II.

Drug-Food interactions:

1. Defination: A change in a drug’s effect on the body when the drug is taken together with
certain foods (or beverages). Not all drugs are affected by food, and some drugs are
affected by only certain foods. A drug-food interaction can delay, decrease, or enhance
absorption of a drug. This can decrease or increase the action of the drug or cause adverse
effects.
2. Classification:
a. Drug -> Nutrient (effect of drug on nutritional status)
b. Food -> Drug ( effect of food on efficiency of medication)
3. Mechansim:
a. Medications can cause: Decrease appetite, nause, vomitting, an unpleasant taste or dry
mouth.
- Decrease nutrient absorption: Laxatives can decrease the absorption of many vitamins
and minerals, some cholesterol lowering medications reduce cholesterol by removing bile
acids.
- Slow down nutrient production: vitaK is produced by bacteria in the intestines, antibiotics
kill bacteria which id responsible for vitaK prduction.
- Interfere with body ability to metabolize nutrients
- Loss of nutrients: aspirin cause increased loss of folate, cause ulcers, bleeding -> loss of
iron -> anemia. Clobazam cause the liver to increase the removal of vitaD.
b. Nutrients could make the medications worl faster, slower or prevent them from working at
all.
- Drugs are are quickly absorbed in the stomach emptying, having food in the stomach will
slow down medication’s absorption
- Dietary Ca bind with antibiotic tetracycline -> body does not absorb the amount of
antibiotic intended.
- Foods interfere with drug’s metabolism in the body.
4. Example:
- Calcium-Rich Foods + Antibiotics: forming an insoluble substance in the stomach and
upper small intestine that the body is unable to absorb.
- Pickled, Cured, and Fermented Foods + MAIOs: dangerous increase in blood pressure.
- Vitamin K-Rich Foods + Warfarin: inhibiting vitamin K. Therefore, an increased intake of the
nutrient can antagonize the anticoagulant effect and prevent the drug from working.
- Alcohol + Prescription Stimulants: cause the patient to not fully realize how intoxicated they
are.
- Grapefruit and Grapefruit Juice + Statins: Compounds in grapefruit called furanocoumarin
chemicals cause an increase in medication potency by interacting with enzymes in the small
intestine and liver. This interaction partially inactivates a number of medications under normal
circumstances.
III. Drug – disease interaction:

1. Defination:occur when a drug affects a preexisting disease or condition.

Diseases can interact with drugs to increase the risk of adverse effects.
2. Classification + Mechanism

a. ChronicKidney Disease: any drug that is toxic to the kidneys, or is

nephrotoxic, must be prescribed with care. Any drug is then excreted
through the kidneys may have delayed excretion in a patient with CKD and
may accumulate in the body to toxic levels. And This may affect how a drug is
metabolized.

b. Cardiovascular Disease: Non-steroidal anti-inflammatory drugs, or NSAIDS, may

also be dangerous in the context of high blood pressure because they cause fluid
retention

c. Digestive Disease: Patients with peptic ulcer disease should not take NSAIDS as
they wear away the stomach lining and increase stomach acidity. In inflammatory
bowel diseases, such as Crohn's disease, the walls of the intestines are often
thickened, which slows the absorption of any drug.
4. Example:

- aspirin increases bleeding in patients with peptic ulcer disease; people with high
blood pressure may be at greater risk for increased heart rate with oral
decongestants found in over-the counter cough, cold and allergy products.
- The anticoagulant warfarin causes more bleeding in elderly patients and usually
requires a lower dose.

IV. medicine is taken with food, during or between meal because: To reduce side
effects of nausea or vomiting (Examples include allopurinol, bromocriptine
 and madopar). To reduce side effects of stomach irritation, including
indigestion, stomach inflammation or ulcers ( Examples include:
 aspirin
 non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac
and ibuprofen
 steroid medication (corticosteroids), such as prednisolone and
dexamethasone). To treat problems such as heartburn, reflux or
indigestion. To ensure the medicine is not washed away. To ensure the
medicine is absorbed into the bloodstream properly. To help the body
process the meal.
----in the morning: Blood pressure. Timing depends on medicine type. Generally take diuretics
early in the day and everything else at bedtime. If you take several meds for blood pressure,
take some in the morning and some before bedtime. Thyroid. Take first thing in the morning on
an empty stomach. Cholesterol. Take statins before bedtime.
V. which system medicine which is suitable for pregnancy

1. Medications to avoid: Thalidomide, Vitamin A derivatives from

supplements or medicines, Certain anticancer drugs and immune-system-
modifying medicines, Alcohol in chronic or high dose.
2. Medications that are safer to take than not
Untreated maternal disease, such as epilepsy or depression, can increase
the likelihood of a child being born with defects.

It may be more harmful for the fetus if the mother stops medication
prescribed for her chronic condition during the pregnancy. This could
include antidepressants, asthma inhalers or anti-convulsants.