Exam 1: Drug Nutrient Interactions Flashcards
what is the significance of drug-nutrient interactions (DNI)?
Foods can interfere with the bodies ability to absorb a medication, reducing the dose or increasing absorption, which can improve availability of the drug or post the risk for toxicity
What are the 2 pharmacologic aspects of drug-nutrient interactions (DNI)?
- Pharmacodynamics
- Pharmacokinetics
What are pharmacodynamics?
examples
Biochemical and
physiological effects of a drug
examples: drug-receptor interaction, patients functional state, placebo effect
What are Pharmacokinetics
⚬ Absorption (GI tract and administration site)
⚬ Distribution (blood)
⚬ Metabolism (liver, kidney, sites of action)
⚬ Excretion (bile or urine)
If drug is metabolized in the liver, how is it excreted?
Bile
If drug is metabolized in the kidney, how is it excreted?
urine
Interaction effects of pharmacologic aspect of drugs depend on:
⚬ Type of medication
⚬ Form of drug
⚬ Dosage
⚬ Site of absorption
⚬ Route of
administration
Describe effects of food on drug therapy
Absorption
Physical incompatibility
Bioavailability
What is the effect of food on drug therapy during absorption in the following: IV drugs
IV drugs have 100% bioavailability absorption because it is administered IV directly to blood
What is the effect of food on drug therapy during absorption in the following: orally
medicine administered orally decreases in bioavailability
What is the effect of food on drug therapy during absorption in the following: stomach/gastric
- Gastric emptying rate affect absorption by delaying it specially when eating high fat meals or high fiber meals
What is the effect of food on drug therapy during absorption in the following: chelation
- Chelation - binding of a drug with a mineral
- certain medications can bind with cation minerals such as Fe Ca Mg
- Chelation can enhance or dec absorption
What is the effect of food on drug therapy during absorption in the following: adsorption
Adsorption- binding drug with another substance
- examples phytate, oxalates,
What is the effect of food on drug therapy during absorption in the following: pH
- GI pH can inc or dec a drug absorption
What is Enteral Nutrition?
- tube feeding when a patient is NPO
- formula food administered via tube goes through GI tract
Concerns with enteral nutrition
- physical incompatibility
What do you do with Enteral nutrition when physical incompatibility on drug therapy occurs?
Flush tube with water
before and after medication
administration
What medicine is affected by food bioavailability on drug therapy during enteral nutrition?
⚬ Dilantin- anti-seizure medication
⚬ Hold tube feeding for 2 hrs
before and after each dose
how can albumin affect the distribution nutrients/food and drug therapy?
⚬ Albumin is a transport protein that can binds numerous drugs
⚬ Low albumin = larger fraction of unbound drug in the bloodstream
what 3 things affect albumin level
- protein malnutrition
- edema
- inflammation
how can grapefruit affect the metabolism of nutrients/food and drug therapy?
⚬ Substance in grapefruit inhibits the metabolism of certain drugs (statins-cholesterol)
⚬ leads to More drug in circulation, thus possible toxicity
how can sodium and lithium affect the excretion of nutrients/food and drug therapy?
⚬ Sodium and lithium
⚬ Low Na intake promotes lithium resorption lead to toxicity
⚬ High Na intake promotes lithium excretion thus drug is not as effective
How can food and nutrients modify drug action?
- enhance drug effects
- decrease drug effects
Describe the foods and meds that decrease drug effects
⚬ Caffeine and depressants
⚬ Alcohol and stimulants
⚬ Vitamin K (coagulant) and warfarin (anticoagulants)
⚬ Licorice and hypertension meds
Licorice and hypertension meds
Describe the foods and meds that enhance drug effects
⚬ MAOIs (antidepressant drugs) and tyramine
⚬ Caffeine and stimulants
⚬ Vitamin E/omega-3 and warfarin
⚬ Alcohol and depressants, NSAIDs, potentially hepatotoxic drugs, insulin, oral
hypoglycemic, and morphine
Explain MAOIs and tyramine interaction
MAOIs prevent breaksown of pressors such as tyramine.
Pressors cause sudden increase in blood pressure causing hypertension
Foods to avoid: aged cheeses, fermented beverages and foods, cured meats,
Explain Caffeine and stimulants interaction
- stimulants stimulate CNS and heart rate
Caffeine and stimulants lead to too much stimulation
Explain Vitamin E/omega-3 and warfarin interaction
- Warfarin is a anticoagulant or blood thinner
- VitE/omega-3/fish oils act as a blood thinner
What medicines should you avoid with alcohol
depressants, NSAIDs, hepatotoxic drugs, insulin, oral
hypoglycemic, and morphine
Alcohol and depressants, NSAIDs, potentially hepatotoxic drugs, insulin, oral
hypoglycemic, and morphine
alcohol is a CNS depressant, raise glucose level lead to hypoglycemia
NSAIDS: mucosal irritants, irritate lining in stomach and making more susceptible to stomach ulceration or gastritis
- toxicity of morphine
How does Chelation decrease the effects of drugs on nutrient absorption?
