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Australian Journal of Pharmacy : November 2006
ucation Alzheimer’s disease.17 A recent (2006) study found that fruit and vegetable juices may play an important role in delaying the onset of Alzheimer’s disease, particularly among those who are at high risk for the disease but no benefit was observed for dietary intake of vitamins E, C, or ß-carotene or tea consumption.18 Medication implementations: Although controversial, vitamin E has been reported to cause changes in anticoagulant response. INR should be closely monitored when changes are made with high dose vitamin E supplements.19 Vitamin K comes in two chemical forms; vitamin K1 (phytom- enadione) found mainly in vegetables, while the K2 vitamins (menaquinones) are produced by bacteria found in the gastroin- testinal tract. Vitamin K deficiency leads to low levels of prothrombin (hypoprothrombinaemia) and other clotting factors, resulting in delayed blood clotting and a tendency to bleed. This may cause oozing from wounds, nosebleeds, and bleed- ing from the gums, intestine, urinary tract, and, rarely, bleeding in the brain.3–6 Food sources include turnip greens, broccoli, cabbage, lettuce and liver. Therapeutic uses: prevention of haemorrhagic disease in new- born, 1mg parenteral/oral dose and in reversal of warfarin anti- K or foods containing high levels of vitamin K should be avoided in patients who are being treated with warfarin. coagulation effect (1–10mg oral or slow IV).10 Medication implementations: Multi-vitamins containing vitamin Water-soluble vitamins Much has been made about the observation that folic acid, pyri- doxine (B6) and vitamin B12 all lower homocysteine levels. Ele- vated homocysteine levels have been observed to be associated with cardiovascular disease. However, a number of recent stud- ies have now shown that lowering homocysteine levels by use of the B group vitamins has not demonstrated any reduction in adverse cardiovascular events.20,21 Thiamine (Vitamin B1) is a co-enzyme of many enzyme sys- tems; it is vital for the breakdown and utilisation of carbohydrates and is important for a healthy nervous system, healthy muscles and normal heart function. Food sources include whole wheat, wheat germ (richest source), yeast, pulses, nuts, pork, duck, Vegemite, oatmeal, for- tified breakfast cereals, cods roe, other meats. Mild deficiency may cause fatigue, irritability, loss of appetite, and disturbed sleep. Severe deficiency may cause confusion, loss of memory, depression, abdominal pain, constipation, and beriberi, a disorder that affects the nerves, brain, and heart. Symptoms of beriberi include tingling or burning sensations in the legs, cramps and tenderness in the calf muscles, in-coordi- nation, palpitations, mental disturbances, and heart failure. In chronic alcoholics with malnutrition, thiamine deficiency may lead to a characteristic deterioration of the central nervous AJPCPE CONTINUING PROFESSIONAL EDUCATION system function known as Wernicke’s syndrome, which results eventually in paralysis of the eye muscles, severe memory loss, and dementia.3–6 Riboflavin (vitamin B2) is a co-enzyme for many enzymes in breakdown and utilisation of fats, proteins and carbohydrates and in energy production in cells using oxygen. Food sources include liver, kidney (richest source), milk, yoghurt, cheese, Vegemite, eggs, wheat germ, wheat bran, mush- rooms, fortified cereals. Prolonged deficiency may lead to chapped lips, cracks and sores in the corners of the mouth, and a red, sore tongue. The eyes may itch, burn, and become unusually sensitive to light. Twitching of the eyelids and blurred vision may also occur.3–6 Niacin (nicotinamide and nicotinic acid, v itamin B3) is a co- enzyme for many enzyme systems, responsible for proper func- tioning of the nervous system, a healthy skin and digestive sys- tem and the manufacture of male and female sex hormones. Food sources include liver, kidney (richest source), meat, poul- try, fish, brewer’s yeast, Vegemite, peanuts, bran, pulses, whole meal wheat and coffee. Severe niacin deficiency causes pellagra (literally, rough skin). Symptoms include sore, red, cracked skin in areas exposed to sun, friction, or pressure, inflammation of the mouth and tongue, abdominal pain and distension, nausea, diarrhoea, and mental disturbances such as anxiety, depression, and dementia. Supranutritional doses: At doses of more than 50mg, nicotinic acid may cause transient itching, flushing, tingling, or headache. Large doses of niacin may cause nausea and aggravate a peptic ulcer. This can be reduced by taking the drug on a full stomach. Medication implementations: Patients taking isoniazid may require additional vitamin B3. At doses more than 2g daily in the treatment of hyperlipidaemia, there is a risk of gout, liver dam- age, and high blood sugar levels.3–6,19 Folic Acid (folate, folacin) is responsible for the activity of sev- eral enzymes, is required for the manufacture of nucleic acids, thus processes of growth and reproduction, and is required for the formation of erythrocytes. Food sources include liver, kidney, spinach, broccoli, lima bean, beetroot, bran, peanuts, cabbage, lettuce, avocados, bananas, oranges, wholemeal bread, eggs and some fish. Deficiency leads to abnormally low numbers of erythrocytes (anaemia). Main symptoms include fatigue, loss of appetite, nau- sea, diarrhoea, and hair loss. Mouth sores are common and the tongue is often sore. Deficiency may also cause poor growth in infants and children. It is of vital importance for embryonic organogenesis, partic- ularly neural tube closure.3–6 Therapeutic indication: Prevention of folate deficiency during pregnancy, thereby preventing foetal neural tube defect (spina bifida) 500mcg daily before conception and continued for the first 12 weeks of pregnancy. THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 NOVEMBER 2006 ? 69