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Why is it important to prevent drug and nutrient/food interactions?
- � Medications achieve intended effects
- � Patients don�t discontinue drugs
- � Need for additional medication decreased
- � Adverse side effects avoided
- � Optimal nutritional status preserved
- � Cost of health care is reduced
- � Less professional liability
What is the impact of grapefruit juice on medications that are sensitive to it?
Grapefruit irreversibly inhibits oxidation of some drugs by the cytochrome P450 system in the small intestine; Calcium-channel blockers, some statins, xanax & valium. Impact (inhibition) lasts 72 hours until more enzyme is produced. Grapefruit causes higher circulating levels of the drug, but its not a predictable amt
How does low serum albumin influence protein-bound medications?
- Causes higher levels in the blood
- o Binding to proteins or tissues; plasma protein binding; albumin is the protein that drugs bind to, so albumin is no longer avail to work on damaged cells; causes more of the active drug to be in the blood, so once all albumin (happens often in a malnourished pt) is bound to drug, higher levels will be in blood & pt can get too much of drug
How is diet managed for patients taking monoamine oxidase inhibitors?
(MAOI taker has to limit amt of tyramine in diet; if don�t avoid them, can have extremely high BP, which causes increased risk of stroke)
Tyramine-controlled diet for MAOI:
- Foods to avoid:
- � Aged and fermented foods
- � Aged cheeses
- � Smoked or pickled meat, fish or poultry
- � Bologna, pepperoni, salami, pastrami, summer sausage
- � Fava beans, eggplant, tomatoes, tomato sauce
- � Soy sauce, fermented tofu, tempeh, miso soup
- � Overripe fruits
- � Alcohol, esp. beer, chianti, sherry, liqueurs
What are the food and nutrient interactions of warfarin?
§ Warfarin (prevents clotting) changes the conformation of the binding site for vitamin K
What are the food and nutrient interactions of lithium?
§ Lithium (antipsychotic) -Some drugs compete with sodium for tubular reabsorption; high Na intake decreases lithium blood levels (b/c of competition in kidney for reuptake)
What are the food and nutrient interactions of Dilantin?
§ Dilantin (trtmt of seizures)- High protein intakes promote increased excretion of barbiturates, theophylline and phenytoin
What are the food and nutrient interactions of Lasix?
Lasix: used with most CHF pts who are also on digoxin (so losing electrolytes, good to lose Na, not to lose K+ and Mg; pts usually on K+ supp)
What are the food and nutrient interactions of Digoxin?
Digoxin- Fiber can inhibit drug absorption-(increases contractility of the heart, given to ppl with CHF; if get too much Digoxin, get "dig toxicity"; which causes symptoms such as nausea and cardiac arrhythmias) (ppl in hospital given lower fiber diet so absorption of Digoxin isn't impaired; sometimes person is given diuretic which causes loss of K & Mg, so pts often told to eat banana, supplement etc)
What are the food and nutrient interactions of Tetracycline?
Tetracycline; do not take with milk (b/c Ca in milk binds up Tetracycline)
6. What are the characteristics of fee-for-service health care plans?
Bill is submitted by dr to insurance co; dr tries to see pt often to get more to submit to insurance
Method of payment for services: _____
Incentive to provide services even if unnecessary or not efficacious
______ (diff drs don’t communicate w/each other)· Fragmented delivery
Little provider risk
Few outcome and service measures
- Bill is submitted by dr to insurance co; dr tries to see pt often to get more to submit to insurance
- § Method of payment for services: patient receives medical services; insurance pays
- § Incentive to provide services even if unnecessary or not efficacious
- · Episodic care (diff drs don’t communicate w/each other)
- · Fragmented delivery
- · Passive consumer
- · Little provider risk
- · Little accountability
- · Few outcome and service measures
Why did managed care health plans evolve? (3)
- Improve the clinical quality of medical services
- Improve the social and customer service aspects of providing care
- Reduce the costs of delivering quality care
What nut services does medicare and medicaid cover?
- Medicare: can see an RD for treatment for diabetes and predialysis kidney disease covered
- Medicaid: generally RD care not covered unless part of prenatal care
What are the implications of managed care for
physicians and patients? (5)
- Change in the physician-patient relationship
- New responsibilities for populations
- PCPs as gatekeepers to specialists
- Increased focus on prevention and health maintenance
- Time constraints, case management, financial incentives and financial withholds
Why are nutrition services often not covered by
health care plans? When Medicare was developed: (4)
- Lack of outcomes and cost- effectiveness data
- Lack of state regulated credential
- No standards of practice
- Failure to be proactive in the market place
How is HIV/AIDS managed? (5)
- Healthy meals- may need high kcal, high protein, esp if anorexic
- Safe food handling practices
- Multi-vitamin & mineral supplement
- Regular exercise
- Medications to combat wasting
How is nut assessment impacted by HIV/AIDS? (8)
- Usual parameters assessed
- Bioimpedence analysis
- Access to food and preparation methods
- Water and food safety practices
- Psychological and economic issues
- Comorbid condition
- Substance abuse
What are the nut implications of HIV/AIDS? (7)
- GI symptoms: anorexia, diarrhea
- Loss of LBM, BCM (BODY CELL MASS)
- METABOLIC COMPLICATIONS DUE TO DRUGS
- Drug & food or nutrient interactions
- Compromised growth in children
- Food safety
How are GI symptoms of HIV/AIDS managed?
- Anorexia- Treat with Megace or Marinol
- Diarrhea – very common side effect
- Medications can cause diarrhea
- Antibiotics for opportunistic infections
- Decreased pancreatic enzymes due to PI (protease inhibitor- PI causes less pancreatic enzymes to be made
- HIV enteropathy – virus in GI mucosa
- Intestinal pathogens- due to immunocompromised
- Malabsorption syndromes
- Management of diarrhea:
- Psyllium fiber (Metamucil)
- Prescription and OTC medications (Immodium, Lomotil, Kaopectate, Pepto bismol)
- Lactaid products- some ppl lactose intolerance
- Pancreatic enzymes
- Glutamine – major amino acid for GI tract; given
- orally or via IV
How is loss of LBM and BCM managed in an HIV/AIDS pt?
- (Catabolic response to infection and inflammatory response preferentially waste protein stores in muscle and organs. Elevated level of cortisol & breaking down of muscle, etc)
- -AIDS Wasting Syndrome
- -Weight not a good indicator- waste in some places but build up fat in other places (Fat redistribution syndrome)
- -Use Bioelectrical Impedence Analysis which better indicates how much lean body mass is being maintained
- · Resistance exercises
- · Growth hormone
- - Testosterone, anabolic steroids
What are the effects of fat redistribution syndrome in an HIV/AIDS patient?
- Hyperlipidemia. Insulin resistance and DM (metabolic syndrome)
- High TC, LDL, TG, BG, low HDL