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CNS Exam 2022 - multi decks > Drug-Nutrient Interactions/Reactions > Flashcards

Drug-Nutrient Interactions/Reactions Flashcards

1
Q

Contraceptive w/ Estrogen:

A

Inhibit absorption of FOLATE (b9), Vitamin A, Vitamin C

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2
Q

Estrogens:

A

Accelerate calcium and magnesium deposition into bone

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3
Q

Amlodipine:
Calcium Channel Blockers (HYPERTENSION)

CHOLESTEROL, HEART

A

Watch grapefruit + Pomegranate consumption (Impacts CYP450 Enzyme, CYP3A4)….

*Over half of drugs available on the market are metabolized by CYP3A4; Grapefruit is selective to Intestinal CYP3A4 inhibitors. When Grapefruit is ingested with a number of medications, CYP3A4 enzymes are deactivated/destroyed. This leads to a 5-fold increased exposure level of the drug in circulation.

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3
Q

(ACE) inhibitors
Angiotensin-Converting Enzyme (hypertension)

CHOLESTEROL, HEART

A

Chelates/inhibits IRON
Depletes ZINC (increases Zinc excretion)
***Inhibit POTASSIUM excretion (holds potassium) = HYPERKALEMIA

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4
Q

ART Medications
*antiretroviral therapy (HIV)

CHOLESTEROL, HEART

A

St. John’s Wort (and Garlic) interfere w/ Blood levels of ART medication (decreasing efficacy of drug)

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5
Q

Atorvastatin (Cholesterol, Statin)

CHOLESTEROL, HEART

A

Statins deplete CoQ10, Metformin, B12, Vitamin D and compete with H2 Blockers/PPI

Grapefruit Juice: Increases serum atorvastatin; induces CYP3A4; Increases plasma atorvastatin

St. John’s Wort Increases LDL/ TTL Chol

Red Yeast Rice: Similar in structure to statins; mold growing on rice; mold = HMG (low Coq10 also incurred by red yeast rice)

HMG coa REDUCTASE.

Common botanicals/herbs/foods that interacts w/ statins/other cytochrome P450 drugs:
Ginseng, therapeutic doses of garlic, ginkgo

Inhibit regulatory enz. In Pathway of CoQ10 synthesis

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6
Q

Anticoagulants (warfarin, coumadin):

*Competes with Vitamin K for binding sites; inhibits synthesis of vitamin K-dependent clotting factors and coagulation inhibitor proteins.

CHOLESTEROL, HEART

A

High vitamin K intake decreases drug effects vitamin K bioavailability also affected by high dose vitamin E

Inconsistent vitamin K intake leads to inconsistent levels/action of Warfarin.

Ginkgo biloba: Potentiates action of anticoagulants

Black currant: Antithrombonic and is an “anticoagulant herb”

Interfere with D activation and osteoblast function

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7
Q

Anticoagulants (warfarin, coumadin):

*Competes with Vitamin K for binding sites; inhibits synthesis of vitamin K-dependent clotting factors and coagulation inhibitor proteins.

CHOLESTEROL, HEART

A

High vitamin K intake decreases drug effects vitamin K bioavailability also affected by high dose vitamin E

Inconsistent vitamin K intake leads to inconsistent levels/action of Warfarin.

Ginkgo biloba: Potentiates action of anticoagulants

Black currant: Antithrombonic and is an “anticoagulant herb”

Interfere with D activation and osteoblast function

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8
Q

Antihypertensives (methyldopa):

CHOLESTEROL, HEART

A

Inhibit enz req’ B6; inhibit enz req’ CoQ10; Grapefruit increases drug absorption

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9
Q

Antihypertensives (methyldopa):

CHOLESTEROL, HEART

A

Inhibit enz req’ B6; inhibit enz req’ CoQ10; Grapefruit increases drug absorption

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10
Q

BETA-BLOCKERS
Antihypertensives

CHOLESTEROL, HEART

A

inhibit enz req’ CoQ10; Melatonin
Chelates/prevents absorption of Ca

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11
Q

Hypocholesterolemics (cholestyramine):

