1. Nutritional Pharmacology Flashcards
(128 cards)
1
Q
What types of drugs are:
Codeine
Paracetamol
Aspirin
Ibuprofen
A
Examples of analgesics
2
Q
What types of drugs are:
Bisacodyl
Senna
A
Examples of laxatives
3
Q
What type of drug is omeprazole?
A
Example of a PPI
4
Q
What type of drugs are:
Cetirizine
Chlorphenamine
A
Examples of anti-histamines
5
Q
What is the active ingredient of a drug?
A
Delivers the mode of action
Responsible for side effects
6
Q
What is the inactive ingredient of a drug?
A
Alters the physical properties of the drug - colours, fillers, preservatives, lactose, gluten
7
Q
What kind of reactions can inactive ingredients trigger?
A
Allergic reactions
Food intolerances
8
Q
What is aspirin used for?
A
Reduces pain, fever, inflammation
9
Q
What are the potential side effects of using aspirin?
A
GI bleeding
Peptic ulceration
Hypersensitivity
10
Q
Which compound in aspirin triggers the side effects?
A
Salicylic acid
11
Q
What is the natural alternative to aspirin?
A
Willow bark
12
Q
Why is willow bark a better alternative to aspirin?
A
Contains salicin which doesn’t convert to salicylic acid
Same benefits without the side effects
13
Q
What is meant by pharmacokinetics?
A
The timed movement of drugs into, through and out of the body
14
Q
What is meant by pharmacodynamics?
A
How drugs interact with the body to exert their effect (mode of action)
15
Q
What are the 4 key processes of pharmacokinetics?
A
Absorption
Distribution
Metabolism
Elimination
16
Q
Why is absorption important in pharmacokinetics?
A
A drug must be absorbed into the bloodstream so it can exert its mode of action
17
Q
Why is distribution important in pharmacokinetics?
A
Once in the bloodstream, the drug can now be distributed to its target site (normally a receptor) to exert its action
18
Q
Why is metabolism important in pharmacokinetics?
A
Once the drug and receptor have interacted, the drug returns to the bloodstream and progresses to the liver to be metabolised and then eliminated from the body
19
Q
Why is excretion important in pharmacokinetics?
A
Once metabolised, excretion normally takes place via urine or bile
20
Q
What is first pass hepatic metabolism?
A
The process by which drugs taken orally are absorbed from the GIT and taken via the portal vein into the liver to be metabolised
21
Q
What happens when a drug is extensively metabolised?
A
The amount of drug entering the bloodstream is greatly reduced
Effect exertion is reduced
22
Q
How should drugs that are extensively metabolised by administered?
A
By a different route
e.g. nitro glycerine (GTN) spray for angina
23
Q
Which two factors determine whether or not a drug reaches its target site of action?
A
Bioavailability
Route of administration
24
Q
What is the bioavailability of a drug?
A
The proportion of the drug that can reach the bloodstream and is, therefore, available for distribution to its intended site of action
25
Where are drugs taken orally mainly absorbed?
SI
26
What are the benefits of sublingual/buccal drugs?
Bypasses liver metabolism
27
What factors affect drug absorption?
GI motility
Malabsorption
Presence of other substances
Format of the drug
28
How does the format of the drug affect absorption?
Acidic drugs absorb quicker in an acidic environment
Liquid medicines absorb quicker than a solid tablet
29
What factors affect drug distribution?
Binding to plasma proteins
Binding to other tissues
Accumulation in lipids
Natural barriers to distribution
30
What happens during drug metabolism?
The drug is changed from a lipid soluble to a more water soluble form for excretion
31
What happens during Phase I drug metabolism?
Drug is altered chemically to make it suitable for Phase II reactions or for excretion
32
Which family of enzymes are involved during Phase I metabolism?
CYP450
33
What happens during Phase II drug metabolism?
