VITAMINS VITAMINS Are organic molecules essential in small quantities for healthy nutrition in man It used to be vitamines because

e they think it was something derived from amino acid proteins. Only they did find out that it was actually that it does not contain amino acids so they dropped the E. The main difference in addition to its solubility in fats, is the tendency to accumulate as opposed to water soluble vitamins which are easily excreted out. There is some degree of overtoxicity with fat soluble vitamins, no overdosage for water-soluble. Your body will take what it is needed and what is not needed is excreted and it results to yellow urine

FAT SOLUBLE vs. WATER-SOLUBLE FAT SOLUBLE VITAMINS fat soluble vitamins are A,D,E,K WATER SOLUBLE VITAMINS Vitamins C, D, and your B complexes. VITAMIN A Generic name for compounds that exhibit biological properties of Retinol Retinol comes mainly in the form of carotene which is a provitamin, an inactive vitamin in stored form, and there is beta-carotene, the main active form. CAROTENE (PROVITAMIN A)- purified plant source BETA CAROTENE- most active - yellow & green fruits & vegetables In foods where you find cholesterol, you find vitamin A.

the only consolation in cholesterol is there is vitamin A from it. Most vitamins from fat and water soluble are derived from the same sources. beta-carotene is the chief type of carotene used in vitamin A.

MAJOR DIETARY SOURCES: liver, butter, cheese, whole milk, egg yolk &

fish VITAMIN A structure

the structural formula for retinol is something associated to the structure of prostaglandins, so retinol is the primary alcohol type of vitamin A.

VITAMIN A

FUNCTIONS:

Plays an essential role in the functions of the retina. (thats why the main manifestation in its deficiency is the problems related to the vision, especially in dim light- NIGHT BLINDNESS) Growth & differentiation of epithelial tissues. Bone, reproduction & embryonic development.

FORMS: Retinal aldehyde form, functional vitamin in vision and maintenance of the retina Retinol alcohol form, responsible for actions in reproductive processes Retinoic acid active form associated with growth, differentiation and transformation Retinoic acid is also an agent that you can use for pharmacologic reasons, maybe because if you want to have a complexion of a movie star, you can eliminate wrinkles by application of retinoic acid continuously for two years, because it tends to preserve and optimize the basal epithelium. RETINOL Its adequate supply is responsible for the functional and structural integrity of epithelial cells Plays a major role in the induction and control of epithelial differentiation in mucus-secreting or keratinizing tissues Basal epithelial cells are stimulated to produce mucus In excess, leads to production of thick layer of mucin, inhibition of keratinization and display of goblet cells Absence leads to disappearance of goblet mucous cells, atrophy of epithelium, and proliferation of basal cells --- Stratified, Keratinizing Epithelium THE VISUAL CYCLE

More potent function of vitamin A is in vision RHODOPSIN BATHORHODOPSIN LUMIRHODOPSIN METARHODOPSIN I METARHODOPSIN II II- CIS RETINAL II- CIS RETINOL ALL-TRANS-RETINAL + OPSIN ALL TRANS-RETINOL

the aldehyde form of vitamin A which is participating in vision, especially night vision, the aldehyde form in its 11-cis configuration combines with the protein opsin to form what is known as the visual purple, that's rhodopsin. 11-cis-retinal is the preferred configuration for the visual purple. 11-cis retinal plus the protein opsin gives the visual purple known as rhodopsin. Rhodopsin once subjected to light becomes very unstable, there is the tendency of opsin to immediately dissociate upon introduction of a photon of light. Light destabilizes rhodopsin and you have first bathorodopsin that is already in the form that tends to dissociate 11-cis-retinal from opsin. Bathorodopsin dissociates to lumirhodopsin, lumirhodopsinn to metarhodopsin I and then metarhodopsin II. These steps in the destabilization of rhodopsin stimulate a protein known as transducin which sensitizes the optic nerve. It is the protein transducin that is stimulated by this cascade of destablizing effect of bathorhodopsin to stimulate transducin which in turn stimulates the optic nerve. And it is at this point that vision becomes possible. So, metarhodopsin eventually dissociates into 11-trans retinal + opsin, and you will see here the different reactions leading to the eventual derivation of cis-retinal. Ang importante pa rin is to derive 11-cis-retinal for it to be conjugated with opsin, because if you don't get the 11-cis retinal configuration, then it is very impossible for you to join it with the opsin of the protein. It is in this form that you should get back rhodopsin. So rhodopsin is the visual purple, upon introduction of light, it is the destabilized. In the cascade of events, rhodopsin eventually is broken to 11-cisretinal thereby the stimulation of transducin which bring about vision SIGNS & SYMPTOMS OF VITAMIN A DEFICIENCY EYES- Nyctalopia & Keratomalacia (dessication, ulceration and xerosis of the cornea and conjunctiva) nyctalopia or night blindness keratomalacia refers to the drying effect and ulceration of the cornea and the conjunctiva BRONCHORESP.- decreased mucus function, keratinization, increased incidence of resp infections There is decreased mucus function so you expect them to have dry hacking cough, not a productive cough, opposite effect, decreased respiration due to increased mucus production SKIN- keratinization and drying of epidermis GENITOURINARY- urinary calculi

