1. Pharmacology
KNH 413
Most Americans are not meeting RDA. Nutrient deficiencies worsen when medication is taken.

2. Pharmacology Pharmacotherapy Medicine
Prescription and over the counter
Pharmacotherapy- use of drugs for treatment of disease and health maintenance. This is an area where nutrition experts can work to prevent drug/nutrient interaction.
Medicine- chemical used for diagnosis, prevention, treatment of symptoms or cure
Prescription OTC- prescription used to treat the symptoms can also have an adverse effect on individuals nutrition status

3. Pharmacology Pharmacology Pharmacokinetics
Pharmacology-study of drugs, properties and their effects
Pharmacokinetics- study of drug absorption, distribution, metabolism and excretion
Medication induced nutrient depletion can occur through any of these mechanisms- absorption, distribution, metabolism, excretion

4. Pharmacotherapy Nutrition affects drug action
“Drug-nutrient” interactions
Preventing interactions is one part of nutrition assessment/ pharmacotherapy
Drug action affects nutrition
And position statement—look at what the national organization has done to help practitioners –give information that can be used in practice

5. Pharmacokinetics Metabolism
Biotransformation rendering inactive for excretion via urine or bile
Liver major site
Through catalyst of enzyme systems
Inhibitor – competition for receptor site; increased drug effect
Inducer - stimulates synthesis of enzyme; decreased drug effect

6. Pharmacokinetics Alterations Altered GI Altered distribution
Altered metabolism
Altered urinary excretion

7. Pharmacokinetics Altered GI Simultaneous consumption with food
Vomiting & diarrhea
Interruptions in transit time or surface area
Circulation deficits
Competition for carriers
Simultaneous consumption with food—an example of this would be food and iron supplements
Interruption in transit time and surface area- disease state examples- Crohn’s Disease – malabsorpative condition

8. Pharmacokinetics Altered Distribution Circulation
Body size & composition
Any situation altering albumin
Circulation= examples of factors influencing this would be age and disease
Body size and composition - example of how body can alter distribution- body fat may slow distribution
Situation altering albumin- liver or kidney disease, malnutriton

9. Pharmacokinetics Altered Metabolism Age
May appear as decreased effectiveness or toxicity
Adequate function of organs
Genetic factors
Gender
Concurrent use of other medications
Altered metabolism- factor that strongly effects this is age
Pharmacokinetics can be seriously altered by function or lack there of- kidneys and liver
Gender- female vs. male fluid/muscle mass
Polypharmacy- many drugs interacting with nutrients and each other

10. Pharmacokinetics Altered Urinary Excretion pH of urine
Presence of competitor for active transport
Urinary flow rates & kidney function
Creatinine clearance
Urinary excretion creatinine clearance is the volume of blood plasma that is cleared of creatinine per unit of time—useful measure of glomerular filtration rate-GFR

11. Nutrition on Drug Action
Nutrition on drug dissolution
pH of stomach
Achlorhydria
HIV/AIDS
Meds
Gastric emptying rate
Prokinetics
Food in stomach
Vomiting, diarrhea
pH of stomach is altered by Meds such as H2 blockers, proton pump inhibitors, and antacids
Gastric emptying rate altered by fat in diet, gastric surgical resection

12. Nutrition on Drug Action
Nutrition on drug absorption
Food may affect availability of drug
Chelation
Compete for carrier systems
Inducers or inhibitors of enzyme activity
Food may affect availability of drugs- Fosomax and Saquinavir (food reduces absorption)
Erythromycin- food increase absorption
Chelation-binding – example would be calcium and the antibiotic tetracycline

13. Stomach acid meds- alter Ca, Mg, Zn, Fe, B12, C
NSAID- decrease folic acid, Fe
Heart medication- alters electrolytes
Diuretics- alter folate, Mg, B6, C, calcium

14. Complications On Nutrient Absorption
Meds that speed transit time or gastric emptying
Side effects such as nausea, vomiting, diarrhea, constipation
Control urine pH
Complications with nutrient absorption can occur –an example would be corticosteriods decrease absorption of calcium

15. Complications On Nutrient Metabolism
Interfere with macronutrient, vitamin and mineral metabolism
Increase Urinary output
Those effect renal output affect reabsorption
Complication with nutrient metabolism may occur with drugs such as-
Dilantin which inhibits folate and vitamin D metabolismleadig to megaloblastic anemia

17. © 2007 Thomson - Wadsworth

18. At-Risk Populations Elderly Multiple meds – polypharmacy
Both OTC and prescribed
Physiological changes
Compliance
Inappropriate dosing
Beer’s criteria
Beer’s Criteria is inappropriate medicine use in elderly—may need to skip a dose or use smaller doses in elderly due to decrease renal function, obesity, decreased metabolism
Consider these measures at age 65 and beyond

19. At-Risk Populations HIV/AIDS Multiple medications Specific guidelines
Significant nutritional side effects
At risk population include AIDS patients with AIDS related wasting syndrome—concerns- GI upset with mediation or n/v/d or malabsorption
Other concerns- anorexia, depression, apathy, fatigue, financial concerns, metabolic abnormalities, altered fat distribution

20. At-Risk Populations Nutrition support
Tube feedings decrease absorption of some meds
Macronutrients may cause chelation of meds
Guidelines – ASPEN
American Society for Parenteral and Enteral Nutrition (ASPEN) has guidelines (see Niihka under pharmacology) for medication use and nutrition related concerns

21. Nutrition Therapy Evaluate past and current medical hx
Baseline lab measures
Treatment regimens
OTC, drugs, supplements, and CAM
Look at nutrition history for natural origins-dietary supplements
OTC medication- over the counter
CAM- complimentary and alternative medicine

22. Nutrition Therapy Potential barriers to compliance
Drug-drug interactions among meds
Drug-nutrient interactions
Overall concerns with nutrition status and medication –
Compliance, interactions, between drugs and with nutrients

23. Clinical Application

24. Clinical Application
Look at need to instruct client on specific nutrient or instruct on taking medication with or without food and timing of certain foods based on medication patient is taking