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Nutrition 2 (Semester I) > 1. Nutritional Pharmacology > Flashcards

1. Nutritional Pharmacology Flashcards

1
Q

What types of drugs are:
Codeine
Paracetamol
Aspirin
Ibuprofen

A

Examples of analgesics

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2
Q

What types of drugs are:
Bisacodyl
Senna

A

Examples of laxatives

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3
Q

What type of drug is omeprazole?

A

Example of a PPI

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4
Q

What type of drugs are:
Cetirizine
Chlorphenamine

A

Examples of anti-histamines

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5
Q

What is the active ingredient of a drug?

A

Delivers the mode of action
Responsible for side effects

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6
Q

What is the inactive ingredient of a drug?

A

Alters the physical properties of the drug - colours, fillers, preservatives, lactose, gluten

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7
Q

What kind of reactions can inactive ingredients trigger?

A

Allergic reactions
Food intolerances

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8
Q

What is aspirin used for?

A

Reduces pain, fever, inflammation

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9
Q

What are the potential side effects of using aspirin?

A

GI bleeding
Peptic ulceration
Hypersensitivity

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10
Q

Which compound in aspirin triggers the side effects?

A

Salicylic acid

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11
Q

What is the natural alternative to aspirin?

A

Willow bark

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12
Q

Why is willow bark a better alternative to aspirin?

A

Contains salicin which doesn’t convert to salicylic acid
Same benefits without the side effects

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13
Q

What is meant by pharmacokinetics?

A

The timed movement of drugs into, through and out of the body

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14
Q

What is meant by pharmacodynamics?

A

How drugs interact with the body to exert their effect (mode of action)

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15
Q

What are the 4 key processes of pharmacokinetics?

A

Absorption
Distribution
Metabolism
Elimination

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16
Q

Why is absorption important in pharmacokinetics?

A

A drug must be absorbed into the bloodstream so it can exert its mode of action

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17
Q

Why is distribution important in pharmacokinetics?

A

Once in the bloodstream, the drug can now be distributed to its target site (normally a receptor) to exert its action

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18
Q

Why is metabolism important in pharmacokinetics?

A

Once the drug and receptor have interacted, the drug returns to the bloodstream and progresses to the liver to be metabolised and then eliminated from the body

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19
Q

Why is excretion important in pharmacokinetics?

A

Once metabolised, excretion normally takes place via urine or bile

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20
Q

What is first pass hepatic metabolism?

A

The process by which drugs taken orally are absorbed from the GIT and taken via the portal vein into the liver to be metabolised

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21
Q

What happens when a drug is extensively metabolised?

A

The amount of drug entering the bloodstream is greatly reduced
Effect exertion is reduced

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22
Q

How should drugs that are extensively metabolised by administered?

A

By a different route
e.g. nitro glycerine (GTN) spray for angina

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23
Q

Which two factors determine whether or not a drug reaches its target site of action?

A

Bioavailability
Route of administration

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24
Q

What is the bioavailability of a drug?

A

The proportion of the drug that can reach the bloodstream and is, therefore, available for distribution to its intended site of action

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25
Q

Where are drugs taken orally mainly absorbed?

A

SI

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26
Q

What are the benefits of sublingual/buccal drugs?

A

Bypasses liver metabolism

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27
Q

What factors affect drug absorption?

A

GI motility
Malabsorption
Presence of other substances
Format of the drug

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28
Q

How does the format of the drug affect absorption?

A

Acidic drugs absorb quicker in an acidic environment
Liquid medicines absorb quicker than a solid tablet

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29
Q

What factors affect drug distribution?

A

Binding to plasma proteins
Binding to other tissues
Accumulation in lipids
Natural barriers to distribution

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30
Q

What happens during drug metabolism?

A

The drug is changed from a lipid soluble to a more water soluble form for excretion

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31
Q

What happens during Phase I drug metabolism?

A

Drug is altered chemically to make it suitable for Phase II reactions or for excretion

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32
Q

Which family of enzymes are involved during Phase I metabolism?

A

CYP450

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33
Q

What happens during Phase II drug metabolism?

A

Molecules from Phase I (or in some cases unchanged drugs) are conjugated to a more water soluble product and aid excretion

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34
Q

What factors can influence the rate of metabolism in individuals?

