‫جامعة اببل ‪ /‬لكية طب الاس نان‬

‫قسم العلوم ا ألساس ية‬

‫مادة الادوية‬

‫‪VITAMINS‬‬
‫اعداد‪:‬‬
‫حوراء عارف كظم‬ ‫•‬
‫زهراء أأنور غن‬ ‫•‬
‫زينب محمد محزة‬ ‫•‬
‫سارة صاحل عبد الكري‬ ‫•‬
‫حوراء عيس محمد‬ ‫•‬
‫ارشاف‪ :‬ادلكتور أأزهر عبد الافظ‬ ‫جنان حات زويد‬ ‫•‬
INTRODUCTION
Vitamins: The name “vitamin” comes from Casimir Funk, who in 1912 thought “vital
amines” (similar to amino acids) were responsible for preventing what we know now as
vitamin deficiencies. He coined the term “vitamins” to describe these organic substances that
were recognized as essential for life, yet unlike other organic nutrients (carbohydrates,
protein, and fat), do not provide energy to the body. Eventually, when scientists discovered
that these compounds were not amines, the ‘e’ was dropped to form the term “vitamins.

Vitamins are organic compounds that people need in small quantities. Most vitamins need to
come from food because the body either does not produce them or produces very little, A
vitamin is an organic compound, which means that it contains carbon. It is also an essential
nutrient that the body may need to get from food.
CLASSIFICATION:
1. Water Soluble Vitamins: Vitamin B1, B2, B3, B6, B9, B12 and Vitamin C
2. Fat soluble Vitamins: Vitamin A, D, E and K
One major difference between water-soluble and fat-soluble vitamins is the way they are
absorbed in the body. Water-soluble vitamins are absorbed directly from the small intestine
into the bloodstream. Fat-soluble vitamins are first incorporated into chylomicrons, along
with fatty acids, and transported through the lymphatic system to the bloodstream and then
on to the liver. The bioavailability (i.e., the amount that gets absorbed) of these vitamins is
dependent on the food composition of the diet. Because fat-soluble vitamins are absorbed
along with dietary fat, if a meal is very low in fat, the absorption of the fat-soluble vitamins
in that meal may be impaired.

1-Water Soluble Vitamins

Thiamine (vitamin B1)
Is a water-soluble vitamin that acts as an essential cofactor for various pathways of
carbohydrate metabolism. Thiamine also acts as a cofactor in the metabolism of glyoxylic
acid. It is absorbed rapidly after oral, intramuscular, or intravenous administration. However,
parenteral administration is recommended for initial management of thiamine deficiency
syndromes.

Food sources: Vegetables: green peas, lima beans, potato, sunflower seeds, tomatoes,
and eggplant, Fruits :oranges and dairy products like yoghurt, cheddar cheese and milk,
Animal sources: are sea fishes like tuna, salmon, mussels and pork and beef.

Mechanism of Action: Thiamine exerts it`s action by influencing carbohydrate metabolism.

It combines with ATP to form thiamine pyrophosphate in the body. Thiamine pyrophosphate
acts as a coenzyme for carbohydrate metabolism, decarboxylation of ketoacids, and hexose
monophosphate shunt. It also has played some role in neuromuscular transmission.

Functions: Carbohydrate metabolism and energy production, Vitamin B1 regulates the

functioning of the nervous system, heart and brain, it is also prescribed to AIDS patients to
partly compensate for the loss of immunity caused by the disease, Vitamin B1 is important to
maintain mental health. It may also reduce the likelihood of memory impairments and
diseases like Alzheimer's.

Vitamin B1 Deficiency Symptoms: A deficiency of vitamin B1 commonly leads to beriberi,

a condition that features problems with the peripheral nerves and wasting. Weight loss and
anorexia can develop. There may be mental problems, including confusion and short-term
memory loss. Muscles may become weak, and cardiovascular symptoms can occur, for
example, an enlarged heart.

The causes of B1 deficiency :Thiamine deficiency is fairly uncommon in developed

countries. However, various factors may increase your risk, including: 1) Alcohol
dependence 2) Old age 3) HIV/AIDS 4) Diabetes 5) Bariatric surgery 6) Dialysis. 7)High-
dose diuretic use.

