Drug-Nutrient Interactions/Reactions Flashcards
Contraceptive w/ Estrogen:
Inhibit absorption of FOLATE (b9), Vitamin A, Vitamin C
Estrogens:
Accelerate calcium and magnesium deposition into bone
Amlodipine: Calcium Channel Blockers (HYPERTENSION)
CHOLESTEROL, HEART
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.
(ACE) inhibitors Angiotensin-Converting Enzyme (hypertension)
CHOLESTEROL, HEART
Chelates/inhibits IRON
Depletes ZINC (increases Zinc excretion)
***Inhibit POTASSIUM excretion (holds potassium) = HYPERKALEMIA
ART Medications
*antiretroviral therapy (HIV)
CHOLESTEROL, HEART
St. John’s Wort (and Garlic) interfere w/ Blood levels of ART medication (decreasing efficacy of drug)
Atorvastatin (Cholesterol, Statin)
CHOLESTEROL, HEART
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
Anticoagulants (warfarin, coumadin):
*Competes with Vitamin K for binding sites; inhibits synthesis of vitamin K-dependent clotting factors and coagulation inhibitor proteins.
CHOLESTEROL, HEART
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
Anticoagulants (warfarin, coumadin):
*Competes with Vitamin K for binding sites; inhibits synthesis of vitamin K-dependent clotting factors and coagulation inhibitor proteins.
CHOLESTEROL, HEART
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
Antihypertensives (methyldopa):
CHOLESTEROL, HEART
Inhibit enz req’ B6; inhibit enz req’ CoQ10; Grapefruit increases drug absorption
Antihypertensives (methyldopa):
CHOLESTEROL, HEART
Inhibit enz req’ B6; inhibit enz req’ CoQ10; Grapefruit increases drug absorption
BETA-BLOCKERS
Antihypertensives
CHOLESTEROL, HEART
inhibit enz req’ CoQ10; Melatonin
Chelates/prevents absorption of Ca
Hypocholesterolemics (cholestyramine):
(clofibrate):
(colestipol):
CHOLESTEROL, HEART
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
Anthracyclines / chemo
(chemotherapy drugs):
IMMUNE, CANCER, ANTI-INFLAMMATORY
Inhibits endogenous synthesis of CoQ10
Methotrexate (cancer drug); Used for RA/Cancer (Antineoplastic)
IMMUNE, CANCER, ANTI-INFLAMMATORY
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,
Methotrexate (cancer drug); Used for RA/Cancer (Antineoplastic)
IMMUNE, CANCER, ANTI-INFLAMMATORY
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,
ANTIBIOTICS (Tetracyclines)
Amoxicillin
IMMUNE, CANCER, ANTI-INFLAMMATORY
Magnesium, Vitamin K
Dairy; Iron (decreases drug absorption), B-vitamins, K, Calcium, Zinc, Magnesium, Probiotics/Enterobiotics
Anticonvulsants (anti-seizure)
*psychiatrists use these for mood-stabilizing in Pt w/ Bipolar, etc
IMMUNE, CANCER, ANTI-INFLAMMATORY
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
Anticonvulsants (anti-seizure)
*psychiatrists use these for mood-stabilizing in Pt w/ Bipolar, etc
IMMUNE, CANCER, ANTI-INFLAMMATORY
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
Antitubercular:
IMMUNE, CANCER, ANTI-INFLAMMATORY
Inhibit conversion of Tryptophan > Niacin; Inhibit enz’ req’ Pyridoxine (b6)
Inhibit Folate/B12 absorption, block Vitamin D activation
-ine = Antimicrobials (cycloserine):
Antimicrobials (sulfasalazine):
Antimicrobials (TETRAcyclines):
IMMUNE, CANCER, ANTI-INFLAMMATORY
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)
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
Iron, Melatonin, Zinc absorption; Take w/ food/milk to decrease GI irritation
**Anti-inflammatory NSAID inhibit FOLATE
Glucocorticoids:
*medicines that fight inflammation and work with your immune system to treat wide range of health problem
IMMUNE, CANCER, ANTI-INFLAMMATORY
Inhibit absorption of Calcium and Folate
