drug – nutrient...
TRANSCRIPT
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Today’s Agenda
Review common terminology
Better understand drug-nutrient interactions
Affect of nutrients on drugs
Affect of drugs on nutrients
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Objectives
Identify common foods that interact with medications
Identify common symptoms
Identify ways of preventing drug-nutrient interactions
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
1. You should always take medications with water.
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
1. You should always take medications with water. Myth
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
2. It is OK to take medications with coffee and tea.
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
2. It is OK to take medications with coffee and tea. Myth
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
3. You should never take medications on an empty stomach.
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
3. You should never take medications on an empty stomach. Myth
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
4. You cannot eat leafy greens while taking Coumadin (warfarin).
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
4. You cannot eat leafy greens while taking Coumadin (warfarin). Myth
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
5. Drug-Nutrient interactions only occur with prescription drugs.
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
5. Drug-Nutrient interactions only occur with prescription drugs. Myth
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
6. You should always tell your doctor and other health care professionals about the medications, herbs or supplements you are taking.
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Drug Nutrient Interactions Ice Breaker: Myth or Fact
6. You should always tell your doctor and other health care professionals about the medications, herbs or supplements you are taking. Fact
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Vocabulary
Drug: any chemical used in the prevention, diagnosis, and treatment of a disease
Polypharmacy: the use of multiple medications at one time
Drug-nutrient interaction: physical, chemical, physiologic relationship between a drug and nutrients present in food or supplements.
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Drugs & Medications
A few of the major types
Antibiotics (fights bacteria)
Analgesic (Pain relievers)
Antihypertensive (Blood pressure control)
Antihyperlipidemic (reduces cholesterol)
Antidepressants (control depression)
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Most Common Prescribed Drugs in the US
Hydrocodone/Ecetamonophen – analgesic or pain reliever
Zocor (simvastatin) - lowers cholesterol
Lisinopril – controls blood pressure
Norvasc – control blood pressure and angina
Prilosec (omeprazole) – treats acid-reflux
Azithromycin – antibiotic
Amoxicillin – antibiotic
Glucophage (metformin) – Treatment for Type 2 diabetes
Hydrochlorothiazide – diuretic, used to lower blood pressure
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How Drugs are Changed by the Body
Absorption: process by which drugs get into the body and then enter the blood stream
Distribution: movement of drugs from one location to another
Metabolism: process by which drugs are chemically changed
Excretion: process by which drugs are removed from the body
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Liver
First pass metabolism through liver via hepatic portal vein
Metabolism of drugs by liver
enzymes
Excretion of metabolites and intact drugs in urine
Kidney
Orally ingested drugs
hepatic vein
Pharmaco-dynamic
activity in body
Parenteral / IV drugs etc.
Renal artery
GI
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Common Symptoms Diarrhea/Constipation
Nausea/Vomiting
Dry or sore mouth
Abnormal sense of taste
Increased appetite
Decreased appetite
Ulcers/gastric bleeding
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Drugs Nutrients Interactions
AbsorptionHow much
enters blood stream
DistributionHow much is
sent to tissues in the body
MetabolismHow much is
used
ExcretionHow much
leaves
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Absorption
Nutrient Absorption: Drugs may increase/decrease or block nutrient uptake in the gut
Drug Absorption – some foods may increase/decrease the absorption of a drug
Delaying digestion, or binding to the drug itself.
Example: Lisinopril may cause the amount of potassium in the blood to increase.
Example: Zantac may decrease absorption of nutrients that rely on acid for absorption (B12, thiamin, iron,)
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Metabolism
Nutrient Breakdown/Metabolism: drugs may speed up the metabolism or use of nutrients, increasing the need for that nutrient or increasing risk of deficiency
Drug Breakdown/metabolism – Increase/decrease the breakdown of drugs
Example: Taking Hydrocodone with alcohol can result in liver toxicity.
Example: Dilantin increases metabolism of folic acid.
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Excretion
Nutrient Excretion: Drugs may increase/decrease the excretion of nutrients in the urine
Drug Excretion – Inhibit or enhance the removal of drugs from the blood stream
Example: Taking diuretics such as Lasix may increase the reabsorption of calcium by the kidneys, while increasing the loss of electrolytes (potassium, sodium, chloride, magnesium)
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Affects of Food on Drugs
Alcohol
Grapefruit Juice
Licorice
Chocolate/ Caffeine
Leafy Greens
Tyramine
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Alcohol Mixing alcohol with certain drugs can result in serious, even
life-threatening interactions.
Symptoms: nausea/vomiting, loss of coordination, drowsiness
Increases risk for internal bleeding, trouble breathing, heart problems.
