4: Food and Drug Interactions and Healthcare Systems

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Questions and Answers

What is a common effect of ACE inhibitors on potassium levels?

Causes potassium retention

No effect on potassium levels

Decreases potassium excretion (correct)

Increases potassium excretion

How do corticosteroids affect sodium and potassium excretion?

Increase sodium excretion and decrease potassium excretion

Decrease sodium retention and increase potassium excretion (correct)

Increase sodium and potassium retention

Decrease both sodium and potassium excretion

Which condition is associated with prolonged use of proton pump inhibitors?

No impact on nutrient absorption

Increased absorption of calcium

Decreased absorption of calcium (correct)

Increased absorption of vitamin B12

What should be done regarding mineral supplements when taking tetracycline?

Take them at least 2-6 hours apart from the drug Signup and view all the answers

Which medication can lead to macrocytic anemia due to increased metabolism of folic acid?

Phenytoin Signup and view all the answers

What is the result of medications damaging the gut mucosa?

Decreased nutrient absorption Signup and view all the answers

What effect does isoniazid have on vitamin metabolism?

Blocks the conversion of vitamin to its active form Signup and view all the answers

Which vitamin is primarily affected by the use of H2-receptor antagonists?

Vitamin B12 Signup and view all the answers

What effect can medications with CNS side effects have on appetite?

They suppress appetite, affecting the desire to eat. Signup and view all the answers

Which of the following conditions can result from medication-induced damage to rapidly turnover cells in the oral cavity?

Stomatitis Signup and view all the answers

What gastrointestinal effect can medications like Aspirin or Advil induce?

Nausea and vomiting. Signup and view all the answers

Which type of medications is commonly associated with increased appetite and potential weight gain?

Antidepressants. Signup and view all the answers

What is a common side effect of medications that suppress appetite?

Nutritional deficiencies. Signup and view all the answers

Which of the following conditions is associated with the destruction of intestinal bacteria due to medications?

Colitis. Signup and view all the answers

Which medication is known to stimulate appetite and is derived from marijuana?

Marinol. Signup and view all the answers

What is an effect of medications causing dysgeusia?

Bitter taste lasting as long as the drug remains in the body. Signup and view all the answers

What is one potential effect of high-fat or high-fiber meals on medication absorption?

They can delay gastric emptying. Signup and view all the answers

Which medications are mentioned to form insoluble complexes with calcium in dairy products?

Fluoroquinolone antibiotics and tetracycline Signup and view all the answers

What effect does grapefruit have on certain medications?

It inhibits the cytochrome P-450 3A4 enzyme system. Signup and view all the answers

How should medications that enhance absorption with food be taken?

After meals to reduce required dose. Signup and view all the answers

Medications in the same pharmaceutical class generally:

Exhibit similar effects. Signup and view all the answers

What effect does excess sodium intake have on lithium levels?

Lower lithium levels due to increased sodium excretion. Signup and view all the answers

What type of chemical reactions can occur between medications and minerals like Fe, Ca, and Mg?

Chelation reactions. Signup and view all the answers

Which statement about reviewing medications for potential food-drug interactions is true?

All medications must be reviewed for potential interactions. Signup and view all the answers

Which medication is commonly prescribed with loop diuretics to prevent electrolyte imbalances?

Potassium supplements. Signup and view all the answers

How does grapefruit juice interact with medication metabolism?

It inhibits certain metabolizing enzymes, increasing drug effect. Signup and view all the answers

What is a common consequence of delayed gastric emptying on drug absorption with certain medications?

Reduced extent of absorption. Signup and view all the answers

What is the primary action of thiazide diuretics on calcium levels?

Increase calcium reabsorption. Signup and view all the answers

If a patient is hyponatremic while taking lithium, what is the possible outcome?

Increased lithium reabsorption leading to toxicity risk. Signup and view all the answers

What is the effect of loop diuretics on electrolytes?

Increased excretion of Na, K, Cl, Mg, and Ca. Signup and view all the answers

How do potassium-sparing diuretics differ from other diuretics regarding potassium?

They decrease potassium excretion. Signup and view all the answers

What can occur if medication dose titration happens while fasting?

Higher serum levels of the drug leading to toxicity. Signup and view all the answers

What is a potential effect of antipsychotic medications like Zyprexa on glucose metabolism?

