HNF 471 EXAM 2 QUESTIONS & ANSWERS
food drug interaction - Answer -includes the effects of a medication on nutritional status
Drug-nutrient reaction - Answer -the specific changes to the pharmacokinetics of a drug
caused by a nutrient or nutrients or changes to the kinetics of a nutrient caused by a
drug (absorption, metabolism, distribution, excretion of drug or nutrient)
Warfarin - Answer -drug - anticoagulant, blood thinner, interacts with many nutrients
(EPA, DHA< Vitamin K, many supplements)
Side effect of long-term use of corticosteroids - Answer -Result in osteoporosis
What drugs can be affected if Vitamin K levels are variable in diet while on this
medication? - Answer -Coumadin/Warfarin
How can food intake affect absorption of drugs? - Answer -gastric emptying rate, GI
transit time, FDI can increase, delay, or decrease drug absorption
How can food affect distribution of drugs? - Answer -Have different target organs,
transported through the blood, those bound to transport proteins are able to act,
UNBOUND fraction produces the effect, albumin = major transport protein, low albumin
will increase the effect of a medication!
How does metabolism of drugs in the body work? - Answer -Heavily dependent on the
cytochrome P-450 enzyme system in the liver to convert fat-soluble compounds to
water-soluble for urinary excretion.
How does protein affect drug metabolism? - Answer -High protein diets can accelerate
metabolism of certain drugs by stimulating cytochrome P-450.
How does the microbiome fit into FDI? - Answer -Diets that change the microbiome
may change the metabolism of certain drugs.
What minerals can decrease the metabolism of drugs in the body? - Answer -Low Ca,
Mg, or Zn can decrease drug metabolism of certain drugs
How does Vitamin C intake affect drug-metabolizing enzymes? - Answer -Vit C
deficiency reduces drug-metabolizing enzymes.
How does excretion of drugs work? - Answer -Usually excreted via urine. Doses are
given for people w/ healthy liver and kidneys
,Who at highest risk for FDI? Why? - Answer -Elderly, undernourished, obese, certain
diseases (HIV, cancer, liver disease, etc), those on nutritional supplements, certain
genotypes
How are malnourished patients at higher risk of FDI? - Answer -UNDERNOURISHED:
alterations in fat/fat-free mass may be problematic for fat-soluble drugs (reduced
effectiveness)
How are the elderly more at risk of FDI? - Answer -ELDERLY: many meds, cognitive
dysfunction, can't remember if they took the meds, lower Alb, poor intake of food
How are obese patients are greater risk of FDI? - Answer -OBESE: alterations in fat/fat-
free mass may be problematicc for fat-soluble drugs (increased effectiveness/toxicity!)
What diseases put you at greater risk for FDI? - Answer -CERTAIN DISEASES: HIV
and cancer meds have well-known FDIs. Vomiting and diarrhea alter transit.
Liver/kidney disease - reduced clearance/risk of toxicity
How can nutritional supplements lead to FDI? - Answer -More of a drug-"drug"
interaction
Ex: St. Johns wort or grafruit juice/methotrexate)
How can genotypes affect FDI? - Answer -Certain genotypes may result in slower or
faster than normal metabolism of certain meds
What effect does food have on medication? - Answer -Bioavailability can be increased
or decreased when taken with food
How can foods increase/decrease bioavailability of a drug? - Answer -Food can slow
gastric emptying/GI transit time. Nutrients may bind with the medication and prevent
absorption. Gastric pH is important for some medications, and eating raises pH
How should you take iron supplements? - Answer -On empty stomach, with water
Propofol/diprivan - Answer -Commonly used sedative in ICU for ventilated patients,
1.1kcal/mL of fat, can be 792 kcal/day from fat. If using >72 hours, low fat feedings are
advised. Increases TG and cool.
Phenytonin (Dilantin) - Answer -Antiepileptic. Do not eat or provide tube feeding for 2
hours before or after administration of suspension (ok w/ chew tab or capsule). Pt
benefits from folate supplement, as Rx depletes folate. Also increases Vitamins D, K
metabolism, may increase BG but decrease CA, P.
