【病例学习第20期】Prenatal Vitamins（产前维生素）

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

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Prenatal Vitamins

SC is a 27-year-old mother of 2 children and is expecting her third child in about 8 months. She comes to the pharmacy with a prescription for iron supplementation, which her obstetrician gave her to treat mild anemia. The pharmacist reviews SC?s prescription profile and notes that she started taking Vitafol-OB prenatal vitamins a few weeks ago. When the pharmacist comes back with her prescription, SC asks if she needs to take both supplements, or can she just take the newer one her physician gave her today?

How should the pharmacist respond?

ANSWER

Prenatal Vitamins
The pharmacist should tell SC that many different formulations of prenatal vitamins are available, but they are all similar due to the increased amounts of folic acid, calcium, and iron in them to help expectant mothers meet their Recommended Daily Allowance (RDA; 0.4 mg of folic acid, 1200 mg of calcium, and 30 mg of iron). The folic acid is important, particularly in the first month of pregnancy, to prevent spina bifida. The calcium helps prevent women from developing decreased bone density, and the iron helps prevent anemia. Most prenatal vitamins (including Vitafol-OB) contain 25 to 65 mg of elemental iron, which meets the RDA for pregnant women; however, in a patient like SC, who is anemic, additional iron supplementation is often prescribed. The pharmacist should inform SC that both medications need to be taken, because the iron supplement does not contain the extra folic acid or calcium she needs. In addition, because SC has 2 children at home, the pharmacist should be sure to remind SC to keep both her prenatal vitamins and iron supplements out of their reach; accidental iron overdose is the leading cause of fatal poisoning in children younger than 6 years of age.

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产前维生素

SC是一位27岁年龄的两个孩子的妈妈，预计她将在8个月以后产下她的第三个孩子。SC带着一张补充铁剂的处方来到药房，此处方是她的产科医生给她用来治疗轻微贫血。药师查看了SC的处方大概内容，注意到几周前SC就开始服用产前维生素Vitafol-OB。当药师拿着处方回来的时候，SC询问她是否需要服用两种补充剂，或者只服用医生几天给她开的新处方？
药师如何回答？

回答：
药师应该告诉SC 不同组成的产前维生素都是有益的，但是由于都是增加叶酸、钙、铁的量以达到每日供给量，其组成相似(每日供给量：叶酸0.4 mg、钙1200 mg、铁 30 mg)。叶酸非常重要，尤其是怀孕第一个月，可预防脊柱裂。钙剂有助于预防怀孕妇女发生骨质疏松，铁剂有助于预防贫血。大多数产前维生素（包括Vitafol-OB）含有25—65mg的铁元素，满足怀孕妇女的每日供给量；然而，像SC患有贫血的患者，通常额外有铁剂补充处方。药师应该告诉SC由于铁补充剂不含有她所需要的叶酸和钙剂，两种药物都应该服用。另外，因为SC家中有两个孩子，药师应该确信已提醒SC将两种药物放在他们不能接触到的地方；六岁以下的孩子意外的铁过量可导致致命的药物中毒。

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