Molecules from Phase I (or in some cases unchanged drugs) are conjugated to a more water soluble product and aid excretion
34
What factors can influence the rate of metabolism in individuals?
Genetic
Environmental
35
What are the main excretion routes for drugs?
Urine
Faeces
36
What are the minor excretion routes for drugs?
Exhaled air
Sweat
Saliva
Tears
37
What dysfunction can affect the rate at which a drug/metabolite is cleared from the body?
Renal
38
What is entero-hepatic circulation?
Where very lipid soluble drugs may be reabsorbed and re-enter the portal vein
Prolongs excretion times
39
What factors can affect a drug's mode of action?
Genetic mutations
Malnutrition
Medical conditions e.g. Parkinson's, Alz
40
What information can pharmacokinetics and pharmacodynamics provide about a drug?
Mode of action
Administration route
Dosage
Side effects
Drug interactions
41
Which substances can affect the effects of a drug?
Food/drink
Nutritional supplements
Herbal medicines
Other drugs
Environmental chemical agents
42
What are narrow therapeutic index (NTI) drugs?
Drugs that may become dangerously toxic or ineffective with only relatively small changes in their blood concentrations
43
What types of drugs are digoxin, phenytoin, theophylline, warfarin and lithium?
Narrow therapeutic index (NTI) drugs
44
Which types of drugs are essential to have highlighted on case notes?
Narrow therapeutic index (NTI) drugs
45
Which populations are at an increased risk of serious side effects from drugs?
Patients experiencing liver/renal dysfunction
Elderly who take more than one drug
Patients taking drugs for multiple chronic long-term illnesses
Critically ill patients
46
What kinds of drugs can garlic interact with?
Cholesterol
Blood pressure
47
How should garlic be consumed to avoid interactions?
Interspersed throughout diet
Regular, high dietary intake and/or supplements should be avoided
48
What kinds of drugs can gingko interact with?
Anti-platelet
Anti-coagulant
(potential to increase bleeding risk)
49
Why should grapefruit and pomegranate be avoided with certain drugs?
Inhibits CYP3A4 in intestinal wall for up to 24 hrs
Increases peak levels of statins
50
Examples of drugs where grapefruit should be avoided
Statins
Digoxin
51
What types of drugs do green vegetables interact with?
Anti-platelet
Anti-coagulant
(potential to increase bleeding risk)
52
How do green vegetables interact with anti-coagulation/platelet drugs e.g. warfarin?
Reduces the effect of the drug
Contain indoles which increase the metabolism of warfarin
Also contain vit K which reduces the anti-clotting effects of warfarin
(vit K = coagulant; warfarin = anti-coagulant)
53
What types of drugs does soy interact with?
Thyroid (levothyroxine)
Oestrogen blocking drugs (tamoxifen)
Anti-coagulants (warfarin)
54
How does soy interact with levothyroxine?
Decreases the absorption of the drug
55
How does soy interact with warfarin?
Reduces effectiveness of the drug
56
What types of drugs can calcium/dairy produce interact with?
Antibiotics
Bisphosphonates
Levothyroxine
57
How does calcium interact with antibiotics, bisphosphonates and levothyroxine?
Reduces their absorption
58
How can high protein diets affect medication?
Can decrease intestinal absorption of drug
Can reduce effects of a drug
59
How can high fibre diets (vegan, Med diet) affect antidepressants?
Reduces serum levels of the drug
(take medication at a different time to high fibre meal)
60
How can salt restriction affect medication?
Can increase serum lithium to toxic levels
(Na is involved in the active transport of lithium; low levels of Na can cause lithium to accumulate in cells)
61
Which nutrients can be depleted by PPIs?
Beta carotene
Ca
Fe
Mg
B9
B12
C
Zn
62
Why are nutrients depleted when taking a PPI?
Reduced gastric acid levels inhibit absorption
63
Natural alternatives to PPIs
Milk thistle
Slippery elm
Dandelion root
Marshmallow root
Aloe Vera gel
64
Which nutrients can be depleted by steroids?
