Vitamin oral administration

Some types of mushrooms contain moderate quantities of good-quality protein and are good sources of dietary fiber, vitamins C and B, and minerals (Breene 1990). Extensive clinical studies have demonstrated that some species have medicinal and therapeutic value, by injection or oral administration, in the prevention/treatment of... 

No information is available on the adverse health effects of hexachloroethane in humans. Animal studies revealed that hexachloroethane primarily causes liver and kidney toxicity. Effects on the nervous system and lungs have also been reported. The mechanism by which these effects are mediated is not well characterized. Reductive metabolism by cytochrome P-450 and production of a free radical intermediate have been suggested as factors in hexachloroethane-induced hepatotoxicity (Nastainczyk et al. 1982a Thompson et al. 1984 Town and Leibman 1984). Accordingly, one possible approach may be to reduce free radical injury. To that end, oral administration of N-acetylcysteine can be used as a means of reducing free radical injury. Also, oral administration of vitamin E and vitamin C may be of value since they are free radical scavengers. 

Isoniazid is bactericidal against growing M. tuberculosis. Its mechanism of action remains unclear. (In the bacterium it is converted to isonicotinic acid, which is membrane impermeable, hence likely to accumulate intracellu-larly.) Isoniazid is rapidly absorbed after oral administration. In the liver, it is inactivated by acetylation, the rate of which is genetically controlled and shows a characteristic distribution in different ethnic groups (fast vs. slow acetylators). Notable adverse effects are peripheral neuropathy, optic neuritis preventable by administration of vitamin Be (pyridoxine) hepatitis, jaundice. 

Vitamin E accumulates in the aortic endothelial cells after parenteral, but not oral, administration (Fig. 5.6). 

There are many retinol containing preparations to treat vitamin deficiency states. Retinoids are also used to treat dermatological diseases like acne, psoriasis, Darier s disease, and ichthyosis. Tretinoin, all-trans-retinoic acid, is a topical preparation while isotretinoin or 13-cis-retinoic acid, and etretinate are available for oral administration. 

Alternative options are increasingly favoured in the form of oral iron polymaltose complexes. These are more expensive but attractive in that complications are less frequently encountered and the lethal toxicity that follows release of large amounts or ionic iron into the circulation does not occur. Carbonyl iron is not often used but available in some countries. In contrast combinations with vitamins and cobalt, still popular in certain areas, have no documented advantage and add quite unnecessary cost. Other routes are intramuscular injections and, except where oral administration is precluded, have disadvantages in that mobilization is unpredictable. Conversely, it is feasible to replace iron as a single total dose infusion but such procedures need to be given under supervised conditions. It is reiterated that the rate of rise in haemoglobin that follows adequate oral replacement is comparable to that achieved par-enterally. 

Vitamins Ki and K2 require bile salts for absorption from the intestinal tract. Vitamin Kl is available clinically in oral and parenteral forms. Onset of effect is delayed for 6 hours but the effect is complete by 24 hours when treating depression of prothrombin activity by excess warfarin or vitamin deficiency. Intravenous administration of vitamin Ki should be slow, because rapid infusion can produce dyspnea, chest and back pain, and even death. Vitamin repletion is best achieved with intravenous or oral administration, because its bioavailability after subcutaneous administration is erratic. Vitamin Ki is... 

The homocystinurias are a group of disorders involving defects in the metabolism of homocysteine. The diseases are inherited as autosomal recessive illnesses, characterized by high plasma and urinary levels of homocysteine and methionine and low levels of cysteine. The most common cause of homocystinuria is a defect in the enzyme cystathionine /3-synthase, which converts homocysteine to cystathionine (Figure 20.21). Individuals who are homozygous for cystathionine [3-synthase deficiency exhibit ectopia lentis (displace ment of the lens of the eye), skeletal abnormalities, premature arte rial disease, osteoporosis, and mental retardation. Patients can be responsive or non-responsive to oral administration of pyridoxine (vitamin B6)—a cofactor of cystathionine [3-synthase. Bg-responsive patients usually have a milder and later onset of clinical symptoms compared with B6-non-responsive patients. Treatment includes restriction of methionine intake and supplementation with vitamins Bg, B, and folate. 

This vitamin is not synthesized in animals, but rather it results from the bacterial or fungal fermentation in the rumen, after which it is absorbed and concentrated during metabolism. Among the known vitamins, this exclusive microbial synthesis is of great interest. One of the major results of vitamin Bn deficiency is pernicious anemia. This disease, however, usually does not result from a dietary deficiency of the vitamin, but rather by an absence of a glycoprotein ( gastric intrinsic factor ) in the gastric juices that facilitates absorption of the vitamin in the intestine. Control of the diseases hence is either by injection of Bn or by oral administration of the intrinsic factor, with or without the vitamin injection. 

