SOCIAL AND PREVENTIVE PHARMACY

ASSIGNMENT TOPICS:
o Sources of Calcium and Iron
o Anaemia
o Role of pharmacists in the Prevention and
Control of COVID-19

NAME OF THE ASSIGNEE: Rakshita Grover

ROLL NUMBER: 73/BPH/16 (10)
COURSE: B.Pharm 8th Semester
UNIVERSITY: DPSRU
 SOURCES OF CALCIUM AND IRON

IRON is an essential body constituent. Total body Iron in an adult is 2.5-5 g with an
average of 3.5 g. It is more in men (50 mg/kg) than in women (38 mg/kg). It is distributed
into:
• Haemoglobin 66%
• Iron stores as ferritin and haemosiderin 25%
• Myoglobin (in muscles) 3%
• Parenchymal Iron (in enzymes etc) 6%
The recommended daily intake of iron is 28 mg for men, 30 mg for nonpregnant women
and 38 mg for pregnant women.

SOURCES OF IRON
1. SHELL FISH: All shellfish is high in iron, but clams, oysters, and mussels are
particularly good sources. The iron in shellfish is heme iron, which our body
absorbs more easily than the non-heme iron found in plants. A 3.5-ounce (100-
gram) serving of clams provides 17% of the daily value for iron.

2. SPINACH: About 3.5 ounces (100 grams) of raw spinach contain 2.7 mg of iron, or
15% of the DV. Although this is non-heme iron, which isn't absorbed very well,
spinach is also rich in vitamin C. This is important since vitamin C significantly
boosts iron absorption.
 3. LIVER AND OTHER ORGAN MEATS: Organ meats are extremely nutritious. Popular
types include liver, kidneys, brain, and heart — all of which are high in iron. a 3.5-
ounce (100-gram) serving of beef liver contains 6.5 mg of iron, or 36% of the DV.

4. LEGUMES: Some of the most common types of legumes are beans, lentils,
chickpeas, peas, and soybeans. They're a great source of iron, especially for
vegetarians. One cup (198 grams) of cooked lentils contains 6.6 mg, which is 37%
of the DV. Beans such as black beans, navy beans, and kidney beans can all help
easily bump up our iron intake. In fact, a half-cup (86-gram) serving of cooked
black beans provides around 1.8 grams of iron, or 10% of the DV.

5. RED MEAT: Red meat is satisfying and nutritious. A 3.5-ounce (100-gram) serving
of ground beef contains 2.7 mg of iron, which is 15% of the DV. In fact, red meat
is probably the single most easily accessible source of heme iron, potentially
making it an important food for people who are prone to anemia. In one study
looking at changes in iron stores after aerobic exercise, women who consumed
meat retained iron better than those who took iron supplements.

OTHER KNOWN SOURCES OF IRON: Gur(Jaggery), Tofu, Broccoli, Pumpkin seeds etc
CALCIUM makes up about 2% of our body weight or 1-1.5kg in an adult. Over 99% of this
is stored in the bones, the rest being distributed in plasma and cells. The proportion in
blood and bone is maintained by the interaction of vitamin D, calcitonin and parathyroi d
hormone. Calcium controls neuromuscular action, including cardiac muscle contraction.
It is essential for coagulation of blood

SOURCES OF CALCIUM
1. SEEDS: Seeds that are high in calcium, including poppy, sesame, celery and chia
seeds. For instance, 1 tablespoon (9 grams) of poppy seeds pack 126 mg of
calcium, or 13% of the RDI. Sesame seeds have 9% of the RDI for calcium in 1
tablespoon (9 grams), plus other minerals, including copper, iron and manganese.