Vitamin B2
Vitamin B2, or riboflavin, is one of eight B vitamins that are essential for human health. It is
crucial for breaking down food components, absorbing other nutrients, and maintaining
tissues. People need to consume vitamin B2 every day, because the body can only store
small amounts, and supplies go down rapidly. Most of it is absorbed Trusted Source in the
small intestine.

Good sources: Vitamin B2 (Riboflavin) can be found in most plant and animal products in
considerable amounts. Our body forms but does not store riboflavin. Some good sources of
riboflavin are; Cheese, Milk, Eggs, Meat, Liver , Beef, Kidneys, Mushrooms , Legumes,
Broccoli , Spinach , Rice, Salmon .Riboflavin can be easily destroyed by exposure to bright
light, so its important to keep these foods out of direct sunlight.

Functions: Essential for the production of energy in the body to support metabolic
processes, Helps in the maintenance of normal skin and mucous membranes, It is essential in
the maintenance of normal red blood cells, Plays a role in the maintenance of normal vision.

Mechanism of action :Binds to riboflavin hydrogenase, riboflavin kinase, and riboflavin

synthase. Riboflavin is the precursor of flavin mononucleotide (FMN, riboflavin
monophosphate) and flavin adenine dinucleotide (FAD). The antioxidant activity of
riboflavin is principally derived from its role as a precursor of FAD and the role of this
cofactor in the production of the antioxidant reduced glutathione. Reduced glutathione is the
cofactor of the selenium-containing glutathione peroxidases among other things. The
glutathione peroxidases are major antioxidant enzymes. Reduced glutathione is generated by
the FAD-containing enzyme glutathione reductase
.
Medications that cause riboflavin (vitamin B2) deficiency:If you use phenobarbital long
term, it may increase how quickly riboflavin is broken down in your body, leading to a
reduction in riboflavin over time.
Vitamin B2 Deficiency Symptoms: Fatigue, Depression, Memory impairment, Brain
dysfunction, Central nervous disorders Difficulty in breathing Fast pulse, Metabolic acidosis
Anorexia, Indigestion Beri - Beri disease Inefficiency.
Vitamin B3
It is also called niacin, helps convert food into energy. It also aids in proper digestion and
healthy appetite, and is important for cell development.

The most prominent sources of vitamin B3 are:Vegetarian sources include avocado,

mushrooms, sweet pepper, and potatoes. Dairy sources include milk, cheddar cheese, whole
milk. Grain products include all fortified breakfast cereals, pasta, and bread.
Rice, wheat, and corn.
Animal sources include sea fishes like tuna, salmon, sardines including egg, chicken .
Vitamin B3 is very stable and does not gets destroyed easily, hence the food sources can be
cooked and consumed.

Functions: it is playing a key role in lowering cholesterol and triglyceride levels in the
blood. B3 vitamin helps in lowering the low-density lipoproteins (i.e. LDL or bad
cholesterols) and effectively increases the high-density lipoproteins (i.e. HDL or good
cholesterol), It is also extremely effective in treating the hardening of the arteries, It plays a
key role in managing diabetes, Vitamin B3 is also essential in improving the cognitive
functioning of the brain. It is also used for preventing and treating Alzheimer’s disease, It
also potentially reduces the risk of skin cancer.

Mechanism of Action: Niacin inhibits a hormone-sensitive lipase in adipose tissue which

reduces the breakdown of triglycerides to free fatty acids, and the transport of free fatty acids
to the liver. The reduction in transport of free fatty acids from fat to liver decreases hepatic
triglyceride synthesis the reduction in hepatic triglyceride synthesis inhibits VLDL secretion
from hepatocytes, which in turn decreases the production of LDL.
The catabolic rate for HDL is decreased.

Medications that cause niacin (vitamin B3) deficiency

Several medications may cause niacin deficiency by making it harder for your body to
convert tryptophan (an amino acid found in foods) to niacin.
1. Isoniazid, is used for treatment of tuberculosis.
2. 5-fluorouracil (5FU) is used for the treatment of colon, breast, and stomach cancer.
3. 6-mercaptopurine, an immunosuppressant used to treat cancer and autoimmune
diseases
4. Phenobarbitalis an antiepileptic medication
5. Azathioprine (Imuran) is an immunosuppressant used after an organ transplants.