A

Genetic
Environmental

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35
Q

What are the main excretion routes for drugs?

A

Urine
Faeces

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36
Q

What are the minor excretion routes for drugs?

A

Exhaled air
Sweat
Saliva
Tears

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37
Q

What dysfunction can affect the rate at which a drug/metabolite is cleared from the body?

A

Renal

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38
Q

What is entero-hepatic circulation?

A

Where very lipid soluble drugs may be reabsorbed and re-enter the portal vein
Prolongs excretion times

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39
Q

What factors can affect a drug’s mode of action?

A

Genetic mutations
Malnutrition
Medical conditions e.g. Parkinson’s, Alz

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40
Q

What information can pharmacokinetics and pharmacodynamics provide about a drug?

A

Mode of action
Administration route
Dosage
Side effects
Drug interactions

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41
Q

Which substances can affect the effects of a drug?

A

Food/drink
Nutritional supplements
Herbal medicines
Other drugs
Environmental chemical agents

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42
Q

What are narrow therapeutic index (NTI) drugs?

A

Drugs that may become dangerously toxic or ineffective with only relatively small changes in their blood concentrations

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43
Q

What types of drugs are digoxin, phenytoin, theophylline, warfarin and lithium?

A

Narrow therapeutic index (NTI) drugs

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44
Q

Which types of drugs are essential to have highlighted on case notes?

A

Narrow therapeutic index (NTI) drugs

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45
Q

Which populations are at an increased risk of serious side effects from drugs?

A

Patients experiencing liver/renal dysfunction
Elderly who take more than one drug
Patients taking drugs for multiple chronic long-term illnesses
Critically ill patients

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46
Q

What kinds of drugs can garlic interact with?

A

Cholesterol
Blood pressure

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47
Q

How should garlic be consumed to avoid interactions?

A

Interspersed throughout diet
Regular, high dietary intake and/or supplements should be avoided

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48
Q

What kinds of drugs can gingko interact with?

A

Anti-platelet
Anti-coagulant
(potential to increase bleeding risk)

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49
Q

Why should grapefruit and pomegranate be avoided with certain drugs?

A

Inhibits CYP3A4 in intestinal wall for up to 24 hrs
Increases peak levels of statins

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50
Q

Examples of drugs where grapefruit should be avoided

A

Statins
Digoxin

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51
Q

What types of drugs do green vegetables interact with?

A

Anti-platelet
Anti-coagulant
(potential to increase bleeding risk)

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52
Q

How do green vegetables interact with anti-coagulation/platelet drugs e.g. warfarin?

A

Reduces the effect of the drug
Contain indoles which increase the metabolism of warfarin
Also contain vit K which reduces the anti-clotting effects of warfarin
(vit K = coagulant; warfarin = anti-coagulant)

53
Q

What types of drugs does soy interact with?

A

Thyroid (levothyroxine)
Oestrogen blocking drugs (tamoxifen)
Anti-coagulants (warfarin)

54
Q

How does soy interact with levothyroxine?

A

Decreases the absorption of the drug

55
Q

How does soy interact with warfarin?

A

Reduces effectiveness of the drug

56
Q

What types of drugs can calcium/dairy produce interact with?

A

Antibiotics
Bisphosphonates
Levothyroxine

57
Q

How does calcium interact with antibiotics, bisphosphonates and levothyroxine?

A

Reduces their absorption

58
Q

How can high protein diets affect medication?

A

Can decrease intestinal absorption of drug
Can reduce effects of a drug

59
Q

How can high fibre diets (vegan, Med diet) affect antidepressants?

A

Reduces serum levels of the drug
(take medication at a different time to high fibre meal)

60
Q

How can salt restriction affect medication?

A

Can increase serum lithium to toxic levels
(Na is involved in the active transport of lithium; low levels of Na can cause lithium to accumulate in cells)

61
Q

Which nutrients can be depleted by PPIs?

A

Beta carotene
Ca
Fe
Mg
B9
B12
C
Zn

62
Q

Why are nutrients depleted when taking a PPI?

A

Reduced gastric acid levels inhibit absorption

63
Q

Natural alternatives to PPIs

A

Milk thistle
Slippery elm
Dandelion root
Marshmallow root
Aloe Vera gel

64
Q

Which nutrients can be depleted by steroids?