(clofibrate):
(colestipol):

CHOLESTEROL, HEART

A

Lowers absorption of vitamin B12; Binds bile acid, cholesterol, bile salts, nutrients; Lowers digestion/absorption of fatty acid, fat-sol. Vitamins, iron, and B-carotene

Interferes with absorption of vitamin B12, vitamin A, D, E
Binds/promotes bile acid excretion; lowers fatty acid/fat-sol. Vitamin absorption

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12
Q

Anthracyclines / chemo
(chemotherapy drugs):

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Inhibits endogenous synthesis of CoQ10

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13
Q

Methotrexate (cancer drug); Used for RA/Cancer (Antineoplastic)

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Folate antagonist (potentiate the effects of biologics (will be put on methotrexate along w/ biologic drugs and will be placed on high amounts of folate); B12, CALCIUM; Arrests enterocyte mitosis, causing structural defects and enzyme deficiencies in intestine,

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14
Q

Methotrexate (cancer drug); Used for RA/Cancer (Antineoplastic)

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Folate antagonist (potentiate the effects of biologics (will be put on methotrexate along w/ biologic drugs and will be placed on high amounts of folate); B12, CALCIUM; Arrests enterocyte mitosis, causing structural defects and enzyme deficiencies in intestine,

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15
Q

ANTIBIOTICS (Tetracyclines)
Amoxicillin

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Magnesium, Vitamin K
Dairy; Iron (decreases drug absorption), B-vitamins, K, Calcium, Zinc, Magnesium, Probiotics/Enterobiotics

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16
Q

Anticonvulsants (anti-seizure)
*psychiatrists use these for mood-stabilizing in Pt w/ Bipolar, etc

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Impairs bioavailability of vitamin D, Folate, and B7, B12
Vitamin C decreases drug effects
Accelerates inactivation by liver and bile excretion; Lowers Ca absorption
St. John’s Wort

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17
Q

Anticonvulsants (anti-seizure)
*psychiatrists use these for mood-stabilizing in Pt w/ Bipolar, etc

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Impairs bioavailability of vitamin D, Folate, and B7, B12
Vitamin C decreases drug effects
Accelerates inactivation by liver and bile excretion; Lowers Ca absorption
St. John’s Wort

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18
Q

Antitubercular:

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Inhibit conversion of Tryptophan > Niacin; Inhibit enz’ req’ Pyridoxine (b6)
Inhibit Folate/B12 absorption, block Vitamin D activation

19
Q

-ine = Antimicrobials (cycloserine):

Antimicrobials (sulfasalazine):

Antimicrobials (TETRAcyclines):

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Inhibits absorption of FA, AA, Ca, Na, K+, Folate, Vitamin B12, Iron
Produces structural defects in bile ducts; Decreases bile acid transport to intestine

Inhibits mucosal uptake of Folate

Forms chelates w/ Divalent/trivalent cations; inhibits absorptions (Mg, An, Ca, Mn, Fe, Na)

20
Q

Inhibits absorption of FA, AA, Ca, Na, K+, Folate, Vitamin B12, Iron
Produces structural defects in bile ducts; Decreases bile acid transport to intestine

Inhibits mucosal uptake of Folate

Forms chelates w/ Divalent/trivalent cations; inhibits absorptions (Mg, An, Ca, Mn, Fe, Na)

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Iron, Melatonin, Zinc absorption; Take w/ food/milk to decrease GI irritation
**Anti-inflammatory NSAID inhibit FOLATE

21
Q

Glucocorticoids:
*medicines that fight inflammation and work with your immune system to treat wide range of health problem

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Inhibit absorption of Calcium and Folate
Accelerate bone demineralization

22
Q

Corticosteroid
(Flonase, Dexamethasone, Budesonide, (HYDROCORTISONE) reduce swelling

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Impairs bioavailability of vitamin D; Vitamin C, Vitamin B6, Ca, Mg, K+, Se, Zn, B-Carotene, DHEA, Melatonin, Protein/AA
Impairs bioavailability of Folate and Vitamin B12

