Medications, Herbal Supplements, & Diet-Drug Interactions

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| Medications, Herbal ‏إج!‎ Supplements, & Diet-Drug Interactions Overt & Der Phorepy (‘2% Eder) 

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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 و 5 مهس 

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Medications in Disease Treatment (con’t) ® Although OTC drugs are considered safe enough for self-medication, they can cause adverse effects when used inappropriately 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 brand- name counterparts ‎Der Dherepy ((P* Bara)‏ & مس ‎ ‎ ‎ 

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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) ‎Der Dherepy ((P* Bara)‏ & مس ‎ ‎ ‎ 

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Medications in Disease Treatment (con’t) © Elderly people using multiple meds are especially e patients at greatest risk susceptible.to adverse ® Pregnant & lactating women » ‏مععلاتطك‎ ‎©» 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 Aderton & Dat Doreen (P* Cdn) 

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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 ‎Der Dherepy ((P* Bara)‏ & مس ‎ ‎ 

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Herbal Supplements © 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 ® 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) ‎Det Phevary (P* Bd)‏ & عم ‎ ‎ ‎ 

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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 ‎Det Phevary (P* Bd)‏ & عم ‎ ‎ ‎ 

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‎ADEE‏ یز ‎Examples of Herb-Drug Interactions‏ ‎Herb Drug Interaction “American ginseng Estrogens, corticosteroids Enhances hormonal response ‘American ginseng Breast cancer therapeutic agent Synergistically inhibits cancer cell growth ‘Ametican ginseng, karela Blood glucose regulators Affect blood glucose levels Echinacea (possible Cyclosporine and May reduce drug effectiveness immunostimulant) corticosteroids (immunosuppressants) Evening primrose oll, Anticonvulsants Lower seizure threshold borage Feverfew Aspirin, ibuprofen, and other _Negates the effect of the herb in nonsteroidal antiinflammatory treating migraine headaches drugs Feverfew, garlic, ginkgo, Warfarin, coumarin (anticlotting Prolong bleeding time; increase singer. and Asian ginseng drugs, ‘blood thinners") likelihood of hemorrhage Garlic Protease inhibitor (HIV drug) May reduce drug effectiveness Kava, valerian Anesthetics ‘May enhance drug action Kelp (iodine source) Synthroid or other thyroid Interferes with drug action hormone replacers , licorice, plantain, Digoxin cardiac antiarrhythmic Interfere with drug action and Uuzara oot, hawthom, —_drugderived from the herb. monitoring Asian ginseng foxglove) St Johns wort, saw Iron TTannins in herbs inhibit iron palmetto, black tea absorption Valerian Barbiturates Causes excessive sedation ‏روصت | بج ‎er‏ ] ‎ ‎ ‎ ‎ 

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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 

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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 ‎Det Phevary (P* Bd)‏ & عم ‎ ‎ ‎ 

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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 ‎Det Phevary (P* Bd)‏ & عم ‎ ‎ ‎ 

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Diet-Drug Interactions (con’t) © To prevent diet-drug interactions, find out about all the drugs & supplements a patient takes Drug effects on nutrient absorption © Damage of intestinal mucosa: most widespread cause of problems with nutrient absorption; especially antineoplastic & antiretroviral medications © Drug-nutrient binding: binding of nutrients & drugs in Gl tract, preventing absorption (ex. Ciprofloxacin) © Altered stomach acidity: resulting in impaired absorption of vitamin B,,, folate & iron (ex. Antacids) © Direct inhibition: drugs that impede nutrient absorption by interfering with intestinal metabolism or transport ‎Der Dherepy ((P* Bara)‏ & مس ‎ ‎ ‎ 

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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 ‎Der Dherepy ((P* Bara)‏ & مس ‎ ‎ ‎ 

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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) ‎Det Phevary (P* Bd)‏ & عم ‎ ‎ ‎ 

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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. MAO! and tyramine) © Health professions must understand mechanism of action of drugs & diet-drug interactions for identification &/or prevention ‎Det Phevary (P* Bd)‏ & عم ‎ ‎ ‎ 

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۴ ‏ند‎ FRAC CC ‏د‎ ‎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 & 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 ‎Det Phevary (P* Bd) |‏ & عم ‎ ‎ 

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Examples of Complementary and Alternative Medicine Alternative Medical Systems ‘= Naturopathic medicine ‘= Homeopathic medicine ‘= Traditional Chinese medicine = Ayurveda Mind-Body Interventions ‘= Meditation ‘= Faith healing (prayer) ‘= Mental healing (including hypnotherapy) ‘= Music, art, and dance therapy Biologically Based Therapies 1 Dietary supplements 12 Foods and special diets ss Herbal products ss Hormones = Aromatherapy Manipulative and Body-Based Methods ‘= Chiropractic = Massage therapy ‘= Osteopathic manipulation Reflexology Energy Therapies "= Biofield therapies (including therapeutic touch, acupuncture, rarer & Der 1} _ 24) gone) \ sBioelecrical field (including electrical and magnetic Fels) 

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۴ ‏ند‎ FRAC CC ‏د‎ ‎Complementary & Alternative Therapies ® Role of health practioner ® Identify & communicate with patients who are using CAM ® Educate patients regarding hazards of postponing or discontinuing conventional herapy © 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 ‎Det Phevary (P* Bd)‏ & عم ‎