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Nutrition & Diet Therapy (7 th Edition)

Medications, HerbalSupplements, & Diet-Drug

Interactions

Chapter 15


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Medications in DiseaseTreatment

Medications used to prevent & treat healthproblems

Herbal supplements often used as

alternative therapy Any ingested chemical can affectmetabolism & produce adverse effects Drug-drug interactions

Diet-drug interactions


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Medications in DiseaseTreatment (cont)

Prescription drugs Use requires physician evaluation of

patients 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 usedinappropriately

Generic drugs Chemically identical & act the

same as original drug Cost significantly less than brand-

name counterparts

Although OTC drugs areconsidered safe enough forself-medication, they cancause adverse effects whenused inappropriately


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Risks frommedications Any drug carries some

risk of adverse reaction

Drug considered safewhen benefits of useoutweigh potential risks

Risks greater whenincorrectly used(prescribed &/oradministered)

Potential Risks Side effects Drug-drug interactions Diet-drug interactions Medication errors- see

Table 15-1, InappropriateAbbrev., p.440


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Elderly people using multiplemeds are especiallysusceptible to adverse effects

Patients at greatest risk Pregnant & lactating

women Children

Older adults Individuals with medical

conditions that were notstudied during drugdevelopment

Health professionals shoulddiscuss risks & benefits ofmedications; alert patientsto potential dangers &solutions


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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 ofmedication use, interactions & drug safety


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Herbal Supplements

Widely used by consumersto improve general health& prevent or treat specificillnesses

Do not require FDAapproval before marketing

FDA must show that herbalsupplement is unsafebefore it can be removed

from marketplace (ex.ephedrine)

Manufacturers &distributors are responsiblefor determining safety

Not required to provideevidence FDA notification of illness

or injury related to use ofproduct is not required


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Use of Herbal Products inIllness

Self-medication & herbal remediesmay delay appropriate treatment &allow progression of illness

Herbal products may interact withother medications lack of researchmakes assessment of interactionsdifficult

Herbal products are not reliable

treatment for medical conditions


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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


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Diet-Drug Interactions(cont)

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


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Dietary effects on drug absorption Stomach emptying rate: taking medications on empty

stomach tends to increase absorption rate; takingmedications on full stomach may delay its absorption rate(ex. Aspirin)

Stomach acidity: absorption rates affected by acid oralkaline 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


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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)


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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 foridentification &/or prevention


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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 self -help measures & non -invasive nature of the therapies

National Center for Complementary & AlternativeMedicine 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 toconsumers & health care professionals Health professionals need to be familiar with CAM so

they can communicate with patients & offer advice


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Nutrition in Practice Complementary & Alternative

Therapies Role of health practioner

Identify & communicate with patients who areusing CAM

Educate patients regarding hazards ofpostponing or discontinuing conventionaltherapy

Educate patients regarding possibleinteractions & adverse reactions

Identify ways to integrate CAM & conventionaltreatment Practitioner needs to regularly update knowledge

of alternative therapies in order to knowledgablydiscuss options with patients

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