Symptoms of vitamin B3 deficiency: digestive issues , Severe deficiency may also cause
mental confusion, Severe deficiency can result in a condition called pellagra, with symptoms
such as: rough skin that turns red or brown in the sun, a bright red tongue, vomiting,
diarrhea, suicidal behavior, hallucinations

Vitamin B6 (pyridoxine)
Pyridoxine is a colorless compound soluble in water and alcohol. It is well absorbed in the
upper segment of the small intestine. It is stored in muscle but found in tissues throughout
the body.
Functions: Production of red blood cells, It is readily absorbed from intestines., Improves
immunity.,Improves nervous system fonctions,Reduce muscle spasms, cramps and
numbness, Maintains proper balance of sodium and phosphorous in the body.

Food sources of Pyridoxine: Good food sources include whole grains, legumes,
bananas, potato, liver, kidney and other meats, fortified breads and cereals. Sunflower seeds,
soya beans, walnuts and yeast are the richest sources of pyridoxine among plant foods.

Symptoms of Vitamin B6 Deficiency: Nervousness, Insomnia, Anaemia, oedema,

mental depression.,Loss of muscle control, muscle weakness, tooth decay,Arm and leg
cramps, Water retention, Skin lesions and skin disorder,Vitamin B6 deficiency is usually
caused by pyridoxine-inactivating drugs (e.g., isoniazid), protein-energy undernutrition,
malabsorption, alcoholism, or excessive loss.
Medications that cause vitamin B6 (pyridoxine) deficiency

• Isoniazid is a medication used to treat tuberculosis, and it inhibits the enzyme needed for
your body to activate vitamin B6.
• Hydralazine is a medication used for the treatment of high blood pressure that has also
been shown to improve survival in heart failure patients.Vitamin B6 can bind to hydralazine
to form a substance that is excreted in your urine, increasing vitamin B6 loss.
• Levodopa/carbidopa: is used for the treatment of Parkinson’s disease and may lead to B6
deficiency. Carbidopa binds to and deactivates the active form of vitamin B6.

Vitamin B9(FOLIC ACID):

Folic acid is one of the B vitamins and derives its name from being a bacterial growth factor
present in spinach leaves. Folate is widely distributed, notably in green vegetables, fruits,
yeast and liver, and is found in nature conjugated with glutamate.
FUNCTIONS: Folic acid helps the body to convert carbohydrates into glucose, which is
used to provide energy, Folic acid helps in building of antibodies which prevent and heal
infections, It helps in normal functioning of the nervous system and maintains the mental and
emotional health, It helps in production of body’s generic material - DNA and RNA.
Note: Folic acid (higher dose) should be given to mother throughout pregnancy; neonatal
hemolysis and methemoglobinemia reported in third trimester.
SIDE-EFFECTS :Abdominal distension . appetite decreased. flatulence. nausea. vitamin
B12 deficiency exacerbated.
Symptoms of folic acid deficiency: Fatigue, tongue-swelling, mouth sores, Pernicious
anaemia, megaloblastic anaemia.
The most common causes of folate deficiency are:
• Inadequate intake (usually in patients with undernutrition or alcoholism)
• Increased demand (e.g., due to pregnancy or lactation)
• Impaired absorption (e.g., in celiac disease or due to certain drugs)
Medications that cause vitamin B9 deficiency
• Methotrexate is used for the treatment of rheumatoid arthritis, psoriasis, lupus, Crohn’s
disease, ulcerative colitis, and some cancers. It inhibits an enzyme (dihydrofolate reductase)
that helps your body convert folate from foods, which in turn depletes the pool of folate in
your body.
• Phenytoin (Dilantin), a medication used for the prevention of seizures, makes it harder for
your body to absorb folate.
• Trimethoprim is an antibiotic commonly used for urinary tract infections (in the
combination sulfamethoxazole/trimethoprim, aka Bactrim) that also interferes with an
enzyme important in the conversion of folate.
• Metformin has been reported to decrease your absorption of folate.
Vitamin B12 (Cyanocobalamin)
The vitamin is named as cyanocobalamin, because of the presence of cobalt and cyanide in
its structure. It can be absorbed in the body only in the presence of intrinsic factor (IF).