Megestrol/Megace - Answer -appetite stimulant used for cancer patients,
NOT FOR: diabetics (can raise BG up to 10x),
Side effects: Elevated BG in non-diabetics, increase liver enzymes
, Methotrexate (MTX) - Answer -anti-cancer, anti arthritic. Decreases folate absorption,
supplement necessary.
What nutrient does alcohol inhibit? - Answer -Alcohol inhibits thiamin utilization.
Monoamine Oxidase Inhibitors (MAOI) - Answer -anti-depressants, speeds the rate at
which serotonin and dopamine are removed from the brain
ex: Isocarboxazid, Phenelzine, Selegiline, Tranycypromine
What foods react with MAOIs? Why? - Answer -High tyramine foods interact with
MAOIs, resulting in hypertensive crisis. Tyramine is an AA that helps control blood
pressure.
AVOID: aged cheese, sauerkraut, cured meats, draft beer, fermented soy products.
Seretonin syndrome - Answer -Can occur when taken with other antidepressants but
also with St. Johns wort.
Symptoms: anxiety, agitation, sweating, confusion, tremors, tachycardia.
Side effect = weight gain.
What are statins? How do they interact with foods? - Answer -Cholesterol lowering
medications.
They can interact with grapefruit and other citrus fruits, St. Johns wort, fiber, pectin, and
oat bran -- high fiber diet can reduce effect.
Thiazide diurectics (Hydrochlorothiazide (HCTZ), etc) -- side effects on nutrients -
Answer -Deplete potassium. Can raise BG, BUN, Creatinine
What drugs does grapefruit juice interact with?
How? - Answer -Some cholesterol lowering medications (Zocor, lipitor, statins in
general), Coumadin and other blood thinners, various ABX, some anti-diabetic agents,
phenytoin/Dilantin
Mechanism: inhibits metabolism via CYP-450 in the liver leading to toxicity
Warfarin and green leafy vegetables interaction - Answer -Vitamin K rich foods can
mess with the meds
Opiates side effects relevant to nutrition - Answer -side effect: constipation
Corticosteroids side effects relevant to nutrition - Answer -Increase BG levels
ABX side effects relevant to nutrition - Answer -Diarrhea
Metoclopramide/reglan side effects relevant to nutrition - Answer -speeds GI transit
time
food drug interaction - Answer -includes the effects of a medication on nutritional status
Drug-nutrient reaction - Answer -the specific changes to the pharmacokinetics of a drug
caused by a nutrient or nutrients or changes to the kinetics of a nutrient caused by a
drug (absorption, metabolism, distribution, excretion of drug or nutrient)
Warfarin - Answer -drug - anticoagulant, blood thinner, interacts with many nutrients
(EPA, DHA< Vitamin K, many supplements)
Side effect of long-term use of corticosteroids - Answer -Result in osteoporosis
What drugs can be affected if Vitamin K levels are variable in diet while on this
medication? - Answer -Coumadin/Warfarin
How can food intake affect absorption of drugs? - Answer -gastric emptying rate, GI
transit time, FDI can increase, delay, or decrease drug absorption
How can food affect distribution of drugs? - Answer -Have different target organs,
transported through the blood, those bound to transport proteins are able to act,
UNBOUND fraction produces the effect, albumin = major transport protein, low albumin
will increase the effect of a medication!
How does metabolism of drugs in the body work? - Answer -Heavily dependent on the
cytochrome P-450 enzyme system in the liver to convert fat-soluble compounds to
water-soluble for urinary excretion.
How does protein affect drug metabolism? - Answer -High protein diets can accelerate
metabolism of certain drugs by stimulating cytochrome P-450.
How does the microbiome fit into FDI? - Answer -Diets that change the microbiome
may change the metabolism of certain drugs.
What minerals can decrease the metabolism of drugs in the body? - Answer -Low Ca,
Mg, or Zn can decrease drug metabolism of certain drugs
How does Vitamin C intake affect drug-metabolizing enzymes? - Answer -Vit C
deficiency reduces drug-metabolizing enzymes.
