1. VITAMINS, MINERALS, AND GENERAL NUTRITION CHAPTER - 15

2. “YOU ARE WHAT YOU EAT” Your body needs a balance of nutrients for optimum health … Water, minerals, proteins, vitamins, carbohydrates, fiber & essential fatty acids Higher organisms cannot synthesize many nutrients; we must get these from the environment

3. FOOD & NUTRITION BOARD OF THE NATIONAL ACADEMY OF SCIENCE o Deficiency = Disease o Dietary Reference Intake (DRI) published for vitamins and minerals: EAR (E STIMATED A VERAGE R EQUIREMENT ) RDA (R ECOMMENDED D AILY A LLOWANCE ) AI (A DEQUATE I NTAKE ) UL (U PPER I NTAKE L EVEL )

4. o Vitamins- organic materials required in small amounts. These help biochemical reactions in the body and so are necessary for normal growth & function Common vitamin-deficiency symptoms include … aches/pains overall ‘poor’ feeling of tiredness/low energy o Fat-soluble vitamins can accumulate and cause hypervitaminosis Vitamin A deficiency affects vision Vitamin D deficiency causes rickets Vitamin E Vitamin K deficiency causes bleeding Water soluble vitamins thiamine (B1), riboflavin (B2), folic acid, cyanocobalamin (B12)

5. FOLIC ACID IN PREGNANCY o extremely important supplement for women! o Reduces the incidence of neural tube birth defects such as … * Spina Bifida * anenchephaly * encephalocele o … essential for DNA formation o Women of childbearing age should consume 0.4-mg/day of Folic acid o Also known as ‘Folate’

6. MINERALS o non-organic material, found in the earth o required in small amounts o *****See “lab values” in handout in Doc Sharing***** o help biochemical reactions, help nerve conduction, help cardiac rhythm and some are incorporated into the body o Iron: component of hemoglobin & myoglobin o stored bound to ferritin o deficiency leads to anemia especially in pregnant women o Calcium: deficiency leads to osteoporosis o Phosphorous: important in bone o Potassium: important in cardiac rhythm

7. o Essential fatty acids- found in fats. Important for brain and nervous system functioning. o Saturated can be produced by humans o Unsaturated cannot be produced by humans; found in plants and fish o Antioxidants - inhibit oxidation, reducing tissue damage/aging: Vitamin C Vitamin E Lutien o Fiber - (see table 15-1 for sources) A food substance, found only in plants. Not digested May reduce colon cancer

8. CHAPTER - 26 Drugs affecting the Gastrointestinal Tract and Digestive System

9. GI TRACT – A DEFINITION Long, hollow tube from the mouth to the anus primary purpose - to convert food into chemicals that can be used by the body Food’s pathway through GI tract … … Mouth  Esophagus  Stomach  Small Intestines  [gallbladder, liver, pancreas enzymes]  Large Intestine  Anus Diseases and conditions: Ulcers Gastroesophageal Reflux Disease (GERD) Obesity Vomiting Diarrhea

10. GASTRIC CONDITIONS/ENVIRONMENT 10 Acidic environment is needed in the stomach for enzymes to digest food and inhibit or kill microorganisms found in food and other materials that are ingested Sometimes acid level is toohigh or stomach protection is lost: this can erode the stomach wall/lining Worry and Stress increase secretions in the stomach This can lead to ulcers Gastric ulcer = Peptic ulcer = stomach ulcer ‘Duodenal ulcer’ is found at the junction of stomach and duodenum

11. ULCERS – GENERAL INFO 11 Goal of treatment: to alleviate symptoms, promote healing prevent complications, and prevent recurrence. A bacteria called Helicobacter pylori has been found in >75% of peptic ulcer disease! Drugs (ASA and NSAID’s) can cause ulcers too

12. MEDICATIONS TO TREAT ULCER All these work together to eradicate the microorganism Helicobacter pylori and reestablish an intact lining of the stomach by neutralizing excess hydrochloric acid. Antisecretory Agents (decrease secretion of acid into stomach) H2 receptor antagonists Proton pump inhibitors Antacids (neutralize acid that is currently present) Mucosal protectants (forms a protective barrier on the surface of ulcerated tissue) Antibiotics

13. H2-RECEPTOR ANTAGONISTS Histamine receptors in stomach lining activate the “proton pump” that pumps gastric acid into stomach These drugs inhibits the interaction of histamine with the H2- receptors in stomach so they inhibit acid secretions Very effective for GERD Available as OTC and RX Examples: cimetidine (Tagamet), nizatidine (Axid), ranitidine (Zantac) Tagamet can cause drug interactions by reducing metabolism of other drugs

14. PROTON PUMP INHIBITORS (PPIS) Inhibits the “proton pump” directly For SHORT TERM treatment of gastric ulcers and GERD Side effects are relatively rare (headache, abdominal pain, diarrhea, nausea, constipation are possible) Examples: esomeprazole (Nexium) lansoprazole (Prevacid) omeprazole (Prilosec) pantoprazole (Protonix) * NOTE – see how the generic drug names within the same class tend to end with the same suffix? This is very helpful in learning drugs!

15. ANTACIDS Alkaline (basic) compounds used to neutralize HCl acid in the stomach Relieves symptoms of Gastroesophageal Reflux Disease (GERD) Poorly absorbed (this is good!), therefore they do not alter systemic pH when used properly Can be dosed up to 7 times per day since they have a short duration of action Classified by formulation (aluminum, magnesium, etc) Aluminum (side-effect = Constipation) Calcium (side-effect = Constipation) Magnesium (side-effect = Diarrhea) Aluminum & Magnesium combo is common because these cancel out each other’s negative side-effects … very effective! careful when taking other medications, these can interfere with absorption of other drugs Examples of Antacids … Mylanta, Maalox Tums, Rolaids

16. ANTIBIOTICS for ulcers Commonly used to treat Helicobacter pylori Treatment with two antibiotics decreases resistance Used in combo with bismuth-salts to prevent bacteria from attaching stomach wall. Antibiotics that are commonly used … Amoxicillin Tetracycline Metronidazole (Flagyl) Clarithromycin (Biaxin) antisecretory agents often used in combo (PrevPak)

17. DRUGS THAT CAUSE WEIGHT GAIN OR WEIGHT LOSS 17 megestrol is an appetitite stimulant orlistat (Xenical) blocks the absorption of fat in the GI tract

18. ANTI-EMETICS Emesis (vomiting) caused by many factors dimenhydrinate, meclizine are OTC Good for motion sickness prochlorperazine (Compazine) or trimethobenzamide (Tigan) Post-operatively Granisetron (Kytril), ondansetron (Zofran) chemotherapy

19. ANTI-DIARRHEALS Need to slow down the GI tract Lomotil Loperamide (Imodium)