Drug Nutrient Interactions Flashcards
Sulfasalazine (anti-inflammatory for UC or RA) inhibits
Folate metabolism
Methotrexate inhibits
Folate metabolism
TNF-a Antibody (biologic therapy, IBD) interacts with
Protein metabolism
Corticosteroids alter
Mineral metabolism
Protein metabolism (increased protein oxidation –> nitrogen losses)
Also can cause hyperglycemia and sodium retention
Neomycin - used for HE or SIBO
Partial villous atrophy of gut and steatorrhea
Cholestyramine
(bile acid sequestrant)
Deficiency of fat soluble vitamins
Given too close to med dosing = no chance to breakdown and use
Orlistat (weight control medication)
Steatorrhea
Deficiency of fat soluble vitamins
Octreotide (anti-diarrheal)
Deficiency of fat soluble vitamins through fat malabsorption
Mineral oil (laxative)
Deficiency of fat soluble vitamins
Lomitapide (lipid-lowering agent)
Deficiency of fat soluble vitamins
Cyclosporine (immunosuppressant)
Hyperglycemia
Hyperkalemia
HLD
Hypomagnesemia
Tacrolimus (immunosuppressant)
Alopecia
Hyperglycemia
Hyperkalemia
Hypomagnesemia
Azathioprine (immunosuppressant)
Macrocytic anemia
Pancytopenia
- anemia (low RBC)
- leukopenia (low WBC)
- thrombocytopenia (low platelets)
What foods inhibit cytochrome P450 pathway and result in increased levels of:
cyclosporine
tacrolimus
sirolimus
Grapefruit
Pomegranate
Seville oranges
Star fruit
Which 2 immunosuppressants are associated with new-onset DM after transplant?
Tacrolimus (greater prevalence)
Cyclosporine
Which 3 immunosuppressants can induce hyperlipidemia?
Corticosteroids
Cyclosporine
Sirolimus
Which med can reduce the effect of HLD when used as the primary immunosuppressant?
Tacrolimus
Antibiotics decrease which nutrients?
Vit E
Vit K
Folate
Glucocorticoids alter which nutrients?
Decreased -
Vitamin D
Phosphorous
Increased urinary loss
Calcium
For patients with feedings tubes or dysphagia: should you crush the tablet Atripla?
(antiretroviral: efavirenz/emtricitabine/tenofovir DF)
Do not crush
What should you check in all HIV-infected patients when providing nutrition care?
Triglycerides - especially prior to ILE
This is 2/2 diminished lipoprotein lipase expression in peripheral tissue –> reduced TG clearance –> hyperTG
Major side effect of appetite stimulant megace (megestrol acetate)?
Hyperglycemia
Thrombosis
Adrenal insufficiency
Major side effect of appetite stimulant marinol (dronabinol)?
Somnolence - especially in elderly
Major side effect of growth hormones?
Edema
Insulin resistance
Fat atrophy
What vit/mins can decrease the absorption of some antimicrobial agents?
- azithromycin
- levofloxacin
PO administered cations:
- Calcium
- Magnesium
- Aluminum
Valproic acid can cause a deficiency in:
Carnitine
Valproic acid combines with carnitine leading to carnitine depletion
Meds that increase urinary Vitamin C losses
- Tetracycline (antibiotic)
- Aspirin
- Corticosteroids
Which bronchodilator decreases serum thiamin?
Theophylline
Which medication does water soluble Vitamin E increase the absorption of?
Cyclosporine (immunosuppressant)
Long term corticosteroidsteroid use is associated with
Negative nitrogen balance
Net calcium loss
Glucose intolerance
Immunosuppression
Recent ASPEN guidelines suggest omega 3 supplementation in cancer patients with progressive, unintentional weight loss benefit:
May help stabilize weight in patients on PO diets
ceftriaxone compatibility with PN
Not compatible, forms precipitates with calcium
