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Vitamins and Minerals: What to Know

Vitamins and minerals are essential substances that our bodies need to develop and function normally and stay healthy. Knowing when you need a supplement, which kind of vitamins and minerals are best, and how much your body needs can be confusing.

Where do you start?

Food vs. Supplements
Experts agree – supplemental vitamins can’t replace a nutritious diet.

According to Mayo Clinic, whole foods – such as fruits, vegetables, grains and dairy products – have benefits you can’t find in a supplement, including greater nutrition, essential fiber and phytochemicals. Not to mention, these foods are easier on the wallet. “Vitamins and minerals obtained through food sources are likely cheaper and easier to absorb than those found in supplements,” said Kayla Cole, RDN, LRD, a dietitian at Trinity Health.

Examples of vitamin-rich foods include carrots, beans, peas, spinach, sweet potatoes, apricots, lean meats, poultry, fish, peanuts and peanut butter, whole grains, bananas, berries, citrus fruits, eggs and other dairy products.

Choosing Supplements
While supplements do not offer all the benefits of whole foods, there are times when taking vitamins in the form of a pill, gummy or chewable may be appropriate. “Vitamins can fill in the gaps if you are unable to take in everything you need by food,” said Cole.

There are several factors to consider when deciding which vitamins to take including gender, age, deficiencies, quality, allergies and intolerances, disease or other conditions that affect nutrient intake. For example, if you’re pregnant or trying to become pregnant, nutrients like folic acid, iron and calcium are needed to protect your health and the health of your developing baby. Following menopause, additional calcium and vitamin D can help protect against osteoporosis and the risk of fractures.

If you don’t consume the recommended daily servings of fruit, vegetables and other healthy foods, you may benefit from a multivitamin that contains a variety of essential nutrients. “A multivitamin is considered a good starting place for most people who feel their diet is not
complete,” said Cole. Multivitamins can also be beneficial if you are vegetarian or vegan, have food allergies or intolerances, or have a disease or condition that doesn’t allow you to digest or absorb nutrients properly.

Your primary care provider, a dietitian or a pharmacist can help determine your specific needs and the supplements best suited to meet them.

Safe Usage
In general, vitamins are safe, but they should be used wisely.

1) Look for “USP Verified” on the label. This label ensures the product meets strength, quality and purity standards set forth by the testing organization U.S. Pharmacopeia.

2) Avoid megadoses. Finding and maintaining the right balance of vitamins and minerals is important for good health. However, getting too much of some nutrients can be dangerous. “Avoid megadoses,” said Cole. “High-dose supplements can cause toxic levels of nutrients to build up in your body. Know the tolerable upper intake level of the supplement you are taking.”

3) Seek medical advice. Before taking any supplement, visit with your primary care provider, a pharmacist or dietitian, especially if you have any health problems or are taking medication. Many supplements have possible drug interactions and side effects.

Key Terms
In order to better understand vitamins and minerals, it helps to know a few key terms such as:

Recommended Dietary Allowance (RDA)
The amount of each vitamin and mineral needed daily to meet the needs of nearly all healthy people, as determined by the Food and Nutrition Board of the Institute of Medicine. RDAs for vitamins and minerals are based on your sex, age and physical condition, such as pregnancy.

Adequate Intake (AI)
An AI is a recommended intake level of certain nutrients based on estimates of how much healthy people need. It’s used when there isn’t enough data to establish an RDA.

Daily Value (DV)
This term, set by the Food and Drug Administration, is used on food and supplement labels. DVs are based on a 2,000- calorie-a-day diet, but your DVs may be higher or lower, depending on your calorie needs.

Percent Daily Value
What percentage of the DV one serving of a food or supplement supplies. For instance, if the label on a multivitamin bottle shows that 30% of the DV for a vitamin is provided, you’ll need 70% from other sources throughout the day to meet the recommended goal.

Tolerable Upper Intake Level (UL)
A UL is defined as the highest level of daily intake that is likely to pose no risk of adverse health effects. This amount includes how much of a nutrient you get from both food and supplements.

Source: Mayo Clinic

Your Local Pharmacist: A Name You Can Trust

In January, Gallup’s annual Most Honest and Ethical Professions Poll announced the American public  ranked pharmacists in the top four, following nurses, doctors and teachers. In the survey, 63% of respondents ranked the honesty and ethical standards of pharmacists as very high or high. This trust is not unique to the United States: in most parts of the world, when people feel sick, they don’t call their  doctor. They head to the local pharmacy, where the dying art of the skilled apothecary and knowledgeable druggist still lives on.

For centuries the exclusive way to become an apothecary was through apprenticeship. Under this system the aspiring apothecary would work side-by-side with an established professional practitioner, learning by observing and doing medication-related activities under the tutelage of the master craftsman.

