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N2S3 > Nutritional Pharmacology > Flashcards

Nutritional Pharmacology Flashcards

1
Q

Why do nutritional therapists need to know about pharmacology?

A
  • Clients often use a range of complex prescription and over-the-counter drugs.
  • Every drug produces side effects e.g., gastric ulceration when taking ibuprofen.
  • Food or supplements may interact with a drug producing unwanted effects e.g., increased bleeding risk with warfarin and vitamin E.
  • Drugs can lead to important nutrient depletions e.g., metformin and vitamin B12.
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2
Q

Provide a definition for a ‘medicine’ according to the MHRA.

MHRA = Medicines & Healthcare Products Regulatory Agency

A

“Any substance or combination of substances presented as having properties for treating or preventing disease in human beings.”

OR

“Any substance or combination of substances which may be used in, or administered to, human beings, either with a view to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or to making a medical diagnosis.”

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3
Q

TRUE OR FALSE:

Only prescription drugs need a regulatory licence.

A

FALSE.
All drugs must have a regulatory licence detailing their intended mode of action.

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4
Q

List four possible supply routes for obtaining medicines

A
  • Prescription only (POM) — supplied only under direction of qualified healthcare professional e.g., doctor’s prescription.
  • Controlled medicines — special group of medicines that require extra controls e.g., codeine, morphine.
  • Pharmacy only (PO) — sold by a registered pharmacy
  • General sales list (GSL) — can be sold via a number of outlets including supermarkets.
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5
Q

What are OTC drugs and which two legally distinct classes are there?

OTC = over the counter

A

OTC drugs are products that are used to self-medicate a range of common illnesses. They are generally classified by the legal distinction:
- PO (Pharmacy only)
sold and supplied under pharmacist supervision.
- GSL (General sales list)
supplied by a pharmacy and many non-pharmacy outlets e.g., grocery store.

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6
Q

Why might clients choose to self-medicate?

A

Clients may choose to self-medicate in order:
* To treat a minor ailment e.g., a cough mixture.
* To support a chronic illness when not fully controlled by prescribed medicines e.g., ibuprofen for osteoarthritis.

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7
Q

Which drug class do the following common OTC drugs belong to:
a) Ibuprofen
b) Cetirizine
c) Omeprazole
d) Bisacodyl

A

a) Analgesic
b) Anti-histamine
c) Proton pump inhibitor
d) Laxative

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8
Q

A drug contains both active and inactive ingredients. What are the difference between these two types of ingredients?

A

Active ingredient:
This is the part of the drug that is intended to deliver its mode of action and is responsible for side effects e.g., ibuprofen to reduce inflammation.
Inactive ingredients:
These alter the physical properties of the drug e.g., fillers, colouring agents, preservatives, lactose, gluten, aspartame, other E numbers. Studies increasingly show that inactive ingredients can trigger allergic reactions and food intolerances.

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9
Q

In terms of how drugs are described, what is meant by the following:
a) Generic name
b) Brand name

A

Generic name:
This is the actual active ingredient within the drug e.g., paracetamol (Europe), acetaminophen (US). Paracetamol and acetaminophen are, in fact, the same active ingredient.

Brand name:
Paracetamol can be provided under a number of branded names e.g., Panadol (UK), Tylenol (US).

A nutritional therapist must always look for the generic name.

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10
Q

Explain the following drug terminology:
a) Indication
b) Contraindication
c) Side effects
d) Interactions

A

a) Indication: What the drug is intended for, e.g., hypertension (high blood pressure).

b) Contraindication: When the drug must not be used e.g., in pregnancy, renal failure.

c) Side effects: Ibuprofen can produce gastric ulcers.

d) Interactions: A drug’s activity is affected by another substance causing an increase, decrease or a new effect.

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11
Q

What is the difference in how drugs and nutrients function in the disease process?

A

Drugs suppress and manage symptoms (and do not target the actual underlying cause) whilst nutrients encourage the body to restore homeostasis and heal.

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12
Q

Which plant is aspirin derived from and how does it differ from the whole plant?

A

Aspirin is derived from willow bark (Salix alba) an ancient herb.
- Willow bark contains salicin, which does not convert to salicylic acid (a gastric irritant) until it reaches the bloodstream and body tissues. It naturally reduces fever, inflammation and pain without GI side effects.
- Through research, aspirin was synthetically developed from salicylic acid. Aspirin can cause gastrointestinal bleeding, peptic ulceration and hypersensitivity!
- Willow bark contains numerous active components which influence each other and in totality contribute to its overall healing potential.

