Microsoft PowerPoint - _1021 991005Drug Food/Nutrient


•
MMU.5.1 : Medication prescription
prescription includes evaluation of
() between the medication
& other medications or food.
JCIA PFE.4 Patient and Family Education as appropriate to the patient’s care, includes :
safe use of medications safe use of medical equipment potential interactions between medications
and food () nutritional guidance pain management rehabilitation techniques

real or potential interactions
2. Micromedex
Significance :
• ADRs ( monitoring the
patient ) ( altering therapy )
Severity :
or extended hospital stay • Minor :
mild effects, bothersome or unnoticeable, additional treatment is usually not required.
Documentation:
4.Taking Rx & OTCs at the same time
5.Do not follow medication directions
6.Taking drugs for long periods of time
7.Drinking alcohol & smoking too much
Patients
DoctorsNurses
PharmacistsDieticians
/
production ↓ clotting factors II
& ↑ bleeding.
Encyclopedia of Life Sciences published by John Wiley & Sons, Ltd
The absorptive surface of the small intestine
The human GI tract
synthesis ↓ the amount of iron
incorporated into heme ↓ hemoglobin
urinary excretion of K, Mg & Zn.
4. Histamine-2 receptor antagonists & proton pump
inhibitors, raise the gastric pH ↓ iron
absorption.
nutrient-processing capabilities; nutrient
protein, carbohydrate, & fat metabolism
↑ protein synthesis ↑ nitrogen retention
corticosteroid)
doxorubicin); emetogenic, stimulate the
• diuretics, estrogens, sympathomimetics cause
• Drugs cause a bad taste: gold products, metronidazole, penicillins, & some
other antibiotics.
• Drugs cause taste acuity:
captopril & other angiotensin-converting enzyme
chemotherapeutic agents, anti-cholinergics, autonomic agents, beta blockers ( propranolol or labetalol ), emetogenic agents
• causing gastritis or ulcers: corticosteroids, NSAIDs ( indomethacin, ketorolac ), & serotonin reuptake antagonists.
• altering intestinal motility: • decreasing motility — opiates, anti-cholinergics,
phenothiazines ( chlorpromazine ) • increasing motility — metoclopramide, erythromycin,
& cisapride
• damaging GI tract mucosa: • causing diarrhea : as a result of an ADR or toxicity :
colchicine, cytotoxic agents • significantly altering GI flora & precipitate diarrhea:
antibiotics, quinidine, digoxin, & theophylline. • causing abdominal pain & cramping:
estrogens affecting the pancreas • causing or exacerbating pancreatitis:
diuretics, estrogens, anticonvulsants, corticosteroids, azathioprine, cyclosporine, carbamazepine, alcohol, antibiotics, & asparaginase
• altering pancreatic secretions: octreotide
• altering pancreatic hormone release:
glucocorticosteroid, growth hormone
Drugs affect liver function • Thiazides: increase glycogen synthesis and increase
glycogenolysis
theophylline, diazepam, cimetidine, erythromycin
• affecting drug disposition
• causing hypoalbuminemia and hypoproteinemia
dynamic effect : • phenytoin, phenobarbital, methotrexate
sulfasalazine : folic acid
potassium

chelation

High fiber diet TCA (amitriptyline )
Figure shows the change in plasma drug concentration [D]p with time after administration of a single oral dose k = 0.693/t1/2 t1/2 = 0.693/k Clearance = Vd . ke For most sites of administration drug absorption follows first order kinetics and for most routes of elimination the process also is first order or exponential. Most significant interactions are time & concentration dependent.
Therapeutic window
(hepatic metabolism):

• /:
•:
•:
•: fluoroquinolone
enteral feeding tubes

1. Review periodically for potential incompatibilities. 2 . The tube should be flushed before and after each
medication is administered. 3. Liquid medication formulations.
: direct physical contact during delivery system ( infusion tubing/bags ) or compounding process. :
• (eg, syrup) EN formula hydrolytic process
• IVPN admixtures incompability • IVIV fat emulsion
Warfarin 1.Kwarfarin K

Warfarin 4.
(Noni juice)warafrin
2/

6. warfarin
phenothiazines (); Winsumin, Fluphenazine, Novamin ,Flurazine:CNS
α-adrenergic blockers (); Doxaben, Hytrin:

Glurenorm:CNS
metronidazole ();Flagyl, Anegyn,Metronidazole:
acitretin (A ); Neotigason:-
2004-2009 Center for Food-Drug Interaction Research and Education, University of Florida
Grapefruit juice
individual genetics the medication
Cytochrome P450 Oxidase (CYP2C9)
CYP3A4
Grapefruit 1989, The effect of grapefruit juice with regard to drug absorption
originally discovered
1991, The first published report on grapefruit drug interactions was in the Lancet (British) entitled "Interactions of Citrus Juices with felodipine and nifedipine and was the first reported food-drug interaction clinically.
intestinal CYP3A4 P-gp
torsades de pointes (astemizole , terfenadine )
felodipine > 2
lead to rhabdomyolysis with statins (Crestor, Lipitor, Zocor FCLescol XL)statins
Schematic representation of the complex interrelationships among cytochrome P450 3A (CYP3A), P-glycoprotein (P-gp), and organic anion- transporting polypeptides (OATPs) in enterocytes and hepatocytes..
http://www.nature.com/clpt/journal/v83/n6/fig_tab/clpt200859f1.html#figure-title
buspirone (); Buspar:
carbamazepine (); Tegretol:
fluvoxamine (); Luvox:
amiodarone (); Cordarone:
verapamil (); Isoptin:


clarithromycin (); Klaricid:
itraconazole (); Sporanox:
etoposide (); Vepesid:
lapatinib (); Tykerb :
Tetracyclines () :2-4
E

2 delayed moderate suspected the anticoagulant effect warfarin clearance t1/2 AUC
K
4 delayed moderate possible anticoagulant effect
coumarin derivatives 4 delayed moderate possible warfarin clearance
~ anticoagulant effect 4 delayed moderate possible anticoagulant effect
K
4 delayed moderate possible antagonize warfarin activity
4 delayed major possible risk of bleedingsynergistic anticoagulant effect
4 delayed moderate possible anticoagulant effect leading to thrombus formation
Warfarin
sulfadiazine tetracycline tolcapone
riluzole roxithromycin sucrafate sulfamethoprim
? 1.
The clinically significant drug interaction is put in the patient education leaflet and drug information web page.
2.
653

Fluoroquinolones: levofloxacin, ciprofloxacin :
tyramine


2. 4Atkins diet ( high protein, without carbohydrates ) ?
Propranolol 80 mg bid x 60 Losartan 50 mg qd x 30 Warfarin 3 mg qd x 90 Phyllocontin Continus 225 mg bid x 60 Q1: What are the specific effects of food on propranolol? Q2: What are the specific effects of food on losartan? Q3: What are the specific effects of food on warfarin? Q4: What a crash diet have on Mrs Wang’s drug therapy? Q5: What overall advice should Mrs. Wang be given in relation to food and drink? H1: With a bid dosage for maintenance therapy, it doesn’t usually matter whether
propranolol is taking with or without food. H2: Grapefruit juice reduces the absorption not only on digoxin but also many other drugs. It
is important not to make the changes to the diet ( especially, to grapefruit juice ). H4: Fast loss of body fat may increase plasma concentration of lipid-soluble drugs
( propranolo). Vitamin deficiency is increased. High protein diet increases the metabolism of theophylline ( decrease free form to decrease effectiveness) .
H5: To take her drugd at the same time each day in relation to meals & snacks.
Thank you for your attention !