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6/2/2016

Drug-Nutrient Interactions in the


Elderly: Beyond the Prescription

Megan Finnie, RDN, CSG, LD


Chief Operations Officer
Dietary Consultants, Inc.

Note that all references utilized are

Learning Objectives cited at the end of the presentation,


some are also cited on the slides
throughout the presentation.

 Drug-Nutrient Interaction in the Elderly: Beyond the


Prescription
 1.) Discuss the importance of recognizing the potential for a
drug-nutrient interaction
 2.) Understand the importance of gathering all data regarding
medications and supplements when completing recalls and
interviews
 3.) Review drug-nutrient interactions of common supplements
and prescription medications for the aging population

1.0 hour CE

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Recognizing the
potential for a drug-
nutrient interaction

Drug-Nutrient Interaction Definition

 “Drug-nutrient interactions are defined as physical,


chemical, physiologic, or pathophysiologic
relationships between a drug and a nutrient.
 The causes of most clinically significant drug-
nutrient interactions are usually multifactorial.
 Failure to identify and properly manage drug-
nutrient interactions can lead to very serious
consequences and have a negative impact on
patient outcomes.”

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Nutrient Definition

NUTRIENT:
A substance that provides nourishment
essential for growth and the
maintenance of life.

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Types of Nutrients?

Classes of nutrients: Quick Breakdown


Class Composition Calories Essential Other notes
? ? ?
1.) Carbohydrate C, H, O 4 kcal/g “No” Body does better with carbs, different types of carbs noted

2.) Fat C, H, O 9 kcal/g Yes Essential FA, different types of fats

3.) Protein C, H, O, N 4 kcal/g Yes 8 (9) Essential amino acids

4.) Vitamins Inorganic 0 kcals Yes 13 vitamins (4 Fat-soluble, 9 water soluble)

5.) Minerals Inorganic 0 kcals Yes Ca, Na, K are most abundant, many needed

6.) Water H, O 0 kcals Yes H20 – Mostly what your body is made up of

7.)? Alcohol? C, H, O 7 kcal/g No Ethanol, ETOH.


NOT essential, but arguably a nutrient as it provide kcals
and some possible health benefits

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Vitamins – There are ONLY 13!


Vitamins – 13 in total (Available in different forms)
1 A Fat-soluble
2 D Fat-soluble
3 E Fat-soluble
4 K Fat-soluble
5 C (Ascorbic Acid) Water-soluble
6 B-1 (Thiamine) Water-soluble
7 B-2 (Riboflavin) Water-soluble
8 B-3 (Niacin) Water-soluble
9 B-5 (Pantothenic Acid) Water-soluble
10 B-6 (Pyridoxine) Water-soluble
11 B-7 (Biotin) Water-soluble
12 B-9 (Folic Acid, Folate) Water-soluble
13 B-12 (Cyanocobalamin) Water-soluble
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U.S. Drug-Nutrient Interaction Statistics

 Roughly 13% of the U.S. population is 65 years or


older
 Yet over 33% of all prescription medications are
used by this group
 The combination of alcohol and medication misuse
has been estimated to affect up to 19% of older
Americans.
 Approximately 25% of older adults use prescription
psychoactive medications that have a potential to
be misused and abused.

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Potential for drug-nutrient interaction

 Increases with polypharmacy

 As age increases, usually = increase in need for meds

 Changing digestion and absorption

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Additional Risk Factors

 Dementia/cognitive status change


 Drugs contributing to cognitive status changes
 Availability of food/food insecurity (will eat or drink
what is available)
 Not taking drugs as prescribed (cost, sense of time,
lack of routine schedule, depression/self-neglect, etc.)
 Alcohol and/or drug abuse
 Organ systems not working at max capacity, may
compromise ability to break down or effectively use the
drug, the drug may stay in the body longer than in a
younger person

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Why is it important to watch for


potential drug-nutrient interactions?
 Prevention of negative outcomes, including:
 Death
 Dehydration, Malnutrition
 Decreased quality of life
 Skin integrity deficits
 Vitamin or mineral toxicity, or deficiency
 Drug toxicity, or decreased efficiency of the drug
 Elimination pattern changes (constipation or diarrhea,
excessive or inadequate urine output)
 Change in PO intake patterns
 And more…

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Why is it important to watch for


potential drug-nutrient interactions?
Isn’t that the MD’s job?
Isn’t that the pharmacist’s job?
Isn’t that the nurse’s job?
Isn’t that the dietitian's job?
Isn’t that the resident/patient/client’s job?
Isn’t that the family’s job?

IT’S EVERYONE’S JOB AS PART OF THE


INTERDISCIPLINARY TEAM!
Dietary managers, food service directors, and dietary staff
are all valued members of the team!

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Gathering all data


regarding medications and
supplements when
completing recalls and
interviews

Medications and nutritional recalls


and interviews

Ask individual or family member to bring a


list of all medications they currently take
Record all meds, even ones that may not
“seem” important

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Over-the-Counter (OTC)

 Ask about over-the-counter drugs and supplements


they may either routinely take, or take from time to
time
 NSAIDs - anti-inflammatories (Acetaminophen,
ibuprofen, aspirin, etc.)
 Vitamins and minerals
 Fiber supplements
 Herbs and other plant-based supplements
 Antihistamines (Claritin, Benadryl, etc.)
 Others?

