Ch. 16

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Kymberli
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83057
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Ch. 16
Updated:
2011-05-01 23:12:54
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Nutrition
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How Medications Can Affect Nutrition, Diet, & Oral Health
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  1. Drug-Nutrient Interactions are a 2-WAY STREET:
    • 1.) Nutrients affect Drugs
    • 2.) Drugs affect Nutrients
  2. 3 Nutrient Effects on Drugs:
    • 1.) May alter extent of drug absorption by: alterations in GI pH & mobility; Formation of non-absorbable precipitates &/or chelates
    • 2.) May alter drug metabolism: grapefruit juice increases bioavailability & potency of Calcium Channel Blockers; Cholesterol lowering drugs (statins), when taken with grapefruit juice can RAISE the pt's risk of muscle toxicity
  3. DRUG EFFECTS ON NUTRIENTS
  4. Drugs may ALTER Food Intake by Causing: (3)
    • 1.) CHANGES in appetite
    • 2.) CHANGES in senses of taste & smell
    • 3.) ADVERSE GI effects
  5. Drugs may Affect Nutrient Absorption by Causing 5 Things:
    • 1.) Direct injury to the intestinal mucosa
    • 2.) Alterations in GI pH & motility
    • 3.) Modification of bacterial flora composition
    • 4.) Formation of NON-absorbable precipitates &/or Chelates
    • 5.) Solubilization
  6. Drugs can Affect Nutrient Excretion by: (3)
    • 1.) DISPLACING nutrients from their binding sites
    • 2.) Chelation
    • 3.) REDUCED Renal (kidney) absorption
  7. Chelation -
    • Chelation is the use of a chemical substance to bind molecules, such as metals or minerals, & hold them tightly so they can be removed from the body.
    • Chelation has been scientifically proven to REMOVE excess or toxic metals BEFORE they can cause damage to the body.
  8. Medications can cause side effects that can affect Nutrition by changing a person's: (3)
    • 1.) Appetite
    • 2.) Taste & Smell
    • 3.) Ability to eat
  9. 7 Oral Effects of Medications:
    • 1.) Gingival Hyperplasia
    • 2.) Gingivitis
    • 3.) Mucositis
    • 4.) Oral Candidiasis
    • 5.) Tooth discoloration
    • 6.) Direct tooth damage
    • 7.) Xerostomia
  10. DRUG CATEGORIES/MEDICATIONS & NUTRIENTS THEY AFFECT:
  11. Anticoagulants: (1)
    Warfarin (Coumadin): affects Vitamin K

    • creates partial deficiency of the active form of Vitamin K involved in the posttranslational modification of Vitamin K dependent coagulation factors
    • Requires diet control of Vitamin K intake
    • NO specific oral effects
  12. Hydantoins: (1)
    Phenytoin (Dilantin): Vitamin D; Calcium; Folate (Folic Acid)

    • Vitamin D & Calcium: secondary impairment of Calcium absorption with INCREASED risk for Osteomalacia or Rickets; Gingival Hyperplasia
    • Folate/Folic Acid: INCREASED risk for folate deficiency, cervical dysplasia, & elevated homocysteine levels associated with Cardiovascular Disease; NO specific oral effects
  13. Non-Steroidal Anti-Inflammatories (NSAIDS): (4)
    • 1.) Aspirin: Folate (Folic Acid), Vitamin C, Iron
    • 2.) Sulindac (Clinoril): Folate (Folic Acid)
    • 3.) Naproxen (Naprosyn): Folate (Folic Acid)
    • 4.) Ibuprofen (Motrin/Advil) : Folate (Folic Acid)

    Folate/Folic Acid: INCREASED risk for Folate deficiency implicated in birth defects, cervical dysplasia, & elevated homocysteine levels associated with Cardiovascular Disease; NO specific oral defects

    Vitamin C & Iron: INCREASED risk of GI mucosa damage leading to Iron deficiency, Anemia, & DECREASED absorption of Vitamin C; NO specific oral effects
  14. Blood Thinners: (1)
    Warfarin (Coumadin): HIGH Vitamin K intake

    HIGH Vitamin K intake: DECREASES drug effectiveness
  15. Calcium Channel Antagonists: ( 5)
    • 1.) Amlodipine (Norvasc): HIGH Vitamin C intake
    • 2.) Diltiazem (Cardizem): HIGH Vitamin C intake
    • 3.) Nifedipine (Procardia): HIGH Vitamin C intake
    • 4.) Verapamil (Isoptin): HIGH Vitamin C intake
    • 5.) Benzodiazepines (Midazolam, Triazolam): Interact with Grapefruit Juice

