Food Drug Interactions Flashcards by Sydney Perry

Interactions between medications & nutrients or nutritional status is ________

Drugs can affect individual nutrients or nutritional status

Nutrients or nutritional status can alter the effects of drugs

Food Drug Interactions AKA drug-nutrient interactions

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Movement of the drug through the body: (steps)

Absorption
Distribution
Metabolism
Excretion

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Movement of the drug from the administration site to the bloodstream

Absorption

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Absorption is influenced by:

Route of __________
Rate of ___________ (oral drugs)
Ability of the drug to _________

administration
gastric emptying
cross membranes

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___________=> The fraction of an administered drug that reaches the systemic circulation

Bioavailability

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Movement of the drug from the bloodstream to the site of action

distribution

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Distribution is Affected by________to the organ or tissue

Many drugs are bound to __________ in the bloodstream

blood flow

plasma proteins

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Biotransformation of the drug to a metabolite for elimination

metabolism

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metabolism is Facilitated by ________ in the ________

e.g., cytochrome p450 enzyme system

enzyme systems
liver, intestines, & kidneys

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Most drugs are excreted by the _______

kidneys

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Biochemical & physiologic effects of a drug

pharmacodynamics

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Drug binds to a specific receptor, enzyme, or ion channel in the body to produce its___________ effect

therapeutic

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Presence of food in the stomach can __________

Mechanism of action:
Delayed ________
________ reactions

reduce drug absorption

gastric emptying
Chelation

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Drugs That Have Decreased Absorption if Taken with Food

drugs for bones/osteoporosis
supplement
bacterial infections
HTN, high BP

Bisphosphonates: alendronate, risedronate
- 1/2 hr to an hr before first meal

Iron supplements
- only absorb half

Tetracycline, ciprofloxacin
- bind to calcium magnesium zinc and iron

Captopril
- decreased absorption

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Drugs that Have Enhanced Absorption if Taken with Food

Cefuroxime (for infections)

Invirase (for HIV)

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Patients with serum albumin ______ g/dL are at increased risk for adverse effects from highly protein-bound drugs

_________ serum albumin levels=>_____ drug binding sites=> ____free drug in serum=> ______ drug effects and risk of _______

e.g., _________ and _________

<3.0

Decreased
less
more
increased
toxicity

warfarin (Coumadin)
phenytoin (Dilantin)

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warfarin (Coumadin) with decreased albumin

blood thinner- higher drug effects

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phenytoin (Dilantin) with decreased albumin

seizures- cause dizzy confusion vomiting

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A high protein, low CHO diet increases the hepatic metabolism of _________=> ______ blood levels

theophylline
decreases

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Grapefruit/grapefruit juice can inhibit the intestinal metabolism (__________ enzyme system) of oral drugs=> _______ drug effects & risk of______

the fruit has a substance called ____________

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cytochrome P450
increased
toxicity

furanocoumarins

grapefruit with _______ drugs with result in toxicity and can cause ________ (muscle breakdown) (can last up to ____hours)

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statin
rhabdomyolysis
72 hrs / 3 days

Nutrients can alter the reabsorption of drugs from the renal tubules
Ex: sodium & lithium(Bipolar)

Reabsorption of lithium is closely associated with reabsorption of _______ (will follow ______)

Excess intake=> _______ urinary sodium excretion=> _______ lithium excretion=> __________ therapeutic effect

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sodium
sodium

increased
increased
decreased

______ (anticoagulant) decreases hepatic production of ________-dependent clotting factors, so less clotting
Ingestion of ________ opposes the action of warfarin

Goal: balance between drug dose & vitamin intake

MNT:
Rx Consistent dietary intake of ________
Sources of vitamin K=>_________

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Warfarin
Vitamin K
vitamin K

vitamin K
dark green veggies, green tea, egg yolks

Additional interactions with Warfarin

Avoid _________ – counteracts drug effect

Intake of ______ supplements, ____ supplements, _____ supplements, & _______ can enhance anti-coagulant effects=> increased risk of serious bleeding