Cause hyperglycemia Signup and view all the answers

Which of the following is an important counseling guideline for patients taking medications?

Consult a Registered Dietitian for nutritional information Signup and view all the answers

Which electrolyte is primarily lost due to the use of loop diuretics such as Furosemide?

Potassium Signup and view all the answers

What potential health issue is associated with long-term use of corticosteroids?

Osteoporosis Signup and view all the answers

What is a known effect of antibiotics like Tetracycline when taken with dairy products?

Decreased absorption Signup and view all the answers

Which metabolic effect is commonly associated with corticosteroids?

Fluid retention Signup and view all the answers

What side effect is commonly linked with antipsychotics like Risperdal?

Increased triglycerides Signup and view all the answers

How much potassium reabsorption is altered by thiazide diuretics like HCTZ?

Increased potassium loss and increased calcium reabsorption Signup and view all the answers

Which type of healthcare setting is primarily designated for patients receiving immediate care for severe illnesses or injuries?

Acute care (hospital) Signup and view all the answers

What is the main goal of primary care within the healthcare continuum?

Prevent illness and promote wellness Signup and view all the answers

Which of the following professions is primarily concerned with prescribing medication and managing patient therapy?

Pharmacist Signup and view all the answers

What type of care does secondary care typically provide?

Diagnosis and treatment of diseases Signup and view all the answers

Which of the following healthcare settings specifically supports the work of primary care through ancillary services?

Ambulatory care facilities Signup and view all the answers

Which term is used to describe healthcare services aimed at reducing the risk of permanent disability?

Tertiary care Signup and view all the answers

What is the primary function of a social worker within an interdisciplinary healthcare team?

Assist patients with social needs and resources Signup and view all the answers

In which healthcare setting are birthing centers categorized?

Ambulatory care facilities Signup and view all the answers

Which of the following provider types is involved in both primary and secondary care?

General practitioner Signup and view all the answers

Which category of services includes pain management and palliative care?

Ancillary services Signup and view all the answers

What type of accreditation is typically required for healthcare professionals to legally perform their duties?

Government issued licensure Signup and view all the answers

Which of the following describes a characteristic of long-term care facilities?

Offer housing and personal care assistance Signup and view all the answers

What type of service is primarily focused on the management of chronic illnesses and ongoing health maintenance?

Primary care Signup and view all the answers

Which of the following healthcare professionals is typically involved in rehabilitation services?

Occupational therapist Signup and view all the answers

What is the primary difference between accreditation and certification in healthcare?

Accreditation involves external reviews by accrediting agencies, while certification validates individuals and facilities against predetermined standards. Signup and view all the answers

Which of the following is NOT one of the six dimensions of care aimed at providing high-quality healthcare?

Accessibility Signup and view all the answers

The Plan-Do-Study-Act (PDSA) cycle is used primarily for what purpose in healthcare?

Implementing changes and improving processes based on data analysis. Signup and view all the answers

What is the main goal of quality improvement (QI) projects in healthcare?

To improve processes, programs, systems, or performance to enhance overall quality of care. Signup and view all the answers

Which agency is primarily responsible for regulating medications and ensuring their safety in the United States?

Food and Drug Administration (FDA) Signup and view all the answers

Benchmarking in healthcare primarily serves what purpose?

To compare performance against best practices to identify strengths and weaknesses. Signup and view all the answers

Which of the following organizations primarily focuses on nutrition in healthcare?

Academy of Nutrition and Dietetics Signup and view all the answers

Quality improvement focuses on which of the following aspects?

Program, process, and protocol improvement based on data management. Signup and view all the answers

What is a fundamental requirement for the use of outcome research in healthcare?

It requires Institutional Review Board (IRB) approval due to ethical considerations. Signup and view all the answers

Which step is NOT part of the Plan-Do-Study-Act (PDSA) cycle?

Develop financial models. Signup and view all the answers

Which of the following best describes the role of the US Department of Health and Human Services?

It coordinates federal health programs and services, including policy development. Signup and view all the answers

What is an important characteristic of accreditation in healthcare?

It is a voluntary process aimed at recognizing quality standards. Signup and view all the answers

In quality improvement, what does the term 'equitability' refer to?

Providing care that is fair and unbiased regardless of social status. Signup and view all the answers

What action is recommended when clinical audits reveal trends or practice gaps?