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13
Q

Define the following terms:
a) pharmacokinetics
b) pharmacodynamics

A

a) Pharmacokinetics is the study of the movement of drugs within the body.
b) Pharmacodynamics is the study of how drugs interact with the body to exert their effects.

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14
Q

Which four key processes is involved in pharomacokinetics?

Hint: ADME

A

The
ABSORPTION,
DISTRIBUTION,
METABOLISM and
EXCRETION
of a drug

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15
Q

Why is it important to keep in mind ‘First Pass Hepatic Metabolism’ in the administration of certain drugs?

A

First pass metabolism is the process by which drugs taken orally are absorbed from the GIT and taken via the portal vein into the liver to be metabolised. The effects of this mean that drug concentrations can be reduced by the time they enter systemic circulation.
When a drug is extensively metabolised, the amount of drug reaching the bloodstream is greatly reduced and cannot exert its effect. This type of medicine should be administered by a different route e.g., nitro glycerine (GTN) spray for angina.

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16
Q

What are the two main factors that determine whether a drug reaches its target site of action in the body?

A
  • Bioavailability
    This simply refers to the ‘proportion’ of drug that can reach the bloodstream and is, therefore, available for distribution to its intended site of action.
  • Route of administration
    How a drug is administered e.g., oral tablets, sublingual B12, suppository, injectables, topical creams, patches, all directly influence the medicine’s bioavailability.
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17
Q

Expand on what the following routes of drug administration entails:
a) Oral
b) Sublingual
c) Buccal
d) Topical
e) Parenteral

A

a) Oral: Tablets, capsules, liquids that are taken by mouth (swallowed). The most frequently used route of administation. Absorption is mainly via the small intestine.

b) Sublingual: Sprays, tablets, films placed under the tongue (e.g. glyceryl trinitrate spray) and directly absorbed into the bloodstream (bypasses liver metabolism).

c) Buccal: Tablets placed between the gum and inner cheek and directly absorbed into the bloodstream (e.g. prochlorperazine maleate tablets).

d) Topical:
‒ Local effect: Creams, patches (Cutaneous route), ear (Otic route) and eye (Ocular route) drops.
‒ Systemic effect: Inhalation (Pulmonary route = rapid effects).

e) Parenteral: Injections: Intravenous, sub-cutaneous, intra-muscular. Avoids the intestines and bypasses liver metabolism.

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18
Q

List three factors, related to the body, that can affect the absorption of a drug.

A
  • Gastro-intestinal motility: Diarrhoea increases motility and reduces absorption.
  • Malabsorption states reduce absorption e.g., Coeliac disease.
  • Presence of other substances: E.g., absorption of iron is reduced when given with milk.
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19
Q

Which characteristics of a medicine might enhance its absorption?

A
  • Absorption is greatest for lipid soluble and small molecule drugs.
  • Acidic drugs absorb quicker in an acidic environment e.g., stomach.
  • A liquid medicine will absorb quicker than a solid tablet.
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20
Q

After a drug enters the systemic circulation, it is distributed to the body’s tissues.
List three factors that can affect this distribution.

A

The distribution of a drug is affected by a number of factors:
- Binding to plasma proteins which affects the active concentration of the drug.
- Binding to other tissues e.g., tetracycline (antibiotic) binds to calcium in bones and teeth.
- Accumulation in lipids e.g., general anaesthetics.
- Natural barriers to distribution e.g., blood brain barrier, placental barrier.

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21
Q

Define: ‘Drug metabolism’

A

The process by which drugs are chemically changed from a lipid soluble to a more water-soluble form suitable for excretion

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22
Q

Briefly outline what happens during Phase I and Phase II liver detoxification.

A
  • Phase I: Drug / toxin is altered chemically to make it suitable for Phase II reactions or for excretion. Involves the cytochrome P450 enzyme family.
  • Phase II: Molecules from Phase I (or in some cases unchanged drugs) are conjugated to a more water-soluble product and aid excretion.
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23
Q

What are the main excretion routes by which drugs and their metabolites are removed from the body?

A

Urine
Faeces

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24
Q

Which system, if dysfunctional can affect the rate at which a drug / metabolite is cleared from the body?