Accelerate bone demineralization
Corticosteroid
(Flonase, Dexamethasone, Budesonide, (HYDROCORTISONE) reduce swelling
IMMUNE, CANCER, ANTI-INFLAMMATORY
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
Corticosteroid
(Flonase, Dexamethasone, Budesonide, (HYDROCORTISONE) reduce swelling
IMMUNE, CANCER, ANTI-INFLAMMATORY
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
Analgesic Acetaminophen (Tylenol) *fever, aches
IMMUNE, CANCER, ANTI-INFLAMMATORY
Alcohol
N-acetylcysteine is used to combat tylenol/carbon monoxide poisoning
Analgesic Acetaminophen (Tylenol) *fever, aches
IMMUNE, CANCER, ANTI-INFLAMMATORY
Alcohol
N-acetylcysteine is used to combat tylenol/carbon monoxide poisoning
Reverse Transcriptase Inhibitor (antiretroviral drugs used to treat HIV/AIDS)
IMMUNE, CANCER, ANTI-INFLAMMATORY
Inhibit absorption Vitamin B12, Zinc, Copper
Proton Pump Inhibitors/PPI
(Omeprazole): *reduces gastric acid secretion leading to low B12
Inhibiting acid secretion
GASTROINTESTINAL, ANTACIDS
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
Proton Pump Inhibitors/PPI
(Omeprazole): *reduces gastric acid secretion leading to low B12
Inhibiting acid secretion
GASTROINTESTINAL, ANTACIDS
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
H2 BLOCKERS; -dine:
Decrease acid production
RANITIDINE/ZANTAC
GASTROINTESTINAL, ANTACIDS
GASTROINTESTINAL, ANTACIDS
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
Anti-gout (Colchicine):
GASTROINTESTINAL, ANTACIDS
Induces B12 malabsorption + dietary sugars; Inhibits intestinal mucosal cell replication
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).
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,
Antipsychotics:
Antidepressants/Psychotherapeutics:
Inhibits enzyme reactions of CoQ10
Antidepressants (Tricyclic): *common side effects = dry mouth and tooth decay.
Antidepressants/Psychotherapeutics:
Inhibits actions of enzymes requiring CoQ10
SSRI (Selective Serotonin Reuptake inhibitor) *Prozac
Antidepressants/Psychotherapeutics:
Melatonin,
Folate
Avoid: Tryptophan/5-HTP, SAM-e, Kava Kava, SJW
Barbiturates
*any of a class of sedative and sleep-inducing drugs derived from barbituric acid.
Antidepressants/Psychotherapeutics:
Impairs bioavailability of vitamin D
Folate
Diuretics (K-SPARING):
Diuretics (K-DEPLETING):
Thiazide Diuretics
RENAL, POTASSIUM
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
Diuretics (K-SPARING):
Diuretics (K-DEPLETING):
Thiazide Diuretics
RENAL, POTASSIUM
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
Potassium Repletion:
RENAL, POTASSIUM
Inhibit B12 absorption + (Alters ileal pH)
Laxatives (castor oil, Magnesia, Mineral oils, Phenolphthalein):
RENAL, POTASSIUM
Decrease absorption: Ca, K+, B-carotene, Vitamin A and vitamin K.
Decreases absorption of vitamin D
Albuterol (Data in IV doses)
*treat wheezing and shortness of breath caused by breathing problems
Watch Calcium, Magnesium, Potassium, Phosphorus
Hypoglycemics (Biguanides)
(METFORMIN)
Malabsorption of Vitamin B12/Folic Acid (b9)
**Metformin’s primary site of action is the Liver (Decreases hepatic GLucose production/help reduce insulin resistance*
Levothyroxine; Levothroid; Synthroid (Synthetic Thyroid)
Calcium/COFFEE: ↓drug absorption (↑ TSH) CA/COF LOW drug, high TSH
Vitamin C: ↑drug absorption (↓ TSH)
Grapefruit Juice: Decreases drug absorb
Phosphate Binders
(take w/ meals)
*Types of P binders:
Calcium Acetate, Calcium carbonate, Aluminum hydroxide
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
Drugs that Inhibit Coenzyme Q10 (Primer):
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
