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Drug nutrient interaction
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Drug Nutrient Interaction

Presentation gives an overview of the inter-relationship between nutrition and pharmacy. Its importance is an imperative consideration in patient care. The presentation begins with an introduction to both areas but then focuses on specific drug-nutrient interactions with specific drug categories.

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Drug Nutrient Interaction

  1. 1. Mixing Food and Medicine Presenter: Rasheed Perry MPhil Student
  2. 2. Introduction  Drugs can affect and be affected by food  Patients must be assessed individually for the effect of:  Food on drug action  Drug on nutritional status  Drug nutrient interactions are of greatest potential significance to those in poor nutritional state  Proper planning of meal & drug schedules is necessary
  3. 3. Introduction • Drug - Any chemical substance, natural or manmade (usually excluding nutrients, water, or oxygen), that - by its chemical nature - alters biological structure or functioning when administered and absorbed
  4. 4. Introduction • Food - Edible or potable substance consisting of nutritive components such as carbohydrates, fats, proteins, essential mineral and vitamins, which when ingested and digestion sustains life, generates energy, and provides growth, maintenance, and health of the body.
  5. 5. Therapeutic Importance Therapeutically important interactions are those that: —Alter the intended response to the medication —Cause drug toxicity —Alter normal nutritional status
  6. 6. Therapeutic Importance • Patient with chronic disease • Elderly • Fetus • Infant • Pregnant woman • Malnourished patient
  7. 7. The People Perspective: Food vs Drug
  8. 8. The People Perspective: Food vs Drug • Both Food and Drug are often classified as separate entities but the truth is they are alike in many ways. • Health • Survival • Treatment • Prevention
  9. 9. Drug-Food Interactions
  10. 10. Food Intake • May affect food intake by: • Decrease or increase appetite • Interfering with taste (altered/diminished taste sensation) • Leaving an unpleasant aftertaste - allopurinal • Causing sore mouth – many cancer drugs • Dry mouth • Nausea &/vomiting
  11. 11. Examples of Drug Categories That May Cause Loss of Appetite • Antiinfectives- Metronidazole (Flagyl) • Antineoplastics - Valstar • Bronchodilators - Theophylline • Cardiovascular drugs - Nifedipine
  12. 12. Examples of Drug Categories That May Cause Loss of Appetite Taste Buds Taste aversions develop because of Dysguesia. Zinc depletion is one of the causes. Zinc is used in the repair and replacement of taste buds. Drugs bind to zinc in saliva reducing availability
  13. 13. Considerations: Foods that improve appetite and nausea Beef is high in zinc Citrus fruits remove unwanted tastes Fibre absorbs stomach acids and gastric irritants
  14. 14. Examples of Drug Classes That Cause Nutrient Excretion Drug Food/Nutrient Recommendation Furosemide (Lasix) Potassium depleting Ripe Bananas, Baked potatoes with skin, callaloo Thiazide Potassium depleting Ripe Bananas, Baked potatoes with skin, callaloo Hydralizine Pyridoxine antagonist Cabbage, bok choy, tuna, potatoes, bell peppers Methyldopa Constipation, Dry mouth Fibre and adequate hydration
  15. 15. Acid Suppressing Drugs and Antacids Anciphex, Nexium, Prevacid, Pilosec, Protonix, Tagament, Zantac, Pepcid and others Classified as: H2 antagonists: antagonizes histamine (H2) receptors on gastric mucosal cells and reducing production and secretion of acid. Proton pump inhibitors block the acid-transporter pump on the luminal surface preventing acid from entering the gastric lumen.
  16. 16. Acid Suppressing Drugs and Antacids  Antacids directly neutralize existing acid in the stomach.  Nutrient interaction:  H2 antagonists deplete calcium, iron, zinc, folate, vitamin D and B12  Proton pump inhibitors deplete vitamin B12
  17. 17. Acid Suppressing Drugs and Antacids • Calcium – Milk, Callaloo, cheese • Iron – Callaloo, liver, chicken • Folate – Beans, Lentils, lettuce • Zinc – seafood, beef, nuts, callaloo • Vitamin D – Milk fortified, Tuna, Sardines • B12 – Chicken, Pork, Peef
  18. 18. Analgesics Cause nausea, vomiting and GI upsets When oral intake is permitted, giving the medication along with food can minimize these side effects Salicylates (Aspirin) – increases urinary loss of ascorbic acid, potassium and amino acids. Diet should emphasize potassium and ascorbic acid.