The first college to train pharmacists in the U.S. was founded in 1821 as the Philadelphia College of Pharmacy. Impetus for this came from a plan by local physicians to start training pharmacists. Outraged that physicians would presume to be able to train pharmacists, local pharmacists started their own programs. The first pharmacy program in a public institution began in the late 1860s at the University of Michigan.

Over the years, many of the independent colleges of pharmacy had become affiliated with universities. After WWII, academic health centers began to emerge at U.S. universities as clusters of schools of the health professions assembled with a university hospital operated for the dual purposes of providing patient care and educating future professionals. Many of these operations included colleges of pharmacy.

Pharmacy curriculum also began to shift. Originally heavily rooted in chemistry, the pharmacy curriculum of the early 1900s prepared a pharmacist not only to prepare and dispense medications but also to do what today we call clinical chemistry or medical technology, such as a urinalysis for example. The chemical focus gradually transitioned to a biological focus during the 1960s with increasing emphasis on pharmacology. Then during the 1970s, a clinical focus began to emerge, moving the emphasis from the product to the patient.

As pharmacy curriculum became patient-focused, it was realized that no part of the curriculum included patient contact – a stark contrast to nearly all other training programs for health professionals. In the  1990s a new philosophy of pharmacy practice was advanced: pharmaceutical care. The touchstone of  this approach was that the pharmacist should accept responsibility for assisting patients to  obtain the very best outcomes from their use of medications.

Today, pharmacists work in a variety of settings – hospital, community, ambulatory care,  long term care (LTC), military, veterinary, research and more. Trinity Health has two retail pharmacies:
KeyCare and B&B Northwest, and an inpatient pharmacy that provides medications for all  patients in the hospital, as well as Trinity’s community clinics in the region. Among the three locations, Trinity employs over 80 staff, including pharmacists and pharmacy technicians, to ensure what the Institute for Healthcare Improvement (IHI) calls the “five rights” of medication administration: the right patient, the right drug, the right dose, the right route, and the right time.

“Because of the complexity of medications today, our pharmacy staff counsels each patient to ensure they understand prescribing directions, side effects and precautions,” said Loralee Feininger, director of Retail Pharmacy. “Whether we serve you in the pharmacy, or at the KeyCare drive through, we consider education part of our commitment to customer service.”

Required by the State Board of Pharmacy laws and regulations, the same expert care and consideration is afforded all patients in the hospital as well. “The hospital pharmacy provides medications and consultative services to all hospitalized patients, whether treatments are in IV medication form, or other routes of administration,” said Carolyn Seehafer, pharmacy director at Trinity Hospital.

A pharmacist also looks for many other red flags while filling your prescription, such as drug interactions and dosing, as well as provides direct oversight on orders to ensure safe medication practices. Extensive training, medication expertise, accessibility, and compassion makes community pharmacists uniquely indispensable to the patients they serve.

Trinity Hospital’s New Pharmacies: Welcome to the Neighborhood!

In early Americana, pharmacies and drug stores played a critical role in the life of every town. Even today, you can find a Walgreen’s on every corner in most metropolitan areas. The new Trinity Hospital will have two pharmacies when it opens, playing a critical role in the convenience and wellbeing of our patients.

The inpatient pharmacy is in the Acute Care Tower on the hospital’s south side. This is where drugs are stored and dispensed to other areas of the hospital and community clinics for administration to patients by healthcare providers. As a back of house function, it is not open to the public, so unless you work there, you will never see it.

Design and layout of the inpatient pharmacy includes a centralized area that will house mixing rooms, three of which are dedicated to IV meds. The mixing rooms are designed as Positive and Negative Pressure Rooms to prevent contamination and cross-contamination of medications. To maintain precise sterile conditions, pharmacists gown up in an ante room before entering the mixing room where HEPA filters monitor and control air flow. To maintain long term cleanliness and sterile conditions, these rooms are inspected and recertified every six months.

“The certification process ensures compliance with regulations, which ultimately sustains high quality of care for the patients we serve,” says Carolyn Seehafer, director of pharmacy at Trinity Hospital.

Medications manufactured in the inpatient pharmacy are sent to corresponding departments and medical staff by a highly technological tube delivery system.

For pre-dosed medications, such as a 100 or 200 milligram tablet of Celebrex, for example, a large carousel holds hundreds of bins that store medications by way of a barcode/UPC code. A pharmacist or pharmacy tech enters the name of the drug on a monitor which activates the carousel to rotate to the correct shelf and bin for removal of the medication. Medications are loaded into Pyxis machines and tracked by ways of the established barcode to ensure there are no errors in delivery. Inventory reports are generated daily to ensure meds are replenished in a timely manner.

“Centralizing inpatient pharmacy responsibilities and upgrading to state-of-the-art technology creates efficiencies that translate into fewer mistakes, shorter delivery times and better patient care,” said Dave Kohlman, vice president of Facilities.

