Drug-Nutrient Interactions Flashcards
Ampho B
dec Ca+,Vit D, folic acid, zinc
Dilantin
Dec Vit D, folic acid
ABX
Dec Vit K
Heparin and coumadin
Avoid Large doses Vit C
Zinc decreases with
albumin, Vit A, infection, worsens hepatic dysfunction, dec resp fx, muscle fx and glucose intolerance
Add zinc in what diagnosis
TBI, hypermetabolism, GI losses, wounds
Inc CRP does what to zinc levels
dec 50%
Decreased Copper with what food/vits
phytates (whole grains, legumes, nuts/seeds), fiber, zinc, Fe, large doses Vit C
Dec Vit D with
Decreased Copper in malnourished
Increased zinc when
decreased Copper
Diarrhea depletes
K+ & Magnesium
Prolonged diarrhea depletes
Selenium (SBS)
Low Magnesium- what do you decrease in diet
fat binds to Magnesium and increases stool output
Neomycin- (ABX) does what to GI
partially villous atrophy and steatthorea
Cholestyramine causes what vitamin deficiency
def in ADEK
ACE
In Ca+, K+, Na and Dec PO4
Sulfasalazine (UC, RA)
Dec body stores folic acid, B12 with large doses long term
Dilantin
dec absorption of folic acid, Vit D, Vit K in fetus
Valproic Acid
carnitine
ABX aminoglycosides-tobra, gent
Dec Mg & K+= hearing loss
Cyclosporine
no grapefruit
Albuterol (beta antagonists)
Dec K+
Loop diuretics (lasix)
Dec Mg, K, Ca
Thiazide diuretics (Hctz)
decreased urine excretion of Ca
Jtube drugs not absorbed
carbomazepine (anti-seizure), cipro, Ca, Mg, antacid, Fe, coumadin hold 2 hr before/after
MAOI
no tyramine (aged cheese, salami, sauerkraut, soy, tap beer, wine, vermouth)
Chemo (patins)
loss Mg, Dec Ca-not respond to suppl
Decrease FAt soluble vits
statins, mineral oil laxatives
High protein
inc excretion of Calcium
Flagyl (metronidazole)
avoid ETOH and exilir
Ring worm med (Griseofulvin)
No ketogenic diet
Fatty foods with Gemfibozil
decreases activity
Lithium
HIgh salt=lithium excreted, Low salt= lithium toxic
Digoxin
No fiber TF- watch s/s, no licorice which incrases BP naturally
Zantac
Dec absorption Fe
Average Vit K in diet
90-118 mcg/day (<100mcg per 1000 cals)
Levothyroxine (sythroid) decreased absorption with what type of protein
soy
Which mins have high osmolality and must be spaced out
K, PO4, Mg
High osmolar diuretic that must be diluted
lasix= 3900 with 49% sorbitol
ranitidine in PN with 12 hr cycle
another does for additional 12 hrs off PN
Iron Dextran IV
no lipid in PN, over 18 hrs
Reglan (metroclopramide) helps
nausea with Hyperemesis
Ginger/B6 helps
nausea with Hyperemesis
triamterene
K+ sparing diuretic
ADH released when what happens to serum
Inc osmolality
Large doses Vit C, Avoid with these meds/vits
heparin, coumadin and Copper
Low Mg, decrease this in diet
fat- it binds with Mg to make it lower
HD- lose these vits
water soluble B and Fe
Inflammatory mediators include
cytokines, TNF, interleuken-1
Microcytic, hypochromic anemia
Fe, Copper
Macrocytic anemia
Folic acid
Megaloblastic anemia
B12, Folic acid
Micrcytic
B6
@ risk of B6 deficiency
HD, elderly, steroids, anticonvulsants, ETOH
Decreased Vit D s/s
muscle weakness, High BP, HL
Fe absorbed where?
proximal jejunum
Hold TF with these meds
theophylline, cipro, dilantin, coumadin
metheotrexate can bind with this vit
folate
Decreased absorption of Folic acid with these factors
impaired bile, change jejunal pH
Meds that dec absorption of Folic acid
dilantin, ampho B, sulfasalazine, choestyramine, PD dialysis
citrate, gluconate, lactate acetate are
bicarbs
SIADH
euvolemia, total body inc, conc urine
Inc ADH
conc urine
Independent predictor for m/m in critically ill
alb < 2.6
Starvation
dec Gluc, ketosis, lipolysis
Stress Malnutrition
Hypermetabolism, Inc Gluc, lipolysis
Malnurition is what wt loss criteria
10% wt loss UBW x 6 months, equal or greater than 5% wt loss x 1 month
Jtube feeds, check this vit level
Fe
Overfeeding
resp acidosis
TF syndrome
Hi BUN/creat, Inc Na, dehydration s/t HI PRO/low fluid
Hypocaloric with Obese
BMI > 30, 22 cals/kg
GFR for ESRD
< 15cc/min or 1.73m2
PRO for PD Dialysis
1.2-1.3g/kg/d
CF @ risk what vit def
fat soluble d/t panc insufficiency.
Essential Fatty Acid sources
veg oils- canola, flaxseed, walnut, fish
SB overgrowth
D lactic acidosis
Octreotide
refractory diarrhea
SB 150-200 cm
significant losses
WHO oral rehydration soln
CHO 40g, NA 90g, K 20, Osmo 311
Normal length small bowel
600 cm
Normal length colon
150
SBS without colon
add salt, high fluid/Na output, no simple sugars, isotonic/high Na ORS
Inflammatory hormones
epinephrine, glucogan, cortisol
Body process with Acute Response Phase
glucogenolysis, gluconeogenesis, liplysis, proteolysis
SBS with colon
Intol high fat, hypotonic fluid, bacterial overgrowth, oxalate kidney stones, unabsorbed bile salts damage colon–secretory diarrhea.
Diet for SBS with colon
small freq meals, low fat, complex CHO, limit simple sugars, MCT, EFA, soluble fiber, low oxalates, sip ORS
Diet for SBS without colon
small freq meals, avoid low cals/high fiber, restrict simple sugars, add salt, sip isotonic/high Na ORS,suppl lytes with po /IV, antiperistaltic agents a meals, H2 blockers, PPI
Most widely tool to measure generic healthy status
SF 36
Fat increases blood flow to
GI
Lower threshold with initiation of PN in this population
elderly
GAstric Bypass supple these vits
B12, B1, zinc, copper
