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93 terms

Nutrition and Aging Drug Interaction

Final 5/2/13
STUDY
PLAY
What is drug-nutrient interaction?
the result of the action between a drug and a nutrient that would not happen with the nutrient or the drug alone
What is food-drug interaction?
a broad term that includes drug-nutrient interactions and the effect of a medication on nutritional status
True or False
Elderly more vulnerable to drug-nutrient interactions
False
There is a direct correlation between the _____ and number of _____
Direct correlation between the age and the number of prescriptions
25 - 50% of adverse drug reactions in older adults may be ________
preventable
What is poly-pharmacy?
Taking multiple unnecessary medications
What are the four most common categories of drugs the elderly take?
antihypertensive, analgesic-antipyretics, antirheumatics, anticoagulants
What are the main disorders the elderly get?
•Cardiovascular disease
•Arthritis
•Antihypertensives
•Gastrointestinal disorders
•Bladder dysfunction
If you take prescription drugs and answer yes to 7 questions, you could be at increased risk for polypharmacy. What are the 7 questions?
1.Do you take herbs, vitamins or OTC products?
2.Do you have to take medicine more than once a day?
3.Do you suffer from arthritis?
4.Do you use different pharmacies to fill prescriptions?
5.Do you have poor eyesight or hearing?
6.Do you live alone?
7.Do you sometimes forget to take your medication?
What is Pharmacokinetics?
a branch of pharmacology dedicated to the determination of the fate of substances administered externally to a living organism.
What are the top 5 most commonly used medications in men age 65 and older?
Aspirin (39%)
Acetaminophen (16%)
Furosemide (12%)
Digoxin (9%)
Warfarin sodium (8%)
What are the top 5 most commonly used medications in men age 65 and older?
Acetaminophen (27%)
Aspirin (23%)
Conjugated estrogens (17%)
Ethinyl estradiol (13%)
Hydrochlorothiazide (12%)
What medications are used to manage hypertension and what is the reasoning behind it?
diuretics, beta-blocker bc Depletion of minerals (Potassium, Ca, Mg)
Constipation
What medication is used to manage CHD? What is the nutritional implication to why this is used?
Digitalis, Anorexia and /or nausea
10% elderly do not know ____ of medication
purpose
When the elderly are hospitalized, _____patients use ______
On admission, two medications
When the elderly are hospitalized, when they're ____hospital: prescribed __________.
In hospital: prescribed 6 medications (antibiotics, analgesic, diuretic, sedative, K salts, digoxin, antacid)
What is PRN?
(pro re nata- as needed
What drugs are prescribed as neede?
sedatives,
hypnotics,
analgesics,
laxatives
What are some drug side effects that affect nutritional status?
•Appetite changes
•Oral taste and smell
•Nausea
•Dry mouth
•Gastrointestinal effects
•Organ system toxicity
•Glucose levels
Movement of drugs through the body by
•Absorption
•Distribution
•Metabolism
•Excretion
What does movement of the drug from the site of administration to the bloodstream; depend on?
The route of administration
The chemistry of the drug and its ability to cross membranes
The rate of gastric emptying (for oral drugs) and GI movement
True or False
Food, food components and nutritional supplements do not interfere with absorption, especially if the drug is taken orally
FALSE
Food, food components and nutritional supplements CAN interfere with absorption, especially if the drug is taken orally
Drugs in the bloodstream are often bound to _______
plasma protein
only ______drugs can leave the blood and affect target organs
unbound drugs
_________ can increase availability of drugs and potentiate their effects
Low serum albumin
Where does metabolism that change fat soluble compounds to water soluble occur?
liver
What enzyme facilitates drug metabolism?
cytochrome P-450
Foods or dietary supplements that increase or inhibit cytochrome p-450 enzyme systems can _______
change the rate or extent of drug metabolism
______ are eliminated from the body as an unchanged drug or metabolite
Drugs
What is warfarin? What should it not be taken with?
is an anticoagulant normally used in the prevention of thrombosis and thromboembolism, the formation of blood clots in the blood vessels and their migration elsewhere in the body respectively. Sould not be taken with vitamin K.
__________is the major route of elimination; affected by renal function and urinary pH
renal excretion
Some drugs are eliminated in ____and other body fluids
bile
What are mechanisms of drug-nutrient actions?
1.Interference with normal process (Ingestion and absorption)
2.Depletion of nutrient reserves
3.Effects of drug-receptor interaction
4.Effects of Over-the-Counter (OTC) Drugs
5.Effects of foods on drug
6.Use and abuse of vitamin, mineral supplements
7.Alcohol addition
8.Abuse of drugs
What are antineoplastic drugs?
drugs that inhibit or prevent the growth and spread of tumors or malignant cells
What is an anorectic effect?
loss of appetite
When ingesting _____ and ____ drugs, a side effect is loss of appetite (anorectic)
antineoplastic and cardiac drugs
Ingesting antineoplastic and cardiac drugs can cause a loss of appetite (anorectic effect) ___acuity decreases as well as _____
taste and smell
Drugs with lithium can cause _____
THIRST
What is a psychotrophic drug?
is a chemical substance that crosses the blood-brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in alterations in perception, mood, consciousness, cognition, and behavior.
