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140 Cards in this Set
- Front
- Back
vit E is absorbed in chylomycrons and then taken to the liver where it is inserted into...
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VLDL
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The most dominant of all vit E forms and most potent in the body
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alpha-tocopherol
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these molecules are cleaved in the gut to form regular vit E
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acetate (which along w/ succinate is derived from D-alpha fom of Vit E)
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this form of vit E consists of unsaturated isoprenoids or farnesyl side chains
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tocotrienols
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what is the name of the mixed tocotrienol product?
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tocomin
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what are the food sources for tocotrienols?
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oil fraction of rice bran, palm fruit, barley and wheat germ
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tocotrienols reduce this lipoprotein which inhibits adhesion molecules VCAM-1 and ICAM-1?
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lp(a)
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tocotrienols appear to inhibit this enzyme by increasing farnesol which downregulates this enzyme...
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HMG CoA reductase
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Most vit E supplements are made from
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soy oil
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RDA and therapeutic dosing for vit E
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RDA - 30 IU/day
(T) - 200-3000 IU/day 15 mg = 22IU nat. vit E, and 33 of synthetic vit. E |
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vit E deficiency
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- increase in RBC fragility
- can become deficient in fat (malabsorption syndromes) - dermatitis, dry skin |
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vit E toxicity
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- nausea, vomiting, diarrhea, elevated triglycerides
- very high doses can have concern with increasing BP - increased bleeding |
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Vit E Therapeutics
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-CVD- anti-coagulant, lowering lipids
-fibrocystic breast disease -menopause hot flashes (1200-1600 IUs) -clotting disorders -anti-inflammat. (gamma-tocopherol) -lowers cholesterol (tocotrienols) -antioxidant -intermittent claudication -restless leg syndr |
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Vit E Therapeutics
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-CVD- anti-coagulant, lowering lipids
-fibrocystic breast disease -menopause hot flashes (1200-1600 IUs) -clotting disorders -anti-inflammat. (gamma-tocopherol) -lowers cholesterol (tocotrienols) -antioxidant -intermittent claudication -restless leg syndr |
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vit E might have an interaction w/ this drug...
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coumadin
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what substances decrease vit E absorption?
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antacids, cholestyramine, colestipol, alcoholism, mineral oils, tobacco, sucralfate
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what's the active form of cholesterol?
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calcitriol - 1,25 dihydroxyvitamin D
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what's the main source iof vit D3 (cholecalciferol)?
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-sunlight and diet
It's also the preferred form of suplementation |
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what is the source of vit D2 (ergocalciferol)?
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plant sterols
it's common in supplements |
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what does UV-beta sunlight react with to make previt. D3
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epidermal 7-dehydrocholesterol
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Vit. D Actions
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-induces osteoclast maturation for bone resorption
-promotes calcium deposition in bone -reduces PTH (healthier) |
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increased PTH, which leads to increased intracell. calcium leads to...
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DM, cancer, DJD, neurological diseases
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cells in what tissues take up 25-OH-D to make their own calcitriol?
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In breast, prostate, lung, skin, lymph nodes, colon, pancreas, adrenal medulla and brain
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Aside from reducing inflammation, calcitriol...
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supresses autoimmune rxns, and regulates transcription of numerous genes, esp. those associated w/ differentiation and proliferation (reduces risk for cancer (skin and colon)
-reduces risk of infectious disease (i.e. flu in mental asylum) |
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vit d Therapeutics
(good for the heart and bones) |
-rickets
-osteomalacia -osteoporosis -chronic skeletomuscular pain -prevent CVD -prevent HTN -bone fractures -osteoarthritis -MS -diabetes -psoriasis -depression SAD -migraines -epilepsy |
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PCOs supplementation w/ ____ mg of Ca per day and ___ IUs of Vit D2 weekly normalized the menstruation/fertility of all women in study...
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1,500 mg, 50,000 UIs respectively
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patient suffering from M/S pain received ____ IUs of Vit D in order to resolve M/S (with 100 % success) for ____ months
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5k-10k; for 3 months
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seniors make ___ less vit D with sun exposure than 22-30 yr olds.
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1/3
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what are the 2 other names that ergochalciferol is know for and what's their dosage?
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calciferol, dristol
100-500k IUs |
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This substance is used therapeutically in cases of liver diseases and anticonvulsant induced osteomalacia. Give the dosage...