A

The renal system

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25
Q

What is ‘entero-hepatic circulation’?

A

The process by which some drugs (that are very lipid soluble) may be re-absorbed and re-enter the portal vein. This prolongs excretion times.

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26
Q

What is ‘pharmacodynamics’?

A

Pharmacodynamics is the study of how drugs interact with the body to exert their effects.

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27
Q

List three factors that can affect a drug’s mode of action

A
  • Advancing age
  • genetic mutations
  • malnutrition
  • medical conditions e.g., Parkinson’s disease, Alzheimer’s disease.
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28
Q

What are ‘side effects’?

A

Side effects are unpleasant, unwanted effects of a drug.
They range from mild to severe and in some cases life-threatening and are categorised by occurrence e.g.,
very common, common, uncommon or rare.

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29
Q

Why is it important to be aware of the potential side effects of the drugs a client is taking?

A

It is important to consider that a client’s presenting signs and/or symptoms could be due to a drug’s side effects.

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30
Q

What long-term side effects are patients at risk for when using the following medications:
a) Metformin
b) Thiazide diuretics
c) Corticosteroids
d) Opiate analgesics

A

a) Metformin: Vit B12 deficiency
b) Thiazide diuretics: Gout
c) Corticosteroids: Osteoporosis
d) Opiate analgesics: Dependence

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31
Q

List FOUR worrying and serious side effects from the long-term use of PPIs.

A
  • Bone fractures.
  • Hypomagnesaemia (low blood magnesium).
  • Vitamin B12 deficiency.
  • Bacterial enteric infections e.g., serious Clostridium difficile.
  • Rebound acid hypersecretion (when PPI is stopped).
  • Kidney disease.
  • Dementia.
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32
Q

What is the concerning risk with the use of diclofenac (an NSAID)?

A

It was widely accepted that diclofenac (NSAID) increased the risk of cardiovascular events yet the product was commonly prescribed by medical doctors.

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33
Q

As a nutritional therapist, what should you do if you suspect that a client is experiencing side effects

A
  • Check the presenting sign / symptom against the drug in your selected resource e.g., the BNF.
  • Advise the client to consult his / her GP or medical specialist.
  • Ensure that the food or supplement that you recommend does not interact with the client’s drug which could then cause side effects.
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34
Q

Explain how the cytochrome P450 system affects drugs

A

The cytochrome P450 enzyme family alters drugs / toxins chemically to make it suitable for Phase II liver detoxification.

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35
Q

An interaction occurs when the effects of one drug are altered by the co-administration of another substance.
List three types of substances that can lead to interactions.

A
  1. Drugs.
  2. Herbal medicines.
  3. Food and drinks.
  4. Nutritional supplements.
  5. Environmental chemical agents.
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36
Q

What are Narrow Therapeutic Index (NTI) drugs. Give two examples.

A

Drugs that may become dangerously toxic or ineffective with only relatively small changes in their blood concentrations.
Examples: Digoxin, phenytoin, theophylline, warfarin, lithium.

During a consultation it is essential that these medicines are clearly highlighted on case notes.

37
Q

Why is polypharmacy a concern and which patient populations are at increased risk of serious side effects?

A

The risk of drug interactions increases with the number of drugs used.
Patient populations at increased risk of serious side effects:

  • Patients experiencing renal and liver dysfunction (metabolism and excretion of drugs!).
  • Elderly patients who take more medicines and whose renal and liver function is declining.
  • Patients taking drugs for chronic long-term illnesses e.g., same patient has epilepsy, diabetes and cardiovascular disease (think of the number of drugs administered!)
  • Critically-ill patients.
38
Q

Which drug-nutrient interactions is possible with garlic?

A
  • Interactions have been reported with cholesterol and blood pressure drugs, such as atorvastatin, propranolol, hydrochlorothiazide or captopril.
  • Garlic could theoretically interact with anticoagulant or antiplatelet drugs, but current evidence has shown that at 4g / day it has little effect on warfarin-stabilised patients.
  • Garlic interspersed throughout the diet is fine, but regular, high dietary intake and / or supplements could allow for interactions.
39
Q

With which drugs should the use of Gingko Biloba be avoided?