22
Q

Corticosteroid
(Flonase, Dexamethasone, Budesonide, (HYDROCORTISONE) reduce swelling

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Impairs bioavailability of vitamin D; Vitamin C, Vitamin B6, Ca, Mg, K+, Se, Zn, B-Carotene, DHEA, Melatonin, Protein/AA
Impairs bioavailability of Folate and Vitamin B12

23
Q

Analgesic Acetaminophen (Tylenol) *fever, aches

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Alcohol
N-acetylcysteine is used to combat tylenol/carbon monoxide poisoning

24
Q

Analgesic Acetaminophen (Tylenol) *fever, aches

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Alcohol
N-acetylcysteine is used to combat tylenol/carbon monoxide poisoning

25
Q

Reverse Transcriptase Inhibitor 
(antiretroviral drugs used to treat HIV/AIDS)

IMMUNE, CANCER, ANTI-INFLAMMATORY

A

Inhibit absorption Vitamin B12, Zinc, Copper

26
Q

Proton Pump Inhibitors/PPI
(Omeprazole): *reduces gastric acid secretion leading to low B12

Inhibiting acid secretion

GASTROINTESTINAL, ANTACIDS

A

vitamin B12, FOLATE (b9; after 3years)
Iron and Zinc (also CALCIUM, Mg, B1)

Ex: A Ct on PPI for a long time…which are you.LEAST concerned about?
**Long term use = IBS, Osteoporosis, SIBO
Bone Mineral Density
Vitamin A/E/D/K (mostly, Fat malabsorption)
P. Anemia
H. Pylori

for Ct’s transitioning off PPI: Gastrazyme/Hal Ease (Biotics); Cabbage Juice

27
Q

Proton Pump Inhibitors/PPI
(Omeprazole): *reduces gastric acid secretion leading to low B12

Inhibiting acid secretion

GASTROINTESTINAL, ANTACIDS

A

vitamin B12, FOLATE (b9; after 3years)
Iron and Zinc (also CALCIUM, Mg, B1)

Ex: A Ct on PPI for a long time…which are you.LEAST concerned about?
**Long term use = IBS, Osteoporosis, SIBO
Bone Mineral Density
Vitamin A/E/D/K (mostly, Fat malabsorption)
P. Anemia
H. Pylori

for Ct’s transitioning off PPI: Gastrazyme/Hal Ease (Biotics); Cabbage Juice

28
Q

H2 BLOCKERS; -dine:

Decrease acid production

RANITIDINE/ZANTAC

GASTROINTESTINAL, ANTACIDS
GASTROINTESTINAL, ANTACIDS

A

CALCIUM (Weakens bones by hindering Mineral uptake)
Inhibits absorption of Vitamin B12, Folate, Calcium, Iron, Zinc
Inhibits absorption of Vitamin D

RANITIDINE (ZANTAC) = Contains Significant amounts of Sodium

29
Q

Anti-gout (Colchicine):

GASTROINTESTINAL, ANTACIDS

A

Induces B12 malabsorption + dietary sugars; Inhibits intestinal mucosal cell replication

30
Q

MAO inhibitors:
*Monoamine oxidase inhibitors are a class of drugs that inhibit the activity of one or both monoamine oxidase enzymes: monoamine oxidase A and monoamine oxidase B. They are best known as highly efficacious anti-depressants

Antidepressants/Psychotherapeutics:
Blocks oxidative deamination to cause the accumulation of endogenous catecholamines (serotonin, norepinephrine, and dopamine) at adrenergically active tissue sites (e.g., brain).

A

Inhibit enz req’ B6; Increases appetite + CHO craving (MAO RHYMES WITH TAO)

MAO Interacts w/ Tyramine 
(anchovies, chocolate, meat extracts, sour cream, raspberry, FERMENTED products/AGED cheese, SOY, wine, pickles/PICKLED herring, yeast, fava beans) = (Increases risk for hypertensive/high BP) 
vasopressors may be present in smoked fish, but smoked fish is NOT contraindicated with MAO inhibitors

Vasopressor Agents in foods and drugs (Avoid w/ MAO Inhibitors): 
Norepinephrine, Epinephrine, Dopamine, Histamine, Tyramine, Vasopressin, Phenylephrine, Dobutamine,

31
Q

Antipsychotics:

Antidepressants/Psychotherapeutics:

A

Inhibits enzyme reactions of CoQ10

32
Q

Antidepressants (Tricyclic): *common side effects = dry mouth and tooth decay.

