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80 Cards in this Set

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  • Back
What are the nutrients required at adequate levels for CYP450 enzymes in phase 1 metabolism?
Copper
Magnesium
Zinc
Vitamin C
What is the most important endogenous antioxidant in neutralising free radical toxic metabolites in phase 1 metabolism?
Glutathione
What are the pathways involved in phase 2 metabolism?
Glutathione conjugation
Amino acid conjugation
Methylation
Sulphation
Acetylation
Glucuronidation
Sulphoxidation
High dose of vitamin C will do what in regards to interactions with excretion?
Acidify the urine, which will increase the half life of acidic drugs and decrease the half life of basic drugs
What is an antagonistic interaction?
where the effects of drugs and herbs/nutrients counteract each other
eg sedative drug with stimulant herb
What is a physiochemical interaction?
Where there is a chemical interaction that occurs between 2 compounds, resulting in reduced/increased absorption
What is chelation?
An interaction between a metal ion and another substance, leading to reduced activity or inactivation of mineral and/or drug
eg iron and tetracyclines
Name a positive disease interaction
Glucosamine + OA
SJW + depression
Kava + anxiety
Name a negative disease interaction
Hypertension + licorice
Pregnancy + various substances
Name some postive interactions that reduce adverse effects of drugs
Acidophilus + antibiotics
Gingko + SSRI's
Cranberry + H2 antagonists
St Marys + paracetemol
Name some positive interactions where we can minimise nutrient depletions caused by drug
CoQ10 + statin drugs
B group vitamins + OCP
Name some positive interactions where herbs/ nutrients can strengthen clinical effects of drugs
Echinacea + antibiotics
Gingko + dementia treatment
Mg + antihypertensives
What drugs are most likely to be involved with interactions?
Drugs with NTi
Anticoagulants
Antihypertensives
Antidiabetics
Who are the patients most likely at risk of interactions?
Elderly
Children
Patients with impaired liver or renal function
Name some nutrients/herbs that inhibit the P-gp system
Grapefruit juice
Apple juice
Orange juice
Rosemary extract
Genestein
Diadezine
Resveratrol
Quercetin
Green tea polyphenols
Piperine
St Mary's thistle
Name a herb/nutrient that induces the P-gp system
SJW
Name some nutrients/drugs that inhibits the cytochrome P450 enzymes
Grapefruit juice
Fluoxetine
Cimetidene
Name a herb that induces the CYP enzymes
SJW (CYP3A4)
What are the three most common ezymes in the cytochrome P450 system responsible for metabolism of most medicines
CYP3A4, CYP2D6, CYP1A2
Name the 4 types of diuretic drugs used in hypertension
Thiazide & thiazide like
Loop
Selective aldosterone blocker
Potassium sparing
What is the most common side effect of diuretics?
Hypokalaemia
What is the mechanism of action for diuretics?
Increase sodium excretion, therefore increasing fluid excretion, which then reduces plasma volume and cardiac output
What is the most common drug for the treatment of hypertension?
B-blockers
Name 2 examples of a beta blocker
Atenolol
Bisoprolol
Propranolol
Metoprolol
What is the mechanism of action for b-blockers?
Inhibit the binding of catecholamines at the B-adrenoreceptor site, which reduces CO, peripheral resistance, venous return and renin inhibition
What type of antihypertensive drug is contraindicated for use in congestive heart disease, asthma, COPD and diabetes?
Beta blockers
What are some adverse effects of beta blockers?
Bradycardia
Heart failure
Hypertriglyceridaemia
Depression
GI effects
What are some examples of ACE inhibitors?
Captopril
Lisinopril
Fosinopril
What is the mechanism of action of ACE inhibitors?
Competitive inhibition of the antiogensin-converting enzyme, which then reduces the total peripheral resistance
What are some adverse effects of ACE inhibitors?
Cough
Rash
Hypotension
Hyperkalaemia
What are the 3 classes of calcium channel blockers?
Dihydropyridines
Phenylalkylamines
Benzothiazipines
What is the mechanism of action of calcium channel blockers?