Functions: It is essential for the production and regeneration of red blood cells, It
improves concentration, memory and balance, It synthesizes and regulates DNA, It plays an
important role in normal functioning of brain and nervous system, It also helps to absorb
folic acid.

Food Sources of Vitamin B12: Cyanocobalamin is synthesized by bacteria and is

found in foods of animal origin. Liver is the richest source of cyanocobalamin. Meat,
chicken, oysters, eggs, fish, milk, curd, cheese are good sources of Vitamin B12.

Symptoms of Vitamin B12 Deficiency: Weakness, tiredness, or lightheadedness,

Heart palpitations and shortness of breath Pale skin, A smooth tongue, Constipation,
diarrhea, loss of appetite, or gas, Nerve problems like numbness or tingling, muscle
weakness, and problems walking, Vision loss, Mental problems like depression, memory
loss, or behavioral changes.

Causes of vitamin B12 deficiency: A vegetarian diet, taking some medications

(proton pump inhibitors, some diabetes medications: which may include Metformin),
diabetes or autoimmune diseases, regular alcohol consumption, advanced age, gastritis,
pernicious anemia

VITAMIN C (ASCORBIC ACID)

Vitamin C is also known as ascorbic acid. It is an antioxidant and water-soluble vitamin.
During cooking much of it is destroyed. When the vegetables are cut into fine pieces more
enzymes are released and it causes more loss. Vitamin C is essential in cholesterol
metabolism.
Function of Ascorbic acid: is required for the synthesis of collagen. It is also a
powerful reducing agent (antioxidant) and plays a part in intracellular oxidation-reduction
systems, and in mopping up oxidants (free radicals) produced endogenously or in the
environment, e.g., cigarette smoke.
Sources: Red and green peppers, Oranges and orange juice, Grapefruit, Kiwifruit,
Strawberries, Spinach and other green, leafy, vegetables, Tomatoes, Potatoes, Green peas.
SIDE-EFFECTS: High doses may cause sleep disturbances, headaches and gut upsets.
Ascorbic acid is eliminated partly in the urine unchanged and partly metabolized to oxalate.
Doses above 4 g/day (taken over long periods in the hope of preventing coryza) increase
urinary oxalate concentration sufficiently to form oxalate stones. Intravenous ascorbic acid
may precipitate a hemolytic attack in subjects with glucose-6-phosphate dehydrogenase
deficiency.

Symptoms of Vitamin C deficiency: Gums swell and bleed and become purple and
spongy. This is known as pyorrhea, Foul smell emits from the mouth, Deficiency can lead to
scurvy in which a slight injury produces excessive bleeding and large hemorrhages are seen
under the skin, There is tenderness, swelling and pain in the limbs, Reduced immunity
causes simple infections like common cold, flu- viral, etc, Irritability, anemia, poor wound
healing and Diarrhea, Gastrointestinal discomfort, Weight loss, fatigue and joint pain.

Causes Of Vitamin C Deficiency: Consumption of alcohol on a daily basis, eating

disorders or neurological problems. Disabilities. Metabolism or digestion problems.
Problems with the immune system. Drought. Smoking. Use of a severe or specific diet.
Low income, exposure to chemotherapy or radiotherapy sessions. Kidney failure and
dialysis.
2-Fat soluble Vitamins
Vitamin A
Vitamin A was discovered in 1909 and its chemical name is retinol. The vitamin A
compounds include retinol, retinal and retinoic acid. It has a specific function in the retina of
the eye.

Functions: It provides the required stimulation for vision in the retina and is essential for
maintaining normal vision, it helps in maintaining healthy skin and epithelial tissues, It is
important for proper growth of bones, It helps in normal fetus development, It protects the
mucous membrane of the digestive, respiratory and urinary tracts against infection.

Food Sources of Vitamin A: Vitamin A is present as retinol in animal sources such as egg
yolk, liver. In plants, it is found in the form of carotene which gets converted to vitamin A in
the body. Carrot, turnip, mango, pumpkin, tomatoes, green leafy vegetables, whole milk, etc.