formation of stones mainly because of the crystallization of urine that is retained in the urinary system and SWEAT GLAND- atrophy, keratinizing squamous-cell metaplasia There is atrophy and keratinization of the mucous membranes.

HYPERVITAMINOSIS A Drying of skin, skin desquamation, erythematous dermatitis, fissures of lips, pain & tenderness of bony prominences, headaches (peculiar presentation in hypervitaminosis) VITAMIN K Since this agent participates in coagulation, they used Koagulation in German and vitamin c is discovered earlier than vit k Vitamin K is the active agent for activation of several factors required for coagulation, not for synthesis but activation. This agent, II, VII, IX, X are already present in the system, in the liver. The only difference is that they need to be activated, and the function of vitamin K is to activate these four coagulation factors. The factors are activated by this residue, gamma carboxyglutamic acid. The function of vitamin K is to cause the incorporation of II, VII, IX, X for it to be possible to affix the gamma carboxyglutamic acid . The addition of this gamma, you have now the activation of II, VII, IX, X. II prothrombin VII - proconvertin IX - Christmas/PTC X - Stuart - bridge between extrinsic and intrinsic pathway. Dietary principle essential for normal biosynthesis of several factors required for clotting of blood an essential cofactor for a microsomal enzyme system for the activation of the Vit. K-dependent factors by incorporation of GAMMACARBOXYGLUTAMIC ACID residues Dam gave the name Vitamin K (Koagulation vitamin) FORMS: IMPORTANT!!! VITAMIN K1- PHYTONADIONE (Phylloquinone) Found in plants ( in the chloroplast) Only natural vitamin K available for therapeutic use VITAMIN K2- MENAQUINONE Synthesized by gram-positive bacteria VITAMINE K3- MENADIONE As active on a molar basis as phytonadione synthetically derived In clinics, it is vitamin K3 and K1 that is widely utilized because they are easy to control. COAGULANTS use in some patients wherein there are problems with clotting

Sometimes we use intravenous and parenteral preparation like heparin synthesized by the mast cells of the liver and heparin is an anticoagulant normally reversed by protamine sulfate. There is also an anticoagulant wherein the patient is shifted in tablet form and we call this Warfarin. warfarin is an anticoagulant is normally inhibited by vitamin K, that's why if we give the patient warfarin or coumadin, we should have vitamin K at hand always How do you check coagulation factors? Bleeding or clotting time? What? It's clotting time. You check clotting time to check the integrity of the coagulation cascade, bleeding time for platelet function. If the bleeding time is prolonged, there is a problem in the number of platelets/function. If your clotting time is prolonged, in the coagulation cascade, whether intrinsic/extrinsic or both. Now, when you are using a particular drug which is warfarin, this blocks the vitamin K dependent factors, that's why the antidote of Warfarin is vitamin K. Warfarin is a medication that you sometimes use at home for the use of poisoning from some visitors. ( RATS) Warfarin stands for winscosin alumni research foundation In patient who is bleeding or with liver disease the coagulation system is at fold. Vitamin K is important factor to see especially its range because the liver has difficulty in synthesizing the vitamin k dependent coagulation factor.