Ca
D
Folic acid
Mg
K
Zn
65
Why are nutrients depleted when taking steroids?
Increased urinary excretion
Losses from bone tissue
66
Which nutrient is depleted when taking statins?
CoQ10
67
Why is CoQ10 depleted when taking statins?
Statins block synthesis of mevalonic acid which is the building block of cholesterol and CoQ10
68
Which nutrients are depleted by antibiotics?
B1, 2, 5, 6, 7, 12
K
69
Why are nutrients depleted when taking antibiotics?
Antibiotics can lead to the destruction of normal intestinal microflora which produce various B vits and vit K
70
Which nutrients are depleted by metformin?
B9 (folate)
B12
71
Why are nutrients depleted by metformin?
Malabsorption
72
Which nutrients are depleted by diuretics?
Ca
Mg
K
B1, 6, 9
C
73
Why are nutrients depleted by diuretics?
Increased urinary loss
74
Which nutrients are depleted by antacids?
Ca
Fe
B9
75
Why are nutrients depleted by antacids?
Increased gastric pH may reduce solubility and absorption
Al-containing antacids can bind to Ca preventing absorption
76
Which nutrient is depleted by thyroxine?
Ca
77
Why is Ca depleted by thyroxine?
Increases bone turnover which may lead to increased urinary loss
78
Which nutrients are depleted by the OCP?
A
B1, 2, 6, 9,12
C
Mg
Zn
79
Why are nutrients depleted when taking the OCP?
Reduced absorption
Increased excretion
Increased protein binding and induction of liver enzymes
Reduced liver storage of vit A
Reduced B12 protein binding
80
Why should alcohol be avoided when taking drugs?
Alcohol can inhibit a drug's metabolism by competing for the same set of metabolising enzymes
This may decrease effectiveness of the drug and transform some drugs into toxic chemicals that can cause liver/organ damage
Can magnify the inhibitory effects of sedatives/narcotics at their sites of action in the brain (codeine, morphine)
Some drugs affect the metabolism of alcohol - making them more toxic
81
What are ACE inhibitors prescribed for?
Hypertension
Heart failure
82
What are common side effects of ACE inhibitors?
Persistent dry cough
Angioedema
Constipation
Diarrhoea
Nausea
Vomiting
Postural hypotension
Hyperkalaemia
83
What are statins prescribed for?
Hypercholesterolaemia
Hypertriglyceridemia
Prevention of CV events
84
What are common side effects of statins?
GI disturbance
Headaches
Fatigue
Myositis
Myopathy
85
Which foods interact with statins and should be avoided?
Grapefruit
Pomegranate
86
What is a natural alternative to statins?
Red yeast rice
(cholesterol lowering - but don't take with statins)
87
What can diuretics be prescribed for?
Oedema due to heart failure
Hypertension
88
What are the common side effects of taking diuretics?
Hypokalaemia
Hypotension
GI disturbance
Impotence
89
What are natural alternatives to diuretics?
Dandelion leaf
Nettle
Marshmallow root
90
What is digoxin prescribed for?
Atrial fibrillation
Heart failure
91
What are the common side effects of digoxin?
Nausea
Vomiting
Diarrhoea
Loss of appetite
Abdominal pain
92
Which nutrient should be used with caution alongside digoxin?
Hawthorn
(can increase myocardial contractions so digoxin dose may need to be lowered)
93
What are antacids prescribed for?
GORD
Indigestion
94
What are the common side effects of antacids?
Impaired nutrient absorption
Laxative (if Mg version)
Constipation (if Al version)
Rebound effect from overuse
95
Which nutrient may increase Al uptake from an antacid?
D
96
Lifestyle changes to reduce indigestion
Dietary changes - avoid spicy, fatty food, caffeine
Chew well
Keep fluids away from meals
Lose weight
Stop smoking
Manage stress
97
What are PPIs prescribed for?