2. CHEESE: Most cheeses are excellent sources of calcium. Parmesan cheese has the
most, with 331 mg — or 33% of the RDI — per ounce (28 grams). Softer cheeses
tend to have less — one ounce of brie only delivers 52 mg, or 5% of the RDI.
Many other varieties fall in the middle, providing about 20% of the RDI

3. YOGURT: One cup (245 grams) of plain yogurt contains 30% of the RDI for
calcium. Low-fat yogurt may be even higher in calcium, with 45% of the RDI in
one cup (245 grams). While Greek yogurt is a great way to get extra protein in
your diet, it delivers less calcium than regular yogurt.

4. SARDINES AND CANNED SALMON: A 3.75-ounce (92-gram) can of sardines packs

35% of the RDI, and 3 ounces (85 grams) of canned salmon with bones have 21%
5. BEANS AND LENTILS: Winged beans— a single cup (172 grams) of cooked wing
beans has 244 mg, or 24% of the RDI for calcium. White beans are also a good
source, with one cup (179 grams) of cooked white beans providing 13% of the
RDI. Other varieties of beans and lentils have less, ranging from around 4–6% of
the RDI per cup

6. WHEY PROTEIN: Whey protein is found in milk and has been extensively studied
for its health benefits. It's an excellent protein source and full of quickly digested
amino acid. Whey is also exceptionally rich in calcium — a 1-ounce (28-gram)
scoop of whey protein powder isolate contains 200 mg, or 20% of the RDI

7. MILK: Milk is one of the best and cheapest calcium sources. One cup (237 ml) of
cow's milk has 276–352 mg, depending on whether it's whole or nonfat milk.
Goat's milk is another excellent source of calcium, providing 327 mg per cup (237
ml)
 ANAEMIA
Anaemia is defined as a haemoglobin concentration in blood below the lower limit of
the normal range for the age and sex of the individual. In adults, the lower extreme of
the normal haemoglobin is taken as 13.0 g/dl for males and 11.5 g/dl for females. New-
borns have higher haemoglobin level and, therefore, 15 g/dl is taken as the lower limit
at birth, whereas at 3 months the normal lower level is 9.5 g/dl. Although haemoglobin
value is employed as the major parameter for determining whether or not anaemia is
present, the red cell counts, haematocrit (PCV) and absolute values (MCV, MCH and
MCHC) provide alternate means of assessing anaemia.
TYPES OF ANAEMIA:
The classification of anaemia is based on the cause:
• impaired erythrocyte production
a. iron deficiency
b. megaloblastic anaemias
c. hypoplastic anaemia
• increased erythrocyte loss
a. haemolytic anaemias
b. normocytic anaemia.

IRON DEFICIENCY ANAEMIA:

CAUSES: Insufficient bioavailable iron in the diet to cover needs (which are highest for
menstruating females and during pregnancy, infancy and puberty). Poor bioavailability is
often due to an excess of absorption-inhibitor and a lack of absorption-enhancers.
Another cause is Blood loss – for example, due to heavy menstruation, childbirth or
parasites such as hookworm. Other factors that contribute to or cause anaemia include
other micronutrient deficiencies such as folate, infections such as malaria and
haemoglobinopathies.

SYMPTOMS AND EFFECTS: Iron deficiency anaemia (IDA) leads to decreased

attention spans, learning ability and work productivity. If severe, it increases mortality.
In women it increases the risk of foetal undernutrition and postpartum maternal
mortality (through haemorrhage and sepsis). In children aged 0–2 years IDA is associated
with impaired cognitive development.

