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NUTR 441 > Drug Nutrient Interactions > Flashcards

Drug Nutrient Interactions Flashcards

1
Q

what is drug-nutrient interaction?

A

alteration of kinetics or dynamics of a drug or nutritional elements, or a compromise in nutr status as result of addition of drug

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2
Q

3 drug related outcomes:

A

increased activity of drug, decreased activity, doesn’t do anything

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3
Q

3 mechanisms of drug interaction

A

pharmaceutical, pharmacokinetic, pharmacodynamic

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4
Q

this mechanism occurs before administration of drug

A

pharmaceutical

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5
Q

this mechanism affects absorption, distribution, metabolism / excretion of drug

A

pharmacokinetic

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6
Q

this mechanism modifies drug activity at receptor level

A

pharmacodynamic

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7
Q

major metabolism site for drugs

A

liver

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8
Q

rate limiting step in drug absorption

A

solution

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9
Q

factors affecting oral absorption?

A

drug and formulation (solid/liquid, regular/slow release, chem nature); GI motility (food/fluids, pain/stress); blood flow to absorption area; activity of transporters/metabolizing enzymes; changes in normal flora

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10
Q

active transport mechanisms important in drug absorption:

A

ATP binding cassette, solute-linked carriers

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11
Q

drug metabolizing enzymes:

A

cytochrome P450, monamine oxidase, alcohol dehydrogenase, esterases, amidases, etc

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12
Q

what is the first pass effect?

A

loss of active drug in GI tract and first pass thru liver before drug enters systemic circulation, determines bioavailability

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13
Q

what contributes to FPE?

A

metabolism in gut wall and liver, transporter activity

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14
Q

effects of balanced meal on GI tract

A

delay in gastric emptying, ^ secretions, ^ motility, ^ fluid volumes

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15
Q

potential effects of meal on drug absorption, delayed/reduced absorption

A

delayed response due to slower absorption rate, increased breakdown of acid labile drugs, increased complexation with food constituents, premature release of enteric coated drugs, retention of undissolved tablets in stomach

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16
Q

examples of increased absorption?

A

poorly soluble (acne meds), decrease in metabolism (antidepressant), increased bile secretion (phenytoin), surfactant activity

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17
Q

if ____ F, take drug at least 1 hr before or 2 hrs after meal; if _____ F, take drug w/ or immediately after meals

A

decreased; increased

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18
Q

what is F?

A

fraction of drug absorbed

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19
Q

_____ in food form insoluble chelates with susceptible drugs, excreted in feces

A

metallic ions

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20
Q

important examples of chelating drugs:

A

tetracyclines, quinolones, bisphosphonates

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21
Q

fibre may reduce absorption by bind to certain drugs like:

A

digoxin, lovastatin

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22
Q

fibre may prolong absorption and provide level serum [ ] with drugs like:

A

levodopa

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23
Q

____ responsible for majority of metabolized drugs

A

phase 1 Cytochrome P450 family

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24
Q

what are Phase 2?

A

UDP glucoronosyltransferases (UGTs)

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25
Q

metabolism of drugs found in:

A

GI tract, liver, lungs, skin, kidney

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26
Q

^ CHO and fat ____ metabolism of certain drugs, leading to ____ serum levels

A

decreases; increased (eg. theophylline for COPD)

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27
Q

^ protein can ___ metabolic activity, leading to ___ serum levels of drug

A

increases; decreased (eg. warfarin)

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28
Q

phytochemicals that can inhibit or induce metabolic enzymes/transporters:

A

polyphenols, carotenoids, furanocoumarins, glucosinolates

29
Q

what does grapefruit do?

A

inhibits CYP3A4 in gut wall and OATP/p-glycoprotein; significantly ^ F of drugs with high FPE and v F of drugs absorbed via OATP

30
Q

why pt on warfarin advised not to use cranberry juice?

A

inhibits CYP3A and CYP2C9

31
Q

nutr needed for normal fx of drug metabolizing enzymes:

A

folic acid, pyridoxine, vit c (deficiency may cause decreased clearance of drug)

32
Q

____ diets could theoretically increase unbound drug concentrations

A

low protein, high fat

33
Q

what is interaction of low protein and basic drugs?

A

decreased rate of excretion of basic drugs, increase in urine pH

34
Q

lithium food interactions?

A

cause sodium depletion, and lithium reabsorption, possible toxicity probs with peppers/oregano/rhubarb which are diuretic

35
Q

what is interaction of MAOIs and tyramine?