GORD
Gastric/peptic ulceration
98
What are the common side effects of PPIs?
Headache
GI disturbance
Rebound of acid secretion
99
What are the side effects of long term use of PPIs?
GI infections
SIBO - lack of acid allows bacteria to survive
Increased fracture risk - reduced Ca absorption
B12 def - HCl needed to release B12 from proteins for intestinal absorption
Low blood Mg - decreased intestinal absorption
Fe def - decreased intestinal absorption
100
Why shouldn't PPIs be withdrawn suddenly?
Rebound reflux
101
What protocol can be used to reduce and withdraw PPIs safely?
5R protocol
102
What can warfarin be prescribed for?
DVT
Pulmonary embolism
(blood thinner)
103
What is the most common side effect of taking warfarin?
Haemorrhaging
Bruising
104
Which nutrients should be avoided when taking warfarin?
Vit K rich foods (dark leafy greens, broccoli) - has opposite effect to drug
High dose vit E (same action as drug so increased bleeding risk)
Pomegranate juice - slows blood clotting time
105
What is levothyroxine prescribed for?
Hypothyroidism
106
What are the common side effects of taking levothyroxine?
Tremor
Headache
Insomnia
Anxiety
Flushing
107
What is the typical dosing regime for levothyroxine?
30-60 minutes pre-breakfast or caffeine containing liquids to avoid reduced absorption
108
What nutrients should be avoided when taking levothyroxine?
Fe/Ca supplements
Cow's dairy
(reduce the absorption of levothyroxine)
109
What are common side effects of anti-histamines other than sedation?
Nausea
Vomiting
110
Examples of natural approaches for supporting hay fever
Quercetin
(inhibits release of histamine from mast cells)
Nettle
Bee pollen
Reishi mushroom
111
What are SSRIs prescribed for?
Depressive illnesses
Post-traumatic stress
Obsessive compulsive disorder
112
What are the common side effects of taking SSRIs?
GI disturbance
Constipation
Diarrhoea
Insomnia
Anxiety
Agitation
113
What is serotonin syndrome?
Excess serotonin due to SSRI use, overdose or interactions between drugs
114
What are the common symptoms of serotonin syndrome?
Confusion
Disorientation
Exaggerated reflexes
Fever
Sweating
115
Which herb and nutrient should be avoided when taking SSRIs?
St John's Wort
5-HTP
116
What are NSAIDs prescribed for?
Pain relief
Inflammation
117
Which foods should be avoided in high quantities when taking NSAIDs?
E
Garlic
Turmeric
(may increase risk of bleeding)
118
What are the common side effects of taking NSAIDs?
Gastric bleeding/ulceration
Acute kidney damage
119
Examples of natural alternatives to NSAIDs
Willow bark
Turmeric (curcumin)
Ginger
Boswellia
Anti-inflammatory diet
Quercetin
120
What are corticosteroids prescribed for?
Asthma
Eczema
IBD
AI conditions
121
What are the common side effects of using corticosteroids?
Long term use increases risk of:
Cushing's syndrome
DM
Osteoporosis
Infections
122
Why is it important to not withdraw corticosteroids abruptly?
Adrenal insufficiency
Hypotension
Death
123
What are natural alternatives to corticosteroids?
Anti-inflammatory diet
EFAs
Quercetin
Turmeric
Ginger
124
What does a bulk forming laxative do?
Increases the "bulk" or weight of poo, which in turn stimulates the bowel
125
What does a stimulant laxative do?
Stimulates the muscles that line the gut, helping them to move poo out of anus
126
What are common side effects of taking laxatives?
Dehydration
Loss of potassium
127
What are natural alternatives as laxatives?
Flaxseeds
Chia seeds
Psyllium husks
Water
Mg citrate
Rhubarb/dandelion/burdock root
128
What are natural alternatives to cough mixture?
Thyme
Honey/ginger
Honey/lemon
Rosemary