Block the entry of calcium ions into cells, which reduces the amount of calcium available for excitation-contraction proccess
What are some side effects of calcium channel blockers?
Tachycardia
Flushing
Oedema
GI disturbances
Headache
Hyperkalaemia
Risk of heart block
What are some non drug measures that can reduce hypertension?
Cessation of smoking
Reduction of obesity
Reduction of alcohol consumption
Increased exercise
Reduced sodium intake
Relaxation & stress management
What herb/nutrients have a benefical interaction with hypertensive drugs?
Garlic
Oats
Hawthorn
Fish oil
Olive leaf
Evening primrose oil
What herb/nutrients have a a negative interaction with hypertensive drugs?
Licorice
Guarana
What herb/drug interactions may exist with all diuretic drugs?
Dandelion leaf - positive
Elder - positive
Guarana - positive
Stinging nettle - positive
Licorice - negative
Laxative herb - negative
What nutrient/drug interactions may exist with thiazide diuretics?
Ca- may cause hypercalcaemia
Mg- increase excretion
CoQ10-positive but thiazides increase excretion
Zn-increase urinary exretion
B12 - reduce risk of hyperhomocysteimaemia
What nutrient/drug interactions exist with loop diuretics?
Mg-increase excretion
Zn -increase urinary excretion
B1- reduce levels
What nutrients should be assessed for deficiency if a patient is taking diuretics?
Mg
Zn
Ca
B1
B12
CoQ10
What are the nutrient/drug interactions for b-blockers?
CoQ10- reduce serum levels
Vit E-reduced drug effects
What herb/drug interactions exist for b-blockers?
Myrrh-reduce drug bioavailability
What nutrient/drug interactions exist for ACE inhibitors?
Fe-reduced drug effect, separate doses
Zn-reduced levels, supplement
K-increase serum levels
What nutrient/drug interactions exist for calcium channel blockers?
Ca-reduced drug effect
Vit D - reduced drug effect
Mg - additive effect
Quercetin - increased drug effect
What herb/drug interactions exist with calcium channel blockers?
SJW - reduces drug serum levels via CYP3A4
Guggul-reduced drug effect
Peppermint oil- increased drug effect
Korean ginseng - increased drug effect
What nutrients should you not supplement with in conjunction with calcium channel blockers/
Calcium & Vit D - due to a reduction in drug effect
What nutrient would be beneficial in supplementing with calcium channel blockers?
Magnesium
What would be some drug therapies in the treatment of congestive heart failure?
Digoxin
Diuretics
ACE inhibitors
B-blockers
Peripheral vasodilators
Dopamine antagonists
Why is potassium indicated with digoxin?
Low K levels can increase digoxin toxicity, as K competes with digoxin for binding at the Na+-K+ATPase pump
What are some nutrient/drug interactions with digoxin?
Mg - low levels increase risk of toxicity
Ca- excess calcium with digoxin may lead to sinus bradycardia, AV block
What are some herb/drug interactions with digoxin?
Aloe vera - depletes K levels
Guarana - depletes K levels
Licorice - reduces K levels
Anthraquinone laxatives - reduces K levels
Hawthorn - positive inotropic properties & potentiates effects
What are the drug therapies used in the treatment of hyperlipidaemia/hypercholesterolaemia?
Statins (HMG-CoA reductase inhibitors)
Fibrates
Bile acid binding resins
Nicotinic acid
Cholestrol absorption inhibitors
What are some examples of statins?
Atorvastatin - Lipitor
Rosuvastatin - Crestor
Simvastatin - Zocor
What is the mechanism of action for statins?
They inhibit the enzyme action of HMG-CoA reductase
What are some adverse events of statins?
GIT disturbances
Headache
Fatigue
Rash
What is the mechanism of action of fibrates?
They act at several sites by decreasing triglycerides and increasing HDL
What are some adverse effects of fibrates?
GI symptoms
LFT abnormalities
Increased risk of gallstones
MSK pain
Blurred vision
Raised blood glucose
Mild anaemia
Nephrotoxicity
Sexual dysfunction
What is the mechanism of action of bile acid binding resins?