A

Ca
D
Folic acid
Mg
K
Zn

65
Q

Why are nutrients depleted when taking steroids?

A

Increased urinary excretion
Losses from bone tissue

66
Q

Which nutrient is depleted when taking statins?

A

CoQ10

67
Q

Why is CoQ10 depleted when taking statins?

A

Statins block synthesis of mevalonic acid which is the building block of cholesterol and CoQ10

68
Q

Which nutrients are depleted by antibiotics?

A

B1, 2, 5, 6, 7, 12
K

69
Q

Why are nutrients depleted when taking antibiotics?

A

Antibiotics can lead to the destruction of normal intestinal microflora which produce various B vits and vit K

70
Q

Which nutrients are depleted by metformin?

A

B9 (folate)
B12

71
Q

Why are nutrients depleted by metformin?

A

Malabsorption

72
Q

Which nutrients are depleted by diuretics?

A

Ca
Mg
K
B1, 6, 9
C

73
Q

Why are nutrients depleted by diuretics?

A

Increased urinary loss

74
Q

Which nutrients are depleted by antacids?

A

Ca
Fe
B9

75
Q

Why are nutrients depleted by antacids?

A

Increased gastric pH may reduce solubility and absorption
Al-containing antacids can bind to Ca preventing absorption

76
Q

Which nutrient is depleted by thyroxine?

A

Ca

77
Q

Why is Ca depleted by thyroxine?

A

Increases bone turnover which may lead to increased urinary loss

78
Q

Which nutrients are depleted by the OCP?

A

A
B1, 2, 6, 9,12
C
Mg
Zn

79
Q

Why are nutrients depleted when taking the OCP?

A

Reduced absorption
Increased excretion
Increased protein binding and induction of liver enzymes
Reduced liver storage of vit A
Reduced B12 protein binding

80
Q

Why should alcohol be avoided when taking drugs?

A

Alcohol can inhibit a drug’s metabolism by competing for the same set of metabolising enzymes
This may decrease effectiveness of the drug and transform some drugs into toxic chemicals that can cause liver/organ damage
Can magnify the inhibitory effects of sedatives/narcotics at their sites of action in the brain (codeine, morphine)
Some drugs affect the metabolism of alcohol - making them more toxic

81
Q

What are ACE inhibitors prescribed for?

A

Hypertension
Heart failure

82
Q

What are common side effects of ACE inhibitors?

A

Persistent dry cough
Angioedema
Constipation
Diarrhoea
Nausea
Vomiting
Postural hypotension
Hyperkalaemia

83
Q

What are statins prescribed for?

A

Hypercholesterolaemia
Hypertriglyceridemia
Prevention of CV events

84
Q

What are common side effects of statins?

A

GI disturbance
Headaches
Fatigue
Myositis
Myopathy

85
Q

Which foods interact with statins and should be avoided?

A

Grapefruit
Pomegranate

86
Q

What is a natural alternative to statins?

A

Red yeast rice
(cholesterol lowering - but don’t take with statins)

87
Q

What can diuretics be prescribed for?

A

Oedema due to heart failure
Hypertension

88
Q

What are the common side effects of taking diuretics?

A

Hypokalaemia
Hypotension
GI disturbance
Impotence

89
Q

What are natural alternatives to diuretics?

A

Dandelion leaf
Nettle
Marshmallow root

90
Q

What is digoxin prescribed for?

A

Atrial fibrillation
Heart failure

91
Q

What are the common side effects of digoxin?

A

Nausea
Vomiting
Diarrhoea
Loss of appetite
Abdominal pain

92
Q

Which nutrient should be used with caution alongside digoxin?

A

Hawthorn
(can increase myocardial contractions so digoxin dose may need to be lowered)

93
Q

What are antacids prescribed for?

A

GORD
Indigestion

94
Q

What are the common side effects of antacids?

A

Impaired nutrient absorption
Laxative (if Mg version)
Constipation (if Al version)
Rebound effect from overuse

95
Q

Which nutrient may increase Al uptake from an antacid?

A

D

96
Q

Lifestyle changes to reduce indigestion

A

Dietary changes - avoid spicy, fatty food, caffeine
Chew well
Keep fluids away from meals
Lose weight
Stop smoking
Manage stress

97
Q

What are PPIs prescribed for?

A

GORD
Gastric/peptic ulceration

98
Q

What are the common side effects of PPIs?

