Vitamin and natural products

2 primary forms of vitamin D

D2 - ergocalciferol (plant; primary source)
D3 - cholecalciferol (skin; activated)

Rocaltrol

Calcitriol - D3
for ppl with chornic kidney disease

Sensipar

Cinacalcet
calcimimetic; can cause hypocalcemia

Vitamin D2 supplement dosing

Depends on serum 25(OH) [ng/ml]
<5 50000 u PO QW x12 wk then QM x6 mos
5-15 50000 u PO QW x4 wk then QM x6 mos
16-30 50000 u PO QM x6 mos

Hyperkalemia symptoms

muscle weakness, arrhythmia, tiredness, bradycardia, chest pain, parathesias (tingling)

Hyperkalemia treatment

Mild - sodium polystyrene sulfonate
Mod/Severe - IV insulin & glucose, IV calcium (heart protection), possibly inhaled beta 2 agonist, possibly hemolysis
Emergency tx - sodium polystyrene in sorbitol (Kayexelate) rectally

Vitamin matching

A - Retinol
B1 - Thiamine
B12 - Cobalamin
B2 - Riboflavin
B3 - Niacin
B6 - Pyridoxine
B9 - Folic acid
C - Ascorbic acid

Which calcium supplement is absorbed well on either an empty stomach or if taken with food?

Citracal (calcium carbonate)

Mary believes in natural healing and takes a handful of supplements daily: a fish oil capsule, a B vitamin complex, a multivitamin, a vitamin E 400 IU capsule, St. John's wort, kava and a probiotic supplement. She uses melatonin when she has trouble sleep

Kava

Agnes had her blood pressure checked and it was lower than usual. Which natural product is most likely to provide additive blood-pressure lowering effects?

Arginine

Jerry has high cholesterol. Which of the following agents can help improve cholesterol values? (Select ALL that apply.)

Plant stanols/sterols
Statins
Red yeast rice

The use of metformin can cause a depletion of which of the following nutrients that may need to be supplemented?

B12

Which calcium supplement is absorbed better in an acidic environment and is taken with meals?

Oscal
oyster-shell calcium

Choose the correct statements concerning vitamin supplementation for breast-fed babies: (Select ALL that apply.)

Breast-fed babies need 1mg/kg of iron daily from 4-6 months old and until consuming iron-rich foods
Exclusively breastfed infants or babies drinking less than 1 liter of baby formulat need 400 IU of vitamin D daily

Julia is an elementary school teacher. She suffers from frequent bouts of osteoarthritis pain during the school day and only gets relief when she sits down to rest. This is not always possible. To get by, Julia has been taking 5-6 tablets of Extra Strengt

SAMe
Glucosamine
Chrondroitin

The pediatrician has told a couple that their 3 month old infant requires vitamin D and iron supplementation. Which supplement would be a suitable product?

Poly-Vi-Sol with iron

Marge has decided to use the black cohosh product Remifemin. Choose the correct statement concerning this popular product:

Less effective than estrogen for improving vasomotor symptoms
Black cohosh

Select the agents that are used for anxiety: (Select ALL that apply.)

Chamomile tea
Lemon balm
Valerian root

Mary developed a UTI and received a 3-day course of an antibiotic. She tells the pharmacist that she used to get diarrhea when she took antibiotics but does not expect this to happen now because she uses a probiotic. The pharmacist could offer the followi

If you take the antibiotic in the morning and at night, take the probiotic in the middle of the day

Which natural products can be useful for migraine headache prophylaxis? (Select ALL that apply.)

Feverfew
Magnesium
Riboflavin
Willow bark
Butterbur
Guarana
Fish oil
Coenzyme Q10

A patient with recently-diagnosed active tuberculosis was prescribed isoniazid, rifampin, pyrazinamide and ethambutol. Which vitamin supplement is recommended with this regimen?

B6

A patient used a natural product for a cold and then lost his ability to smell. He was likely using this product, which the FDA has recommended against using due to the risk of anosmia:

Zinc nasal sprays

A 73 year-old male was given a prescription for tamsulosin but wishes to use a natural product instead. Which product has claimed benefit for this indication?

Saw palmetto

Mary is a college sophomore. She recently became involved in a sexual relationship. She went to the clinic and was prescribed Loestrin Fe 1/20. Mary believes in natural healing and takes a handful of supplements daily: a fish oil capsule, a B vitamin comp

Concurrent use of birth control pills and St. John's wort

Mary believes in natural healing and takes a handful of supplements daily: a fish oil capsule, a B vitamin complex, a multivitamin, a vitamin E 400 IU capsule, St. John's wort, kava and a probiotic supplement. She uses melatonin when she has trouble sleep

Vitamin E

Which natural product can be useful for urinary tract infection prophylaxis?