MAJOR DIETARY SOURCES: green leafy vegetables, cabbage, liver Present in hog liver fat, alfalfa, chloroplasts of plant leaves and in many vegetable If you are using Coumadin or warfarin you are advise to avoid eating vegetables which are high in Vitamin k. VITAMIN K structure

FUNCTION: (not?)HEPATIC BIOSYNTHESIS but for HEPATIC ACTIVATION (main function) OF: Factor II- PROTHROMBIN Factor VII- PROCONVERTIN Factor IX- PTC, CHRISTMAS FACTOR Factor X- STUART

SYMPTOMS OF DEFICIENCY: Increased tendency to bleed Ecchymoses Epistaxis Hematuria Gastrointestinal bleed Post-operative hemorrhage Intracranial Hemorrhage Hemoptysis (uncommon) Intracranial hemorrhage and hemoptysis are the threatened symptoms. VITAMIN E Alpha-tocopherol, similar with the chemistry and function of coenzyme Q10 Antisterility Vitamin in lower vertebrae not for humans MAJOR DIETARY SOURCES: Wheat germ, nuts, legumes, green leafy vegetables, veg,oils VITAMIN E structure

The only difference in structure with the coenzyme q10 is that the coenzyme q10 has isoprenoid tail but both are similar in antioxidant function. FUNCTIONS: Antioxidant Prevents oxidation of essential cellular constituents i.e. ubiquinone (Coenzyme Q) Prevents the formation of toxic oxidation products Has striking structural similarity to Coenzyme Q Antisterility vitamin in lower vertebrae Little evidence of nutritional significance in man If you want to reduce the effect of cholesterol which is high, vit e is a good agent to use. It was studied before that youre cholesterol level will not settle down unless your vit e has highly concentration.

 Intake of LDL which becomes foam cells will only happen when LDL is oxidized, so when youre vit e is high ( taking 400 units of vit.e/ day) you are protective in atherosclerosis becauase LDL will not be oxidized. *Intestinal absorption of Vitamin A is enhanced by Vitamin E SYMPTOMS OF DEFICIENCY (in lower vertebrae and in animals) NERVOUS SYSTEM- axonal degeneration REPRODUCTIVE SYSTEM- degeneration of germinal epithelium MUSCULAR SYSTEM- muscular dystrophy ( possible in man because this is the theory in ERBS DUCHENNE MUSCULAR DYSTROPHY ) HEMATOPOIETIC SYSTEM- disturbed hematopoiesis VITAMIN D Cholecalciferol Great significance in man Considered as hormone and is already preformed in the body Plays a major role in the precise control of the concentration of calcium ion in plasma Synthesized in the skin by the stimulating effect of ultraviolet radiations then transported by blood to distant sites in the body, where it is activated to affect target tissues.\

Present in our body (skin) as 7 DEHYDROCHOLESTEROL upon exposure to uv radiation it is converted vit D3 ( cholecalciferol in the blood) then transported to the liver for the initial hydroxylation process. Cholecalciferol is hydroxylated to 25 dihydrocholecalciferol (calcifediol) in the liver. Then transported to liver where it undergoes second hydroxylation process. In renal mitochondria with the participation of molecular oxygen and NADPH it is hydroxylated to 1, 25 dihydrocholecalciferol (calcitriol).

MAJOR DIETARY SOURCES: Cod-liver oil, eggs, dairy products, fortified milk and margarine Functions to promote growth and mineralization of bones, Increases absorption of calcium and phosphorous in small intestines DEFICIENCY: Rickets (children) Osteomalacia (adults) VITAMIN D structure

Cyclopenthano perhydro penanthrene ring (ISRAEL!!!).Cholesterol is not entirely bad, it should not be in excess. FUNCTION: Positive regulator in calcium and phosphate homeostasis Facilitates absorption of Ca & PO4 in the small intestine Enhance their mobilization from the bone Decrease their excretion by the kidneys ***the bottom line is tries to maintain the serum calcium level at normal level CALCIUM DEFICIENCY- muscle cramps, when you have decrease calcium, muscle is hyperpolarized and easy to cause muscle contraction because calcium is the relaxing factor so there is no relaxation what,you have is heightened tetanic contraction which you feel as muscle cramps. TREATMENT: take calcium tablet for 3 to 5 days LATE SIGNS OF HYPOCALCEMIA Chvostek sign- try to tap the facial nerve and you can have tetanic contractions in ipsilateral side of the face Torseug sign- you stimulate this when you get the blood pressure cuff and put it midway in the pulse pressure and you have carpal spasm Main d accocheur- you have carpal spasm without any trigger it can be elicited by letting your patient hyperventilate. (Also known as HYSTERY???) You can see this sign in parathyroid problems. VITAMINS & VITAMIN-LIKE NUTRIENTS WATER-SOLUBLE VITAMINS THIAMINE (B1) Precursor of co-enzyme THIAMINE PYROPHOSPHATE ( krebs cycle)

