Chapter 9 nutrition and nutraceuticals

Question 1

Influences of food on bioavailability

Answer 1

• presence of food influences absorption (no food slows, too much food slows, fatty foods increase)
• gastric pH influences absorption
• chemical interactions between drug and specific foods ( i.e. Tetracycline, phenytoin)

Question 2

Bioavailability

Answer 2

Percentage of drug available to produce pharmacological effect

Question 3

CYP450

Answer 3

major grp. responsible for metabolizing foreign chemicals

-rate of drug metabolism influenced by nutrient intake

Question 4

adverse reaction of grapefruit juice on CYP3A4

Answer 4

-can increase levels of:
   calcium channel blk
   cyclosporins
   tacrolimus
   statins

Question 5

Drug-induced nutrient depletion

Answer 5

• drugs can induce or inhibit metabolic processes affecting nutrient metabolism/bioavailability
• i.e. loop diuretic leading to depletion of electrolytes and eventually malabsorption
• i.e. phenytoin inhibits intestinal enzymes absorbing folic acid

Question 6

Populations needing nutritional supplementation per ADA:

Answer 6

infants/children-400IU vit D/day
women 400 mcg/day folic acid
pregnant women 600 mcg/day folic acid, multi-vitamin, iron,B12
pt.>50y B12, vit D, calcium

Question 7

Nutraceuticals

Answer 7

foods claiming to have medicinal effects on health

5 categories; dietary fiber, vitamins and minerals, biactive substances, fatty acids, pre-pro-and symbiotics

Question 8

Vitamin A

Answer 8

• role in vision, bone growth, reproduction, immune function
• deficiency seen in developing countries and chronic ETOH abuse
• supplement decreases bronchopulmonary dysplasia in low birth weigh infants

Question 9

Vitamin B1 thiamine

Answer 9

deficiencies lead to beriberi and Wernicke’s encephalopathy

-ETOH abusers at higher risk for encephalopathy

Question 10

vitamin B2 riboflavin

Answer 10

• deficiency rare but ETOH abusers, anorexics, and those who are lactose intolerant at risk
• can decrease head aches and migraines

Question 11

Vitamin B3 niacin

Answer 11

• deficiency aka pellagara due to inadequate intake

- can be treatment for hyperlipidemia

Question 12

Vitamin B6 pyridoxine

Answer 12

• needed for protein, red blood cell metabolism, glucose regulation
• deficiency may be drug induced by isoniazid, cycloserine, or hydrazine-can be given prophylactically if on these meds to prevent neuropathy
• intake can be increased by fortified cereals, potatoes, bananas, meat

Question 13

Vitamin B12

Answer 13

• essential in red blood formation and neurological function
• deficiency leads to megaloblastic anemia, fatigue, loss of appetite, neurological changes
• recommended dose: 2.4 mg/day for older adults

Question 14

vitamin C ascorbic acid

Answer 14

• deficiency causes scurvy
• decreased in smokers
• populations at high risk are infants fed evaporated milk or boiled milk, those with malabsorption disorders and end stage renal patients on dialysis

Question 15

Vitamin D

Answer 15

• available in some food-egg yolks and fatty fish
• needed for calcium absorption and regulates calcium and phos levels (calcitriol)
• deficiencies lead to rickets (kids) and osteomalacia (adult)
• recommended dose: 400 IU daily

Question 16

vitamin K

Answer 16

• component of blood clotting
• new borns high risk of deficiency-usually give IM injection within 24 hours of birth-2 weeks
• warfarin interferes with vit. K

Question 17

Folate

Answer 17

• needed for production and maintenance of new cells
• found in foods-green leafy veggies, citrus fruits, dried legumes
• increased demand for pregnant women
• meds that interfere with absorption: antiepileptics, metformin, methotrexate, barbiturates, oral contraceptives, isoniazid
• deficiencies lead to macrocytic-normochromic anemia
• recommended dose: 400 mcg/day females of child bearing age; 600 mcg/day for pregnant women; 500 mcg/day for lactating women

Question 18

calcium

Answer 18

• needed for muscle contractions, blood vessel health, bone health, and nerve conduction-decreased amounts leads to tetany
• at risk populations-postmeno women, amenorrheic women, women with female athlete triad, lactose intolerant

Question 19

iron

Answer 19

• needed for regulation of cell growth and differentiation, and o2 transport
• deficiency leads to microcytic-hypochromic anemia (IDA)
• recommended dose: 27 mg/day for pregnant women

Question 20

fatty acids

Answer 20

• needs to be consumed (body can not produce)-nuts, veg. oils, leafy greens, and meats
• fish oil-reduces mortality in CAD pts.
• omega 3 decreases triglyceride levels in DM pts, and essential in central nervous development in infants-may have link to autism and ADHD

Question 21

plant sterols

Answer 21

• associated reduction of LDL especially in conjunction with low-chol. diet and medication
• present in edible oils, seeds, nuts and added to margarine, orange juice,

Question 22

pre-,pro, symbiotics

Answer 22

probiotics nonpathogenic bacteria found in intestinal microflora-lactobacillus acidophilus and bifidobacterium
prebiotics-nondigestable food ingredients that stimulate growth of probiotic organisms
symbiotics are combination of both
-probiotics reduce antibiotic-assoc. diarrhea in adults, improves IBS or necrotizing enterocolitis, prevents NEC and death in preterm infants

Question 23

foods and CYP1A2

Answer 23

• can lead to therapeutic failure

i. e. low potassium and high carbohydrates effect metabolizing enzymes

Question 24

influence on diet on drug excretion

Answer 24

• some foods can change urinary pH drug excretion
  i. e. foods that make more alkaline: milk, veggies, citrus fruits
  i. e. foods that make more acidic: meats, fish, eggs