TREATMENT: The management of iron deficiency anaemia consists of 2 essential

principles: correction of disorder causing the anaemia, and correction of iron deficiency.
 • CORRECTION OF THE DISORDER. The underlying cause of iron deficiency is
established after thorough checkup and investigations. Appropriate surgical,
medical or preventive measures are instituted to correct the cause of blood loss.
• CORRECTIONOF IRON DEFICIENCY. The lack of iron is corrected with iron therapy
as under:
a. Oral therapy. Iron deficiency responds very effectively to the
administration of oral iron salts such as ferrous sulfate, ferrous fumarate,
ferrous gluconate and polysaccharide iron. These preparations have
varying amount of elemental iron in each tablet ranging from 39 mg to
105 mg. Oral iron therapy is continued long enough, both to correct the
anaemia and to replenish the body iron stores.
b. Parenteral therapy. Parenteral iron therapy is indicated in cases who are
intolerant to oral iron therapy, in GIT disorders such as malabsorption, or
a rapid replenishment of iron stores is desired such as in women with
severe anaemia a few weeks before expected date of delivery. A common
preparation is iron dextran which may be given as a single intramuscular
injection, or as intravenous infusion after dilution with dextrose or saline

CONTROL: Strategies used are:

Modifying diets by:
a. increasing intake of haem iron-rich foods although this may be impractical
where foods such as meat are expensive;
b. increasing intake of absorption enhancers (e.g. vitamin C-rich fruits and
vegetables) and decreasing intake of absorption inhibitors (e.g. not
drinking tea with meals);
c. fortifying foods. Wheat flour and condiments such as curry powder and
fish sauce are fortified in some countries and fortification of salt and sugar
are being investigated;
d. promoting exclusive breastfeeding which increases the period of maternal
amenorrhea.

Plant breeding to increase iron and lower phytate content.

Giving supplements of iron, often with folic acid, to priority groups. Where IDA is
common all women of reproductive age, children, adolescents (especially girls) and
vulnerable old people need supplements.

MEGALOBLASTIC ANAEMIA AND PERNICIOUS ANAEMIA

Maturation of erythrocytes is impaired when deficiency of vitamin B12 and/or folic acid
occurs and abnormally large erythrocytes (megaloblasts) are found in the blood. When
deficiency of vitamin B12 and/or folic acid occurs, the rate of DNA and RNA synthesis is
reduced, delaying cell division.

CAUSES:
a. VITAMIN B12 DEFICIENCY. In Western countries, deficiency of vitamin B12
is more commonly due to pernicious (Addisonian) anaemia. True
vegetarians like traditional Indian Hindus and breast-fed infants have
dietary lack of vitamin B12. Gastrectomy by lack of intrinsic factor, and
small intestinal lesions involving distal ileum where absorption of vitamin
B12 occurs, may cause deficiency of the vitamin. Deficiency of vitamin B12
takes at least 2 years to develop when the body stores are totally
depleted.
b. FOLATE DEFICIENCY. Folate deficiency is more often due to poor dietary
intake. Other causes include malabsorption, excess folate utilisation such
as in pregnancy and in various disease states, chronic alcoholism, and
excess urinary folate loss. Folate deficiency arises more rapidly than
vitamin B12 deficiency since the body’s stores of folate are relatively low
which can last for up to 4 months only.
c. OTHER CAUSES. These include many drugs which interfere with DNA
synthesis, acquired defects of haematopoietic stem cells, and rarely,
congenital enzyme deficiencies.
SIGNS AND SYMPTOMS:
1. Anaemia. Macrocytic megaloblastic anaemia is the cardinal feature of deficiency
of vitamin B12 and/or folate. The onset of anaemia is usually insidious and
gradually progressive.
2. Glossitis. Typically, the patient has a smooth, beefy, red tongue.
3. Neurologic manifestations. Vitamin B12 deficiency, particularly in patients of
pernicious anaemia, is associated with significant neurological manifestations in
the form of subacute combined, degeneration of the spinal cord and peripheral
neuropathy, while folate deficiency may occasionally develop neuropathy only.
4. Others. In addition to the cardinal features mentioned above, patients may have
various other symptoms. These include: mild jaundice, angular stomatitis,
purpura, melanin pigmentation, symptoms of malabsorption, weight loss and
anorexia.
TREATMEMT: Most cases of megaloblastic anaemia need therapy with appropriate
vitamin. This includes: hydroxycobalamin as intramuscular injection 1000 μg for 3 weeks
and oral folic acid 5 mg tablets daily for 4 months. Severely-anaemic patients in whom a
definite deficiency of either vitamin cannot be established with certainty are treated
with both vitamins concurrently. Patients of PA are treated with vitamin B12 in the
following way:
 a. Parenteral vitamin B12 replacement therapy.
b. Symptomatic and supportive therapy such as physiotherapy for neurologic
deficits and occasionally blood transfusion.
c. Follow-up for early detection of cancer of the stomach.
CONTROL:
• Intake of supplements of folic acid and methyl cobalamin can be done.
• Switch to food containing high content of vit b12 and vit b9 and also to food that
can increase their absorption like salmon, liver, eggs, milk, beef etc
• Regular checkups and tests for deficiency of these vitamins can be done.
• Regular checkups for anaemia.
• Watch out for symptoms of this type of anaemia.