A

Headache
GI disturbance
Rebound of acid secretion

99
Q

What are the side effects of long term use of PPIs?

A

GI infections
SIBO - lack of acid allows bacteria to survive
Increased fracture risk - reduced Ca absorption
B12 def - HCl needed to release B12 from proteins for intestinal absorption
Low blood Mg - decreased intestinal absorption
Fe def - decreased intestinal absorption

100
Q

Why shouldn’t PPIs be withdrawn suddenly?

A

Rebound reflux

101
Q

What protocol can be used to reduce and withdraw PPIs safely?

A

5R protocol

102
Q

What can warfarin be prescribed for?

A

DVT
Pulmonary embolism
(blood thinner)

103
Q

What is the most common side effect of taking warfarin?

A

Haemorrhaging
Bruising

104
Q

Which nutrients should be avoided when taking warfarin?

A

Vit K rich foods (dark leafy greens, broccoli) - has opposite effect to drug
High dose vit E (same action as drug so increased bleeding risk)
Pomegranate juice - slows blood clotting time

105
Q

What is levothyroxine prescribed for?

A

Hypothyroidism

106
Q

What are the common side effects of taking levothyroxine?

A

Tremor
Headache
Insomnia
Anxiety
Flushing

107
Q

What is the typical dosing regime for levothyroxine?

A

30-60 minutes pre-breakfast or caffeine containing liquids to avoid reduced absorption

108
Q

What nutrients should be avoided when taking levothyroxine?

A

Fe/Ca supplements
Cow’s dairy
(reduce the absorption of levothyroxine)

109
Q

What are common side effects of anti-histamines other than sedation?

A

Nausea
Vomiting

110
Q

Examples of natural approaches for supporting hay fever

A

Quercetin
(inhibits release of histamine from mast cells)
Nettle
Bee pollen
Reishi mushroom

111
Q

What are SSRIs prescribed for?

A

Depressive illnesses
Post-traumatic stress
Obsessive compulsive disorder

112
Q

What are the common side effects of taking SSRIs?

A

GI disturbance
Constipation
Diarrhoea
Insomnia
Anxiety
Agitation

113
Q

What is serotonin syndrome?

A

Excess serotonin due to SSRI use, overdose or interactions between drugs

114
Q

What are the common symptoms of serotonin syndrome?

A

Confusion
Disorientation
Exaggerated reflexes
Fever
Sweating

115
Q

Which herb and nutrient should be avoided when taking SSRIs?

A

St John’s Wort
5-HTP

116
Q

What are NSAIDs prescribed for?

A

Pain relief
Inflammation

117
Q

Which foods should be avoided in high quantities when taking NSAIDs?

A

E
Garlic
Turmeric
(may increase risk of bleeding)

118
Q

What are the common side effects of taking NSAIDs?

A

Gastric bleeding/ulceration
Acute kidney damage

119
Q

Examples of natural alternatives to NSAIDs

A

Willow bark
Turmeric (curcumin)
Ginger
Boswellia
Anti-inflammatory diet
Quercetin

120
Q

What are corticosteroids prescribed for?

A

Asthma
Eczema
IBD
AI conditions

121
Q

What are the common side effects of using corticosteroids?

A

Long term use increases risk of:
Cushing’s syndrome
DM
Osteoporosis
Infections

122
Q

Why is it important to not withdraw corticosteroids abruptly?

A

Adrenal insufficiency
Hypotension
Death

123
Q

What are natural alternatives to corticosteroids?

A

Anti-inflammatory diet
EFAs
Quercetin
Turmeric
Ginger

124
Q

What does a bulk forming laxative do?

A

Increases the “bulk” or weight of poo, which in turn stimulates the bowel

125
Q

What does a stimulant laxative do?

A

Stimulates the muscles that line the gut, helping them to move poo out of anus

126
Q

What are common side effects of taking laxatives?

A

Dehydration
Loss of potassium

127
Q

What are natural alternatives as laxatives?

A

Flaxseeds
Chia seeds
Psyllium husks
Water
Mg citrate
Rhubarb/dandelion/burdock root

128
Q

What are natural alternatives to cough mixture?

A

Thyme
Honey/ginger
Honey/lemon
Rosemary

Nutrition 2 (Semester I) (15 decks)

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