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calciferol or calderol
20 or 50 mcg |
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this form of vit D is used in nephrotic syndrome, renal failure, and severe malabsorption. What dosage is used?
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calcitriol, calciiex, rocaltrol
0.25 mcg or 0.5 mcg |
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This is the synthetic analog of vit D2. What is its dosage and when is it used?
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Dihydrotachysterol (DHT, Hytakerol)
tablets: 0.125, 0.2, and 0.4 solution: 0.2 mg/ml capsules: 0.125 mg It is used to correct idiopathic or post surgical hypocalcemia when more rapid action is necessary |
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treatments for patients with severe Vit D defficiency
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-50k IUs orally once or twice a week for up to 2 months
-daily 6000-10k IUs/day |
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moderate to mild Vitamin D defficiency
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-50k IUs/week for 2 months
-daily dosage of 4k-8k IU/day |
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which forms of vit D are used as a last resort in case that ero- and cholecalciferol don't work.
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Rocatrol or calcijex
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How long do you monitor patient with abnormal indices after beginning vit. D replacement to mae sure that levels normalize?
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6-8 weeks
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vit D toxicities can occur at levels ...
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>40k IUs/day for wks/months
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Sx of Vit D toxicities
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N/V, poor appetite, constipation, weakness, weight loss, polyuria, polydipsia, nervousness
High levels of calcium --> confusion, heart arrythmias and tissue calcinosis |
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vit. K deficiency symptoms
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-hemorrhagic disease of the newborn
-clotting problems -osteoporosis -bleeding in urine, stool, nosebleeds, bleeding gums, and heavy menstrual bleeding |
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vit. K may have interactions with what drugs?
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-warfarin, coumadin (do not supplement above 100 mcg/day)
-pregnant women on anticonvulsants, rifampin, INH -cephalosporins and salicylates may decrease vit. K recycling -cholestyramine, cholestipol, orlistat, mineral oil, olestra, |
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This is the fat lipid soluble ester of Vit. C used as an antioxidant which prevents peroxidation and is likely broken down in gut and absorbed as sat fat and vit C.
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ascorbyl palmitate
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This is the fat lipid soluble ester of Vit. C used as an antioxidant which prevents peroxidation and is likely broken down in gut and absorbed as sat fat and vit C.
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ascorbyl palmitate
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What plant contains the highest amount of vit.C?
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rosehips (7gms/100gms of fruit)
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where is vit C found in the body?
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High in pituitary, adrenals, wbc, brain.
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what's the % of vit C absorbed when comsuming 30mg, 180 mg, 1-1.5 gm?
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100%, 70-90%, and 50% respectively
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axns of vit C
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-reducing agent
-boosts immune sys. -anti-oxidant -cofactor in L-Carnitine biosynthesis and catecholamine NTs and O-3 --> EPA -anti-histamine -involved in biosynthesis of elastin, fibronectin, proteoglycans, collagen gene expression -involved in normal c |
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Vit C therapeutics
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-cataract prevention
-wound healing -diabetes -gout -env. toxicities -tobaco smokers and alcoholics -infertility -cancer -elevated lipids -schizophrenia -periodontal disease -allergies -frequent colds and flus -antioxidant protection -cancer -strengthen b |
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vit C deficiency
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Scurvy--weakness; muscle fatigue; connective tissue degeneration; easily bruised skin; soft, swollen, bleeding gums; decreased wound healing, osteoporosis, anemia.
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dosage required to rpevet scurvy
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5-10 mg/day
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25% of Vit C can be lost by boiling or steaming foods, by freezing and unthawing of fruits and veggies
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25
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Cooking veggies for 10-20 minutes can cause ___% Vit C loss.
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50
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Canned and reheated veggies can lose __% of their Vit C.
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33
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Doses of vit. C above gut absorption tolerance will cause
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osmotic diarrhea
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vit C interactions
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-regenerates vit E
-These can decrease Vit C body stores: cigarette smoke, OCP, NSAIDs, corticosteroids, sulfa drugs, barbituates. -G6PD—definitely watch Vit C intake, particularly with IVs, which mainly are contra-indicated. |
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Human studies have shown that this substance can raise TPP levels up to 120-430% vs. regular thiamin.
