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CNH Nutrition 2 S3 > Nutritional Pharmacology > Flashcards

Nutritional Pharmacology Flashcards

(52 cards)

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1
Q

What do nutritional therapists need to know about drugs?

A
  1. Side effects
  2. Food and supplements may interact
  3. Drugs can cause nutrient depletions
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2
Q

What is a medicine according to the MHRA?

A

A substance or combination of substances that have properties for treating or preventing disease in human beings.

Drugs - modify physiological functions by exerting a pharmacological, immunological or metabolic action.

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3
Q

What are the four supply routes for drugs?

A
  1. Prescription only (POM)
  2. Controlled - e.g. codeine / morphine
  3. Phamacy only (PO)
  4. General sales list (GSL)
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4
Q

What are the two types of OTC drugs?
2 Reasons why clients self medicate?

A

PO - pharmacy only
GSL - general sales list

  1. treat a minor ailment
  2. support a chronic illness not fully controlled
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5
Q

6 common types of OTC drugs and an example of each \

AP CLAD

A

Analgesics - codeine, paracetomol, asprin
PPI’s - omeprozole

Cough mixtures - diphenhydramine
Laxatives - senna, bisacodyl
Anti-histamines - chlorphenamine, cetrizine
Decongestants - pseudoephedrine

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6
Q

2 key elements of a drug and examples

A
  1. Active ingredient - deliver mode of action and often linked to side effects - ibuprofen
  2. inactive - alter physical properties - fillers, colouring, preservatives, lactose, gluten
    - can trigger allergic reactions and food intolerances
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7
Q

2 terms used for naming a drug and example

A

Generic name of the active ingrdeint e.g. paracetomol

Brand name - e.g. panadol

Nutritional therapistcs should use the generic name.

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8
Q

What do these terms mean:

Drug class
Indication
Contraindication

A

Drug class - penicillian is an antibiotic
Indication - what the drug is intended for
Contraidication - when the drug must not be used

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9
Q

What is the difference between a drug and a nutrient?

Example

A

Drugs supress and manage symptoms

Nutrients encourage the body to resotre homeostasis and heal.

Willow bark / salix alba / salicin - gastric irritant in paracetomol
Willow bark doesn’t convert until it reaches the bloodstream and body tissues.

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10
Q

What does pharmacokinetics and pharmacodynamics mean?

A

Pharmacokinetics - movement of drugs within the body - 4 processes (ADME) - absorption, distribution, metabolism and elimination.

Pharmacodynamics - how drugs interact with the body and exert their side effects.

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11
Q

Describe what is meant by ADME

A

Abosrbed - entering the body and absorption into the blood steam

Distuibution - in the bloodstream the drug is distributed to its target site.

Metabolised - Once the drug and receptor have interacted the drug returns to the blood stream to be taken the liver to be metabolised.

Excretion - once metabolised excretion is by urine or bile.

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12
Q

What is first pass hepatic metabolism?

A

Drugs are obsorbed in the GIT and taken by the portal vein to the liver to be metabolised.

This means that drugs may be less concentrated by the time they reasch systemic circulation.

This type of medicine should be administered by a different route e.g. nitro glycerine spray for angina.

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13
Q

What 2 main factors determine if a drug reaches its target site of action in the body?

A
  1. Bioavailability - proportion of the drug that reaches the blood stream for distribution.
  2. Route of administration - e.g. oral, sublingual, suppository, injections, creams, patches.
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14
Q

4 main routes of drug administration and examples

A

Oral - tablets, capsules, liquids - absorption via small intensine.

Sublingual / buccal - glyceryl trinitrate spray - bypasses liver

Topical - local effect - creams, patches, ear and eye drops
Systemic - inhalation

Parenteral - injections - intravenous, sub-cutaneous, intro-muscular

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15
Q

4 factors that impact drug absoprition

A

GIT motility - diarroea reduces absorption
Malabsorption - e.g. coeliac disease
Other substances - iron reduced with milk
Lipid soluble and small molicule easier to absorb
Acidic drugs absorb quicker in an acidic environment.

