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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
metabolism of drugs found in:
GI tract, liver, lungs, skin, kidney
26
^ CHO and fat ____ metabolism of certain drugs, leading to ____ serum levels
decreases; increased (eg. theophylline for COPD)
27
^ protein can ___ metabolic activity, leading to ___ serum levels of drug
increases; decreased (eg. warfarin)
28
phytochemicals that can inhibit or induce metabolic enzymes/transporters:
polyphenols, carotenoids, furanocoumarins, glucosinolates
29
what does grapefruit do?
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
why pt on warfarin advised not to use cranberry juice?
inhibits CYP3A and CYP2C9
31
nutr needed for normal fx of drug metabolizing enzymes:
folic acid, pyridoxine, vit c (deficiency may cause decreased clearance of drug)
32
____ diets could theoretically increase unbound drug concentrations
low protein, high fat
33
what is interaction of low protein and basic drugs?
decreased rate of excretion of basic drugs, increase in urine pH
34
lithium food interactions?
cause sodium depletion, and lithium reabsorption, possible toxicity probs with peppers/oregano/rhubarb which are diuretic
35
what is interaction of MAOIs and tyramine?
buildup of norepinephrine in neurons, ^ BP, headache, nausea, palpitations, potential for MI/stroke
36
foods containing tyramine?
fermented, spoiled, protein-rich
37
what is interaction of vit K with warfarin?
antagonizes effect of oral anticoagulants like warfarin (new class of DOACs not affected by diet)
38
food constituents with potential for anticoagulant activity:
garlic, cayenne, turmeric, cloves, ginger, flaxseed, fish oil, resveratrol
39
hypokalemia is a concern with ___
digoxin (for heart failure, arrhythmias)
40
hyperkalemia caused by:
ACE inhbitors plus K-sparing diuretics
41
large amts of Ca and vit D with calcium channel blockers causes:
blunted antihypertensive effects of CCBs (IV infusion only)
42
folate and nitroglycerin interaction?
more folic acid (tetrahydrobiopterin) prevent tolerance and increase therapeutic effect of nitrates
43
ppl with higher risk of drug nutrient interaction?
elderly, very young, pt. receiving multiple drug therapies, pt with marginal nutr intake, declining renal/hepatic function
44
why elderly more at risk?
GI lower absorption, kidneys, liver, more meds and illnesses, social isolation, mobility issues
45
drug therapy may impact negatively on nutr status by altering nutr____:
intake, digestion/absorption, metabolism/transport, excretion, requirement
46
examples of drugs that cause altered taste (dysgeusia)
antineoplastic (methotrexate), antiinfective (like clarithromycin), cardiovascular/antihyperlipidemic, CNS, misc
47
examples of drugs that cause anorexia:
antiinfectives, antineoplastics, bronchodilators, cardiovascular, stimulant
48
examples of drugs that increase appetite:
psychotropics, antipsychotics, antidepressants, anticonvulsants, hormones
49
these drugs cause prolonged dry mouth caused by decreased saliva production that decreases taste sensation and ^ risk of dental caries
drugs with anticholinergic effects (tricyclic antidepressants, antipsychotics)
50
ulcerogenic drugs
aspirin, NSAIDs
51
drugs that should be taken with lots of water and not lying down
bisphosphanates, extended release K salts, iron salts, NSAID, quinidine, tetracycline
52
these interrupt acid production in stomach, impairing B12 absorption
proton pump inhibitors
53
long term use of____ cause steatorrhea and decreased absorption of fat soluble vits
cholestyramine
54
drugs that cause diarrhea:
antigout, antineoplastic, antiinfective, antiviral, GI, antihyperglycemic
55
isoniazid interferes with ___ metabolism
B6 (via decreasing pyridoxal phosphate synth)
56
mech of action for warfarin:
exerts effect by inhibiting hepatic reductase, converting storage form of vit K to active form (competitive inhibition of vit K activity)
57
glucocorticoid effects on metabolism:
^ BG, decrease protein synth, ^ protein degradation, bone loss, round face and wt gain in abdomen
58
phenytoin cause ____ deficiency
folate (^ folate turnover)
59
what is filtration
bring things out of bloodstream in to tube where urine is made
60
what is reabsorption
take some stuff from urine and put back into blood
61
what is secretion
from blood back into urine by very specific transporter
62
how does potassium depleting diuretic work?
^ Na excretion and also K excretion, causing decreased serum K
63
types of potassium depleting diuretics:
loop diuretics (furosemide) and thiazides
64
mechanism of loop diuretics:
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
mechanism of thiazides:
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
example of potassium sparing diuretic
spironolactone
67
how does potassium sparing diuretic work
decrease Na reabsorption in distal tubule-->this means K secretion also decreases
68
how does long term broad spectrum antibiotics ^ risk of Vit K deficiency?
depressing gut bacterial synth of vit

NUTR 441 (14 decks)

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