    • HIGH Vitamin C intake: DECREASES drug absorption; NO specific nutritional effects; Gingival Hyperplasia - encourage proper oral hygiene
    • Grapefruit Juice: consumption with Grapefruit Juice can INCREASE the activity of the drug; NO specific oral effects
  16. Antacids: (3)
    • 1.) Aluminum (Amphogel): Phosphorus, Vitamin B12, Folate/Folic Acid, Iron, Zinc
    • 2.) Aluminum & Magnesium (Maalox, Mylanta): Vitamin B12, Folate/Folic Acid, Iron, Zinc
    • 3.) Sodium Bicarbonate (Alka-Seltzer): Vitamin B12, Folate/Folic Acid, Iron, Zinc

    • Phosphorus: INCREASES risk for Bone Demineralization & induced Hypophosphatemia with proximal limb muscle weakness; NO specific oral effects
    • Vitamin B12 & Folate: INCREASED RISK for Folate deficiency implicated in Birth Defects, Cervical Dysplasia, & elevated Homocysteine levels associated with Cardiovascular Disease; NO specific oral effects
    • Iron & Zinc: INCREASED RISK for Iron-Deficiency Anemia & immune function abnormalities/immunosuppression; NO specific oral effects
  17. 5 Drug Categories/Medications that Grapefruit Juice Affects:
    • 1.) Antihistamines: Terfenadine - INCREASES drug effects; INCREASES activity of drug; may contribute to Xerostomia
    • 2.) Antihyperlipidemics: Atorvastatin (Lipitor) & Simvastatin (Zocor) - Muscle aches & weakness
    • 3.) Antihypersensitives (Vasodilators): Felodipine (Plendil, Renedil) - INCREASES drug effects; INCREASES blood levels of drug
    • 4.) Calcium Channel Antagonists: Benzodiazepines (Midazolam, Triazolam) - INCREASES activity of drug; NO specific oral effects
    • 5.) Hormones: Conjugated estrogens (Premarin), Esterfied Estrogens (Ogen), Ethinyl Estradiol - INCREASES drug effects & cause Gingivitis
  18. Gingival Hyperplasia:
    • OVERGROWTH of the gingival tissue
    • COMMON complication of Phenytoin (Dilantin) therapy (Hydantoins or Anti-epileptic/Anti-seizure Drug) & Calcium Channel Blockers
  19. Gingivitis:
    Associated with the use of Hormone Therapy: Corticosteroids, Androgens, Estrogens, Progestins

    Symptoms: tenderness, swelling, MINOR bleeding of gums
  20. Clinical symptoms of Plaque-Induced Gingivitis are INTENSIFIED during ELEVATED blood levels of Hormones from: (4)
    • 1.) Immune suppression
    • 2.) Increased Fluid Exudation
    • 3.) Stimulation of Bone Resorption
    • 4.) Stimulation of Fibroblast activity
  21. Nearly __ % of patients treated with Chemo Agents (Chemotherapy) develop oral side effects.
    40 %
  22. 3 Side Effects of Chemo Agents (Chemotherapy):
    • 1.) Mucositis: DECREASE in surface thickness & keratinization of mucous membrane in mouth (ulcer)
    • 2.) Bleeding: may compromise pt's nutritional status
    • 3.) Infection: may compromise pt's nutritional status
  23. 3 Treatments of Gingivitis & Other Oral Muscosa Effects:
    • 1.) Mouthwashes w/Local Anesthetics: Lidocaine, Dyclonine
    • 2.) Histamines: Diphenhydramine, Corticosteroids
    • 3.) Antifungals: Nystatin

    Treatment is palliative! (focused on relieving & preventing pain)
  24. TOOTH DISCOLORATION
  25. Tetracyclines & Tooth Discoloration:
    Tetracyclines can deposit in the Dentin & Enamel of developing teeth & cause PERMANENT tooth discoloration of yellow to gray-brown

    Tetracycline Antibiotics should be AVOIDED in children < 8 years old
  26. 3 Causes of SUPERFICIAL Staining of Teeth:
    • 1.) Chlorahexadine (CHX) Mouthrinse: chewing Sugar-Free Gum for 20 minutes AFTER use of Chlorahexidine (CHX) Rinse may DECREASE staining
    • 2.) Liquid Iron
    • 3.) Tobacco
  27. XEROSTOMIA
  28. Xerostomia & Medications:
    • Drugs that cause dry mouth can INCREASE caries risk
    • Drugs with Anticholinergic side effects REDUCE saliva production: Tricyclic Antidepressants, Phenothiazine Antipsychotics
    • Rx artificial saliva (saliva supplements), oral Pilocarpine, & use of sugarless candies or lozenges
  29. 5 Reasons WHY Xerostomia Affects Older People:
    • 1.) Medication induced
    • 2.) Medical condition induced
    • 3.) Therapy induced
    • 4.) Recession from Periodontal disease
    • 5.) Abrasion from poor brushing technique
  30. 4 Nutritional Considerations of Xerostomia:
    • 1.) Inadequate intake of Nutrients
    • 2.) Taste changes
    • 3.) Lack of interest in eating
    • 4.) Poor appetite