HYPOPLASTIC AND APLASTIC ANAEMIA:

Hypoplastic and aplastic anaemias are due to varying degrees of bone marrow failure.
Bone marrow function is reduced in hypoplastic anaemia, and absent in aplastic
anaemia. When all three cell types are low, the condition is called pancytopenia, and is
accompanied by anaemia, diminished immunity and a tendency to bleed. The condition
is often idiopathic, but the known causes include:
• drugs, e.g. cytotoxic drugs, some anti-inflammator and anticonvulsant drugs,
some sulphonamides and antibiotics
• ionising radiation
• some chemicals, e.g. benzene and its derivatives
• chronic nephritis
• viral disease, including hepatitis
• invasion of bone marrow by, e.g., malignant disease, leukaemia or fibrosis.

HEMOLYTIC ANAEMIA:
These occur when red cells are destroyed while in circulation or are removed
prematurely from the circulation because the cells are abnormal or the spleen is
overactive.
• Sickle cell anaemia: The abnormal haemoglobin molecules become misshapen
when deoxygenated, making the erythrocytes sickle shaped
• Thalassaemia: There is reduced globin synthesis with resultant reduced
haemoglobin production and increased friability of the cell membrane, leading to
early haemolysis.
NORMOCYTIC NORMOCHROMIC ANAEMIA:
In this type the cells are normal but the numbers are reduced and the proportion of
reticulocytes in the blood may be increased as the body tries to restore erythrocyte
numbers to normal. This occurs:
• in many chronic disease conditions, e.g. in chronic inflammation
• following severe haemorrhage
• in haemolytic disease.

ROLE OF PHARMACIST IN PREVENTION AND CONTROL OF

COVID-19

A fundamental role of the pharmacist during the times of this critical pandemic is to
make possible the availability of the drugs used in symptomatic relief of COVID-19.
Consider the example of Hydroxychloroquine. India has been asked by many countries
like USA, Israel, Brazil for the export of this drug as India manufactures 70% of the
world’s supply of hydroxychloroquine. This has to be acknowledged that this supply was
made possible only by the manufacturing done by pharmacists. So, the pharmacists who
are involved in manufacturing have a key role in balancing the supplies of critical drugs
for COVID-19 nationally and globally.
Pharmacists at community level play the role by providing awareness against infections
and the prevention and control of the disease including hand wash and social distancing
measures, sanitising the floors and surfaces etc.
Community pharmacists can also calm the people during these critical times by
providing them with correct and authentic information and by psychological counselling.
They can guide the people to avoid rumours and fake news regarding the disease to
make a clear picture of the current situation.
Another important aspect of pharmacist’s role is his part in therapeutic drug monitoring
(measuring drug concentrations in blood at various time intervals). This is necessary to
manipulate the treatment according to patient specific responses to a treatment. TDM
at this time can allow us to deliver best treatment and thus reducing hospital stays.
Pharmacists with higher education like a PHD in Rational Drug Design and Development
are one of the important sources of designing new drugs and vaccines for the treatment
and control of this pandemic.