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benfotiamine
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Found in crushed leeks, onions, garlic (Allicin family)
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allithiamine
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This substance is fat soluble and therefore more absorbable than regular thiamine
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benfotiamine
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benfotiamine increases this enzyme's activity which blocks glucose induced damage
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transketolase
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This substance cause oxidative cellular destruction all over the body and enhances hexosamine pathways
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Advanced Glycosylated End-Product formation (AGE) of benfotiamine
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benfotiamine helps this pathway which decreases aldose reductase, sorbitol concentrations
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benfotiamine
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therapeutic indications for benfotiamine include...
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-diabetic neuropathy
-diabetic retinopathy -diabetic nephropathy |
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what pathways is thiamine involved in..
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The citric acid pathway
The Pentose Phosphate pathway |
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Thiamine is a cofactor for these rxns needed to turn ______ into ribonucleotides, ATP, GTP, nucleic acids, DNA, RNA, NADPH
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ribose-5-phosphate
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signs for increased need for thiamine
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fever, prego, growth spurts, high physical exertion/injuries
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Excessive thiamin loss from body results in
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Kidney failure and/or diuretic use.
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anti-thiamin factors in diet include
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-High coffee, tea, betel leaves
-Raw seafood or shellfish - contain thiaminase which is broken down by cooking. |
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This disease is associated with alcoholics and vegans eating white rice. It Causes nerve degeneration, nerve tingling, poor coordination, muscle pain, confusion, heart problems, anorexia, constipation, nausea, depression, fatigue.
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Beri-beri
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this condition involves heart and circulatory system-->sodium and water retention, heart failure, peripheral vasodilation with increased cardiac output.
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"wet" beri-beri
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this disease affects peripheral nervous system-->paresthesias of toes, burning feet, loss of ankle/foot reflexes, footdrop, toedrop, calf muscle tender/cramps.
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"dry" beri-beri
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this condition is due to this vit. deficiency (due to alcoholism)--> Mental confusion, uncoordinated or paralyzed eye muscles, ataxia.
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cerebral Beri-beri or Wernicke-Korsakoff Syndrome
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Vit B1 therapeutics
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-Deficiency in B1
-Neuropathy in Diabetics--particularly the allithiamine form. -Depression and/or Anxiety and/or cognition -Antioxidant--protecting brain against damage, even from lead. -Kidney protection -In all alcoholics and vegans. -Congestive hea |
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what substance can lower thiamine levels?
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Phenytoin
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This substance can inhibit the phosphorylation of thiamin to TPP
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5-FU
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what's the active form of riboflavin?
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riboflavin-5-phosphate
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Riboflavin turns urine this color...
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bright yellow/green
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Riboflavin is a precursor for what 2 coenzymes?
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flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD):
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FMN and FAD's actions include...
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-Involved in redox reactions
-Energy Production--CHO, PRO, Fats -Cofactor in production of reduced glutathione (needs FAD containing enzyme glutathione reductase). -Helps with homocysteine metabolism: FAD and FMN are needed as cofactors in enzymes involv |
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This vitamin seems to aid iron absorption, decrease intestinal loss of iron, and aid synthesis of hemoglobin.
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B2
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This vitamin is needed to form Flavin Dependent Enzyme pyridoxine-5-phosphate oxidase which is needed to convert Vit B6 to ___
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vit B2, P5P
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This vitamin is needed to make Flavin Dependent Enzyme Kyurenine monooxygenase which is needed to convert Tryptophan to ___.
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vit B2, NAD and NADP
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This vitamin is needed to make this enzyme which is needed to synthesize folate coenzyme which catalyzes what reaction?
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vit B2, homocysteine-->methionine.
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B2 deficiency is also referred to as..
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ariboflavinosis
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signs of ariboflavinosis
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-Glossitis, cheilosis, angular stomatitis
-Dermatitis, inflammed eyelids -Photophobia, sore throat -Increased lipid peroxidation -Normochromic normocytic anemia |
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etiology or causes for B2 deficiency
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-From dietary inadequacy or anorexia
-chronic liver disease -ETOHs, -TPN* patients. -Light therapy in newborn jaundice can increase B2 breakdown -Dairy allergy/Lactose intolerance--dairy is a good source of B2. -Hypothyroidism and Adrenal insufficiency |
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B2 toxicities
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None known except for diarrhea and polyuria in doses of 400 mg/day in two people.
