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7 Factors that may predispose patients to drug and nutrient interactions.
- 1. Polypharmacy
- 2. Chronic drug therapy
- 3. Pre-existing disease, other medical conditions
- 4. Poor nutritional status
- 5. Extremes of age - peds and elderly
- 6. Increased nutritional needs
- 7. Herbal products?
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Describe 3 mechanisms by which food may adversely affect drug therapy.
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Identify 2 major drug-nutrient interactions and outline strategies for prevention/management.
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Outline the "Dilantin" - food/enteral issue.
- Risk of SUB-therapeutic levels and loss of seizure control
- May need to hold gastric tube feeding 1-2 hours before and after dose
- may need to change to other dosage form, higher dose? Be careful!
- Switch to different drug?
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Describe 3 common drug-enteral problems...
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"Take on an empty stomach" for better absorption
- Tetracycline (avoid dairy), Penicillin, Levothyroxine
- Azithromycin suspension, tabs +/-
- Cipro > Levo.. chelation by cations
- ECN: film and enteric coated, PCE dispertabs
- Captopril: same time each day
- INH (isoniazid)
- Zidovudine (Retrovir), indinavir (crixivan), didanosine
- Sucralfate (carafate): needs empty stomach for therapeutic effect.
- Alendronate (fosamax): w/ H20 30 minutes before anything else
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"Take with food"
- To lessen GI irritation: ex. KCL, NSAIDs, nitrofurantoin, estrogens
- To decrease side effects: ex. misoprostol, quinidine
- Enhanced absorption: EES, lovastatin, propranolol, metoprolol, nitrofurantoin, CSA (better with milk)
- Best if taken with a high fat meal: griseofulvin, atovaquone, sironolactone, saquinavir
- Maximum effect: glipizide, 30 min. ac, glyburide with first main meal of the day
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A patient calls in after a wine and cheese party...Splitting headache, racing pulse...
Which of the following meds is most likely to be involved?
B. phenelzine
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What drug(s) does the following nutrient interact with...
Calcium
Tetracycline
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What drug(s) does the following nutrient interact with...
Potassium
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What drug(s) does the following nutrient interact with...
Vitamin K
Warfarin
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What drug(s) does the following nutrient interact with...
Vitamins A, D, E, K
These are the fat soluble vitamins...
Mineral oil
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What drug(s) does the following nutrient interact with...
Phosphorus
Aluminum-base antacids
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Regarding Grapefruit Juice...
Intake can cause toxicity of certain medications by increasing their absorption.
True
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Enteral feedings administered with _____ can result in _____ levels which may cause _____.
Ways to resolve this interaction may include:
1. _______
2. _______
3. _______
Enteral feedings administered with PHENYTOIN can result in SUB-THERAPEUTIC levels which may cause LOSS OF SEIZURE CONTROL.
- Ways to resolve this interaction may include:
- 1. HOLD THE FEEDING 1-2 HOURS BEFORE AND AFTER THE DOSE.
- 2. ALTERNATE CHOICE - CHANGE TO A DIFFERENT DRUG
- 3. INCREASE THE DOSE- BUT WATCH OUT FOR TOXICITY IF CHANGE IN TF.
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General protein requirement in inflammatory bowel disease.
1 -2 g/kg
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General Kcal requirement in inflammatory bowel disease.
25 - 30 kcal/kg
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How much protein necessary for fistula patient.
1.5 - 2.5 g/kg
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Important nutrient to replace in fistula patient.
Zinc
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Fluid requirement in small bowel syndrome.
? > 4L/day
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Protein req in SBS
1-1.5 g/kg
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Calorie req in SBS
35 kcal/kg
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Vitamins to watch out for in SBS
B12, Calcium, Magnesium
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Complications of nutritional support in SBS
- Nephrolithiasis ( high oxalate)
- Gastric hypersecretion
- bacterial overgrowth
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When is hypocaloric feeding indicated?
Very obese patient (>150% IBW)
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calories in obese
20-25 kcal/kg IBW?
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Fat requirements in obese
just enough to provide essential fatty acids
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protein in obese
- 1.5 -2.5 g/kg based on LBW
- check N balance
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When do you give 1.5-2.5 g/kg pro?
- CRT therapy
- Fistula
- Very obese
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How do you calculate BMI
body wt (kg)/Ht (m2)
- obesity > 30
- normal = 18.5-25
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Indications for bariatric surgery
- BMI > 40kg/m2 = 200% IBW
- or35 kg/m2 and co-morbidities such as
- DM
- HTN
- Sleep apnea
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Stomach capacity after bariatric surgery
about 30ml
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Bariatric Surgery Post op calorie/protein reg.
- < 900 kcal/day
- 60-120 g pro
seperate solids and liquids
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Vomiting after bariatric surgery. What nutrient def could be responsible?
Thiamine.
Give 100 mg IM/IV x 7-14 days then 10 mg PO until Sx resolve.
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