Causes Of Vitamin A Deficiency:

Primary vitamin A deficiency is usually caused by Prolonged dietary deprivation. It is
endemic in areas such as southern and eastern Asia, where rice, devoid of beta-carotene, is
the staple food.
Secondary vitamin A deficiency may be due to: Decreased bioavailability of provitamin
A carotenoids, Interference with absorption, storage, or transport of vitamin A, Interference
with absorption or storage is likely in celiac disease, cystic fibrosis, pancreatic
insufficiency, duodenal bypass, chronic diarrhea, and cirrhosis

Symptoms of Vitamin A deficiency

Night blindness: Initially there is itching, burning and inflammation of eyelids and the
person gradually loses vision to see in the dim light.
Keratomalacia: This occurs due to poor intake or poor absorption of vitamin A. When
conjunctival xerosis is not treated it may develop into a condition known as keratomalacia.
Cornea becomes dull.
Xeropthalmia: This occurs in which the eyes become thickened, wrinkled and extremely
dry followed by progressive cloudiness.
Pitot's spot: Silver grey foamy deposits on the delicate membranes covering the whites of
the eyes.

SIDE-EFFECTS: Overdose Massive overdose can cause rough skin, dry hair, an enlarged
liver, and increases in erythrocyte sedimentation rate, serum calcium and serum alkaline
phosphatase concentration.

PREGNANCY: Excessive doses may be teratogenic. In view of evidence suggesting that

high levels of vitamin A may cause birth defects, women who are (or may become) pregnant
are advised not to take vitamin A supplements, except on the advice of a doctor .

Vitamin D
Vitamin D is otherwise known as ‘sunshine vitamin’ as it can be synthesized from sunlight
by our body. In the absence of exposure to sunlight a daily intake of 400 IU vitamin D is
suggested. Vitamin D is produced under the skin after exposure to ultraviolet rays.

Functions: It helps in the formation of bones and teeth, it helps to increase the absorption
of calcium and phosphorus, it helps in increase of citrate content in bones and blood.

Sources of Vitamin D: Sunlight, Food products (Cod liver oil, liver, salmon and
herring fish, fortified milk, egg yolk, butter, cheese, ghee, cream, fortified milk, etc.)

The medications can cause low vitamin D levels?

1. Phenytoin and phenobarbital are used to treat seizure disorders. It’s recommended
that folks taking these medications also take vitamin D supplements.
2. Carbamazepine is used to treat seizures and pain from trigeminal neuralgia and to
prevent migraines. Taking this drug may lower your vitamin D levels.
3. Isoniazid and rifampin are antibiotics that effectively treat tuberculosis (TB), and both
can lower vitamin D levels.
4. Oxcarbazepine is another seizure medication, but it’s also used as a mood stabilizer in
bipolar disorder. Low vitamin D levels may occur with oxcarbazepine use.
Symptoms of Vitamin D deficiency:
Symptoms in children Rickets: When children’s bodies don’t get enough vitamin D, they
cannot absorb enough calcium and phosphorus to mineralize and harden the bones and teeth.
If calcium and phosphorus are not deposited enough to form strong bones, results it in the leg
bones become bent and deformed.

Symptoms in Adults:
Osteomalacia: Adults get osteomalacia. In this disease, the bones become soft, fragile and
easily bendable and are more prone to multiple fractures, Cramps are common, Spinal cord,
thorax, limbs and pelvis may be deformed and back may be hunched. Person may suffer
from lower back pain.

Symptoms in Old age

Osteoporosis: It is a calcium related health problem and occurs frequently in old
people. This disease is characterized by having light porous and spongy bones that break
very easily. Severe bone pain is reported which is relieved by immobilization. Fractures
occur due to brittle bones which heal off normally.

SIDE-EFFECTS: Common or very common Abdominal pain. headache. hypercalcemia.

hypercalciuria. nausea. skin reactions, Uncommon Appetite decreased. constipation. thirst.
Vomiting, Overdose Symptoms of overdosage include anorexia, lassitude, nausea and
vomiting, diarrhea, constipation, weight loss, polyuria, sweating, headache, thirst, vertigo,
and raised concentrations of calcium and phosphate in plasma and urine

PREGNANCY: High doses teratogenic in animals but therapeutic doses unlikely to be

harmful.