    Rx appetizing & inviting foods; Presentation, appearance, appeal
  31. 9 Nutrient Deficiencies of Xerostomia:
    • 1.) Vitamin A
    • 2.) Vitamin C
    • 3.) Vitamin B6
    • 4.) Fiber
    • 5.) Potassium
    • 6.) Calcium
    • 7.) Zinc
    • 8.) Protein
    • 9.) Fluids
  32. 7 Recommendations for Xerostomic Patients:
    • 1.) Fluids with & between meals
    • 2.) Nutrient-dense, soft, moist foods
    • 3.) Sauces & gravies
    • 4.) Non-nutritive sweetener use
    • 5.) Ice chips
    • 6.) Sour, tart items to stimulate saliva
    • 7.) Avoid: dry, crumbly, sticky, spicy, alcohol mouthrinses, alcohol, tobacco, caffeine - makes mouth dryer
  33. Drug Treatments for Asthma & Tooth Damage:
    • Certain drug treatments for Asthma may cause tooth damage
    • Powdered form of most drugs: pH of 5.5
    • Tooth enamel begins to dissolve(demineralization/caries): pH of 5.5
    • Use mouthrinse after EVERY inhalation & use spacer devices to PREVENT Erosion
  34. ORAL CANDIDIASIS (THRUSH)
  35. Oral Candidiasis (Thrush):
    • is a fungal infection of the oral cavity
    • caused by Candida albicans, a resident fungus of the normal oral flora
  36. 2 Medications that Cause Oral Candidiasis (Thrush):
    • 1.) Nasal Steroids (inhaled steroids)
    • 2.) Systemic Steroids &/or Antibiotics concurrently (taking both together)
  37. Treatment for Oral Candidasis (Thrush):
    Rx pt's to use mouthrinse AFTER every use of those 2 medications (Nasal/inhaled Steroids & Systemic Steroids w/ OR w/out Antibiotics)
  38. Chronic Hyperplastic Candidosis:
    white plaque, usually NEAR the angle of mouth & cheek mucosa
  39. 8 Predisposing Factors of Chronic Hyperplastic Candidosis:
    • 1.) Antibiotic Therapy
    • 2.) Corticosteroid Therapy
    • 3.) Xerostomia
    • 4.) Diabetes Mellitus
    • 5.) HIV/AIDS
    • 6.) Chemotherapy & Radiation
    • 7.) Immunosuppression
    • 8.) POOR Oral Hygiene
  40. EFFECTS OF DRUGS ON NUTRITION
  41. 3 Drugs that Affect Nutrition:
    • 1.) Oral Contraceptives: DEPLETES many B Vitamins, Folic Acid/Folate, Vitamin C, Magnesium, Selenium, Tyrosine (amino acid), Zinc
    • 2.) Anti-Diabetes Drugs: Sulfonylureas (Glipizide) -CoQ10; Biquanides (Metaformin)- Vitamin B12
    • 3.) Anti-Ulcer & Heartburn Drugs: H2 Receptor Antagonists/H2 Blockers deplete Vitamin B12, Folate/Folic Acid, Vitamin D, Calcium, Iron, Zinc
  42. 5 Effects of Birth Control & Folate (Folic Acid) Depletion
    • 1.) Anemia
    • 2.) Birth Defects
    • 3.) Cervical Dysplasia
    • 4.) Depression
    • 5.) INCREASED RISK of Breast & Colorectal Cancer
  43. Birth Control & B Vitamins:
    • Folic Acid, Vitamins B6 & B12: are necessary to metabolize homocysteine (toxic amino acid); elevated homocysteine is a MAJOR risk for plaque build-up in the arteries (Heart Attack, Stroke)
    • Vitamin B6: converts Tryptophan to Serotonin; DEPLETION of B6 can cause Depression & Insomnia
  44. Birth Control & Vitamin C:
    • Birth Control causes up to 40% DECLINE in Vitamin C levels in the blood
    • This leads to: WEAKENED immune system, POOR wound healing, EASY bruising
  45. Birth Control & Zinc:
    Zinc deficiency impacts the immune system (immunosuppression)
  46. 10 Things Magnesium deficiency due to Birth Control can Cause:
    • 1.) Osteoporosis
    • 2.) Muscle Cramps
    • 3.) Weakness
    • 4.) Insomnia
    • 5.) Anxiety
    • 6.) Depression
    • 7.) Blood Clots
    • 8.) HPT (Hyperthyroidism?)
