis
• Deficiency : megaloblastic anaemia
• Indications:
1. Megaloblastic anaemia
2. Pregnancy (Prevention of Neural Tube Defects )
3. anti-convulsant therapy
• Preps: Folic acid 1mg tabs
Neural tube defects
• are birth defects of the brain, spine, or spinal cord.
• happen in the first month of pregnancy, often before a woman even
knows that she is pregnant.
• The two most common neural tube defects are spina bifida. In spina
bifida,
• the fetal spinal column doesn't close completely.
Vitamin C (Ascorbic acid)
• found in citrus fruits,.
• essential for the formation of connective tissue (collagen - the tissue
that holds the body's structures together).
• helps the body to absorb iron.
• Like vitamin E, vitamin C is an antioxidant
• deficiency may cause scurvy (Bleeding beneath the tissues (spots),
bleeding gums.
Scurvy
Minerals
Drug Treatment of Anaemias
• Anaemia is a condition in which the number of red blood cells or
amount of hemoglobin (the protein that carries oxygen) in them is
below normal taking into account both sex & age.
• At birth – 20g/dl
• Adult male – 13 –15g/ dl
• Adult female – 12 – 14g/ dl
• Different forms of anaemia.
1. Iron deficiency anaemia produces small erythrocytes.
2. A deficiency of folic acid or vitamin B12 produces large immature
erythrocytes.
3. Haemolytic anaemia produces small erythrocytes.
4. Aplastic anaemia produces few erythrocytes with normal
appearance.
Iron deficiency anaemia
• Reasons
• 1. Intake of Iron
• 2. Absorption of Iron
• 3. Loss of Iron

1. Oral Therapy
2. Parenteral Therapy
Oral Iron
• Iron salts should be given by mouth unless there are good reasons for using
another route.
• Ferrous salts we absorbed , but ferric salts are much less absorbed.
• The oral dose of elemental iron for deficiency should be 100 to 200 mg
daily.
• Ferrous sulphate, 200 mg (equivalent to 65 mg elemental iron) three times
daily
• When Hb concentration become normal (over 3 - 4 weeks) treatment
should be continued for a further three months in an attempt to replenish
the iron stores.
• Vit C improve absorption of iron from GIT
• Iron content of different Iron salts

Iron salt Amount Content of ferrous Iron

Ferrous sulfate 200mg 65mg
Ferrous glucanate 300mg 35mg
Ferrous succinate 100mg 35mg
Ferrous fumarate 200mg 65mg
Adverse effects
• Gastro-intestinal irritation,
• epigastric pain,
• constipation or diarrhoea
• Black colour stools

• MR dosage forms.

• Compound Preparations
Patient Advices
1. Follow the full cause of treatment
2. How to minimize gastric problems
3. Not to worry about stool colour
4. Not to drink tea with oral iron
Parenteral Iron
• Iron can be administered parenterally as
1. Iron dextran -
2. Iron sucrose –
• Parenteral iron is generally reserved for use when oral therapy is
unsuccessful because the
1. patient cannot tolerate oral iron, or
2. does not take it reliably, or
3. if there is continuing blood loss, or
4. in malabsorption.
• Parenteral iron may also have a role in the management of chemotherapy-
induced anaemia, when given with erythropoietins, in specific patient
groups
Dugs used in megaloblastic anaemias
• Most megaloblastic anaemias result from a lack of either vitamin B12
or folate,
• It is essential to establish in every case which deficiency is present
and the under- lying cause
• In folate-deficient megaloblastic anaemia (because of poor nutrition,
pregnancy, or antiepileptic drugs), daily folic acid supplementation for
4 months
• For prophylaxis in chronic haemolytic states, malabsorp- tion, or in
renal dialysis, folic acid is given daily or sometimes weekly, depending
on the diet and the rate of haemolysis.
Anaemia - macrocytic or microcytic
• macrocytosis occurs when there are problems with the synthesis of
the blood cells, as in vitamin B12 or folic acid deficiency,
• microcytosis is associated with deficiency of haemoglobin production,
such as iron deficiency or thalassaemia.
Mean Corpuscular Volume