______ intake reported to increase drug effect; however, no effect if < _____ ml

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St. John’s wort

garlic
vit E
fish oil
ginseng

Cranberry
250

Caffeine Increases the adverse effects of stimulant drugs=> ___________ Results in nervousness, tremor, insomnia Decreases the therapeutic effect of anti-anxiety drugs

amphetamines theophylline

Alcohol If consumed with: _________ (e.g., Valium, phenobarbital)=> excessive drowsiness _______________=> increased risk of GI ulceration & bleeding ___________________=> hepatotoxicity

sedatives aspirin or NSAIDs (ibuprofen) Tylenol or methotrexate

Vasopressor Agents & Monoamine Oxidase Inhibitors (MAOIs) Vasopressor agents found in foods=> ____________ MAOI drugs inhibit ____________=> prevents breakdown of vasopressor agents E.g., phenelzine & isocarboxazid (anti-depressants) and selegiline (Parkinson’s disease) Ingestion of vasopressor agents while on MAOI drugs=> __________

tyramine, dopamine, histamine monoamine oxidase hypertensive crisis

Food Sources of Vasopressor Agents to be Avoided if on a MAOI

Aged cheese Aged meats: salami, dry sausage Tap beer Fermented soy products: soy sauce, miso, tempeh, soybean curd Sauerkraut, kimchi Fava beans, snow pea pods Concentrated yeast extracts (e.g., Vegemite)

Food Sources of Vasopressor Agents to be CAUTIOUS with if on a MAOI

Wine – limit to 4 oz/d Bottled beer – limit 12 oz/d Coffee, cola, & other caffeinated beverages – limit to 16 oz/d (dont contain the dopamine etc, but it is a vasopressor itself)

Drugs that Decrease Nutrient Absorption Reduced intestinal transit time Ex: laxatives=>diarrhea=>losses of _______

K+ & Ca

Altered _______ can decrease nutrient absorption Ex: H2-receptor antagonists (e.g., Pepcid) and proton pump inhibitors (e.g., Prilosec)=> Decrease _____ production=> impairs absorption of vitamin ________

gastric pH HCl B12 & iron

______ reactions between drugs & minerals __________ decreases absorption of ___________ Take drug ____ hours before or ____ hours after consuming dairy products, Ca-fortified foods; __________supplements, or MVI with minerals

Chelation ciprofloxacin Ca, Fe, Mg, & Zn 2 6 Ca, Mg, Zn, or Fe

Drugs that damage the intestinal mucosa e.g., ________________

chemotherapeutic agents

Drugs that affect intestinal transport mechanisms _________ (for _____________)=> inhibits absorption of _____, take _________ supplement

Sulfasalazine Inflammatory Bowel Disease folate 1 mg folate

Drugs that Alter Nutrient Metabolism _________=>increases hepatic metabolism of __________ _________(used for TB) => blocks the conversion of vitamin ______ to its active form - _____________ supplementation of ________ mg/d for those with a low intake of vitamin ___

Phenobarbital vit D, vit K, & folate Isoniazid (INH) B6 Rx pyridoxal 5-phophate 25-50 B6

Drugs that Alter Nutrient Excretion _________ (e.g., furosemide)=> increases urinary excretion of ________ ___________ (e.g., prednisone) - Increase urinary excretion of ____ - Decrease urinary ____ excretion=> ________ retention

Loop diuretics K+, Mg, Ca Corticosteroids Ca Na Na & water

Drugs can cause ______ (altered taste) e.g., _____________

dysgeusia cisplatin, captopril, phenytoin

Decreased salivary flow=> ________ e.g., _____________

xerostomia amitriptyline, diltiazem

Mucositis e.g., ______________

antineoplastic drugs=> carboplatin

Inflammation, ulceration e.g., ____________

Fosamax (reflux) NSAIDs, aspirin

N/V can be caused by: 1. Stimulation of the ___________________ 2. Direct irritation of the ______ e.g., ___________ drugs=> ____________

chemoreceptor trigger zone GIT antineoplastic cisplatin, doxorubicin

Constipation e.g., ____________

narcotics (morphine)

Diarrhea e.g., _________________

antibiotics, antineoplastic drugs

Extended use of broad-spectrum antibiotics=> destroy _________=> overgrowth of opportunistic, pathogenic bacteria=> ________________

gut flora Clostridium difficile (C. diff) colitis

Drugs that may cause anorexia:

Antineoplastic drugs Some antibiotics: metronidazole (Flagyl) Bronchodilators: theophylline CNS stimulants: Adderall

Drugs that may increase appetite and cause weight gain:

Some antidepressants: amitriptyline, paroxetine (Paxil) Corticosteroids: prednisone Antipsychotic drugs: haloperidol (Haldol)

“Inactive ingredients” added to drugs Function as binders, fillers, flavoring, coloring, preservatives, coating Need to consider intolerances & allergies

excipients

Assessing for food-drug interactions is part of the ________ Review medication list Obtain a diet history including use of micronutrient or herbal supplements, alcohol use Identify potential food-drug interactions Nutrition interventions e.g., nutrition education

nutrition assessment

Food Drug Interactions Flashcards

(49 cards)