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What are the three main things that food can affect in the body in relation to drugs?
What are the three main things that food can affect in the body in relation to drugs?
Drug absorption, metabolism, distribution, and excretion.
Which of these options are correct? (Select all that apply)
Food-drugs interactions can:
Which of these options are correct? (Select all that apply)
Food-drugs interactions can:
Food affects drug absorption, metabolism, distribution, and excretion.
Food affects drug absorption, metabolism, distribution, and excretion.
True
Drugs can affect food absorption, metabolism, distribution, and excretion.
Drugs can affect food absorption, metabolism, distribution, and excretion.
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Drug's side effects can impact food intake and nutrient absorption.
Drug's side effects can impact food intake and nutrient absorption.
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What can occur when drugs are combined with certain types of food?
What can occur when drugs are combined with certain types of food?
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Do food-drug interactions mainly occur with pharmacokinetics or pharmacodynamics?
Do food-drug interactions mainly occur with pharmacokinetics or pharmacodynamics?
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Most food-drug interactions occur at the stage of absorption and then metabolism.
Most food-drug interactions occur at the stage of absorption and then metabolism.
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There are very few food-drug interactions with pharmacodynamics.
There are very few food-drug interactions with pharmacodynamics.
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Where do most food-drug interactions with pharmacodynamics occur?
Where do most food-drug interactions with pharmacodynamics occur?
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What can happen when someone consumes excessive potassium while taking ACE inhibitors?
What can happen when someone consumes excessive potassium while taking ACE inhibitors?
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A fatty meal can increase the absorption of Acitretin.
A fatty meal can increase the absorption of Acitretin.
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Alendronic acid is best absorbed with food or milk.
Alendronic acid is best absorbed with food or milk.
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A fatty meal increases the solubility of Albendazole.
A fatty meal increases the solubility of Albendazole.
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Ampicillin is best absorbed without food.
Ampicillin is best absorbed without food.
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Atovaquone is best absorbed with a fatty meal.
Atovaquone is best absorbed with a fatty meal.
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Azithromycin capsules should be taken with food.
Azithromycin capsules should be taken with food.
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Captopril has no dietary restrictions.
Captopril has no dietary restrictions.
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A consistent meal routine helps maintain a steady level of Carbamazepine in the body.
A consistent meal routine helps maintain a steady level of Carbamazepine in the body.
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Food can affect both the rate and extent of drug absorption.
Food can affect both the rate and extent of drug absorption.
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What are the five categories of drug-food interactions that are related to absorption?
What are the five categories of drug-food interactions that are related to absorption?
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Delayed absorption of a drug is usually due to a slower gastric emptying rate and/or increased gastric pH.
Delayed absorption of a drug is usually due to a slower gastric emptying rate and/or increased gastric pH.
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Delayed absorption usually results in a decreased Cmax and a shorter Tmax.
Delayed absorption usually results in a decreased Cmax and a shorter Tmax.
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Delayed absorption will always affect overall all extent of absorption (AUC).
Delayed absorption will always affect overall all extent of absorption (AUC).
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Decreased absorption refers to an increase in the extent of gastrointestinal medicine absorption.
Decreased absorption refers to an increase in the extent of gastrointestinal medicine absorption.
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Diabetes mellitus and inflammatory bowel diseases can affect drug bioavailability.
Diabetes mellitus and inflammatory bowel diseases can affect drug bioavailability.
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In certain cases, patients with diabetes mellitus may experience delayed gastric emptying due to autonomic neuropathy.
In certain cases, patients with diabetes mellitus may experience delayed gastric emptying due to autonomic neuropathy.
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Aspirin is best taken 2 hours after meals with a full glass of water.
Aspirin is best taken 2 hours after meals with a full glass of water.
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Food slows down the absorption of Isoniazid.
Food slows down the absorption of Isoniazid.
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Isoniazid should be taken 1 hour before or 2 hours after meals.
Isoniazid should be taken 1 hour before or 2 hours after meals.
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Increased intestinal drug uptake results from delayed gastric emptying and increased secretion of bile salts.
Increased intestinal drug uptake results from delayed gastric emptying and increased secretion of bile salts.
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Accelerated drug uptake is caused by the up-regulation of carrier-mediated transport systems in response to high-protein meals.
Accelerated drug uptake is caused by the up-regulation of carrier-mediated transport systems in response to high-protein meals.
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Fatty foods and low-fiber foods speed up stomach emptying.
Fatty foods and low-fiber foods speed up stomach emptying.
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Griseofulvin and oltipraz show increased absorption and bioavailability after a high-fat meal.
Griseofulvin and oltipraz show increased absorption and bioavailability after a high-fat meal.
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Ascorbic acid inhibits iron absorption.
Ascorbic acid inhibits iron absorption.
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Carbonated drinks and acid juices slow down drug dissolution in the stomach.
Carbonated drinks and acid juices slow down drug dissolution in the stomach.
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Tetracyclines are best absorbed with food containing calcium, magnesium, or aluminium.
Tetracyclines are best absorbed with food containing calcium, magnesium, or aluminium.
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The physical and chemical characteristics of a drug can influence its absorption.