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When completing a dietary recall or


interview with someone:

The number of meds can provide great clues


as to what is going on. Recognizing
categories of drugs and their common uses
can also provide great insight as to health
conditions

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Suggested Interview/Recall
Questions
 Are you taking any vitamin or mineral supplements?
What and how often?

 Do you smoke or chew tobacco? How many cigarettes


(cigars or chewing tobacco, e-cigs) per day?

 Do you drink any alcohol? How much per day and


when?

 Are there any foods your doctor or pharmacist has told


you to avoid due to drug-nutrient interactions?

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Review the list of meds with others,


such as the dietitian, and the IDT

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Drug-nutrient interactions of
some common supplements
and prescription medications
for the aging population

5 Most Common Foods that Contribute


to Drug-Nutrient Interactions
1.) Grapefruit juice
2.) Leafy green vegetables
3.) Salt substitutes
4.) Natural Black Licorice (Glycyrrhiza)
5.) Tyramine-containing foods
 Includes: chocolate, aged and mature cheeses,
smoked and aged/fermented meats, hot dogs, some
processed lunch meats, fermented soy products
and draft beers (canned and bottled beers are OK)

http://www.eatright.org/resource/health/wellness/preventing-illness/common-
food-drug-interactions

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Most common plant/herb supplements


r/t drug-nutrient interactions
 Gingko Biloba
 Garlic
 St. John’s Wort
 Milk Thistle
 Echinacea
 Ginseng
 Hawthorne
 Saw Palmetto

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Common prescription medications r/t


drug-nutrient interactions
Generic Name Brand Name Type of drug/Use Drug-nutrient interaction

Warfarin Coumadin Blood thinner Vit. K r/t blood clotting


Digoxin Lanoxin Treat HF, A-Fib Avoid black licorice (Natural)

Prednisone Deltasone Corticosteroid, immunosuppressant Ca, K+, Mg, other losses


Maxzide HCTZ Diuretic K+ wasting
Spironolactone Aldactone Diuretic K+ sparing

Torsemide Bumex Diuretic K+ wasting, Mg, Ca, others


Furosemide Lasix Diuretic K+ wasting, Mg, Ca, others
Phenytoin Dilantin Anticonvulsant Vit D needs increase
Cholestyramine Questran Cholesterol-lowering drug Can bind with fat-soluble vit

Glucophage Metformin Oral agent r/t diabetes B12 Def.


Rheumatrex Methotrexate Cancer drug, RA and psoriasis control Folic acid needs increase

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Common prescription medications r/t


drug-nutrient interactions

Classes Drug Names Drug Use Drug Nutrient 


of drugs interaction
MAOI phenelzine Psychotropic meds Tyramine-containing
tranylcypromine foods can raise
blood pressure
dangerously
STATINS pravastatin, Cholesterol lowering Grapefruit juice
simvastatin, meds
atorvastatin,
lovastatin, etc.

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In Conclusion:

 Elderly more at risk for drug-nutrient interactions r/t


change in metabolism/physiological function, and
likelihood of polypharmacy

 Drug metabolism changes are not well understood


in the elderly

 Alcohol and caffeine interfere with most


prescription and OTC meds

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In Conclusion (Cont.)

 Your healthcare facility should not serve: grapefruit


juice or natural licorice products

 Your menu should have consistent amounts of high


Vitamin K foods (cabbage, broccoli, greens)

 Refer to your diet manual, contact your pharmacist


and dietitian with questions on drug-nutrient
interactions

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Questions?
THANK YOU!
Megan Finnie, RDN, CSG, LD
Email: mfinnie@dietaryconsultants.com

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References

Begun, Rachel. “5 Common Food-Drug Interactions.” http://www.eatright.org/resource/health/wellness/preventing-illness/common-


food-drug-interactions. Web. 9 Oct 2014.

Bobroff L, Lentz A, and Turner RE. “FOOD/DRUG AND DRUG/NUTRIENT INTERACTIONS: What You Should Know About Your
Medications.” http://edis.ifas.ufl.edu/pdffiles/He/HE77600.pdf Web. May 2009.

Chan LN. “Drug-nutrient interactions.” JPEN J Parenter Enteral Nutr. 2013 Jul;37(4):450-9. doi: 10.1177/0148607113488799. Epub
2013 May 14.

Genser D. “Food and drug interaction: consequences for the nutrition/health status.” Ann Nutr Metab. 2008;52 Suppl 1:29-32. doi:
10.1159/000115345. Epub 2008 Mar 7.

Salazar JA, Poon I, Nair M. “Clinical consequences of polypharmacy in elderly: expect the unexpected, think the unthinkable.”
Expert Opin Drug Saf 2007;6:695–704.

Thomas JA, Burns RA. “Important drug-nutrient interactions in the elderly.” Drugs Aging. 1998 Sep;13(3):199-209.

U.S. Food and Drug Administration. “Avoid Food-Drug Interactions: A Guide from the National Consumers League and the U.S.
Food and Drug Administration.”
http://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/Gen
eralUseofMedicine/UCM229033.pdf. Web. Accessed 1 May 2016.

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