Vitamines slide Dr Madhuri chatterjee mam

Vitamines

1. VITAMINS
Delinition
Vitaminsareorganicnutrientsthatare
requiredinsmallquantitiesforavarietyof
biochemicalfunctionsandwhichgenerally
cannotbesynthesized inthebodyandmust
besuppliedbythediet

2. Fatsoluble
Vitamins
VitaminsA,D,E
&K
Watersoluble
Vitamins
•VitamninB
complex&
VitaminC

3. VITAMIN BCOMPLEX
Watersolublevitamin-Obtainedfrombothvegetable,
animalsourcesexceptVitB12
Thiamine-Activeform-ThiaminePyrophosphate
(TPP)-coenzymeincarbohydratemetabolism
Roleinneuromusculartransmission
WetBeriBeri&DryBeriBeri
100mgIM/IVthenmaintenance-orally
HYDROCHLORIOE
THIAMINE
4ldsism
Bi
estese
Kashah

4. VitaminBcomplex
Riboflavin VitaminB2:RoleinactiveformFlavin
MonoNucleotide(FMN)andFlavinAdenine
Dinucleotide(FAD)-coenzymeforflavoproteins-
Oxidation-reductionreactions &carbohydrate
flowmmetabolism
UsedwithotherVitamins-5-20mg
a

5. Dmota
Vitamin
B3
Dawths
Niacin-activeformNAD
&
Telegra
NADP.
Coenzyme-Oxidation
reduction
Reactions-
cellularrespiration,fat
andcarbohydrate
metabolism
Tryptophan-provitamin

6. VitaminB3
Deficiency-1)Pellagra
Moreinalcoholics
Prophylaxis–15-20mg
Treatment-200mgalong
WithotherBvitamins+
Dietarysupplements
withtryptophan
2)Hyperlipoproteinemia
-Toxicity-Nicotinic acid
Pruritus,flushingofface
ypue
to?

7. Pyridoxine(VitaminB6)
Coenzyme-Pyridoxalphosphate/Pyridoxine
phosphate-metabolism ofcarbohydrate,fatand
protein,GABA,hemesynthesis
Peripheralneuropathy,seizure-deficiencydisease
DrugInteractions-Levodopa
(INH),Cycloserine,Hydralazine,Penicillamine
2halLe un
ProphylaxisandtreatmentofPeripheralneuropathy
10-25mgand100mgdoserespectively
Morningsickness
Pyvdoane

8. VitaminC
Watersoluble-cofactorinvariousreactions
Necessaryforcollagenbiosynthesis,Adrenalsteroid
synthesis,conversion offolicacidtofolinicacidand
helpsinironabsorption-FerrousF2t
Scurvy-1-1.5g
Antioxidant-100mg
Withhematinicsvibctee
Indication-viralURI,
AcidificationofurineinUTI

9. ScD
Pregnancy,
lact
Dietary
def
ntestinalpathology
alcoholism,
Poorabsorption:
FOLATE
DRUGS: Folateabs,
DEFICIENCYDihydrofolate inhibitors
DNAsynthesisdirectly
LAMINOACIDBIOSYNTHESIS
LPURINESYNTHESIS
PYRIMIDINESYNTHESIS
Sulehoanle
Tsimete
MEGALOBLASTICANEMIA
JDNA&RNASYNTHESIS
Mettx

10. DietaryFolate
Gastrointestinaltract
Biood
Intracellular
5-methyltetrahydrotolate
Homocysteine
Methioninesynthase
VitaminB12
Methionine
(methylcobalamin)
Tetrahydrofolate
polygiutamate
DNA
S-adenosylmethionine
Dihydrofolate Purineand
polyglutamate Pyrimidine
synthesis
Formyl
tetrahydrofolate
polyglutamate
5,10-methylene
tetrahydrofolate
polygutanate
Thymidylate
synthase
dUMP
LINKBETWEENDIETARYFAANDVitB12metabolism

11. FOLICACID(PTEROYLGLUTAMICACID)
FAfromdiet400microgram
-absorbedinmonoglutamateform
Presentinplasmain5methyltetrahydrofolate
Entersthecell-Demethylatedtotetrahydrofolate
-Reaction-requiresVitaminB12
Largedosesofsyntheticfolicacid(5mg/dayp.o.for4
months)areusedtotreatfolatedeficiency
Arkep
lst4rako

12. VitaminB12
Thecobalaminsareafamilyofcompounds(cyano-,
hydroxyo-,methyl-andadenosylcobalamin) thathave
vitaminB12activity.
VitaminB12isproducedonlybymicroorganisms -obtain
itbyingestingfoodsofanimalorigin.
VitaminB12isrequiredbyallcells
forDNASynthesis; itisalsorequiredforredcell
production,methylationandmyelinsynthesis

13. VITAMINB12
IngestedvitaminB12bindstointrinsicfactor(IF)
Transportedtoileumandabsorbed-FAtransportedby
transcobalamin-takenupandstoredintheliver

14. Deficiency
Inadequatedietaryintake:theelderlyandvegans.
Perniciousanaemia.Autoimmunedestructionof
gastricparietal cellsatrophicgastricmucosa
andreducedsecretionofintrinsicfactor.
VitaminB12deficiencyresultsfromfailuretoabsorb
cobalamin intheterminalileum.