Define goals and initiate quality improvement projects to address the gaps. Signup and view all the answers

Study Notes

Food and Drug Interactions

Medications can affect or be affected by food
Each patient must be individually assessed for potential food-drug interactions:
- effect of food on medication action
- effect of medication on nutritional status
- all medications must be reviewed for potential interactions
Medications in the same pharmaceutical class generally exhibit similar effects

Effect of Food/Nutrients on Medication Absorption

Food in the stomach can decrease the rate of absorption or extent of drug absorption
- High-fat or high-fiber meals delay gastric emptying, this is usually not clinically significant as long as the extent of absorption is not affected, but it can be clinically significant with antibiotics or analgesics
- Chelation reactions between medications and divalent or trivalent cations (Fe, Ca, Mg, Zn) reduce drug absorption
- Fluoroquinolone antibiotics (ex: Cipro) and tetracycline form insoluble complexes with calcium in dairy products or calcium fortified foods, this prevents or reduces absorption of the drug and nutrients
- Ceftin (antibiotic) and Invirase (antiretroviral drug) have enhanced absorption with the presence of food and should be taken after a meal to reduce the dose required to reach an effective level

Effect of Food/Nutrients on Medication Metabolism

Food can alter the metabolism of drugs
- Grapefruit (juice, segments, extract) inhibit the cytochrome P-450 3A4 enzyme system responsible for metabolism of many orally administered drugs: simvastatin (Zocor), lovastatin, cyclosporine, carbamazepine (anticonvulsant), +many others
  - This decrease in metabolism increases the amount of medication that reaches systemic circulation, leading to an increased pharmacologic effect and possible toxicity
  - Effects of grapefruit on cytochrome P-450 can last up to 72 hours
- Competition between food & drugs may decrease first pass metabolism of certain drugs (propranolol, metoprolol)
  - Competing for the same metabolizing enzymes
  - Reduction in first pass metabolism increases the serum level of the drug
  - This can result in a toxic effect if dose titration occurs in a fasting state

Effect of Food/Nutrients on Medication Excretion

Alteration of renal excretion can alter blood levels of certain drugs
- Lithium is reabsorbed in the kidney at the same site as Na
  - Excess sodium intake increases sodium excretion and lithium excretion, producing lower lithium levels, and possible therapeutic failure
  - If concurrently hyponatremic while taking lithium, it increases lithium re-absorption due to its similar molecular structure to Na, increasing the risk of toxicity

Effect of Medication on Nutrient Excretion

Drugs can increase or decrease urinary excretion of nutrients
- Loop diuretic (Lasix) increases excretion of Na, K, Cl, Mg, Ca
  - K supplement is routinely prescribed with loop diuretics
  - Ca and Mg supplementation should also be considered, especially with long-term use of loop diuretics
  - Requires close monitoring of electrolyte levels
- Thiazide diuretics (hydrochlorothiazide HCTZ) increases excretion of K and Mg BUT decrease excretion of Ca (increased renal reabsorption of Ca)
- Potassium-sparing diuretics (spironolactone, Aldactone) increase excretion of Na, Cl, and Ca, but not K (K-sparing)
  - Can reach dangerous K blood levels if taken with a K supplement
- Antihypertensive angiotensin-converting enzyme (ACE) inhibitors (blood pressure, Vasotec) decrease excretion of K
- Corticosteroids (prednisone) decrease sodium excretion (sodium & water retention) and increase excretion of K and Ca
  - Ca and Vitamin D supplements are recommended with long-term use to prevent osteoporosis

Effect of Medication on Nutrient Absorption

Drugs can decrease the absorption of the drug, nutrient, or both
- Tetracycline and ciproflaxin (antibiotics) chelate with cations, such as calcium found in supplements or dairy products
  - This is also true for Fe, Mg, Zn (mineral supplements or multivitamin-mineral)
  - Reduces the amount of mineral available for absorption
  - Minerals should be taken at least 2-6 hours apart from the drug
- Prolonged use of H2-receptor antagonists (Pepcid, Zantac) or proton pump inhibitors (Prilosec, Nexium); anti-ulcer, anti-GERD; antacids
  - Alters gastric acidity (increased gastric pH) decreases absorption of B12
  - PPIs decrease Ca absorption, increasing the risk of osteoporosis
- Medications can damage the gut mucosa, decreasing nutrient absorption
  - This alters the ability for the GI tract to absorb minerals (Fe, Ca)
  - Antineoplastic medication (methotrexate), non-steroidal anti-inflammatory drug (NSAIDs), long-term antibiotic use