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16
Q

4 factors that impact a drug’s distribution

A
  1. binding to plasma proteins with effects concentration
  2. binding to other tissues - tetracycline binds to calcium in bones and teeth
  3. Accumulation in lipids - e.g. anaesthetics
  4. Natural barriers e.g. BBB, placental barrier.
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17
Q

How are drugs changes from a lipid soluable to water-soluable for excretion?

A

Phase I - chemically altered using cytochrome P450 enzyme family

Phase II - Conjugated to a more water-soluable product.

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18
Q

What are the major and minor excretion routes for drugs and what can impact them?

A

Major - urine, faeces

Minor - exhaled air, sweat, saliva, tears

Renal - small water-soluble molecules - renal dysfunction can impact

Some lpid soluable drugs may be re-absorbed - entero-hepatic circulation.

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19
Q

What factors influence the pharmacodynamics of a drug?

A

Advancing age
Malnutrition
Medical conditions
Dosage
Side effects and drug interactions
Administration route

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20
Q

What are common side-effects and how are drug side effects classified

A

Nausea and vomiting
Dizziness
Constipation
Diarrhoea
Indigestion
Skin rashes
Dry mouth

Very common, common, uncommon or rare

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21
Q

Examples of long-term drug side effects?

Study These Flashcards
A

Nutrient deficiencies - metformin and B12
Metabolic - omeprozole and low magensium
Dependence - diazepam, opiate analgesics
Osteoporosis - corticosteroids
Gout - thiazide diuretics
Cardovascular disease - diclofenac (NSAID)
Peptic ulceration - NSAID

22
Q

5 side effects of PPIs

Study These Flashcards
A

A BBB DM

Acid rebound

B12 deficiency
Bacterial infections
Bone fractures

Dementia
Magnesium deficiency

23
Q

Diclofenac story

Study These Flashcards
A

Increases the risk of cardiovascular events but was commonly prescribed

Guidance changed in 2013 but OTC sales via pharmacies still permitted.

24
Q

3 steps if you think a client is experiencing side effects?

Study These Flashcards
A

Check - againsts drugs resource
Advice - client to consult GP or specalist
Ensure - your recommendations do not interact

