Nutrition and Diet Therapy – Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session # 16

LESSON TITLE: Medications, Diet-Drug Interactions, Materials:

and Herbal Supplements Pen and notebook

LEARNING OUTCOMES:

At the end of the lesson, you can:

1. Explain how medications are used in patient care and
discuss the potential risks associated with their use;
2. Identify the different types of diet-drug interactions and
Reference:
give examples of each; and,
DeBruyne, L.K., Pinna, K., & Whitney E., (2016).
3. Give examples of some popular herbal products and Nutrition and diet therapy: Principles and practice
explain why they are not considered reliable treatments (9th ed.). USA: Cengage Learning.
during illness.

LESSON PREVIEW/REVIEW
Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the
space provided. You may use the back page of this sheet, if necessary. Have fun!

Instruction: In your opinion which is better in documenting nutritional care ADIME or SOAP?
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MAIN LESSON
You will study and read their book, if available, about this lesson.

A. Medications in Disease Treatment

Drugs must be proved to be safe and effective before they can be marketed in the United States. The Food and Drug
Administration (FDA) is responsible for approving sales of new drugs and inspecting facilities where drugs are
manufactured. By law, drugs are divided into two categories:
1. Prescription drugs are usually given to treat serious conditions and may cause severe side effects. For these
reasons, they are sold by prescription only, which ensures that a physician has evaluated the patient’s medical
condition and determined that the benefits of using the medication outweigh the risks of incurring side effects.
2. Over-the-counter (OTC) drugs are those that individuals can use safely and effectively without medical
supervision. People use them to treat less serious illnesses that are easily self-diagnosed. Examples include
aspirin to treat headaches or pain and antacids to combat acid reflux. The FDA regulates labels on OTC drugs to
make sure they provide accurate information about the drugs’ appropriate uses and dosages and potential
adverse effects. Prescription drugs considered safe enough for self-medication are often given OTC status,
sometimes in smaller doses than are available by prescription.

Brand-name drugs are usually given patent protection for 20 years after the patent is submitted. After the patent expires,
a less-expensive generic drug may be sold. To gain FDA approval, the generic version of a drug must have similar
biological effects as compared with the original drug: it must contain the same active ingredients; be identical in strength,
dosage form, and route of administration; and meet the same requirements for purity and quality. In some cases, the
bioavailability (amount absorbed) of a brand name drug and generic drug may differ due to differences in the drugs’
solubility or the types of inactive ingredients present; thus, greater benefit may be obtained by using the brand-name drug.
Most often, however, consumers can be confident that generic drugs are as safe and effective as the brand-name
products they replace.

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B. Risks from Medications

Side Effects by the time a drug reaches the marketplace, large-scale clinical trials have revealed the majority of side
effects associated with its use. However, rare side effects are sometimes detected only after a drug has been more widely
used. In some instances, these effects occur because the drugs are used for longer periods or in different circumstances
than originally anticipated.
Drug-Drug Interactions. When a person uses multiple drugs, one drug may alter the effects of another drug, and the risk
of side effects increases. These problems are common in older adults, who often use several medications daily over long
periods. Although primary care physicians typically supervise medication use, some individuals use drugs prescribed by a
number of different physicians. Others may use OTC medications and dietary supplements in addition to prescription
drugs without being aware of the risks associated with certain combinations of substances.

Diet-Drug Interactions. Substances in the diet may alter the effectiveness of drugs, and drugs may affect food intake or
the digestion, absorption, metabolism, or excretion of nutrients. Later sections of this chapter describe these interactions
in detail.

Medication Errors. A medication error is any preventable event that causes inappropriate drug use or patient harm due to
mistakes made by the health professional, patient, or caregiver. Many medication errors involve the use of incorrect drugs
or improper dosages.

C. Patients at High Risk of Adverse Effects

Health care professionals should be aware that some patients are more vulnerable than others to adverse effects from
drugs. This category includes the populations that rarely participate in clinical trials that determine product safety:
pregnant and lactating women, children, and people with medical conditions that are not the main focus of the study.

To reduce the likelihood of adverse effects, health professionals should discuss with patients the potential benefits and
risks of using medications before prescribing them. These suggestions may help:
⎯ Advise the patient that drugs should not be taken unless absolutely necessary. Discuss dietary or lifestyle
practices that have benefits similar to those of drugs. For example, laxatives may not be necessary if an individual
increases consumption of foods high in fiber and begins exercising regularly.
⎯ Request a complete list of prescription medications, OTC drugs, and dietary supplements that the patient is
taking. Ensure that at least one physician is coordinating the patient’s drug use. Encourage the patient to
purchase all medications at the same pharmacy so that the pharmacist can alert physicians and patients to
potential problems.
⎯ Verify that the patient understands how to take medications properly. Alert the patient to potential drug-drug and
diet-drug interactions.
⎯ Encourage the patient to keep track of side effects. Inform the patient that new or unusual symptoms may be due
to a new medication rather than the medical condition. In some cases, another medication that treats the condition
may have fewer side effects.