Effect of Medication on Nutrient Metabolism

Drugs increase metabolism of nutrients, increasing nutrient requirement and possibly leading to deficiency
- Phenytoin (Dilantin, anticonvulsant) and phenobarbital (barbiturate, CNS depressant; seizures) induce hepatic enzymes, increasing metabolism of folic acid, vitamins D and K
  - This can lead to macrocytic anemia and osteoporosis
  - Supplementation is often provided with these medications
Drugs may cause vitamin antagonism, blocking the conversion of a vitamin to its active form
- Isoniazid (anti-tuberculosis drug) blocks the conversion of pyridoxine (B6) to its active form

Effects of Medication on Nutritional Status

Side Effects / Gastrointestinal Effects:
- Impair salivary flow, leading to dry mouth, increased caries, stomatitis, glossitis
- Bitter taste in saliva (for as long as the drug remains in the body)
- Suppression of natural oral bacteria, leading to oral candidiasis
- Cause dysgeusia, abnormal sense of taste
- Damage to cells that rapidly turnover, leading to stomatitis, glossitis, oral ulceration, esophagitis
- Induce dry mouth, throat, mucositis, leading to dysphagia
- Irritate stomach mucosa, leading to nausea, vomiting, bleeding, ulceration (Aspirin, Advil)
- Slow intestinal peristalsis, leading to constipation
- Destroy intestinal bacteria, leading to colitis (secondary inflammation due to bacterial overgrowth)

Effects of Medication on Nutritional Status

Appetite Changes:
- Suppression of appetite
  - Example: CNS stimulants used to treat ADHD (Adderall, Ritalin)
  - Example: Medications with CNS side effects (drowsiness, dizziness, tremor, confusion, headache, weakness, peripheral neuropathy) can interfere with the ability or desire to eat, especially in the elderly or chronically ill
  - Common with anti-infective drugs (antibiotics, antifungals), antineoplastics, bronchodilators (albuterol), stimulant drugs
- Increased appetite (often feeling ravenous)
  - Example: antidepressants (Elavil), antipsychotic drugs (clozapine)
  - Example: corticosteroids associated with dose dependent weight gain (appetite stimulation + sodium/water retention)
  - Drugs used as appetite stimulants: Megace, Marinol (dronabinol, marijuana derivative), Remeron (antidepressant)

Effects of Medication on Nutritional Status

Metabolic Effects:
- Affect glucose metabolism, leading to hypoglycemia, hyperglycemia, diabetes
  - Stimulate glucose production, impair glucose uptake, inhibit insulin secretion, decrease insulin sensitivity, increase insulin clearance
  - Example: Antipsychotics (Zyprexa) → hyperglycemia
  - Example: Corticosteroids → gluconeogenesis, insulin resistance, inhibit glucose uptake → hyperglycemia
- Lipid abnormalities (increased cholesterol, increased triglycerides)
  - Example: Antipsychotics (Zyprexa, Risperdal)

Counseling Guidelines

Patient counseling should include:
- Pertinent medication information (name, indications, duration of therapy)
- When and how to take the medication (i.e., with meals)
- Food and beverages to avoid or limit
- Expected side effects; potential nutritional problems
- Dietary changes that may alter drug action
- Advice on alcohol ingestion
- Potential interactions between medication and supplements
- Importance of following a prescribed diet
- Nutritional information – consult a Registered Dietitian
- Medication information – consult a Registered Pharmacist

Some Prevalent Interactions

Diuretics
- Loop: Furosemide (Lasix): losses of K+, Mg+, Ca+
- Thiazides (HCTZ): losses of K+, Mg+, increased Ca+ re-absorption
- Potassium Sparing (spirulactone): K+ sparing
Steroids
- Prednisone, Dexamethasone, many others
- Hyperglycemia, fluid retention, increased BP, weight gain
- Altered protein metabolism, GI ulceration/hemorrhage
- Long-term: Osteoporosis
Antibiotics (Tetracycline/Ciprofloxin)
- Decreased absorption with dairy products Ca, Fe

Healthcare Settings

Inpatient settings include acute care hospitals, long-term care facilities, and rehabilitation centers.
Acute care hospitals can be general (teaching, community, or public) or specialty-focused (pediatric, cancer).
Long-term care facilities can be assisted living, independent living, nursing facilities, residential care, or retirement communities.
Ambulatory care facilities can be hospital-based or free-standing.
Hospital-based ambulatory care facilities include ambulatory surgery centers, clinics, emergency departments, and observation services.
Freestanding ambulatory care facilities include birthing centers, neighborhood health clinics, physician practices, urgent care centers, school health clinics, and dialysis centers.