A
  • The use of Gingko should be avoided with any antiplatelet and anti-coagulant medication, as it has a small potential to increase bleeding risk. It should be stopped one week before surgery.
  • Due to possible CYP induction, it is best to monitor with the following drugs: Benzodiazepines (sedatives), anti-epileptic medication, anti- psychotic drugs, diabetic drugs, HIV medications, omeprazole (for gastrointestinal reflux), nifedipine and talinolol (blood pressure drugs).
40
Q

What should you be mindful of when recommending grapefruit or pomegranate to clients?

A

Grapefruit and pomegranate selectively inhibits CYP3A4 in the intestinal wall for up to 24 hours, but NOT in the liver. Caution is advised with the many drugs that are metabolised via this pathway ― e.g., digoxin, statins. CYP 3A4 is involved in the metabolism of over 50% of all drugs.

41
Q

What interaction could result from a sudden dramatic increase of green vegetables in the diet?

A
  • Large amounts of green vegetables such as broccoli, spinach, cabbage, Brussels sprouts, seem to reduce the effect of anticoagulants such as warfarin.
  • They contain indoles which increase the metabolism of warfarin, and also contain vitamin K, which reduces the anti-clotting effects of warfarin. Vitamin K is a coagulant, whilst warfarin is an anti-coagulant.
42
Q

List two drugs with which dietary soy could cause an interaction

A
  • Soy decreases absorption of levothyroxine (Separate ingestion by three hours).
  • Soy may also interfere with oestrogen-blocking drugs such as Tamoxifen, due to its isoflavone (phytoestrogen) content (both positive and negative effects observed).
  • Soy may reduce the effectiveness of warfarin.
43
Q

What effects could the following dramatic changes in diet have on medication:
a) High protein diet
b) High fibre diet
c) Salt restriction

A

a) High protein diets may reduce the effects of theophylline - used for lung diseases (appears to increase renal clearance) and L-Dopa (decreases intestinal absorption and interferes with transport from the bloodstream to the brain).
b) High-fibre diets can reduce serum levels of tricyclic antidepressants e.g., amitriptyline (decreases intestinal absorption ― take medication away from high-fibre meals).
c) Salt restriction can increase serum lithium to toxic levels (sodium is involved in active transport of lithium, low levels can cause lithium to accumulate in cells).

44
Q

Which nutrients will have inhibited absortprion due to reduced gastric acid levels resulting from the use of PPIs?

A
  • Beta-carotene
  • calcium
  • chromium
  • iron
  • magnesium
  • folate
  • vit. B12
  • vit. C
  • zinc.
45
Q

How might metformin contribute to a client’s fatigue?

A

It causes the malabsorption of Vitamin B12 and B9, both important for the production of red blood cells.

46
Q

Which of the following nutrients are depleted by steroids such as prednisolone?
a) Vitamin C
b) Calcium
c) Zinc
d) Iron
e) Folic Acid
f) Vitamin D
g) Magnesium

Hint: there are 5

A

b) Calcium
c) Zinc
e) Folic Acid
f) Vitamin D
g) Magnesium

47
Q

Which nutrient is depleted by statins?

A

CoQ10

48
Q

Which common drug prescribed in Type 2 Diabetes cause malabsorption of Vitamin B12 and folate (B9)?

A

Metformin

49
Q

Which nutrients are commonly depleted by diuretics and by which mechanism?

A

Calcium, magnesium, potassium, folate, vits. B1, B6, C are depleted by increased urinary loss.

50
Q

By which mechanism does Thyroxine deplete calcium?

A

Increased bone turnover may lead to increased urinary calcium losses.

51
Q

List 9 nutrients affected by the Oral Contraceptive Pill

A
  1. Vitamin A
  2. Vitamin B1
  3. Vitamin B2
  4. Vitamin B6
  5. Vitamin B9 (folate)
  6. Vitamin B12
  7. Vitamin C
  8. Magnesium
  9. Zinc
52
Q

How does long-term or chronic alcohol ingestion affect drug metabolism?

A
  • Long-term alcohol ingestion may activate drug-metabolising enzymes, thus decreasing the drug’s availability and diminishing its effects.
  • Enzymes activated by chronic alcohol consumption transform some drugs into toxic chemicals that can damage the liver or other organs.
53
Q

Your client is taking a statin for hypercholesterolaemia. She read online that grapefruit juice should be avoided with statins. Explain the reason for this.

A

Grapefruit selectively inhibits CYP3A4 enzymes in the intestinal wall for up to 24 hours, but NOT in the liver. Caution is advised with drugs such as statins that are metabolised via this pathway.