The physical and chemical characteristics of a drug can influence its absorption.
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Fluconazole and itraconazole belong to different chemical classes.
Fluconazole and itraconazole belong to different chemical classes.
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Itraconazole displays increased absorption in the presence of food.
Itraconazole displays increased absorption in the presence of food.
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Meals can influence the chiral inversion of ibuprofen.
Meals can influence the chiral inversion of ibuprofen.
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The size of the meal does not affect drug absorption.
The size of the meal does not affect drug absorption.
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High-fat content in meals can increase bioavailability of lipophilic drugs.
High-fat content in meals can increase bioavailability of lipophilic drugs.
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A high fiber content enhances the bioavailability of certain medications.
A high fiber content enhances the bioavailability of certain medications.
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Grapefruit juice can increase the Cmax of felodipine.
Grapefruit juice can increase the Cmax of felodipine.
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Calcium in milk and milk products increase absorption of certain antibiotics.
Calcium in milk and milk products increase absorption of certain antibiotics.
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Orange juice can enhance iron absorption.
Orange juice can enhance iron absorption.
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Taking medications with soda or high acid fruit juice can potentially cause excess stomach acidity.
Taking medications with soda or high acid fruit juice can potentially cause excess stomach acidity.
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Fatty foods can decrease the absorption of griseofulvin.
Fatty foods can decrease the absorption of griseofulvin.
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Dietary components significantly influence certain medications' metabolism.
Dietary components significantly influence certain medications' metabolism.
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Malnutrition contributes to altered hepatic metabolism.
Malnutrition contributes to altered hepatic metabolism.
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Grapefruit juice inhibits the activity of CYP3A4 enzymes, affecting the metabolism of many medications.
Grapefruit juice inhibits the activity of CYP3A4 enzymes, affecting the metabolism of many medications.
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Garlic inhibits the activity of CYP2C19 enzymes.
Garlic inhibits the activity of CYP2C19 enzymes.
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Broccoli induces the activity of CYP2C9 enzymes.
Broccoli induces the activity of CYP2C9 enzymes.
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Piperine present in black pepper enhances the bioavailability of certain drugs.
Piperine present in black pepper enhances the bioavailability of certain drugs.
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Piperine inhibits the activity of hepatic and intestinal aryl hydrocarbon hydroxylase and UDP-glucuronyl transferase.
Piperine inhibits the activity of hepatic and intestinal aryl hydrocarbon hydroxylase and UDP-glucuronyl transferase.
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Piperine's effect on the ultrastructure of intestinal brush border decreases drug absorption.
Piperine's effect on the ultrastructure of intestinal brush border decreases drug absorption.
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Piperine has been shown to decrease the oral bioavailability of phenytoin in normal and epileptic patients.
Piperine has been shown to decrease the oral bioavailability of phenytoin in normal and epileptic patients.
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Dietary changes can significantly alter drug excretion.
Dietary changes can significantly alter drug excretion.
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Changes in urine pH caused by food can significantly affect drug excretion rates.
Changes in urine pH caused by food can significantly affect drug excretion rates.
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A drug in unionized state can diffuse more easily out of the urine back into the blood.
A drug in unionized state can diffuse more easily out of the urine back into the blood.
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Antacids can increase the excretion rate of acidic drugs.
Antacids can increase the excretion rate of acidic drugs.
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Warfarin's effect can be directly antagonized by ingesting foods rich in vitamin K.
Warfarin's effect can be directly antagonized by ingesting foods rich in vitamin K.
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Avocado intake has been reported to cause warfarin antagonism.
Avocado intake has been reported to cause warfarin antagonism.
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Potassium-rich foods like bananas and spinach can potentially lead to hyperkalaemia when taken with diuretic drugs.
Potassium-rich foods like bananas and spinach can potentially lead to hyperkalaemia when taken with diuretic drugs.
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Certain food components compete with levodopa for transporters.
Certain food components compete with levodopa for transporters.
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Corticosteroids can increase appetite.
Corticosteroids can increase appetite.
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Antidepressants often increase appetite.
Antidepressants often increase appetite.
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Laxatives can cause nutrient loss.
Laxatives can cause nutrient loss.
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Antacids are known to increase nutrient absorption.
Antacids are known to increase nutrient absorption.
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Cancer drugs often cause nausea and vomiting.
Cancer drugs often cause nausea and vomiting.
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Amoxicillin is a common antibiotic that can cause diarrhoea.
Amoxicillin is a common antibiotic that can cause diarrhoea.
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Reduced gastric emptying often leads to a decreased Tmax.
Reduced gastric emptying often leads to a decreased Tmax.
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Increased blood flow to the GI tract can lead to increased AUC and Cmax for some drugs.
Increased blood flow to the GI tract can lead to increased AUC and Cmax for some drugs.
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Increased gastric pH can create an environment that favors the absorption of acidic drugs.
Increased gastric pH can create an environment that favors the absorption of acidic drugs.
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Food ingredients can alter solubility of drugs, particularly lipophilic drugs.
Food ingredients can alter solubility of drugs, particularly lipophilic drugs.