Cranberry

Agnes had a stent placement in a coronary artery. She has been using the following medicines for many months: clopidogrel, aspirin, rosuvastatin, amlodipine, atenolol and the natural products arginine, coenzyme Q10 and cinnamon. Agnes has felt confused la

Ginkgo biloba is unsafe with the rest of the med (increased bleeding risk)
Consider using a humidifier in the room where you spend the most time

Marge requires calcium supplementation. Her sister suggested CitraCal, but she has trouble swallowing the large capsules. Marge does not use any prescription or over the counter medicines. Choose the correct statement:

Calcium carbonate tablets will be smaller and may be an acceptable alternative
CitraCal (calcium citrate) weigh 1500 mg but contains 315 mg elemental per tablet

A woman needs to take a prescription bone density agent. She has little calcium or vitamin D in her diet but does not like to take too many pills. She asks which prescription agent does not require supplemental calcium and vitamin D? Select the correct re

None

Jessica has self-treated acne for the past three years. She has tried spot treatments, facial scrubs and exfoliation kits that contain either benzoyl peroxide or salicylic acid to help clear her skin. These are useful, but leave her skin dry and sore. She

Tea tree oil

It is flu season and your pharmacy is selling a lot of natural products to fight viral infections. Which of the following products are used for colds and flu? (Select ALL that apply.)

Elderberry
Echinacea
Vitamin C
Zinc lozenges

A patient has depression and sore knee joints from when he used to be a runner. Which natural product might be useful for both conditions?

SAMe
for both depression and osteoarthritis

Marge is having night sweats and cannot get a good night's sleep. She has been told by her doctor that she is in the perimenopause. All of these natural products are used for menopausal symptoms except?

Saw palmetto
drugs that work:
Black cohosh
Red clover
Evening primrose
Dong quai

A patient presented with poor muscle coordination, confusion and vision changes. He was diagnosed with Wernicke's encephalopathy. Select the correct statement:

B1 deficiency (thiamine)
Can lead to permanent cognitive deteroration and cause psychosis

Which patient populations are considered at-risk for low calcium intake: (Select ALL that apply.)

Males taking daily steroids or androgen blocking agents
Females during pregnancy and around menopause
Children

Olga is a 51 year-old pharmacist with night sweats. Due to having difficulty sleeping, she is moody at work and the pharmacist interns are quite unhappy. Olga is in the peri-menopause. What supplement/s are used by some to possibly provide a mild benefit?

Estroven (black cohosh + soy)
Black cohosh

Jessica is a skilled-nursing facility patient who is 73 years old. She is started on monthly Boniva. She eats the following foods as part of her regular diet: one cup of vitamin D-fortified milk with cereal in the morning and a cup of yogurt with lunch of

Jessica needs supplemental vitamin D

Mel is a pharmacist in Los Angeles who has made it a priority to increase folic acid intake among women of child-bearing age. What is Mel's motivation for this important work?

To reduce the risk of serious birth defects in children born to women with low folic acid intake

What is the NIH's Recommended Adequate Intake (AI) for calcium in a 65 year-old female?

1200 mg daily
19-50 - 1000 mg daily

A product labeled as homeopathic is supposedly useful for sleep and anxiety. It contains an inert filler and an active ingredient labeled as Anxol. A patient using it regularly develops liver damage. Select the correct statement:

Homeopathic products may not be homeopathic but labeled as such to sound pleasing to the patient

Which agent is a precursor to androgens (male sex hormones)?

DHEA

Choose the correct statement concerning vitamin D supplements:

Cholecalciferol is vitamin D3 and is the preferred source
50000 unit D2 are used in renal insufficiency or short term in adults with deficiency

Michelle is a patient at the pharmacy who is planning to take a cruise to the Bahamas. She explains that she gets really bad motion sickness and does not want to take Dramamine due to sedation. She has tried this before and does not wish to sleep through

Ginger
Dramamine (Dimenhydrinate)

A patient named Marla is experiencing constipation from the use of hydrocodone-acetaminophen 5/325 mg, taken 3-4 times daily. She states that she is "sick" of using medicines and asks if there is an herbal that can be used for constipation. The pharmacist

Sennosides (senna)

A patient brings in a prescription for orlistat. Which of the following vitamins should the pharmacist recommend the patient take while on this medication? (Select ALL that apply.)

A D E K

Natalie is considerably overweight. She has purchased an over-the-counter weight loss product at the pharmacy. It is a "natural" product that contains bitter orange, guarana and green tea. Natalie feels less hungry the first day, but feels that her heart

Caffeine containing product
Ephedra like compound, not safe
No lasting weight loss with the product
May cause serious health consequences

A patient does not consume dairy products and needs 1,000 mg calcium daily. She has purchased calcium carbonate 500 mg elemental per tablet. What is the best way to take the two tablets she needs each day?

Take one with breakfast and the other with dinner
MUST be divided dose for better absorption

Melatonin is used for the following conditions: (Select ALL that apply.)

Insomnia
Jet lag

Jerry gets canker sores (apthous ulcers) whenever he is under stress. Which agent is sometimes recommended to help reduce this occurrence?

Lysine

What is the NIH's Recommended Adequate Intake (AI) for vitamin D in a 65 year-old female?

Adults up to 70 yo - 600 IU
>70 - 800 IU