This can cause the drug concentration to increase and, with it, the risk of side effects.

Grapefruit is high in ‘furanocoumarin’ which deactivates CYP3A4

54
Q

What effect could alcohol have on slow-release ‘depot’ injections as in some anti-psychotic drugs?

A

Alcohol can also force certain drugs (slow-release ‘depot’ injections) out of their depot (storage in muscle) resulting in overdose.

55
Q

Your client is taking warfarin after suffering from a DVT 4 years ago. What should he pay attention to in his diet, to avoid possible drug interactions?

A

Large amounts of green vegetables such as broccoli, spinach, cabbage, Brussels sprouts, seem to reduce the effect of anticoagulants such as warfarin. They contain indoles which increase the metabolism of warfarin, and also contain vitamin K, which reduces the anti-clotting effects of warfarin. Vitamin K is a coagulant, whilst warfarin is an anti-coagulant.

Garlic interspersed throughout the diet is okay, but regular, high dietary intake and / or supplements could allow for interactions.

Soy may reduce the effectiveness of warfarin.

56
Q

What are ACE Inhibitors / Angiotensin II Antagonists prescribed for and how should the client’s diet be adjusted?

A

Prescribed for:
Heart failure, hypertension.

Avoid potassium-rich diets if not taking a drug which lowers potassium alongside (e.g., a thiazide or loop diuretic).

  • ACE inhibitor examples: Ramipril, lisinopril, captopril.
  • Angiotensin II antagonist examples: Losartan, candesartan.
57
Q

What are statins prescribed for and which side-effects should the practitioner be mindful of?

A

STATINS

Prescribed for: Hypercholesterolaemia (incl. familial), hypertriglyceridemia, prevention of cardiovascular events in those with atherosclerotic disease or diabetes.

Side effects:
GIT disturbance, headaches, fatigue, insomnia, myositis (inflammation of muscles), statin-induced myopathy.
Statin use can lead to rhabdomyolysis — the breakdown of muscle cells. This can result in kidney disease and even failure. Extra care is needed with foods / supplements that may interfere with metabolism.

58
Q

Which substance can you recommend as part of a protocol to naturally lower cholesterol in the client that does not wish to take statins

A

Red yeast rice
A combination of mevinic acids and derivatives e.g., monacolin K (identical to the active in Lovastatin), and other constituents that exhibit cholesterol lowering activity.

59
Q

What are diuretics prescribed for and which side-effects should the practitioner be mindful of?
Give an example of a diuretic.

A

DIURETICS

Prescribed for:
Oedema due to heart failure, hypertension.

Side effects:
Hypokalaemia (can be dangerous), hypotension, GIT disturbance, impotence. Milk-alkali syndrome may occur when thiazides are combined with large quantities of calcium carbonate!

Examples:
- Furosemide (loop diuretic)
- bendroflumethiazide (thiazide diuretic)
- Spironolactone (potassium-sparing diuretic).

60
Q

Which natural substance can act as a diuretic?

A

Dandelion (Taraxacum officinalis)
acts as a diuretic but also supplies potassium (the leaf), unlike most pharmaceutical diuretics.

61
Q

Which herbal substance can increase myocardial contraction and caution should be taken with concomittant use of digoxin?

A

Hawthorn (Crataegus)

62
Q

What are antacids prescribed for and which side-effects should the practitioner be mindful of?

A

ANTACIDS

Prescribed for:
Gastro-oesophageal reflux disease (GORD), indigestion.

Side effects:
Impaired nutrient absorption; magnesium versions can be laxative, aluminium versions can be constipating.

63
Q

A client approaches you for help with indigestion and would like to stop using antacids. What is likely to be your advice?

A

Firstly, advise the client that they might have low gastric HCl from using antacids and that a rebound effect is possible if the drug is discontinued (the acid comes back more strongly).

Diet and lifestyle changes:

  • Chew food well, fluids away from meals
  • demulcent / anti-inflammatory herbs: aloe vera juice, slippery elm, liquorice, marshmallow root
  • avoid caffeine
  • lose weight
  • if needed, stop smoking
  • manage stress e.g., breathing exercises to support a shift into a parasympathetic state.
64
Q

What drug class does Omeprazole fall under and what is it commonly prescribed for?

A

Omeprazole is a Proton Pump Inhibitor and is commonly prescribed for Gastro-oesophageal reflux disease (GORD), prevention of NSAID-associated ulcers, triple therapy with antibiotics for gastric / duodenal ulceration.

