Transcript Pharmacology and the Nursing Process, 4th ed. Lilley/Harrington

4/11/2016
1
4/11/2016
2







Inorganic elements or salts
Bind with enzymes or other organic
molecules
Help to regulate many body functions
Building blocks for many body structures
Required for intracellular and extracellular
body fluid electrolytes
Macrominerals
Microminerals, or trace elements
4/11/2016
3





Most abundant mineral element in the body
Accounts for 2% of body weight
Highest concentration in bones and teeth
Efficient absorption requires adequate
amounts of vitamin D
Found in many foods especially milk and
dairy products
4/11/2016
4
SOFT TISSUE
100,000 mg
4/11/2016
5

Calcium requirements high for
 Growing children
 Women who are pregnant or breast-feeding
4/11/2016
6

Essential for normal maintenance and function
of:
 Nervous, muscular, skeletal systems
 Cell membrane and capillary permeability


Catalyst in many enzymatic reactions
Essential in many physiologic processes
 Transmission of nerve impulses
 Contraction of cardiac, smooth, and skeletal muscles
 Renal function, respiration, and blood coagulation
4/11/2016
7

Calcium deficiency: hypocalcemia
 Infantile rickets
 Adult osteomalacia
 Osteoporosis
 Many other conditions associated with calcium
deficiency
4/11/2016
8




Inadequate intake of calcium or vitamin D
Hypoparathyroidism
Malabsorption syndrome
Many other causes
4/11/2016
9



Used to treat various deficiency states
Dietary supplement for women during
pregnancy and lactation
Toxicity: Hypercalcemia may occur with therapy
 Anorexia, nausea, vomiting, constipation
 Stone formation

Physical drug interaction: Calcium salts will bind
(chelate) with tetracyclines to produce an
insoluble complex
4/11/2016
10
Main source of dietary Ca in industrialized societies is
milk which contains ~1150 mg ca/L.
 Other good sources of calcium include milk products
except butter and cream, sardines, salmon, shellfish
(oysters, tulya), dried dilis, green vegetables that do
not contain much phytates and oxalates like mustasa,
malunggay, petsay, saluyot, and gabi leaves calcium set
tofu, some legumes, canned fish, seeds, nuts, and
fortified food products. Breads and cereals, although
relatively low in calcium, contribute significantly to
total calcium intake because of the frequency of
consumption. Fish and other seafoods contain more
calcium than pork, beef, or chicken.

4/11/2016
11
4/11/2016
12
Menopausal women should take at least 500 to
2000 mg of calcium daily for minimum of 2 years to
prevent bone loss.
 It is also recommended that dose of 400 to 800 iu of
vitamin D3 be given with 1000 mg calcium to reduce
hip fracture risk of older individuals esp those with
limited sun exposure, ie. housebound.
 It is not routinely recommended to give vitamin D
analogues.

4/11/2016
13
%
Elemental
Calcium
Cost
Convenience
Absorption
CaCO3
40
Inexpensive
Convenient
Adequate
when taken
with food
Ca lactate
13
Inconvenient:
need more
tablets
Adequate
when taken
with food
Ca
gluconate
9
Inconvenient
IV
Adequate
when taken
with food
Ca citrate
21
4/11/2016
Expensive
Well
absorbed
Levine In: DeGroot, 2001
14



One of the principal cations of intracellular
fluid
Essential for enzyme systems associated with
energy metabolism
Required for:
 Nerve physiology
 Muscle contraction
4/11/2016
15

Dietary sources
 Vegetables and other foods

Required in higher amounts in those with
diets high in protein-rich foods, calcium, and
phosphorus
4/11/2016
16

Hypomagnesemia
 Malabsorption
 Alcoholism
 Long-term IV feedings
 Diuretics
 Metabolic disorders (hyperthyroidism, diabetic
ketoacidosis)
4/11/2016
17






Nutritional supplement
Treatment of magnesium deficiency
Anticonvulsant in magnesium deficiency
Preeclampsia and eclampsia
Tocolytic agent for inhibition of uterine
contractions in premature labor
Many other uses
4/11/2016
18

Adverse effects are due to hypermagnesia






4/11/2016
Tendon reflex loss: form of paralysis
Difficult bowel movements
CNS depression
Respiratory distress
Heart block
Hypothermia
19
 Infants (0-5 mos): 26 mg
6 to < 12 mos: 54 mg
 Children
(<10 years): 65-100 mg
10-12 yrs: 155-160 mg; 13-18 yrs 220-260 mg
 Male adults: 235 mg
Female adults: 205 mg
 Pregnant: 205 mg
 Lactating: 250 mg
4/11/2016
20



Widely distributed in foods
Dietary deficiency is rare
Deficiency due to non-dietary causes
 Mal-absorption
 Extensive diarrhea or vomiting
 Hyperthyroidism
 Long-term use of aluminum or calcium antacids
 Hepatic disease
4/11/2016
21





Required precursor for the synthesis of essential
body chemicals
Responsible for cellular energy transfer
Necessary for the dev’t and maintenance of the
skeletal system and teeth
Building block for body structures
Required for the synthesis of:
 Nucleic acid
– AMP
 ADP
– ATP
4/11/2016
22


Treatment of deficiency states
Dietary supplement
4/11/2016
23






Diarrhea
Nausea and vomiting
Other GI disturbances
Confusion
Weakness
Breathing difficulties
4/11/2016
24
 Infants (< 6 mos): 90 mg
6 to < 12 mos: 275 mg
 Children: 460-500 mg
 10-18 years old: 1250 mg
 adults: 700 mg
 Pregnant and Lactating: 700 mg

4/11/2016
25




Trace element
Essential in metabolic reactions of proteins
and carbohydrates
Important for normal tissue growth and
repair, especially wound repair
Recently recognized as important for the
prevention of recurrent diarrhea
4/11/2016
26
 Infants (<6mos): 1.4 mg
 6- <12 mos:
4.2 mg
 Children: 4.5-5.4 mg
 Male adults: 6.4 mg
 Female adults: 4.5 mg
Pregnant 1st trim 5.1 mg, 2nd trim 6.6, 3rd trim
9.6
 Lactating: 11.5 mg
4/11/2016
27
Appendix C: Food Tips
a. Food based solutions are preferable to help ensure a balanced diet and
good eating habits.
b. 2 glasses of high calcium milk each day is a guaranteed way to meet all
your calcium requirements. In addition, milk provides large amounts
of phosphorus and components such as lactose and casein
phosphopeptides which may enhance calcium absorption.
c. Some fortified milks also supply adequate amounts of vitamin D, zinc,
and magnesium for optimal bone health.
d. Other sources of calcium include green leafy vegetables and soy
products, although calcium is less well absorbed from these sources.
e. Eat green vegetables cooked, rather than raw, to boost their calcium
content. Cooking releases some of the calcium that’s bound to a
compound called oxalic acid.
f. Don’t take iron supplements with calcium-rich foods, since these
minerals compete for absorption.
g. Drink tea and coffee between, rather than during meals. Natural
compounds in these beverages inhibit calcium absorption.
4/11/2016
28