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Transcript
Medications, Herbal Supplements, & Diet-Drug Interactions Chapter 15 Nutrition & Diet Therapy (7th Edition) Medications in Disease Treatment • Medications used to prevent & treat health problems • Herbal supplements often used as alternative therapy • Any ingested chemical can affect metabolism & produce adverse effects – Drug-drug interactions – Diet-drug interactions Nutrition & Diet Therapy (7th Edition) Medications in Disease Treatment (con’t) Prescription drugs – Use requires physician evaluation of patient’s condition • Given to treat serious conditions • May cause severe side effects Over-the-counter drugs – Can be used safely & effectively without medical supervision • Used for less serious conditions • May cause adverse effects, especially if used inappropriately Generic drugs – Chemically identical & act the same as original drug – Cost significantly less than brandname counterparts Nutrition & Diet Therapy (7th Edition) • Although OTC drugs are considered safe enough for self-medication, they can cause adverse effects when used inappropriately Medications in Disease Treatment (con’t) • Risks from medications – Any drug carries some risk of adverse reaction – Drug considered “safe” when benefits of use outweigh potential risks – Risks greater when incorrectly used (prescribed &/or administered) Nutrition & Diet Therapy (7th Edition) • • • • Potential Risks Side effects Drug-drug interactions Diet-drug interactions Medication errors-see Table 15-1, Inappropriate Abbrev., p.440 Medications in Disease Treatment (con’t) • Elderly people using multiple meds are especially susceptible to adverse effects • Patients at greatest risk – Pregnant & lactating women – Children – Older adults – Individuals with medical conditions that were not studied during drug development • Health professionals should discuss risks & benefits of medications; alert patients to potential dangers & solutions Nutrition & Diet Therapy (7th Edition) Medications in Disease Treatment (con’t) • Reducing risk – Patient counseling & education – Discussion of lifestyle or dietary practices as alternatives to drug therapy – Assessment of all medications, including prescription, OTC & dietary supplements – Monitoring side effects – Assessment of patient understanding of medication use, interactions & drug safety Nutrition & Diet Therapy (7th Edition) Herbal Supplements • Widely used by consumers to improve general health & prevent or treat specific illnesses • Do not require FDA approval before marketing • FDA must show that herbal supplement is unsafe before it can be removed from marketplace (ex. ephedrine) Nutrition & Diet Therapy (7th Edition) • Manufacturers & distributors are responsible for determining safety • Not required to provide evidence • FDA notification of illness or injury related to use of product is not required Effectiveness & Safety • Benefits of use of herbal products is unclear • Many herbal “remedies” of dubious effectiveness • Efficacy: limited number of studies to support traditional uses & benefits • Consistency in ingredients: variations occur in composition of herb & in preparation; may contain harmful components • Safety issues: products often considered “natural,” therefore safe; may have toxic effects, however—some serious, even dangerous • Interactions: may potentiate or interfere with actions of other herbs or drugs • Contamination: some products found to contain lead & other toxic metals; other contaminants include molds, bacteria, pesticides • Adulteration of imported products, including addition of synthetic drugs not identified on labels Nutrition & Diet Therapy (7th Edition) Nutrition & Diet Therapy (7th Edition) Use of Herbal Products in Illness • Self-medication & herbal remedies may delay appropriate treatment & allow progression of illness • Herbal products may interact with other medications—lack of research makes assessment of interactions difficult • Herbal products are not reliable treatment for medical conditions Nutrition & Diet Therapy (7th Edition) Diet-Drug Interactions • Diet-drug interactions fall into the following categories: – Medications can alter food intake by suppressing appetite or causing complications that interfere with food intake – Medications can alter absorption, metabolism & excretion of nutrients – Nutrients & other food components can alter absorption, metabolism & excretion of medications – Some interactions between food components & medications can be toxic Nutrition & Diet Therapy (7th Edition) Diet-Drug Interactions (con’t) Drug Effects on Food Intake • Reduce food intake through… – – – – – – – – Nausea & vomiting Alteration of taste sensations Suppression of appetite Drying mouth, inflammation or lesions in mouth or GI tract Side effects, including abdominal discomfort, constipation, diarrhea Drowsiness Other symptoms-p. 447 Table 15-5 Ex: sedatives Nutrition & Diet Therapy (7th Edition) Diet-Drug Interactions (con’t) • To prevent diet-drug interactions, find out about all Drug effects on nutrient absorption the drugs & supplements a • Damage of intestinal mucosa: patient takes most widespread cause of problems • • • with nutrient absorption; especially antineoplastic & antiretroviral medications Drug-nutrient binding: binding of nutrients & drugs in GI tract, preventing absorption (ex. Ciprofloxacin) Altered stomach acidity: resulting in impaired absorption of vitamin B12, folate & iron (ex. Antacids) Direct inhibition: drugs that impede nutrient absorption by interfering with intestinal metabolism or transport Nutrition & Diet Therapy (7th Edition) Diet-Drug Interactions (con’t) Dietary effects on drug absorption • Stomach emptying rate: taking medications on empty stomach tends to increase absorption rate; taking medications on full stomach may delay its absorption rate (ex. Aspirin) • Stomach acidity: absorption rates affected by acid or alkaline medium • Interactions with food components: may bind with drugs & inhibit absorption Drug effects on nutrient metabolism • Enhancement or inhibition of activities of enzymes needed for nutrient metabolism (ex. Methotrexate with folate) • Alteration in absorption & metabolism Nutrition & Diet Therapy (7th Edition) Diet-Drug Interactions (con’t) Dietary effects on drug metabolism • Alteration in activities of enzymes that metabolize drugs – Increased blood concentration of drug (stronger physiological effects)-ex. Grapefruit and statins – Decreased effectiveness of drug (ex. Warfarin and vitK) • Counteraction of drug effects in other ways Drug effects on nutrient excretion • Alteration in mineral reabsorption • Increased excretion of vitamins & minerals (ex. INH and vit. B6) Nutrition & Diet Therapy (7th Edition) Diet-Drug Interactions (con’t) Dietary effects on drug excretion • Alterations in excretion causing toxicity or reduced effectiveness of the drug • Increased or decreased reabsorption (ex. Li and Na) • Alterations in drug actions Diet-drug interactions & toxicity • Interactions can result in toxicity or exacerbate drug side effects (ex. MAOI and tyramine) • Health professions must understand mechanism of action of drugs & diet-drug interactions for identification &/or prevention Nutrition & Diet Therapy (7th Edition) Nutrition in Practice— Complementary & Alternative Therapies • Use of complementary & alternative medicine (CAM) most prevalent among individuals with chronic, debilitating diseases • Reasons for popularity include growing interest in “selfhelp” measures & non-invasive nature of the therapies • National Center for Complementary & Alternative Medicine established in 1998 – One of institutes making up the National Institutes of Health – Mission is to investigate CAM through scientific studies and to provide authoritative information to consumers & health care professionals • Health professionals need to be familiar with CAM so they can communicate with patients & offer advice Nutrition & Diet Therapy (7th Edition) Nutrition & Diet Therapy (7th Edition) Nutrition in Practice— Complementary & Alternative Therapies • Role of health practioner – Identify & communicate with patients who are using CAM – Educate patients regarding hazards of postponing or discontinuing conventional therapy – Educate patients regarding possible interactions & adverse reactions – Identify ways to integrate CAM & conventional treatment • Practitioner needs to regularly update knowledge of alternative therapies in order to knowledgably discuss options with patients Nutrition & Diet Therapy (7th Edition)