However, not everything is centralized in the inpatient pharmacy. Consultant pharmacists are found on designated floors and work side-by-side with providers on drug regimens for patient care. They perform medication regimen reviews based on a patient’s health history to evaluate the appropriateness, safety, benefits, risks and cost-effectiveness of medication therapy. The consultant pharmacist may provide alternate treatment options, as well as medication management guidance including drug monitoring, documentation, administration and storage.

As the transition from the current to the new hospital evolves, the inpatient pharmacy will load all its inventory into the new site, as well as maintain the 50 Pyxis machines that auto dispense medication in various units. Larger store rooms will allow Trinity to maintain a larger inventory, better pricing and quicker turnarounds for medication requests.

Retail Pharmacy

Trinity’s outpatient/retail pharmacy is a new addition to the locations it currently operates. It is open to the public and will be located near the first-floor elevators on the north side of the new medical office building. For additional ease, the pharmacy is accessible from both the front and back doors of the building. Better yet, the drive through kiosk is located right off 37th Avenue SW, so you don’t even need to leave your vehicle!

The interior design provides more retail space, a larger waiting area and seating. However, soon-to-be discharged hospital patients are assisted by Trinity’s Meds4U Program, a free service that offers education about medication and delivers prescriptions and over the counter medications to patients before they leave the hospital. This service helps prevent medication interruptions and the inconvenience of another stop (or long wait) before going home.

Whether at the counter or drive through, Trinity Health Outpatient Pharmacy will be ready to serve patients in a fresh, white, bright and light environment. Soon enough, it will become your preferred neighborhood pharmacy.

“Our location in the medical building places the pharmacy in a key location that is either on your way to or from an appointment. We will be available to fill prescriptions as patients leave their providers’ office, or at the drive through kiosk when they need a quick refill,” said Loralee Feininger, director of retail pharmacy. “We look forward to seeing both new and familiar faces in our new location!”

Despite the behind-the-scenes activity in these busy hubs, Trinity’s pharmacies operate like an undertow: a constant, rhythmic current, barely noticeable on the periphery of our consciousness. And yet, they serve as an essential contributor to the ebb and flow of an individual’s healthcare management.

Spring Cleaning? Don’t Overlook Your Medicine Cabinet

You could be a drug dealer and not even know it.

According to the 2019 National Survey on Drug Use and Health, 9.7 million people misused prescription pain relievers, 4.9 million people misused prescription stimulants, and 5.9 million people misused prescription tranquilizers or sedatives. The survey also showed that most misused prescription drugs were obtained from family and friends, often from the home medicine cabinet.

National Prescription Drug Take Back Day is on April 27 and aims to bring awareness to a crucial  public safety issue: unused or expired medications lead to potential accidental poisoning, misuse and overdose. Pharmaceutical drugs can be just as dangerous as street drugs when taken without a prescription or a doctor’s supervision. According to the Drug Enforcement Agency, the non-medical use of prescription drugs ranks second only to marijuana as the most common form of drug abuse in America. Since the fall of 2010, more than 15.2 million pounds of medication have been collected on National Drug Take Back Day.

“While National Drug Take Back Day is an excellent way to remind us to properly dispose of  old or unused medicines, KeyCare Pharmacy provides year-round access to a secure medicine collection bin that provides a safe and convenient disposal option,” said Loralee Feininger, Pharm.D., RPH, director of retail pharmacy.

Trinity Health’s KeyCare Pharmacy, 400 Burdick Expressway East, is one of several locations in Minot that provide a convenient drop off for prescription drug disposal. The Medsafe receptacle is secured to the wall and is equipped with two separately keyed locks on the main door and a one-way medicine drop with lock. It is DEA and DOT compliant to accept controlled (Schedules II-V), non-controlled and over the-counter medicines. It is not necessary to remove drugs from containers or blister packs, and patients do not need to remove or black out private information on bottles or packaging, such as their name and address, as the disposal method is completely confidential.

Feininger says that when the inner liner is full, it is removed from the collection receptacle by authorized persons, securely sealed and returned by common carrier for proper destruction. The liner is waterproof,tamper resistant, tear resistant and features a unique identification number for easy tracking. The service is funded by the North Dakota Board of Pharmacy and costs nothing for sponsors or end users, such as patients.

“It is not uncommon to see family members come in with bags of old prescriptions after cleaning out the medicine cabinet of a recently deceased loved one,” she said. “We are pleased to offer this service and feel it keeps our patients, their families and the environment safe.”

If there is a not a take back location in your community, the next best thing is to

• Take meds out of their bottle

• Mix them with something unappealing like used kitty litter or coffee grounds and add water

• Seal them in a bag or disposable container, mix and throw away

Unused prescription drugs thrown in the trash can be retrieved and abused or illegally sold. Unused drugs that are flushed contaminate the water supply. Proper disposal of unused drugs saves lives and protects the environment.

Keycare Pharmacy is open 8 a.m. to 8 p.m. Monday through Friday, and 9 a.m. to 5 p.m. Saturday and Sunday, and all holidays.