25
5 substances that can interact with drugs
Other drugs Herbal medicine Food and drink Nutritional supplements Chemicals in the environment
26
What type of drugs shoudl nutritional therapists exercise caution for?
Narrow Therapeutic Index drugs - drugs that can become dangerously toxic or ineffective with small changes in blood concentration e.g. digoxin, warferin, lithium
27
Garlic interactions
Cholesterol and blood pressure drugs e.g. atorvastatin Anticoagulant and antiplatelet drugs - 4g/day little effect Garlic throughout the day but high dietary intake and supplements could cause interactions.
28
Ginkgo interactions
Anticoagulant and antiplatelet medication - stop 1 week before surgery CYP induction drugs monitor - e.g. anti-epileptic, diabetic, HIV drugs, omeprazole.
29
Grapefruit / Pomegranate interactions
Inhibits CYP3A4 in intestinal wall for up to 24 hours but NOT liver Caution drugs metabolised by this pathway (50% all drugs) including digoxin and statins
30
Green vegetables interactions
Reduce effect of anticoagulants - warfarin Contain Indoles increase warfarin metabolism and vitamin K reduces effect Vitamin K is a coagulant
31
Soy interactions
Levothyroxine - decreases absorption May interfere with oestrogen-blocking drugs e.g. *Tamoxifen* due it its *isoflavone* content. Warfarin - may reduce effectiveness.
32
Dairy / Calcium interactions?
Antibiotics (quinolones & tetracycline) & bisphophonates - may bind to and reduce absorption. Levothyroxine - reduces absorption. Take 4 hours apart. bisphophonates - slow down / help prevent bone loss.
33
4 nutrients PPI's deplete and what is the mechanism?
Reducing gastric acid levels impacts absorption Magnesium Folate B12 Zinc Beta-carotine Calcium Chromium Iron Vit C
34
4 nutrients steroids (prednisolone) depletes and the mechanism?
Increases urinary excretion / losses from bones Calcium Vit D Magnesium Zinc Folate Chromium Potassium
35
1 nutrient statins deplete and the mechanism?
Block mevalonic acid synthesis - precursor to cholesterol and CoQ10 CoQ10
36
4 nutrients antibiotics deplete and the mechanism
Destruction of microflora may reduce absorption of B vitamins and vitamin K B1 B2 B5 B6 B12 Vitamin K
37
2 nutrients metformin depletes and the mechanism
Malabsorption Folate B12
38
4 Nutrients diuretics depletes and the mechanism - think water-soluable vitamins
Increased urinary loss B1 B6 Folate C Magnesium Calcium Potassium
39
2 nutrients antacids deplete and the mechanism
Increased gastric pH may reduce solubility and absorption Aluminium can bind to calcium preventing absorption Calcium Iron Cromium Folate
40
1 nutrient thyroxine can deplete and the mechanism
Calcium Increased bone turn over may lead to increased urinary calcium loss.
41
4 nutrients the OCP can deplete and the mechanism
**Reduced absorption, increased excretion.** Vitamin A - reduced liver storage Zinc - B12 - reduced protein binding, increased requirement Folate Magnesium B6 B2 B1 C
42
What is the impact of alcohol on drug metabolism 3 key points
Alcohol may complete for the same metabolising enzymes 1. Long-term can activate drug-metabolising enzymes - decreasing drug availability 2. May transform drugs into toxic chemicals that can damage the liver 3. May magnify the inhibitory effects of sedative and narcotic drugs
43
2 types of drugs where alcohol has a specific negative impact
Cimetidine (for gastric ulcers) reduces stomach acid which inhibits alcohol dehydrogenase. Slow-release depot injections - can be forced out of storage in muscle resulting in overdose. E.g. antipsychotic drugs.
44
Why should grapefruit (/pomegranate) juice be avoided with statins?
Inhibits the CYP3A4 enzyme in intestinal wall for 24 hours needed for absorption of the drug.
45
Key cautions with warfarin
Garlic and green leafy veg can have an additive effect due to the vitamin K which supports blood clotting
46
How can metformin contribute to feeling fatigued
Contributes to malabsorption of folate and B12.
47
What are ACE inhibitors / Angiotensin II antagonists? Examples, contraindications and side effects.
For heart failure, hypotension ACE inhibitors - ramipril Angiotensin II antagonists - losartan Contra - pregnancy / breastfeeding Side effects dizziness constipation / diarrhoea nausea / vomiting ACE inhibitors - persistent dry cough (rise in bradykinin) Avoid *potassium-rich diets*
48
What are statins used for? Examples, contraindications and side effects.
Hypercholesterolaemia Hypertriglyceridemia Prevention of cardiac events in those with atherosclerotic disease or diabetes Atorvastatin Simvastatin Inhibit HMG CoA reductase - to reduce cholesterol (+CoQ10) synthesis Contra - pregnancy / breast feeding / liver diease GIT disturbance Headache Fatigue Insomnia Stain-induced myopathy Inflammation of muscles - can lead to a breakdown of muscle cells (rhabdomyolysis) Caution: grapefruit / pomegranate juice
49
What is rhabdomyolysis and what drug is it linked to?
breakdown of muscle cells Statins
50
What naturopathic supplement has an additive effect with statins?
Red rice yeast May increase side effects if taken with statins
51
What are diuretics used for? Examples, contraindications and side effects.
Oedema due to heart failure Hypertension Furosemide (loop diuretic) Bendroflumethiazide (thiazide diuretic) Spironolactone (potassium-sparing diuretic) Inhibit reabsorption of filtrate from nephron - increasing urine output.
52

CNH Nutrition 2 S3 (8 decks)

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