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B2 Therapeutics
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-Treat Deficiency
-Prevent cataracts -Acne rosacea -Migraines--400 mcg/day. (Theory: Migraine etiology related to impaired mitochondrial oxygen metabolism in brain. FMN and FAD are needed by flavoproteins in the mitochondria for proper functioning of the |
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B2 Therapeutics
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-Treat Deficiency
-Prevent cataracts -Acne rosacea -Migraines--400 mcg/day. (Theory: Migraine etiology related to impaired mitochondrial oxygen metabolism in brain. FMN and FAD are needed by flavoproteins in the mitochondria for proper functioning of the |
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these drugs can decrease B2 absorption
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Cholestyramine, Colestipol
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These substances can inhibit B2 by targetting FMN and FAD production
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Phenothiazine derivatives, Tricyclic antidepressants, Adriamycin, Quinacrine (anti-malarial)
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These substances can reduce NRTI lactic acidosis
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Nucleoside reverse-transcriptase inhibitors
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This substance taken with B2 may decrease absorption
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psyllium
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B2 may potentiate the antioxidant effects of what vitamin?
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Vit E
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Niacin is AKA
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nicotinic acid, nicotinamide
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what's the Bioactive form of vit. B3?
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Niacinamide
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what's the non-dietary source?
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Produced from kyurenine pathway in the liver from tryptophan.
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60 mg Tryptophan--> X mg of Niacin
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1
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Actions of NAD and NADP
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-Cofactors for numerous dehydrogenase enzymes, such as lactate or malate.
-NAD: Involved in catabolism of CHO, PRO, Fats to garner energy. -NADP: Involved in synthesis of EFA and cholesterol. |
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Niacin Lipid Actions
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-Inhibits hepatic uptake of apolipoprotein A-1-->higher levels of HDL in blood-->more cholesterol taken from peripheral cells to liver for excretion.
-Reduces LDL-C and TG by interfering with their production in the liver. -Blocks mobilization of FFAs fro |
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B3 deficiency leads to
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pellegra- The Four Ds: Dementia, Dermatitis, Diarrhea, Death.
- In US, alcoholics are biggest risk. |
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Causes of B3 deficiency
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-Low niacin or tryptophan dietary intake
-Hartnup disease--defective conversion of tryptophan to B3. -Malignant carcinoid syndrome--excess serotonin production thus less tryptophan enters kyurenine pathway, -Drug therapies (isoniazid). |
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B3's (Niacin) side effects
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Niacin:
-Vasodilation esp to face, neck, chest--perhaps due to prostaglandin and histamine. -Pruritus -Headaches -Dizziness, palpitations, SOB, sweating, chills, N/V. -Hepatoxicity--in time-released form at 3 gm or higher a day. -Impaired glucose tolera |
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B3/Niacin Toxicities
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Should monitor liver enzymes on:
-Risk increasing uric acid and gout -Flushing Cardiac arrhythmias, tachycardia, palpitations -Hypotension -Acanthosis nigricans -Worsening of peptic ulcer disease -In combination with statins: Higher risk of myopathy and |
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Absolute B3 CIs
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- Hepatic dysfunction
- Active PUD - Arterial bleeding |
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B3 precautions
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-gallbladder disease
-gout predisposition -unstable angina -renal dysfunction |
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B3 therapeutics for lowering lipid panels w/ no toxicity
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-Inositol hexaniacinate
|
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This substance treats:
-Osteoarthritis -Helps prevent pancreatic damage in honeymoon phase of DM 1. -Anxiety |
Niacinamide
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This substance lowers cholesterol , small dense LDL, VLDL, lp(a), and triglycerides, raises HDL--reduces fatty acid mobilization from adipose tissue
-Can reduce glycogen and fat stores in heart and muscle tissue -Can increase blood glucose -Can increase |
Niacin
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B3 (SSUN)
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-Schizophrenia--Hoffer protocol
-Stop smoking -Used for energy production: NAD, NADPH -Needed for desaturase enzyme systems |
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Form of Niacin that offers immediate release
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Niacor, OTC Nicotinic Acid
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Form of Niacin that offers extended release
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-Niaspan
-Advicor (ER Niacin with lovastatin) |
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sustained release form of Niacin
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Slo-Niacin, OTC slow release Nicotinic Acid.