Prescriptions, Over the Counter, and herbal supplements
Cold/flu/allergies
Arthritis
Enlarged prostate
Sleep aids
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GrapefruitCan enhance a drug’s effect by up to 1400%
Grapefruit inhibits activity of cytochrome P450 enzyme in the intestinal wall.
Serum drug levels increase and can be toxic.
Many drugs affected
Simvastatin (Zocor)
Pazopanib (Votrient)
Setraline (Zoloft)
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Licorice Contains compound glycyrrhizin
May cause a drop in the level of potassium
May result in high blood pressure, abnormal heart rhythms, congestive heart failure
May interact with certain drugs:
Ace-inhibitors or diuretics
Digoxin
Insulin
Aspirin
Laxatives
corticosteroids
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Chocolate
Food may act like a drug, enhancing its effects or creating a drug toxicity
The real concern is the caffeine content
High caffeine intake may increase adverse effects of Ritalin (nervousness, tremors, insomnia)
May decrease the effect of sedatives (Ambien)
MAO inhibitors (antidepressants)
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Dark Leafy GreensFood may act against a drug
Vitamin K – essential vitamin that helps form blood clots and is found in greens
Coumadin/Warfarin - Prevents blood clots “thins the blood”
Too much Vitamin K works in opposition of Coumadin – can potentially result in embolism/stroke
The key is CONSISTENCY
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Tyramine
Tyramine enhances the toxic effects of MAO inhibitors Can lead to a hypertensive crisis and death.
Tyramines are natural substances found in certain foods that aged or fermented. A byproduct when the amino acid tyrosine is broken down.
Aged cheeses (blue cheese, cheddar, feta, Gouda, mozzarella, gorgonzola, parmesan, Romano, Muenster, provolone, Swiss )
Dried sausages (pepperoni)
Processed meats (bologna, bacon, salami)
Sauerkraut
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Other Effects
Food in the stomach can increase or decrease drug absorption.
Examples:
Fosamax (osteoporosis) absorption is decreased by 60% with coffee or juice.
Ciprofloxacin forms an insoluble complex with calcium
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Herbal Supplements Herbs have pharmacological properties including side
effects and can interact with drugs
Herbal supplements are not regulated by the FDA
Many people take herbal supplements but deny this to their doctors
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Dietary Supplements St John’s Wort
Green Tea
Garlic
Ginseng
Ginko Biloba
Melatonin
Saw Palmetto
Echinacea
Black Cohosh
Glucosamine & Chondroitin Sulfate
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St John’s WortWhat the Science says
Although some studies of St. John’s wort have reported benefits for depression, others have not.
Side effects & cautions: interacts with many medications
Antidepressants
Birth control pills
Seizure-control drugs, such as phenytoin and phenobarbital
Warfarin and related anticoagulants.
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Green TeaWhat the Science says
Laboratory studies suggest that green tea may help protect against or slow the growth of certain cancers, but studies in people have shown mixed results.
Side effects & cautions
Green tea is safe for most adults when used in moderate amounts.
Green tea contains small amounts of vitamin K, which can make anticoagulant drugs, such as warfarin, less effective.
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GarlicWhat the Science says
Preliminary research suggests that taking garlic may slow the development of atherosclerosis
garlic may slightly lower blood pressure, particularly in people with high blood pressure.
Side effects & cautions
can thin the blood
May interfere with the effectiveness of saquinavir, a drug used to treat HIV infection
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Ginseng What the science says
Some studied have shown that ginseng may help to lower blood sugar. Other studies show possible beneficial effects on the immune system.
Research has not yet conclusively supported all of the health claims
Side effects and cautions
Can increase effects of heparin, aspirin
May increase effects of NSAIDS: ibuprofen, ketoprofen, naproxen
When taken with MAO inhibitors can cause nervousness and hyperactivity
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Avoiding Complications
Doctors, nurses, and registered dietitians should know about the drugs and herbs you are taking
Read directions carefully (prescribed & OTC & supplements)
Pay attention to when pills should be taken (empty vs. full stomach)
Don’t share or take someone else’s medications
Don’t take medications with alcohol
Ask your doctor or dietitian about deficiencies
Ask questions!
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Conclusion Be open with your health care providers
Ask questions before you start taking new medications
Helpful Resources:
MedlinePlushttp://www.nlm.nih.gov/medlineplus/druginfo/meds
www.fda.gov Avoiding Drug Interactions
Familydoctor.org Herbal Products and Supplements
National Center for Complementary and Alternative Medicine, nccam.nih.gov
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Questions?
Sarah Jacobson & Laura Gurvits
Keene State Dietetic Internship
2013-2014