D. Diet-Drug Interactions

When working with patients, medical personnel should be alert to possible interactions between drugs and dietary
substances. These interactions can raise health care costs and result in serious, and sometimes fatal, complications.
Accordingly, health professionals must learn to take steps to prevent or lessen their adverse consequences. Diet-drug
interactions (also called food-drug interactions or drug-nutrient interactions) generally fall into the following categories:
⎯ Drugs may alter food intake by reducing the appetite or by causing complications that make food consumption
difficult or unpleasant. Other drugs may increase the appetite and cause weight gain.
⎯ Drugs may alter the absorption, metabolism, or excretion of nutrients. Conversely, nutrients and other food
components may alter the absorption, metabolism, and excretion of drugs.
⎯ Some interactions between dietary components and drugs can cause drug toxicity.

Drug Effects on Food Intake

Some drugs can make food intake difficult or unpleasant: they may suppress the appetite, cause mouth dryness, alter the
sense of taste, lead to inflammation or lesions in the mouth or gastrointestinal (GI) tract, or induce nausea or vomiting.
Certain side effects of drugs, including abdominal discomfort, constipation, and diarrhea, may be worsened by food

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consumption. Medications that cause drowsiness, such as sedatives and some painkillers, can make a person too tired to
eat.

Drug complications that reduce food intake are significant only when they continue for a long period. Although many drugs
can cause nausea in certain individuals, the nausea often subsides after the first few doses of the drug and therefore has
little effect on nutrition status

Drug Effects on Nutrient Absorption

The medications that are most often because nutrient malabsorption is those that either upset GI function or damage the
intestinal mucosa. Antineoplastic drugs and antiretroviral drugs are especially detrimental, whereas nonsteroidal
anti-inflammatory drugs (NSAIDs) and some antibiotics can have similar, though milder, effects. This section describes
additional ways in which medications may alter nutrient absorption.

Drug-Nutrient Binding. Some medications bind to nutrients in the GI tract, preventing their absorption.

Altered Stomach Acidity. Medications that reduce stomach acidity can impair the absorption of vitamin B12, folate, and
iron. Examples include antacids, which neutralize stomach acid by acting as weak bases, and antiulcer drugs (such as
proton pump inhibitors and H2 blockers), which interfere with acid secretion.

Direct Inhibition. Several drugs impede nutrient absorption by interfering with their transport into mucosal cells. For
example, the antibiotics trimethoprim (Proloprim) and pyrimethamine (Daraprim) compete with folate for absorption into
intestinal cells. The anti-inflammatory medication colchicine, a treatment for gout, inhibits vitamin B12 absorption.

E. Dietary Effects on Drug Absorption

Stomach-Emptying Rate Drugs reach the small intestine more quickly when the stomach is empty. Therefore, taking a
medication with meals may delay its absorption, although the total amount absorbed may not be lower. As an example,
aspirin works faster when taken on an empty stomach, although taking it with food is often encouraged to reduce stomach
irritation.

Stomach Acidity. Some drugs are better absorbed in an acidic environment, whereas others are absorbed better under
alkaline conditions. For example, reduced stomach acidity (due to secretory disorders or antacid medications) may reduce
the absorption of ketoconazole (Nizoral, an antifungal medication) and atazanavir (an antiretroviral medication), but
increase the absorption of digoxin (Lanoxin, which treats heart failure) and alendronate (Fosamax, which treats
osteoporosis). Some drugs can be damaged by acid and are available in coated forms that resist the stomach’s acidity.

Interactions Between Drugs and Dietary Components. Various dietary substances can bind to drugs and inhibit them
absorption. As mentioned earlier, minerals can bind to some antibiotics, reducing absorption of both the minerals and the
drugs. High-fiber meals can decrease the absorption of some tricyclic antidepressants due to binding between the fiber
and the drugs. Conversely, the absorption of many lipophilic drugs (those with fat-soluble structures) is improved when the
drugs are taken with a fat-containing meal.

Drug Effects on Nutrient Metabolism. Drugs and nutrients share similar enzyme systems in the small intestine and liver.
Consequently, some drugs may enhance or inhibit the activities of enzymes needed for nutrient metabolism

Dietary Effects on Drug Metabolism. Some food components alter the activities of enzymes that metabolize drugs or
may counteract drug effects in other ways. Compounds in grapefruit juice (or whole grapefruit) have been found to inhibit
or inactivate enzymes that metabolize a number of different drugs.