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Effx of immediate release niacin
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Most Over The Counter
High Flushing: 52-100% of patients High discontinuance problem with patients Flushing effect may decrease ASA may decrease flushing effect Hepatotoxicity At doses >3 gm, may increase serum glucose, temporarily |
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Extended release Niacin
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-Dissolves intermediate to IR and SR
-Lower flushing effects -No increased risk of hepatotoxicity -FDA approved for treatment of dyslipidemia. -Niaspan—dosed once daily at bedtime. |
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Sustained release
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-Less flushing effect
-Associated with hepatotoxicity and liver failure. |
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-Niacin is metabolized via two pathways:
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1)Conjugated with glycine-->nicotinuric acid--> FLUSHING
-Used only when other pathway is saturated which IR does quickly. 2) Converted to nicotinamide-->pyrimidine metabolites-->HEPATOTOXICITY SR niacin mainly flows through this pathway. |
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Is there a higher or lower risk of liver disease when switching from IR to SR.
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higher
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what's the max therapeutic dosage for IR and ER Niacin dosing?
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3000 and 2000 mg/day respectively
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What are B3s combined with possibly causing increased risk for rhabomyolysis?
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statins
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what effect do alpha 1 blockers (doxazosin, prazosin, terazosin) and calcium channel blockers have when taken w/ B3?
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may potentiate the hypotensive effect of A1B
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Alpha glucosidase inhibitors (Acarbose, miglitol) and metformin and meglitinides and Sulfonylureas and TZDs with high doses of B3 may...
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antagonize antidiabetic action
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these substances may reduce absorption of B3
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Cholestyramine, colestipol
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what drugs combined w/ B3 blunt B3 flushing and which may aggravate flushing effect
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nicotinic patch - aggravate
NSAIDS, ASA - blunt |
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what drug can induce pellagra when combined w/ B3?
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5-FU, and INH (maybe)
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Red yeast rice and B3
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has resulted in rare cases of rhabdomyolysis.
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ETOH with B3
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can increase flushing effects.
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Hot beverages and hot foods
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may increase flushing
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Pantothenic acid is formed from
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alanine and pantoic acid.
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Pantothenic acid actions
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-Synthesis of CoA
-Acyl Carrier Protein-->Fatty acid synthesis, phosopholipids, sphingolipids |
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B5 Deficiency/Toxicity
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Deficiency is Rare: h/a, acne, orthostatic low BP, fatigue, constipation, V, gut distress, numb/tingling in hands/feet, insomnia.
-there are no known toxicities |
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B5 Therapeutics
|
-Adrenals-needed for adrenals to produce steroid hormones.
-dermititis -Lowers total cholesterol, LDL, apoB and TG -Increases HDL and apoA1 -Rheumatoid Arthritis--only type of arthritis B5 seems to help (2000 mg/day). -High dose may help acne vulgaris |
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what substances may increase need for B5?
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OCP with estrogen and progestin
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high dose B5 can inhibit the absorption of ______
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Biotin
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high dose B5 can inhibit the absorption of ______
|
Biotin
|
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what's the bioactive form of B6?
|
pyridoxal-5-phosphate (P5P)
|
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Typical supplement of B6
|
Pyridoxine HCL
|
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B6 actions
|
-Cofactor for over 100 enzymes--transaminases, decarboxylases: Schiff’s base formation is the basic chemistry accounting for the wide range of B6 reactions.
(Schiff’s Bases are reaction products of aldehyde and amino groups attached to P5P. Basis for |
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Signs of B6 deficiency
|
PMS
Microcytic, hypochromic anemia Insomnia, Depression Smooth tongue Convulsions--due to low GABA levels Kidney stones Dermatitis Carpal tunnel |
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Neuro symptoms for B6
|
numbness/tingling in extremities: At very high doses and will not occur if magnesium is added (Pfeiffer)
|
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This vitamin helps with dream recall (Pfeiffer)
|
B6
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B6 Therapeutics
|
-Carpal Tunnel Syndrome--50-200 mg/day.
-PMS and other menstrual disorders--perhaps by increasing dopamine and serotonin -Nausea of pregnancy -Preeclampsia -Seborrheic dermatitis -High homocysteine levels--antiatherogenic. http://lpi.oregonstate.edu/info |