A

buildup of norepinephrine in neurons, ^ BP, headache, nausea, palpitations, potential for MI/stroke

36
Q

foods containing tyramine?

A

fermented, spoiled, protein-rich

37
Q

what is interaction of vit K with warfarin?

A

antagonizes effect of oral anticoagulants like warfarin (new class of DOACs not affected by diet)

38
Q

food constituents with potential for anticoagulant activity:

A

garlic, cayenne, turmeric, cloves, ginger, flaxseed, fish oil, resveratrol

39
Q

hypokalemia is a concern with ___

A

digoxin (for heart failure, arrhythmias)

40
Q

hyperkalemia caused by:

A

ACE inhbitors plus K-sparing diuretics

41
Q

large amts of Ca and vit D with calcium channel blockers causes:

A

blunted antihypertensive effects of CCBs (IV infusion only)

42
Q

folate and nitroglycerin interaction?

A

more folic acid (tetrahydrobiopterin) prevent tolerance and increase therapeutic effect of nitrates

43
Q

ppl with higher risk of drug nutrient interaction?

A

elderly, very young, pt. receiving multiple drug therapies, pt with marginal nutr intake, declining renal/hepatic function

44
Q

why elderly more at risk?

A

GI lower absorption, kidneys, liver, more meds and illnesses, social isolation, mobility issues

45
Q

drug therapy may impact negatively on nutr status by altering nutr____:

A

intake, digestion/absorption, metabolism/transport, excretion, requirement

46
Q

examples of drugs that cause altered taste (dysgeusia)

A

antineoplastic (methotrexate), antiinfective (like clarithromycin), cardiovascular/antihyperlipidemic, CNS, misc

47
Q

examples of drugs that cause anorexia:

A

antiinfectives, antineoplastics, bronchodilators, cardiovascular, stimulant

48
Q

examples of drugs that increase appetite:

A

psychotropics, antipsychotics, antidepressants, anticonvulsants, hormones

49
Q

these drugs cause prolonged dry mouth caused by decreased saliva production that decreases taste sensation and ^ risk of dental caries

A

drugs with anticholinergic effects (tricyclic antidepressants, antipsychotics)

50
Q

ulcerogenic drugs

A

aspirin, NSAIDs

51
Q

drugs that should be taken with lots of water and not lying down

A

bisphosphanates, extended release K salts, iron salts, NSAID, quinidine, tetracycline

52
Q

these interrupt acid production in stomach, impairing B12 absorption

A

proton pump inhibitors

53
Q

long term use of____ cause steatorrhea and decreased absorption of fat soluble vits

A

cholestyramine

54
Q

drugs that cause diarrhea:

A

antigout, antineoplastic, antiinfective, antiviral, GI, antihyperglycemic

55
Q

isoniazid interferes with ___ metabolism

A

B6 (via decreasing pyridoxal phosphate synth)

56
Q

mech of action for warfarin:

A

exerts effect by inhibiting hepatic reductase, converting storage form of vit K to active form (competitive inhibition of vit K activity)

57
Q

glucocorticoid effects on metabolism:

A

^ BG, decrease protein synth, ^ protein degradation, bone loss, round face and wt gain in abdomen

58
Q

phenytoin cause ____ deficiency

A

folate (^ folate turnover)

59
Q

what is filtration

A

bring things out of bloodstream in to tube where urine is made

60
Q

what is reabsorption

A

take some stuff from urine and put back into blood

61
Q

what is secretion

A

from blood back into urine by very specific transporter

62
Q

how does potassium depleting diuretic work?

A

^ Na excretion and also K excretion, causing decreased serum K

63
Q

types of potassium depleting diuretics:

A

loop diuretics (furosemide) and thiazides

64
Q

mechanism of loop diuretics:

A

they promote Na excretion by decreasing Na reabsorption in Loop of Henle–>more Na presented to distal tubule so more is reabsorbed there in exchange for equivalent amt K secreted (increasing K excretion in aldosterone regulated step)

65
Q

mechanism of thiazides:

A

promote Na excretion by decreasing Na reabsorption in proximal tubule–>more Na presented to distal tubule than usual so more is reabsorbed there in exchange for = amt K secreted

66
Q

example of potassium sparing diuretic

A

spironolactone

67
Q

how does potassium sparing diuretic work

A

decrease Na reabsorption in distal tubule–>this means K secretion also decreases

68
Q

how does long term broad spectrum antibiotics ^ risk of Vit K deficiency?

A

depressing gut bacterial synth of vit

NUTR 441 (14 decks)

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