    • 9.) IRREGULAR Heartbeat (Heart Arrhythmia)
    • 10.) INCREASED RISK of Heart Attack
  47. 2 Anti-Diabetes Drugs & Nutrient Deficiencies:
    • 1.) Sulfonylureas (Glipizide)
    • 2.) Biquanides (Metformin)
  48. 1.) Sulfonylureas (Glipizide):
    inhibit enzymes necessary for CoQ10 synthesisCoQ10 is an antioxidant that is important for pancreatic production of insulin & for heart health
  49. 2.) Biquanides (Metformin)
    NEGATIVELY impacts the production of intrinsic factor & causes B12 depletion
  50. Anti-Ulcer & Anti-Heartburn Medications & Nutrient Deficiencies:
    • Acidity level of GI Tract is CRITICAL for the absorption of MANY nutrients
    • H2 Receptor Antagonists (H2 Blockers) DEPLETE Vitamin B12, Vitamin D, Calcium, Folate (Folic Acid), Iron, Zinc
    • Vitamin D depletion causes skeletal problems, muscle weakness, tooth decay, hearing loss
    • Calcium depletion causes Osteoporosis, Heart & Blood Pressure irregularities, & Tooth Decay
    • Iron deficiency causes hair loss, brittle nails, Anemia, weakness, fatigue, LOW energy
  51. MEGA-DOSES OF VITAMINS
  52. 8 Vitamins:
    • 1.) Vitamin A
    • 2.) Vitamin B3 (Niacin)
    • 3.) Vitamin B6
    • 4.) Folic Acid (Vitamin B9)
    • 5.) Vitamin B12
    • 6.) Vitamin C
    • 7.) Vitamin D
    • 8.) Vitamin E
  53. Vitamin A:
    • Fat-soluble vitamin that is crucial for: vision, cell growth, immune system function
    • Can cause FAILURE of Periodontal surgery sites to heal at levels OVER 5,000 IU/day
    • Do NOT take in EXCESS of 10,000 IU (2x RDA) ?
  54. Vitamin B3 (Niacin):
    • WATER-soluble Vitamin
    • > 3,000mg used for Heart Disease can cause flushing & redness of skin, Heartburn, Gastric Ulcers, INCREASED Blood-Glucose levels
    • vision loss & injured Liver can ALSO occur with mega-doses
  55. Vitamin B6:
    • WATER-soluble vitamin required for: protein metabolism, delivery of oxygen to cells, regulation of blood glucose
    • EXCESSES can cause debilitating & dangerous Nerve damage
    • Do NOT exceed 100 mg/day
  56. Vitamin B9/Folic Acid:
    • WATER soluble vitamin
    • Contributes to development of DNA
    • Necessary for metabolism of Amino Acids
    • Crucial for pregnant women
    • May MASK B12 deficiency anemia
    • Do NOT exceed 1,000 mcg/day
  57. Vitamin B12
    • WATER soluble vitamin
    • essential to:
    • HEALTHY red blood cells & nerve cells
    • creation of DNA
    • Do NOT exceed 3,000 mcg/day
  58. Vitamin C:
    WATER soluble vitamin

    • NECESSARY for:
    • production of collagen
    • growth & repair of tissues
    • HEALTHY immune system

    • TOO MUCH can cause harmful oxidation in body, GI upset, interfere with activity of Anticoagulants, cause Kidney Stone formation, Gout
    • NO MORE than 2,000 mg/day
  59. Vitamin D:
    • FAT-soluble vitamin
    • EXCESSIVE amounts can lead to Bone pain, Nausea, Vomiting, Kidney Stone, defects of developing teeth, & Hypercalcification of soft tissue, bones, brain, nerves, & arteries
    • Do NOT take MORE THAN 10,000 IU
  60. Vitamin D is IMPORTANT for 2 Things:
    • 1.) Normal levels of Phosphorus & Calcium in blood
    • 2.) Contributes to STRONG Bones & Teeth
  61. Vitamin E
    FAT-soluble vitamin

    • Antioxidant that PROTECTS against free radicals
    • taking MORE THAN 1,000 mg/day can cause Heart problems, INCREASED Lipids, & EXCESSIVE bleeding
    • If taken WITH Aspirin, it can cause gingival bleeding

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