Drug Effects on Nutrient Excretion. Drugs that increase urine production may reduce nutrient reabsorption in the
kidneys, resulting in greater urinary losses of the nutrients.

Dietary Effects on Drug Excretion. Inadequate excretion of medications can cause toxicity, whereas excessive losses
may reduce the amount available for therapeutic effect. Some food components influence drug excretion by altering the
amount reabsorbed in the kidneys.

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F. Herbal Supplements

Effectiveness and Safety of Herbal Products. Despite the popularity of herbal products in the United States, the
benefits of their use are uncertain. Although many medicinal herbs contain naturally occurring compounds that exert
physiological effects, few herbal products have been rigorously tested, many make unfounded claims, and some may
contain contaminants or produce toxic effects.

Efficacy. Herbs have been used for centuries to treat medical conditions, and many have acquired reputations for being
beneficial for individuals with specific diseases. Unfortunately, only a limited number of clinical studies support the
traditional uses, and the results of studies that suggest little or no benefit are rarely publicized by the supplement industry
Consistency of Herbal Ingredients. Herbs contain numerous compounds, and it is often unclear which of these
ingredients, if any, might produce the implied beneficial effects. Because the compounds in herbs vary among species and
are affected by a plant’s growing conditions, different samples of an herb can have different chemical compositions. The
preparation method may also cause variations in the composition of an herbal product. Some manufacturers attempt to
standardize the herbal extracts they sell so that the compound believed to be beneficial is more likely to be obtained from
each dose

Safety Issues Consumers. often assume that because plants are “natural,” herbal products must be harmless. Many
herbal remedies have toxic effects, however.18 The most common adverse effects of herbs include diarrhea, nausea, and
vomiting.

Herb-Drug Interactions. Like drugs, herbs may either intensify or interfere with the effects of other herbs and drugs or
they may raise the risk of toxicity

Use of Herbal Products in Illness.

When people self-medicate or ask the advice of store clerks instead of seeking effective medical treatment, the
consequences are sometimes serious and irreversible. Purchasing an herbal remedy may be less stressful than a visit to
the doctor, but it may delay getting an appropriate treatment and allow an illness to progress. Although retailers are not
legally permitted to provide medical advice, sellers of herbal products routinely make improper claims that the products
are able to treat, prevent, or cure specific illnesses. Patients are often unaware that herbal products may be unsafe or can
interact with medications.

Elderly individuals (65 years old and older) are at highest risk of herb-drug interactions because most individuals in this
age group take three or more prescription drugs over the course of a year. Some pharmacology textbooks and handbooks
now contain information about herbal supplements and potential herb drug interactions, and various consumer websites
and periodicals provide information about the safety of brand-name herbal products. Health professionals should turn to
these resources to help patients who plan to use herbal supplements.

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not
allowed.

1. Over-the-counter drugs:
a. rarely cause adverse effects.
b. are unlikely to interact with dietary components.
c. are usually taken for longer periods than prescription medications.
d. are used to treat illnesses that are typically self-diagnosed and self-treated.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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2. Recommendations for reducing the incidence of medication errors include:

a. avoiding the use of confusing terms on clinical documents.
b. advising patients to take only one medication at a time.
c. requiring that prescriptions be handwritten instead of typed.

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d. physician supervision whenever drugs are administered.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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3. Adverse drug effects are most likely when:

a. multiple medications are used.
b. generic drugs are substituted for brand-name drugs.
c. patients begin using a new medication.
d. medications are taken for just one or two days.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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4. Examples of medication-related symptoms that can significantly limit food intake include:
a. ringing in the ears.
b. persistent nausea and vomiting.
c. insomnia
d. skin rash.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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5. Medications that reduce stomach acidity can impair the absorption of:
a. fat-soluble vitamins.
b. thiamin and riboflavin.
c. sodium and potassium.
d. vitamin B12, folate, and iron.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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RATIONALIZATION ACTIVITY
The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
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2. ANSWER: ________
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3. ANSWER: ________
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4. ANSWER: ________
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5. ANSWER: ________
RATIO:________________________________________________________________________________________
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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT 3-2-1

This strategy provides a structure for you to record your own comprehension and summarize your learning. Let us see
your progress in this chapter!

Three things you learned:

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2. __________________________________________________________________________________________
3. __________________________________________________________________________________________
Two things that you’d like to learn more about:
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2. __________________________________________________________________________________________
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One question you still have:

1. __________________________________________________________________________________________
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