Due to gastric pH_____ and HCL_____, absorption may decline
pH increase and HCL decrease
What drugs decrease motility?
anticholinergic drugs
____ change GI pH, & can cause thiamin deficiency
antacids
Antibiotics can influence _____
microflora (bacteria from other organisms)
Tetracycline binds ______ and _____ it _____ absorption
binds to Ca and Mg it DECREASES absorption
50 % Absorption of iron from supplements______
50% decrease when taken with food
____is best absorbed when taken with 8 oz of water on empty stomach
iron supplements
If you take iron supplements, avoid foods such as
bran, eggs, fiber supplements, tea, coffee, dairy products, calcium supplements
True or False
Presence of food enhances the absorption of some medications
True
True or False
All drugs damage intestinal mucosa destroying microvilli and villi (e.g. colchicines for gout)
False
some drugs damage intestinal mucosa destroying microvilli and villi (e.g. colchicines for gout)
Drug distribution : Affected by changes in body composition. Fat, LBM and body water affects drug distribution. Which one has a more effective distribution?
Fat.
_____ are vitamin K antagonist
warfarin
_____ depresses folate metabolism
methotextrate *commonly used to terminate pregnancies
____ decreses hydroxylation of vitamin D
isoniazid
_____ is an anticoagulant that prevents the conversion of vitamin K to a usable form
warfarin
What are other foods with anticlotting qualities
garlic, onions, vitamin E in large amounts, and ginseng
______can make drugs more potent by increasing availability to tissues
low albumin levels ( a family of globular proteins) can result in poor hemmorrhage
_______ or ______persons have a higher ratio of adipose tissue; fat soluble drugs may accumulate in the body ↑ risk of toxicity
obese, elderly
Metabolism Liver metabolism decrease due to:
decrease blood flow, decrease hepatic mass
Excretion Glomerular filtration & renal blood flow _____
decrease
Patients on low______diets will reabsorb more lithium along with _____
sodium, sodium
patients on high _____diets will excrete more lithium and need higher doses
sodium
Some extreme diets may affect _______pH which affects _____
urinary pH, affects resorption of acidic and basic medications
Drug use over extended period of time can
deplete nutrient reserves
Name some drugs that effect drug receptor interactions
•Diuretics
•Antihypertensives
•Cardiac drugs
•Drugs to manage diabetes
•Analgesics
Some receptor sites for drugs on cells increase in sensitivity with
age (increase drug uptake)
Decreased receptor sensitivity may also
occur leading to need for more drug for Rx effect
What are the side effects of laxatives?
chronic diarrhea, leading to sodium, potassium imbalance and cause heart rhythm irregularities.
What are the side effects of antihistamines?
confusion
What are the side effects of cold medications?
increase blood pressure and lead to strokes
What are the side effects of caffeine?
anxiety and insomnia
Foods alter
Rate of gastric emptying
Rate of dissolution of the drug
_____can interfere with trace elements
calcium
Folate can mask a _____ deficiency
B 12
Mega doses of ____ and ____ supplements may be dangerous
vitamin and mineral supplements
What is the 12th leading cause of death in the U.S.(1999)
Chronic Liver Disease and Cirrhosis
What factors increase the use of alcohol?
Physical and emotional distress
Loneliness
Bereavement
Tolerance to alcohol decreases with age
_____ interacts with drugs
alcohol
_____exacerbates several diseases
alcohol
True or false
Half of elderly alcoholics are early onset drinkers and one-third are late onset (after age 60)
False
Two-thirds of elderly alcoholics are early onset drinkers and one-third are late onset (after age 60)
Why are elderly people less tolerant to alcohol?
Alcohol has a higher absorption rate in the elderly, causing a greater degree of intoxication
Elderly people are less tolerant to alcohol. One reason is because of a fall in ratio of ______ to _____
A fall in ratio of body wat
Alcohol decreases _____blood flow
hepatic-liver will receive more damage
Elderly people don't have efficient ____enzymes therefore alcohol will not be broken down as efficiently
liver
What are some indications of alcohol or medication related problems?
•Memory trouble after having a drink or taking a medication
•Loss of coordination ( walking unsteadily, frequent falls)
•Changes in sleeping habits
•Unexplained bruises
•Being unsure of oneself
•Irritability, sadness, depression
•Unexplained chronic pain
•Changes in eating habits
•Wanting to stay alone much of the time
•Failing to bathe or keep clean
•Having trouble concentrating
•Difficulty staying in touch with family or friends
•Lack of interest in usual activities
_______ inhibits metabolism of many drugs
grapefruit
What does grapefruit inactivate?
Inactivates metabolizing intestinal enzyme resulting in enhanced activity and possible toxicity
Effect persists for ____ hours so it is not helpful to separate the drug and the grapefruit
72
What are some drugs known to interact with grapefruit juice?
anti-hypertensives, immunosuppressants, antihistamines, protease inhibitors , lipid-lowering drugs, anti anxiety, anti depressants
What are some benefits of minimizing food drug interactions?
•Medications achieve their intended effects
•Improved compliance with medications
•Less need for additional medication or higher dosages
•Fewer caloric or nutrient supplements are required
•Adverse side effects are avoided
•Optimal nutritional status is preserved
•Disease complications are minimized
When medications are initiated, patients should be provided with complete written and verbal ________at an appropriate reading level including food-drug interaction information
drug education
Clinicians including dietitians should obtain a ____ drug and diet history including the use of"
full: OTC and dietary supplements and review potential drug-food interactions
A _____ should be developed for dealing with ______ for short and long term drug therapy
plan, potential drug-food interactions