65
Q

List three key long-term side effects of PPI use

A
  • Increased risk of GI infections (e.g., Clostridium difficile) and SIBO. Alkaline gastric pH allows bacterial survival.
  • Increased fracture risk: Reduced calcium absorption leads to decreased bone mineral density, possible inhibition of osteoclast activity.
  • Vitamin B12 deficiency: Gastric acid is needed for release of vit. B12 from proteins to help intestinal absorption.
  • Low blood magnesium due to decreased intestinal absorption. Also reduced iron absorption (= possible iron deficiency anaemia).
66
Q

What approach could be used to support clients to reduce and withdraw from PPIs over a period of time?

A

The 5R approach:
Remove
Replace
Repopulate
Repair
Rebalance

67
Q

Give an extensive outline of the 5R approach which could be used to support clients to reduce and withdraw from PPIs over a period of time

A

Remove:

  • Remove trigger foods (acidic — tomatoes, alcohol, caffeine, spicy food, fatty foods, dairy, chocolate). Identify and manage any food intolerances e.g., gluten. Stop smoking.
  • Avoid overeating, avoid fluid intake with meals (also to reduce stomach distension). Eat last meal at least 4 hours before bed.
  • Prone position ― elevate head of bed by 4‒6 inches.
  • Reduce intra-abdominal pressure — weight loss / avoid tight-fitting clothes.

Replace:

  • Increase nutritious foods to replace deficiencies e.g., magnesium rich. Clients may also need supplementation of B12, magnesium, Vitamin A (introduce a general multivitamin and mineral).
  • Digestive enzymes / betaine HCl / digestive bitters.

Repopulate:

Introduce probiotics — some clients may suffer from SIBO after long-term acid suppression.

Repair:

To protect and repair the gut lining, use slippery elm, marshmallow, chamomile, glutamine.

Rebalance:

Reduce and manage stress: acupuncture, aerobic exercise (not following meals). Stress is a key trigger.

68
Q

What is warfarin prescribed for and what is its mode of action and most notable side-effect?

A

Warfarin is the most common anti-coagulant prescribed for conditions such as DVT, pulmonary embolism and transient ischaemic attacks (TIA).

Mode of action: Antagonises the effects of vitamin K — a co-factor for the production of four clotting factors.

Side effect: Haemorrhage is the worrying side effect

69
Q

Which of the following are most likely to interact with warfarin?
a) Beetroot juice
b) Pomegranate juice
c) Cranberry juice

A

Pomegranate juice increases the INR by inhibiting the CYP450 enzyme that metabolises warfarin.

INR = International Normalised Ratio – a measure of how long it takes the blood to clot.

70
Q

Your client is taking levothyroxine but it does not seem as effective as it used to be and her GP wants to increase the dose. What important factors about dosing should you check with your client?

A

When is she taking it?
The dose should be taken 30–60 minutes pre-breakfast or caffeine-containing liquids to avoid reduced absorption.

What is she taking it with?
Oral iron and calcium supplements (and cow’s dairy) reduce the absorption of levothyroxine. It is important that doses are separated by at least four hours.

71
Q

Anti-histamines are commonly used to treat allergy symptoms such as hayfever. List ONE alternative approach to managing hayfever.

A

Starting with 1/2tsp (up to 3tbsp, to tolerance), take bee pollen daily for 4-6 weeks before allergy season to build up tolerance.

72
Q

Name ONE phytonutrient that also has anti-histamine properties.

A

Quercetin

(200 - 400mg 3 x per day)

73
Q

Which drug class does sertraline, citalopram and fluoxetine belong to and what could it be prescribed for?

A

They are anti-depressants (SSRIs) commonly prescribed for depressive illness, post-traumatic stress and obsessive compulsive disorder

SSRIs = Selective Serotonin Re-uptake Inhibitors

74
Q

What is ‘Serotonin Syndrome’?

A

Serotonin syndrome is associated with an excess of serotonin due to therapeutic drug use, overdose or interactions between drugs:
- Although rare, it can be fatal.
- It can occur when two or more drugs affecting serotonin are given at the same time or after one serotonergic drug is stopped and another started.
- Special care is needed when switching from an SSRI to an MAOI (mono amine oxidase inhibitor) or vice versa.

75
Q

What are the symptoms of Serotonin Syndrome?

