Medications, Herbal Supplements, & Diet-Drug Interactions
اسلاید 1: Nutrition & Diet Therapy (7th Edition)www.tabaye.ir
اسلاید 2: Nutrition & Diet Therapy (7th Edition)Medications, Herbal Supplements, & Diet-Drug Interactions
اسلاید 3: Medications in Disease TreatmentNutrition & Diet Therapy (7th Edition)Medications used to prevent & treat health problemsHerbal supplements often used as alternative therapyAny ingested chemical can affect metabolism & produce adverse effectsDrug-drug interactionsDiet-drug interactions
اسلاید 4: Medications in Disease Treatment (con’t)Nutrition & Diet Therapy (7th Edition)Prescription drugsUse requires physician evaluation of patient’s conditionGiven to treat serious conditionsMay cause severe side effectsOver-the-counter drugsCan be used safely & effectively without medical supervisionUsed for less serious conditionsMay cause adverse effects, especially if used inappropriatelyGeneric drugsChemically identical & act the same as original drugCost significantly less than brand-name counterpartsAlthough OTC drugs are considered safe enough for self-medication, they can cause adverse effects when used inappropriately
اسلاید 5: Medications in Disease Treatment (con’t)Nutrition & Diet Therapy (7th Edition)Risks from medicationsAny drug carries some risk of adverse reactionDrug considered “safe” when benefits of use outweigh potential risksRisks greater when incorrectly used (prescribed &/or administered)Potential RisksSide effectsDrug-drug interactionsDiet-drug interactionsMedication errors-see Table 15-1, Inappropriate Abbrev., p.440
اسلاید 6: Medications in Disease Treatment (con’t)Nutrition & Diet Therapy (7th Edition)Elderly people using multiple meds are especially susceptible to adverse effectsPatients at greatest riskPregnant & lactating womenChildrenOlder adultsIndividuals with medical conditions that were not studied during drug developmentHealth professionals should discuss risks & benefits of medications; alert patients to potential dangers & solutions
اسلاید 7: Medications in Disease Treatment (con’t)Nutrition & Diet Therapy (7th Edition)Reducing riskPatient counseling & educationDiscussion of lifestyle or dietary practices as alternatives to drug therapyAssessment of all medications, including prescription, OTC & dietary supplementsMonitoring side effectsAssessment of patient understanding of medication use, interactions & drug safety
اسلاید 8: Herbal SupplementsNutrition & Diet Therapy (7th Edition)Widely used by consumers to improve general health & prevent or treat specific illnessesDo not require FDA approval before marketingFDA must show that herbal supplement is unsafe before it can be removed from marketplace (ex. ephedrine)Manufacturers & distributors are responsible for determining safetyNot required to provide evidenceFDA notification of illness or injury related to use of product is not required
اسلاید 9: Effectiveness & SafetyNutrition & Diet Therapy (7th Edition)Benefits of use of herbal products is unclearMany herbal “remedies” of dubious effectivenessEfficacy: limited number of studies to support traditional uses & benefitsConsistency in ingredients: variations occur in composition of herb & in preparation; may contain harmful componentsSafety issues: products often considered “natural,” therefore safe; may have toxic effects, however—some serious, even dangerousInteractions: may potentiate or interfere with actions of other herbs or drugsContamination: some products found to contain lead & other toxic metals; other contaminants include molds, bacteria, pesticidesAdulteration of imported products, including addition of synthetic drugs not identified on labels
اسلاید 10: Nutrition & Diet Therapy (7th Edition)
اسلاید 11: Use of Herbal Products in IllnessNutrition & Diet Therapy (7th Edition)Self-medication & herbal remedies may delay appropriate treatment & allow progression of illnessHerbal products may interact with other medications—lack of research makes assessment of interactions difficultHerbal products are not reliable treatment for medical conditions
اسلاید 12: Diet-Drug InteractionsNutrition & Diet Therapy (7th Edition)Diet-drug interactions fall into the following categories:Medications can alter food intake by suppressing appetite or causing complications that interfere with food intakeMedications can alter absorption, metabolism & excretion of nutrientsNutrients & other food components can alter absorption, metabolism & excretion of medicationsSome interactions between food components & medications can be toxic
اسلاید 13: Diet-Drug Interactions (con’t)Nutrition & Diet Therapy (7th Edition)Drug Effects on Food Intake Reduce food intake through…Nausea & vomitingAlteration of taste sensationsSuppression of appetiteDrying mouth, inflammation or lesions in mouth or GI tractSide effects, including abdominal discomfort, constipation, diarrheaDrowsinessOther symptoms-p. 447 Table 15-5Ex: sedatives
اسلاید 14: Diet-Drug Interactions (con’t)Nutrition & Diet Therapy (7th Edition)Drug effects on nutrient absorptionDamage of intestinal mucosa: 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 transportTo prevent diet-drug interactions, find out about all the drugs & supplements a patient takes
اسلاید 15: Diet-Drug Interactions (con’t)Nutrition & Diet Therapy (7th Edition)Dietary effects on drug absorptionStomach 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 absorptionDrug effects on nutrient metabolismEnhancement or inhibition of activities of enzymes needed for nutrient metabolism (ex. Methotrexate with folate)Alteration in absorption & metabolism
اسلاید 16: Diet-Drug Interactions (con’t)Nutrition & Diet Therapy (7th Edition)Dietary effects on drug metabolismAlteration in activities of enzymes that metabolize drugsIncreased blood concentration of drug (stronger physiological effects)-ex. Grapefruit and statinsDecreased effectiveness of drug (ex. Warfarin and vitK)Counteraction of drug effects in other waysDrug effects on nutrient excretionAlteration in mineral reabsorptionIncreased excretion of vitamins & minerals (ex. INH and vit. B6)
اسلاید 17: Diet-Drug Interactions (con’t)Nutrition & Diet Therapy (7th Edition)Dietary effects on drug excretionAlterations in excretion causing toxicity or reduced effectiveness of the drugIncreased or decreased reabsorption (ex. Li and Na)Alterations in drug actionsDiet-drug interactions & toxicityInteractions 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
اسلاید 18: Nutrition in Practice—Complementary & Alternative TherapiesNutrition & Diet Therapy (7th Edition)Use of complementary & alternative medicine (CAM) most prevalent among individuals with chronic, debilitating diseasesReasons for popularity include growing interest in “self-help” measures & non-invasive nature of the therapiesNational Center for Complementary & Alternative Medicine established in 1998One of institutes making up the National Institutes of HealthMission is to investigate CAM through scientific studies and to provide authoritative information to consumers & health care professionalsHealth professionals need to be familiar with CAM so they can communicate with patients & offer advice
اسلاید 19: Nutrition & Diet Therapy (7th Edition)
اسلاید 20: Nutrition in Practice—Complementary & Alternative TherapiesNutrition & Diet Therapy (7th Edition)Role of health practionerIdentify & communicate with patients who are using CAMEducate patients regarding hazards of postponing or discontinuing conventional therapyEducate patients regarding possible interactions & adverse reactionsIdentify ways to integrate CAM & conventional treatmentPractitioner needs to regularly update knowledge of alternative therapies in order to knowledgably discuss options with patient
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