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Medications, Herbal Supplements,

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Title: Medications, Herbal Supplements & Diet-Drug Interactions Author: Janet Westhoff Last modified by: Alexandra Paige Kiefer Created Date: 2/10/2007 1:13:17 AM – PowerPoint PPT presentation

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Title: Medications, Herbal Supplements,


1
Medications, Herbal Supplements, Diet-Drug
Interactions
  • Chapter 15

2
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

3
Medications in Disease Treatment (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 used
    inappropriately
  • Generic drugs
  • Chemically identical act the same as original
    drug
  • Cost significantly less than brand-name
    counterparts
  • Although OTC drugs are considered safe enough for
    self-medication, they can cause adverse effects
    when used inappropriately

4
Medications in Disease Treatment (cont)
  • 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)
  • Potential Risks
  • Side effects
  • Drug-drug interactions
  • Diet-drug interactions
  • Medication errors-see Table 15-1, Inappropriate
    Abbrev., p.440

5
Medications in Disease Treatment (cont)
  • 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

6
Medications in Disease Treatment (cont)
  • 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

7
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)
  • 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

8
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, howeversome 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

9
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10
Use of Herbal Products in Illness
  • Self-medication herbal remedies may delay
    appropriate treatment allow progression of
    illness
  • Herbal products may interact with other
    medicationslack of research makes assessment of
    interactions difficult
  • Herbal products are not reliable treatment for
    medical conditions

11
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

12
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

13
Diet-Drug Interactions (cont)
  • 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 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

14
Diet-Drug Interactions (cont)
  • 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

15
Diet-Drug Interactions (cont)
  • 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)

16
Diet-Drug Interactions (cont)
  • 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

17
Nutrition in PracticeComplementary 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

18
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19
Nutrition in PracticeComplementary 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
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