 Helps the body to convert food into energy and aids in the function in the heart, brain and nervous system. DEFICIENCY: BERI-BERI- a form of cardiovascular disease that is manifested as anasarca, hypotension, pronounce vasodilatation that is massive because you lose the integrity of the vessels when you have this disease. Sometimes termed as WET BERI BERI because of the CONGESTIVE HEART FAILURE

RIBOFLAVIN (B2) Precursor of FMN & FAD ( respiratory chain and krebs cycle)

DEFICIENCY: may lead to growth retardation

NICOTINIC ACID/ NIACIN (B3) Precursor of NAD( glycolysis), NADP (HMP shunt) Only agent pharmacologically available that can lower down your both cholesterol and triglycerides at the same time but its side effect is pruritus and burning sensation in the entire body. To escape with the side effect take aspirin 30mins before getting nicotinic acid. If triglycerides are high, this is the risk factor for hemorrhagic pancreatitis. ( BANGUNGOT- the only Filipino termed included in HARRISONS book. :- ) Start treating triglycerides when it exceed to 200mg/dl, when it is 400mg/dl it is in danger zone The number one treatment for increased triglycerides is increase activity Fibrates are the pharmacological treatment for increase triglycerides.

Deficiency: leads to PELLAGRA

PANTOTHENIC ACID (B5) Precursor or Coenzyme A Deficiency: Dermatitis in chicken BIOTIN (B7) Precursor of enzyme BIOCYTIN Deficiency: Dermatitis in MAN PYRIDOXINE (B6) Precursor of Coenzyme PYRIDOXAL PO4

Deficiency: DERMATITIS

FOLIC ACID (B9) Precursor of Co-enzyme TETRAHYDROFOLIC ACID Deficiency: ANEMIAS ( megaloblastic anemia) CYANOCOBALAMIN (B12) ( extrinsic factor ) Precursor of Co-enzyme DEOXYADENOSYL COBALAMIN ( important in rbc formation ) Leads to PERNICIOUS ANEMIA WATER-SOLUBLE VITAMINS ASCORBIC ACID (Vitamin C) Co-substrate in HYDROXYLATION of PROLINE in COLLAGEN Good agent that protects you from viral infection ( influenza ) Hasten the injury to rapidly resolved Epistaxis- one way to strengthen the blood vessels is to take ascorbic acid Cataracts- the first enzyme that will convert water into sorbitol is blocked by ascorbic acid One factor that may protect you from developing cancer. Deficiency leads to SCURVY - bleeding in gums lips and nose because of the loss of integrity in the blood vessels.

Cell membrane in the cell has phospholipids. The phospholipids are phosphatidylcholine, phosphatidylinositol,

phosphatidylcerine and phosphatidylethanolamine

In almost all pathologic and physiologic processs you have oxidation of the

four for the formation of arachidonic acid.

Arachidonic acids will give prostaglandin with 2 subtrates. If It has

prostaglandin with 1 substrate it is linoleic acid.

With 3 substrates- EICOSAPENTHAENOIC ACID- seen in fish oil The enzyme is phospholipase c In every peristaltic contraction this happens- phospholipase will remove the

arachidonic in phosphatidyl. Arachidonic has 2 competing system ( lipooxygenase and cyclooxygenase)

This will lead to formation of radicals. Leukotriene a, b, e and f are collectively known as SRSA. PGA PGB PGC PGD PGD-PGE PGI2 PGF2 ALPHA TROMBOXANE AGENT If you are asthmatic probably you have high levels of pgf2 alpha- treatment is pge Pgf is also the prostaglandin that causes contraction during parturition. Pge will produce pain- mefenamic acid to block cyclooxygenase to block formation of pge Thre are very strong reciprocal between the pgi and the thromboxane. Pgi will cause increase in atp, cylic amp,vasodilatation, platelet dispersion. Thromboxane- not causes atp to increase. Aspirin is given to inhibit the effect of thromboxane in patient with ischemia in low dose. Asthmatic- be sure you are not allergic to aspirin. Benzane will block cyclooxygenase and the pathway will go to lipooxygenase pathway which more potent to bronchoconstriction that will lead to respiratory arrest. Carnitine will promote the movement of fatty acid to mitochondria then converted to enery via omega and beta oxidation.

VITAMINS FOR SPIRITUAL BODY VITAMIN A-ttendance in church service, & offering ourselves to the LORD. VITAMIN B-ible study, we need this daily to gain more knowledge about GOD. VITAMIN C-hristian service, showing our Love & kindness to everyone VITAMIN D-aily prayer, dont forget to communicate with GOD.