They interfere with the reabsorption of bile acids (made from cholesterol), therefore the reduced bile levels stimulates an increase in bile production using cholesterol.
The increase in bile depletes cholestrol, this then stimulates the up-regulation of HDL receptors to draw more cholestrol from the bloodstream for bile maintenance
What are some adverse effects of resins (bile acid binding?
Bloating
Indigestion
Constipation
Nausea
Bleeding haemorrhoids
What is the mechanism of action for nicotinic acid drugs?
It inhibits VLDL which results in a reduction of LDL.
Occurs by the inhibition of fatty acid metabolism and the inhibition of triglyceride productions
What are the adverse effects of nicotinic acid ?
Hypotension
Nasal stuffiness
Diarrhoea
Headache
Hyperuricaemia
Hepatic dysfunction
What drug with a dose of 2g/day can cause liver toxicity?
Nicotinic acid
What nutrient/drug interactions exist for hyperlipadaemia drugs?
Oats - positive, reduce total cholestrol levels
Garlic - positive
Chromium - positive
Psyllium - positive
Red Yeast rice - positive
Fish oil - positive
Nicotinic acid - positive
What herb/drug interactions exist with hyperlipidaemia drugs?
Myrrh - positive, lipid lowering
Fenugreek - positive
What nutrient/drug interactions exist for statins?
Sitosterol - positive
Policosanol - positive
CoQ10 - positive
Vit A - negative
What herb/drug interactions exist with statins?
SJW - negative due to induction of CYP3A4
St Marys thistle - positive
Peppermint oil - positive
What nutrient/drug interactions exist with fibrate
CoQ10- positive
Vit A,E,K,D, Fe & folate - reduce absorption - separate dose by 4 hours
What are some examples of anti-coagulant/anti-platelet drugs?
Warfarin
Aspirin
Heparin
Pehindione
What is the mechanism of action for warfarin?
Inhibits the synthesis of Vit K dependent coagulation factors
What are some mild adverse effects associated with warfarin?
Easy bruising
Poor appetite
Nausea
Vomiting
Abdominal cramps
Patch hair loss
Mild skin rash
Hives
What are some more serious advserse effects associated with warfarin?
Adnormal bleeding
Abnormally heavy/persistent periods
Blood in stools
Nosebleeds
Allergic reaction
What cytochrome P450 enzymes is warfarin metablised by?
CYP2C9
CYP3A4
CYP1A2
What is the most significant nutrient interaction with warfarin?
Vitamin K - patients should avoid any products that contain Vit K
What are some foods with a high vitamin K level?
Asparagus
Avocado
Brocolli
Cabbabe
Celery
Cauliflower
Corn
Eggs
Fish
Kale
Lettuce
Meat
Milk
Mustard greens
Turnip
What are some nutrient/drug interactions for warfarin?
CoQ10- decreases drug effects
Carnitine- may cause excess bleeding/bruising
Chondroitin- increased risk of bleeding/bruising
Vit E - increased risk of bleeding/bruising
Evening primrose oil - negative
Fish oil - negative
Psyllium - reduce absorption
What herb/drug interactions exists with warfarin?
Garlic - negative, may increase bleeding
Ginger- negative, inhibits platelet aggregation
Korean ginseng - negative, inhibits platelet aggregation
SJW- negative, increases metabolism of warfarin
Andrographis, cranberry, devil's claw, dong quai, ginko, guarana, licorice, rosemary, St marys thistle
What are the actions of anti-platelet drugs like aspirin/
Inhibition of platelet aggregation
Analgesic
Anti inflammatory
Antipyretic
What are some common adverse effects of aspirin?
GIT distress
Nausea
Vomiting
Erosion of gastric mucosa
Ulceration
Blood loss
What are the herb/drug interactions for anti-platelet drugs?
Garlic - negative, increase bleeding time
Ginger- negative, inhibits platelet aggregation
Willowbark - positive, enhance antiinflammatory & antiplatelet effects
What nutrient/drug interactions exist for anti-platelet drugs?
Fish oil - negative, possible increased bleeding/bruising
Vit C - aspirin decreases levels, supplement