Antidepressants/Psychotherapeutics:

A

Inhibits actions of enzymes requiring CoQ10

33
Q

SSRI (Selective Serotonin Reuptake inhibitor) *Prozac

Antidepressants/Psychotherapeutics:

A

Melatonin,
Folate
Avoid: Tryptophan/5-HTP, SAM-e, Kava Kava, SJW

34
Q

Barbiturates
*any of a class of sedative and sleep-inducing drugs derived from barbituric acid.

Antidepressants/Psychotherapeutics:

A

Impairs bioavailability of vitamin D
Folate

35
Q

Diuretics (K-SPARING):

Diuretics (K-DEPLETING):
Thiazide Diuretics

RENAL, POTASSIUM

A

Calcium, Zinc, Folic Acid
INHIBIT urinary excretion of Potassium (K+)
(Potassium sparing diuretics SPARES POTASSIUM)

Increase urinary excretion of Potassium (K+)…..also Thiamin (B1), Magnesium (Mg)
Depletes/lowers concentration of potassium

36
Q

Diuretics (K-SPARING):

Diuretics (K-DEPLETING):
Thiazide Diuretics

RENAL, POTASSIUM

A

Calcium, Zinc, Folic Acid
INHIBIT urinary excretion of Potassium (K+)
(Potassium sparing diuretics SPARES POTASSIUM)

Increase urinary excretion of Potassium (K+)…..also Thiamin (B1), Magnesium (Mg)
Depletes/lowers concentration of potassium

37
Q

Potassium Repletion:

RENAL, POTASSIUM

A

Inhibit B12 absorption + (Alters ileal pH)

38
Q

Laxatives (castor oil, Magnesia, Mineral oils, Phenolphthalein):

RENAL, POTASSIUM

A

Decrease absorption: Ca, K+, B-carotene, Vitamin A and vitamin K.
Decreases absorption of vitamin D

39
Q

Albuterol (Data in IV doses)
*treat wheezing and shortness of breath caused by breathing problems

A

Watch Calcium, Magnesium, Potassium, Phosphorus

40
Q

Hypoglycemics (Biguanides)
(METFORMIN)

A

Malabsorption of Vitamin B12/Folic Acid (b9)
**Metformin’s primary site of action is the Liver (Decreases hepatic GLucose production/help reduce insulin resistance*

41
Q

Levothyroxine; Levothroid; Synthroid (Synthetic Thyroid)

A

Calcium/COFFEE: ↓drug absorption (↑ TSH) CA/COF LOW drug, high TSH
Vitamin C: ↑drug absorption (↓ TSH)
Grapefruit Juice: Decreases drug absorb

42
Q

Phosphate Binders
(take w/ meals)

*Types of P binders:
Calcium Acetate, Calcium carbonate, Aluminum hydroxide

A

Cts often neglect to take Phosphate binders due to the following:

> Causes constipation, Acid Reflux, difficult to swallow, cannot feel a difference when taking them


> Iron, antiarrhythmic drugs/ginkgo biloba

43
Q

Drugs that Inhibit Coenzyme Q10 (Primer):

A

Anthracyclines (cancer) - Inhibits endogenous synthesis of CoQ10


Antidepressants (Tricyclic) - Inhibits actions of enzymes requiring CoQ10

Antihypertensives (Methyldopa) - Inhibits enzymes reactions of CoQ10 (also Iron, Folate, B12)

Antihypertensives (Beta-blockers) - Inhibits enzymes reactions of CoQ10, (also Chelates Ca (prevents absorption)

Antipsychotics - Inhibits enzymes reactions of CoQ10

HMG-CoA Reductase Inhibitors - Inhibits regulatory enzymes CoQ10 pathway

CNS Exam 2022 - multi decks (4 decks)

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