Healthcare Professions

Professionals in healthcare include physicians, physician assistants, registered nurses, medical assistants, surgical techs, dental hygienists, pharmacists, pharmacy technicians, clinical psychologists, audiologists, speech therapists, registered dietitians, social workers, physical therapists, occupational therapists, respiratory therapists, and radiation therapists.

Physician Specialties

Common physician specialties include family practice, anesthesiology, pediatrics, obstetrics and gynecology, cardiology, gastroenterology, rheumatology, ophthalmology, orthopedic surgery, plastic surgery, dermatology, pathology, neurology, oncology, and nephrology.

Ancillary Services

Ancillary services support the primary physician and healthcare team.
The interdisciplinary care team includes speech therapists, physical therapists, occupational therapists, psychologists, nutritionists, social workers/case managers, pain management specialists, and palliative care providers.

Continuum of Care

Primary care focuses on prevention and wellness, aiming to reduce the risk of illness in the community.
Secondary care focuses on diagnosis and treatment of a disease, aiming to detect illness early and expedite treatment.
Tertiary care focuses on restorative or rehabilitative care, aiming to decrease the risk of permanent disability related to a disease or illness.

Licensure, Accreditation, and Certification

Licensure is a legal authority granted by government agencies, usually at the state level, permitting specific acts or services.
Accreditation is a voluntary recognition granted to institutions that meet established standards and qualifications.
Certification is a credential earned by individuals and facilities that demonstrate meeting predetermined standards of care.

Healthcare Agencies and Organizations

Federal agencies include the US Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and National Institutes of Health (NIH).
Organizations and associations include the American Medical Association, American College of Surgeons, Academy of Nutrition and Dietetics (AND), American Society for Parenteral and Enteral Nutrition (ASPEN), American Diabetes Association, American Heart Association, American Hospital Association, and the World Health Organization (WHO).

Quality of Healthcare

The goal of healthcare is to improve patient safety and quality of care.
Six dimensions of care include safety, timeliness, effectiveness, efficiency, equitability, and patient-centeredness.

Quality Improvement

Quality improvement (QI) projects aim to improve processes, programs, systems, or performance by comparing current practices to published standards.
They promote consistent, effective, safe, and patient-centered care.
Examples of QI projects include evidence-based protocols, bundled care, order sets, and policy and procedure refinement.

Plan-Do-Study-Act Cycle

The Plan-Do-Study-Act (PDSA) cycle is a common improvement strategy.
PLAN: Define goals, plan data collection and analysis, and determine project timelines.
DO: Test the change, document problems, and track progress against benchmarks.
STUDY: Review the plan, analyze data, compare results to goals, and summarize findings.
ACT: Implement changes and repeat the cycle or implement learnings.

Quality Improvement vs Outcome Research

QI and outcome research share similarities in identifying outcomes, measuring outcomes, intervening, and re-measuring.
QI focuses on programs, processes, and systems, while outcome research is hypothesis-driven.
QI uses data for internal use, while outcome research requires Institutional Review Board (IRB) review for publication.

Benchmarking

Benchmarking compares performance against best-practice organizations, internal or external to the industry.
Benchmarking is a continuous process that monitors ongoing changes in best practices and requires constant surveillance.
Examples of benchmarking efforts include programs to reduce NPO (nothing by mouth) hours after surgery, efforts to reduce weight loss in ambulatory oncology patients, and tracking Registered Dietitian Nutritionist (RDN) exam pass rates against a benchmark of 90% first-time pass rate.

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Description

Test your knowledge on how food impacts medications and their absorption. This quiz covers the assessments required to identify potential food-drug interactions and the implications of nutritional status on drug efficacy. Understand the importance of considering food types in medication administration.