Vitamin E:
Vitamin E protects cell membranes and other fat-soluble parts of the body. They are called as
tocopherol. This word is derived from ‘tocos’ meaning child birth, and ‘phenos’ meaning to
bear and ‘ol’ means alcohol. The vitamin is stored in all the tissues and the tissue stores can
provide protection against the deficiency for long periods.

Functions: Vitamin E is an important antioxidant, Promotes normal growth and

development, Promotes normal red blood cell formation, Acts as anti-blood clotting agent,
helps in absorption of vitamin A and vitamin C, Vitamin E dilates the capillaries and enables
the blood to flow freely into blood deficient muscle tissue, thus strengthening both the
tissues and the nerves supplying them, reduces the risk of heart diseases

Food Sources of Vitamin E: The principal source of vitamin E in diet is vegetable oils -
Corn, and peanut oil. Nuts and seeds - Almonds, hazelnuts, sunflower seeds, saffiower, soya.
Human milk has more vitamin E than cow’s milk and is sufficient for infants.

Symptoms of Vitamin E deficiency: Anemia in premature infants, Increased risk of

oxidative damage to body tissues, Vitamin E deficiency may lead to heart and lung disease
and brain stroke, Frequent blood clots may occur which in turn play a role in the production
of varicose veins.
Diseases cause vitamin E deficiency : chronic pancreatitis, cholestasis, cystic fibrosis,
primary biliary cirrhosis, Crohn’s disease, short bowel syndrome.

Side Effects: Vitamin E is LIKELY SAFE for most healthy people when taken by mouth in
amounts lower than 1000 mg daily if it taken in higher doses, it can nausea, diarrhea, stomach
cramps, fatigue, weakness, headache, blurred vision, rash, and bruising and bleeding.

Vitamin K
Vitamin K is called coagulation vitamin. It is essential for the production of a type of protein
called prothrombin and other factors involved in the blood- clotting mechanism.

Functions: Helps in clotting of blood, Participates in bone formation and remodeling

(synthesis of osteocalcin. Vitamin K is essential for the prevention of internal bleeding and
hemorrhages, It is important for the normal functioning of the live, It is involved in energy
producing activities of the tissues and nervous system.

Food Sources of Vitamin K: The concentration of vitamin K in foods is highest in dark

green leafy vegetables, especially spinach. It is also found in soyabean, yoghurt, wheat, oats,
milk, meat, lettuce, cauliflower, cabbage, broccoli and liver

Symptoms of Vitamin K deficiency: Leads to increased tendency to hemorrhages,

Defective blood clotting, Bleeding occurs in nose, Prothrombin levels are reduced.

Causes of Vitamin K Deficiency: The most common causes of vitamin K deficiency

are insufficient dietary intake, inadequate absorption, and decreased storage of the vitamin
due to liver disease, but it may also be caused by decreased production in the intestines.

Note: Some medications, such as antibiotics, antacids, and anti-seizure medications can
interfere with the absorption of vitamin K1, decrease the quantity of K2 produced in the
intestines, or cause degradation of vitamin K. High doses of aspirin may increase vitamin K
requirements.

References:
1. Joint Formulary Committee (Great Britain),Bnf 78 (British National Formulary) September 2019, Pharmaceutical
Press; 78th Revised edition (September 2, 2019)

2. Sharon Orrange, MD,MPH،Common Medications That Can Mess With Your Vitamin Levels,February
7, 2020, (PT)[article]

3. Choi M, Yamada S, Makishima M: Dynamic and ligand-selective interactions of vitamin D receptor with retinoid
X receptor and cofactors in living cells. Mol Pharmacol. 2011 Dec;80(6):1147-55. doi: 10.1124/mol.111.074138.
Epub 2011 Sep 14.

4. Tamil Nadu State Board, 11th STD NUTRITION & DIETETICS, Chapter 11 : Vitamins Minerals and Water

5. Garg A, Grundy SM (1990): Nicotinic acid as therapy for dyslipidemia in non-insulin-dependent diabetes mellitus.
JAMA Aug 8; 264(6):723-726.