  19. 19. Anti-Hypertensives Categories: Ace Inhibitors, Angiotension Receptor blockers (enalopril), Calcium Channel blockers (Nifedipine), Beta Blockers (Propanolol), thizade diuretics Works by reducing total peripheral resistance or by reducing cardiac output or both
  20. 20. Anti-Hypertensives • ACE Inhibitors deplete zinc • Calcium channel blockers and thiazade diuretics deplete potassium • Beta blockers deplete coenzyme Q10 • Diet should be supplied with • Adequate potassium: Bananas, potatoes, callaloo • Q10: beef, poultry, herring
  21. 21. Anti-Hypertensives  Diuretics: Lasix, Microzide (HCTZ), Zaroxolyn, Aldactone, Diamox and others  Nutrient Interactions:  Depletion of Zinc, magnesium and potassium  Potassium sparing diuretics deplete folic acid.
  22. 22. Cholesterol Lowering Drugs: Statins Lipitor, Crestor, Pravaschol, Zocor, Lescol, Mevacor and others Statins inhibit HMG reductase Nutrient Interaction: Q10 deficiency Supplement with sources of:
  23. 23. Oral Hypoglycemics • Biguanides: Metformin ( glucose production in liver and Insulin sensitivity) • Sulphonylureas: Diamicron MR ( Insulin Production) • Thiazolidinediones: Actos ( Insulin sensitivity) • DPP-4 Inhibitors : Januvia ( inhibits DPP- 4
  24. 24. Oral Hypoglycemics • Nutrient Interaction: • Vitamin B12 and Folate deficiency • Supplement with sources of: B12 Folate Shell fish Beans Beef ( highest in liver) Callaloo Fish (highest in mackerel) Lentils Fortified cereal Avocado
  25. 25. Antianxiety Agents • Benzodiazepines enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties.
  26. 26. Antianxiety Agents • Can cause drowsiness which interferes with food intake • Alprazolam and choldiazepoxide can stimulate the appetite and lead to weight gain. • Diazepam, lorazepam and oxazepan can cause constipation, diarrhea or dry mouth.
  27. 27. Antianxiety Agents • Nutrient interaction: • Endogenous melatonin depletion • Increase in metabolism of Vitamin D, reduction in Ca+ uptake • Supplement Diet with sources of Vitamin D:
  28. 28. Sedatives • Sedation may lead to reduced food intake. • Cause nausea • Propofol • a lipid based sedative that contains 1.1 kcal per milliliter and can provide a significant amount of energy from fat. • When propofol is provided to acutely stressed clients, enteral and parenteral formulas must be adjusted to avoid overfeeding. DeChicco et al, 1995
  29. 29. Marijuana • Recently decriminalized • THC and CBD most studied cannabinoids. Drugs available • Dronabinol – used to treat appetite loss in patients living with HIV/AIDS • Nabilone – used to treat nausea and vomiting in patients undergoing chemotherapy. Haney et al, 2007
  30. 30. Marijuana • Nutrition Carbohydrates - fructose, galactose, arabinose, glucose, mannose, rhamnose, sucrose, maltose and raffinose, cellulose, hemicellulose, pectin, xylan. Fats - Linoleic acid (53–60% of total fatty acids), linolenic acid (15–25%), and oleic acid. Proteins – Edestin (Brenneisen R, 2012)
  31. 31. References • Brenneisen R (2012). Chemistry and Analysis of Phytocannabinoids and Other Cannabis Constituents. Retrieved from:http://www.medicinalgenomics.com/wp- content/uploads/2011/12/Chemical-constituents-of-cannabis.pdf • Caribbean Food and Nutrition Institute (1994). Clinical Nutrition: Food – Drug Interactions. Caribbean Food and Nutrition Institute. • DeChicco R, Matarese L, Hummel A.C, Speerhas R. , Seidner D, Steiger E. (1995). Contribution of Calories from Propofol to Total Energy Intake. Retrieved from website:http://www.sciencedirect.com/science/article/pii/S0002822395004386
  32. 32. References • Haney M, Gunderson E.W, Rabkin J, Hart C.L, Vosburg S. K,Comer S.D and Foltin R.W. (2007). Dronabinol and Marijuana in HIV- Positive Marijuana Smokers Caloric Intake, Mood, and Sleep. Retrieved from website:http://www.safeaccess.ca/research/pdf/HaneyTHCCannabis HIVAIDS2007.pdf • Merk Manual (2016). Drug information. Retrieved from website: http://www.merckmanuals.com/professional/appendixes/brand-names-of-s
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Presentation gives an overview of the inter-relationship between nutrition and pharmacy. Its importance is an imperative consideration in patient care. The presentation begins with an introduction to both areas but then focuses on specific drug-nutrient interactions with specific drug categories.

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