A

Symptoms include confusion, disorientation, exaggerated reflexes, abnormal movements, fever, sweating, hypo / hypertension.

76
Q

Which two supplements must not be combined with SSRIs?

A

5-HTP and St. John’s wort must not be combined with SSRIs as the additive effect significantly increases the risk of serotonin syndrome.

77
Q

Which nutrients/herbs can interact with NSAIDs such as Ibuprofen, diclofenac or naproxen?

A

Concomitant use of NSAIDs with high doses of nutrients and herbs with antiplatelet activity e.g., vitamin E, garlic and turmeric, may increase the risk of bleeding.

78
Q

What are common side-effects of NSAIDs?

A
  • NSAIDs inhibit prostaglandins that play a vital role in gastric mucosal defence, increasing the risk of gastric bleeding and ulceration.
  • They block renal prostaglandins that normally dilate vessels in the kidneys. This can lead to reduced blood flow and oxygen supply causing acute kidney damage.
79
Q

List three herbs with analgesic properties that can be used as NSAID alternatives

A
  • Willow bark
  • Turmeric
  • Ginger
  • Boswellia
80
Q

What are corticosteroids prescribed for and what side-effects can result from long-term systemic use?

A

CORTICOSTEROIDS

Prescribed for:
Asthma, eczema, IBD, hypersensitivity reactions, autoimmune conditions.

Side effects:
Long-term systemic use increases risk of Cushing’s syndrome, diabetes mellitus, osteoporosis and infections.

81
Q

Outline an alternative approach to corticosteroid use.

A

Anti-inflammatory diet: nutrients and herbs that inhibit inflammatory mediators e.g., EFAs, quercetin, turmeric, ginger.
Liquorice root has been shown to modify or even increase the body’s levels of cortisol.

82
Q

Identify TWO side effects of laxatives

A
  • Bloating
  • Cramping
  • Lazy bowel syndrome
83
Q

Consider TWO natural approaches to addressing constipation.

A
  • Increase fibre and water
  • Consume mucilaginous foods/herbs (chia, flax, okra, slippery elm)
  • Reduce stress to calm colon contraction
  • Rule out and treat SIBO or hypothyroidism if an issue
84
Q

Why is it essential that the practitioner ensures to ask about use of pharmaceutical medication in the case-taking process?

A
  • Most people regard pharmaceuticals as primary medications, and patients may be using them but forget to tell you.
  • In the rare event that there is a problem with a supplement / food- drug interaction, the supplement may well get the blame.
  • Specifically ask about OTC as well as prescribed medications. Ask women of reproductive age about the oral contraceptive as it may not be perceived by the client as a medication!
85
Q

What information do you need to retrieve to provide an overall drug picture in terms of the client?

A
  1. Ensure that a full list of drugs is identified (prescribed and OTC drugs).
  2. Understand why they are using the drug even if it is obvious e.g., levothyroxine for underactive thyroid.
  3. The duration of treatment — how long has the client taken / used the medication?
  4. Establish how often they take / use the medication e.g., once daily, twice daily.
  5. Ensure the dosage is recorded e.g., levothyroxine 100 mcg.
86
Q

How does the Nutritional Therapist respond to the client’s questions about stopping a prescription medication?

A

It is outside the remit of a Nutritional Therapist to stop a client’s prescribed drug.
You should educate the client about the drug and its side effects as it could be causing their presenting signs / symptoms.
However, if there is an opportunity to reduce a drug, you can work with the client’s healthcare professional. We must always be open to this!

87
Q

Your client is self-medicating with a range of OTC drugs. What is your role as an NT?

A

A nutritional therapist has a major role to play in removing OTC drugs that provide no benefit or indeed do more harm.
Explaining to clients that OTC drugs are causing their signs / symptoms often comes as a surprise!

88
Q

During a consultation, you identify that a prescribed drug is contributing to severe side effects. How would you manage this scenario?

A
  1. Consult a dependable drug reference source and interaction checker to be sure of all side-effects and interactions.
  2. Explain the side-effects and interactions to the client.
  3. Write a letter of referral to the client’s GP
89
Q

What dietary advice could you give a client that is taking a statin medication?

A
  • Advise the client that a statin could deplete CoQ10 and lead to fatigue. Consider supplementation.
  • Statins and alcohol interact and can increase liver toxicity so alcohol should be avoided.

N2S3 (4 decks)

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