i.e. antibiotics
Chelation is when a medication binds to a cation (metal)
- Antibiotics bind to calcium
recommendation: consume Ca separate from abx dose 2 hours before or after
How does adsorption decrease the effect of drugs on nutrient absorption?
i.e. Questran
- adsorption is binding with anything not a mineral
Questran is a cholesterol drug that binds to bile. Bile is needed for absorption of fat-soluble vitamins
- Questran and fat-soluble vitamins
recommend: supplement fat-soluble vitamins
How does transit time decrease the effect of drugs on nutrient absorption?
i.e. laxatives
- laxatives inc transit time
- can cause loss of potassium and zinc in stool do to inability to absorb it fast enough
- laxatives and potassium and zinc
Which 3 GI environment decrease the effect of drugs on nutrient absorption?
⚬ pH:
⚬ Intestinal mucosa:
⚬ Gut flora:
Which GI environment decrease the effect of drugs on nutrient absorption?
environment: pH
⚬ pH: anti-GERD drugs and iron and B12
- anti GERD dec acidity in stomach
- Fe and B12 require acidic environment for absorption
- recommend : supplement Fe and B12
Which GI environment decrease the effect of drugs on nutrient absorption?
environment: intestinal mucosa
⚬ Intestinal mucosa: NSAIDs and iron
- NSAIDS irritate linning of stomach and mucos production
- loss of iron becuase iron not absorbed
Which GI environment decrease the effect of drugs on nutrient absorption?
environment: But flora
- antibiotics kill bacteria
⚬ Gut flora: antibiotics and vitamin K
recommend vit K
What two drugs block conversion of vitamins to active form during nutrient metabolism
Isoniazid (tuberculosis med) block B6
Methotrexate (cancer treatment, rheumatoid arthritis, ectopic pregnancy) block folic acid
What drugs inhibit enzymes during nutrient metabolism
- statins (cholesterol-lowering) inhibit coenzyme Q10
- statins block hmp cholesterol reductase
- Q10 important for reduce heart disease
Describe the effects of drugs on nutrient excretion
i.e. potassium
may inc or dec excretion by interfering with resorption
- lasix diuretics promote urination so lose fluids and potassium
- potassium wasting or potassium-sparing diuretics
- supplement potassium
6 Effects of drugs on nutrient status
Sensory effects
GI effects
Appetite changes
Hepatotoxicity
Nephrotoxicity
Corticosteroids
Sensory effects of drugs on nutritional status
Taste
Smell
Taste effects of drugs on nutritional status
⚬ Dysgeusia: altered taste-metalic
⚬ Hypogeusia: dec/loss of taste
⚬ Xerostomia: dry mouth
⚬ Antineoplastics: anti chemo med
Smell effects of drugs on nutritional status
⚬ Dysosmia: alter smell
⚬ Hyposmia: dec smell
⚬ Anesthesia:
GI effects of drugs on nutritional status
- Irritation and ulceration (NSAIDs)
- Nausea and vomiting: antineoplastics
- Constipation: narcotics/opioids
- Diarrhea: antineoplastics, laxatives, abx
What drugs cause Irritation and ulceration of drugs on nutritional status
NSAIDS
What drug cause Nausea and vomiting effects of drugs on nutritional status
antineoplastics
What drugs cause constipation effects of drugs on nutritional status
Narcotics and Opiods
What drugs cause Diarrhea effects of drugs on nutritional status
antineoplastics
laxatives
Abx
What drugs cause anorexia effects of drugs on nutritional status
anorexia=lack of appetite
- CNS stimulants
- antineoplastics
What drugs cause increased appetite effects of drugs on nutritional status
- antipsychotics
- antidepressants
- gain weight
What drugs cause hepatotoxicity effects of drugs on nutritional status
- hypotoxicity = liver damage
Antihyperlipidemics
e.i. statins and high levels of niacin
What drugs cause nephrotoxicity effects of drugs on nutritional status
- nephrotoxicity= kidney damage
- antineoplastics
What symptoms do corticosteroids meds have that effect nutritional status?
what is does - anti inflamatory
when - chronic inflammatory disease
side effects:
- increase appetite lead to weight gain
- raised blood sugar hyperglycemias
high blood pressure hypertension
impair absorption of vitamin D and Ca
-
What are the 6 potential interactions caused by drug excipients
excipients added for shelf life of drugs
- Allergies
- Lactase deficiency
- Gluten sensitivity
- Sugar alcohol intolerance (-tols)
- Added calories from sugars or fats
- Diprivan/Propofol (sedative) contains 1.1 kcals/mL (inc fat caloies)