FIGURE 11.8 Plasma Vitamin E concentration after oral administration of a Vitamin E solid dispersion. Key ( ) PEG-32 glyceryl laureate (Gelucffe44/14) solid dispersion and commercial product. (Adapted from Barker, S.A., Yap, S.P., Yuen, K.H., McCoy, C.P., Murphy, J.R., and Craig, D.Q.M. (2DGQ>ntrol. Rel., 91 477-488.)... 

Vitamin B12. Vitamin B12 is a larger molecule than the other vitamins, and it can be absorbed via the intestine, which involves binding to specialized transport proteins.44 After oral administration, vitamin B12 binds to intrinsic factor (IF) produced from the parietal cells in the stomach and proximal cells in the duodenum. The vitamin B12—IF complex passes down the small intestine until it reaches the ileum, where the complex binds to a specific IF receptor located on the apical membrane of the villous enterocyte. The complex is then internalized via RME, vitamin B12 is released from IF by the action of cathepsin L on IF, and free vitamin B12 consequently forms the complex with transcobal-amin II to be delivered into the basolateral side of the membrane via the transcytotic pathway. 

Vitamin B12 is available in pure form for oral administration or in combination with other vitamins and minerals for oral or parenteral administration. The choice of a preparation always must be made with recognition of the cause of the deficiency. Although oral preparations may be used to supplement deficient diets, they are of relatively little value in the treatment of patients with deficiency of intrinsic factor or ileal disease. Even though small amounts of vitamin B12 may be absorbed by simple diffusion, the oral route of administration cannot be relied upon for effective therapy in the patient with a marked deficiency of vitamin B12 and abnormal hematopoiesis or neurological deficits. Therefore, the preparation of choice for treatment of a vitamin B12-deficiency state is cyanocobal-amin, and it should be administered by intramuscular or deep subcutaneous injection. 

The bisulphite addition compounds have a vitamin K activity equal to that of the 2-methyl-l,4-naphthoquinone contained in the molecule. The compounds, although suitable for oral administration, are particularly adaptable in aqueous solution for parenteral administration in the treatment of hemorrhagic conditions. 

Nl, Nyberg, W., Absorption and excretion of vitamin B12 in subjects infected with Di-phyllobothrium latum and in non-infected subjects following oral administration of radioactive B12. Acta Haematol. 19, 90-92 (1958). 

Schilling, R. F., Intrinsic factor studies. II. The effect of gastric juice on the urinary excretion of radioactivity after the oral administration of radioactive vitamin B12. /. Lab. CUn. Med. 42, 860-866 (1953). 

Emulsions have been used for centuries for the oral administration of medical oils and vitamins and as dermatological vehicles. Recently, their application has been extended as drug carriers in the delivery and targeting of ophthalmic drags. An indomethacin emulsion has been reported to increase ocular bioavailability and efficacy compared to commercially available formulation in rabbits. 0.4% indomethacin emulsion showed 2.2 fold increase in the area under the anterior aqueous drag concentration/time curve compared to a 1% indomethacin suspension. The emulsion formulation also reduced ocular surface irritation caused by indomethacin Similar advantages have been shown for a pilocarpine emulsion which produced a prolonged therapeutic effect in comparison with pilocarpine hydrochloride eyedrops in man. It can be administered only twice a day, rather than four times daily for conventional formulation. 

The correct answer is B (excretion depends on the kidney). Most of the p-lactam antibiotics depend on the kidney for excretion. Ceftazidime is predominantly eliminated by glomerular filtration. Thus in this patient the dose of ceftazidime would have to be modified due to the patient s renal status. A (effective on oral administration) is incorrect. Ceftazidime is only given par-enterally. C (interferes in vitamin K function to cause an anticoagulant effect) is incorrect. This property is peculiar to cefoperazone and cefamandole. D (causes ototoxicity at high serum levels) is not correct. E. Ceftazidine is administered IV or intramuscularly (IM). 

Coumarins are well absorbed after oral administration. Their duration of action varies considerably. Synthesis of clotting factors depends on the intrahepatocytic concentration ratio between coumarins and vitamin K. The dose required for an adequate anticoagulant effect must be determined individually for each patient (monitoring of the International Normalized Ratio, INR). 

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