How does excretion of drugs work? - Answer -Usually excreted via urine. Doses are
given for people w/ healthy liver and kidneys
,Who at highest risk for FDI? Why? - Answer -Elderly, undernourished, obese, certain
diseases (HIV, cancer, liver disease, etc), those on nutritional supplements, certain
genotypes
How are malnourished patients at higher risk of FDI? - Answer -UNDERNOURISHED:
alterations in fat/fat-free mass may be problematic for fat-soluble drugs (reduced
effectiveness)
How are the elderly more at risk of FDI? - Answer -ELDERLY: many meds, cognitive
dysfunction, can't remember if they took the meds, lower Alb, poor intake of food
How are obese patients are greater risk of FDI? - Answer -OBESE: alterations in fat/fat-
free mass may be problematicc for fat-soluble drugs (increased effectiveness/toxicity!)
What diseases put you at greater risk for FDI? - Answer -CERTAIN DISEASES: HIV
and cancer meds have well-known FDIs. Vomiting and diarrhea alter transit.
Liver/kidney disease - reduced clearance/risk of toxicity
How can nutritional supplements lead to FDI? - Answer -More of a drug-"drug"
interaction
Ex: St. Johns wort or grafruit juice/methotrexate)
How can genotypes affect FDI? - Answer -Certain genotypes may result in slower or
faster than normal metabolism of certain meds
What effect does food have on medication? - Answer -Bioavailability can be increased
or decreased when taken with food
How can foods increase/decrease bioavailability of a drug? - Answer -Food can slow
gastric emptying/GI transit time. Nutrients may bind with the medication and prevent
absorption. Gastric pH is important for some medications, and eating raises pH
How should you take iron supplements? - Answer -On empty stomach, with water
Propofol/diprivan - Answer -Commonly used sedative in ICU for ventilated patients,
1.1kcal/mL of fat, can be 792 kcal/day from fat. If using >72 hours, low fat feedings are
advised. Increases TG and cool.
Phenytonin (Dilantin) - Answer -Antiepileptic. Do not eat or provide tube feeding for 2
hours before or after administration of suspension (ok w/ chew tab or capsule). Pt
benefits from folate supplement, as Rx depletes folate. Also increases Vitamins D, K
metabolism, may increase BG but decrease CA, P.
Megestrol/Megace - Answer -appetite stimulant used for cancer patients,
NOT FOR: diabetics (can raise BG up to 10x),
Side effects: Elevated BG in non-diabetics, increase liver enzymes
, Methotrexate (MTX) - Answer -anti-cancer, anti arthritic. Decreases folate absorption,
supplement necessary.
What nutrient does alcohol inhibit? - Answer -Alcohol inhibits thiamin utilization.
Monoamine Oxidase Inhibitors (MAOI) - Answer -anti-depressants, speeds the rate at
which serotonin and dopamine are removed from the brain
ex: Isocarboxazid, Phenelzine, Selegiline, Tranycypromine
What foods react with MAOIs? Why? - Answer -High tyramine foods interact with
MAOIs, resulting in hypertensive crisis. Tyramine is an AA that helps control blood
pressure.
AVOID: aged cheese, sauerkraut, cured meats, draft beer, fermented soy products.
Seretonin syndrome - Answer -Can occur when taken with other antidepressants but
also with St. Johns wort.
Symptoms: anxiety, agitation, sweating, confusion, tremors, tachycardia.
Side effect = weight gain.
What are statins? How do they interact with foods? - Answer -Cholesterol lowering
medications.
They can interact with grapefruit and other citrus fruits, St. Johns wort, fiber, pectin, and
oat bran -- high fiber diet can reduce effect.
Thiazide diurectics (Hydrochlorothiazide (HCTZ), etc) -- side effects on nutrients -
Answer -Deplete potassium. Can raise BG, BUN, Creatinine
What drugs does grapefruit juice interact with?
How? - Answer -Some cholesterol lowering medications (Zocor, lipitor, statins in
general), Coumadin and other blood thinners, various ABX, some anti-diabetic agents,
phenytoin/Dilantin
Mechanism: inhibits metabolism via CYP-450 in the liver leading to toxicity
Warfarin and green leafy vegetables interaction - Answer -Vitamin K rich foods can
mess with the meds
Opiates side effects relevant to nutrition - Answer -side effect: constipation
Corticosteroids side effects relevant to nutrition - Answer -Increase BG levels
ABX side effects relevant to nutrition - Answer -Diarrhea
Metoclopramide/reglan side effects relevant to nutrition - Answer -speeds GI transit
time