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Inhibition of GI enzymes or transporter activity can lead to decreased drug metabolism and uptake.
Inhibition of GI enzymes or transporter activity can lead to decreased drug metabolism and uptake.
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Inhibition of GI enzymes or transporter activity can result in lower AUC and Cmax for some drugs.
Inhibition of GI enzymes or transporter activity can result in lower AUC and Cmax for some drugs.
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Study Notes
Food and Drug Disposition
- This lecture covers the effects of nutrition on drug pharmacokinetics and pharmacodynamics, as well as the effect of drugs on food.
- Food-drug interactions can reduce or increase the effect of a drug, leading to therapeutic failure, increased toxicity, and adverse effects on patient care.
- These interactions can also prolong treatment time or hospitalisation.
- Food impacts drug absorption, metabolism, distribution, and excretion.
- Drugs can also impact food absorption, metabolism, distribution, and excretion, as well as affect food intake and nutrient absorption.
- Food-drug interactions can occur at the level of pharmacokinetics (majority of interactions) and pharmacodynamics (few interactions).
- Pharmacokinetic interactions often occur during absorption or metabolism.
- Pharmacodynamic interactions mostly occur at competing sites.
- Several specific examples of drugs and how they interact with food are provided. Relevant dietary recommendations are included in the summary tables for different drug classes
Objectives
- Students will be able to describe the impact of nutrition on drug pharmacokinetics.
- Students will be able to describe the impact of nutrition on drug pharmacodynamics.
- Students will be able to describe the effect of drugs on food pharmacokinetics.
Food-drug Interactions
- Food can affect absorption (rate and extent) of drugs.
- Absorption interactions are classified as: reduced extent, delayed rate, increased extent, accelerated rate, and no effect.
- Delayed absorption typically results from slower gastric emptying or increased gastric pH from food ingestion, leading to reduced Cmax and prolonged tmax, but not impacting overall AUC.
- Decreased absorption can be due to disease states (e.g. diabetes, inflammatory bowel disease) affecting drug bioavailability.
- Increased/accelerated absorption, associated with delayed gastric emptying, increased secretion of bile salts, or upregulation of carrier systems (particularly with high-protein meals), leads to increased drug dissolution rates.
- Certain foods reduce drug absorption rates and increase others.
Effects of Food on Drug Absorption
- Food can influence the rate and extent of drug absorption from the gastrointestinal tract.
- Examples of foods that reduce drug absorption include food with aspirin (take 2 hours after meals with a full glass of water) and isoniazid (consume 1 hour before or 2 hours after a meal.)
- Certain foods increase drug absorption, e.g., fatty foods increasing absorption of griseofulvin.
Factors Affecting Drug Absorption
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Drug characteristics (e.g., pKa, solubility, and formulation).
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Meal characteristics (size and composition, high-fat content, fiber content).
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Timing of drug and meal intake.
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Grapefruit juice can increase the drug concentration (Cmax) of certain drugs by up to 99%.
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Calcium found in dairy products reduces the absorption of certain antibiotics such as Tetracycline.
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Ascorbic acid (e.g., found in orange juice) enhances iron absorption.
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Drugs should not be taken with sodas or high-acid fruits due to potential disruption of drug absorption (stomach acidity dissolving drugs).
Effects of Food on Drug Metabolism
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Various dietary compounds affect drug metabolism.
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Cruciferous vegetables, charcoal-broiled beef, and certain proteins are examples of substances impacting metabolism.
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Malnutrition can alter hepatic metabolism and reduce elimination of conjugates.
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Cytochrome P450 enzymes play a central role in drug metabolism.
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Garlic can inhibit CYP2C19, leading to potentially increased levels of omeprazole and diazepam.
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Broccoli can induce CYP2C9, affecting drugs like warfarin and tolbutamide.
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Black pepper (piperine) can enhance the bioavailability of several drugs by inhibiting hepatic and intestinal enzymes.
Food Effects on Drug Excretion
- Urine pH changes due to food can influence excretion of acid and bases.
- Unionised drugs are more readily reabsorbed from urine into the blood, prolonging drug action.
- Acidic urine enhances the effect of acidic drugs.
- Antacids alter urine pH, affecting drug excretion.
Pharmacodynamic Interactions
- Food can directly antagonise (for example, vitamin K-rich food can counteract warfarin).
- Potassium-rich foods can increase potassium in blood when taken with diuretics (e.g. hyperkalemia).
- Some food components compete with drugs (e.g., levodopa) for specific transporters.
Effects of Drugs on Food
- Drugs can impact appetite (corticosteroids or antidepressants).
- Drugs can change nutrient absorption, metabolism or excretion (laxatives, antacids).
- Drugs can cause side effects like nausea/vomiting or diarrhea.
Summary Examples
- Several examples summarized how food can alter drug PK and PD effects, with emphasis on absorption, metabolism, and excretion.
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Description
Explore the intricate interactions between food and drugs in this quiz covering pharmacokinetics and pharmacodynamics. Understand how nutrition affects drug efficacy and safety, and learn the consequences of food-drug interactions on patient care. Dive into specific examples and dietary recommendations for optimal treatment outcomes.