15. Deficiency
Malabsorptionsyndromes.Intestinaldiseaseaffecting
theternminalileumcaninterruptthenormal
enterohepatic circulationofvitaminB12andresultin
vitaminB12deficiency.
Malabsorption canalsoresultfrompoorreleaseof
vitaminB12fromfoodasaconsequenceofimpaired
secretionofacidandpepsinbythestomach.

16. Deficiency
DrugsthatreducevitaminB12absorption,
Metformin,
Aminosalicylic acid,
Nicotine,
PhenytoinandlargedosesofvitaminC.

17. Deficiencydisorders
Megaloblasticanemia-ovalmacrocytesand
hypersegmentedpolymorphs
Subacutecombineddegenerationofthecord
Epithelial celldisorderofGltract-soretongue,
alabsorption

18. Treatment
Hydroxocobalamin isthepreferred
formofvitaminB12forclinicaluse
doseof1mgIM.threetimesperweekfor2weeks(6
doses)toreplenishbodyvitaminB12stores.
Maintenancetherapy(1mgevery
3months)isrequired iftheunderlyingcausecannotbe
corrected,suchasinperniciousanaemia,which
requireslifelongvitaminB12therapy

19. Reversalofneurologicaldamageisslow,rarelymarked,
andinverselyrelatedtotheextentanddurationof
neuropathy
IronandFAisrequiredforincreasederythropoiesis
Hypokalemiaissometimesprecipitatedsopotassium
supplementation

20. VitaminE
Tocopherol
Roleasantioxidant,antisterilityvitamin,Preventionof
Cancers,DementiaandCVSdiseases
Uses:Nocturnal musclecramps
Fibrocysticdiseaseofthebreast
Antioxidant-delayscataract,coronaryarterydisease

21. VITAMINA
•VitaminA,
VitaminAz
•Bcarotene

22. VISUALCYCLE
Rhodopsin
Lightenergy
(psec)
Bathorhodopsin
(nsec)
Lumirhodopsin
(usec)
(minutes) Metarhodopsin I
(msec)
Metarhodopsin ll
(sec)
Scotopsin
11-cisretinal
Isonerase
all-transretinal
11-cisretinol
lsonerase
all-transretinol
(VitaminA)

23. FUNCTIONS
Epithelialintegrity
Reproduction
Roleinimmunity
Darkadaptation-combineswithopsinstorhodopsin
Requiredforproperbonegrowthanddevelopment

24. Uses:Prophylaxis3000-5000IU/day
Treatment ofestablisheddisease:50000-100000
Iu/dayfor1-3daysfollowedbyintermittent
supplementaldoses
Inpsoriasis,ichthyosis,acneretinoicacidand2/3
generationretinoids

25. Toxicity
Hypervitaminosis
Acute-headache,drowsiness,vomiting,Raised
intracranialpressure,denudedskinafter24hours
Chronic-Dry,pruriticskin,hairloss,headache,brittle
nails,increased triglyceridesandDecreasedHDL

26. Vitamin Aanalogues
Etretinate-refractorypsoriasis
Trans-retinoicacidTretinoin-actiononlyonepithelial
cells-Acne,preventphotoaging
Isotretinoin-orallyfornodulocysticacne
Acitretin-synthesisedfromretinoicacid-orallyin
pustularpsoriasis,Lichenplanusandicthyosis
Tazarotene/Bexarotene-gelformulationtopicallyin
acneandpsoriasis

27. VitaminK
VitaminK1-phytomenadione- oral/IM.Onset isfast
Oralroute-avoidedinobstructivejaundice
1mgIMroutinelyinnewborns
NDÉ
VitaminK3Menadione-watersoluble,lateonset.
Maycausehaemolysisandkernicterus innewborn
(competitivelyinhibitsbilirubinglucuronidation
Malabsorption-VitK3orallyorVitK1IM

28. 1.ApatientwithldiopathicParkinsonismshows
deteriorationdespiteuseofLevodopaasheis
takinganOTCdrug.Whichmedicine isikelytodo
this
Bo(?yYidoxi)
2.AladywithepilepsyisonPrimidone.Whichvitamin
needstobeadminsteredtohercaBa
3.Rubya16yroldgirlhaspulmonarytuberculosis.
TheFourdrugregimenHRZEisstarted.She
complainsofparaesthesiaandpinsandneedlesin
theperiphery.Give reasons