Question

1. Cameron has been experiencing knee pain on an ongoing basis and decided to start taking two tablets of Aleve daily. What precautions would you and a pharmacist inform this individual of?
2. Sandy has been prescribed Lipitor to help manage her serum cholesterol. What dietary restriction does she need to be educated about and why?
3. Raymond was recently admitted to the hospital for heart failure and received written orders for administration of Warfarin, a blood thinner. As his RD, explain the food-drug interaction patient education you would provide him with.
4. Wendy’s diet consists of predominantly Vietnamese food. However, she was temporarily given a prescription for a MAO Inhibitor for the next month. Describe the impact that certain foods can have on her health while on that medication and the type of diet she needs to follow. Why is it imperative for her to adhere to this restriction?
5. Carl is a type 2 diabetic who maintains stable blood sugar levels each day. He had a medical emergency with symptoms that warranted daily administration of Solumedrol. Over the past week, he has noticed feeling hungrier than usual. What nutrition-related side effects would you advise this patient on?
6. Karen suffered a severe back injury from a MVA a couple weeks ago. Her back and hip pain has been more intense than she expected even after a couple weeks. In addition to ongoing physical and occupational therapy, she has been prescribed a daily double dosage of Oxycontin. Explain some nutrition-related precautions this patient should be counseled about.

Answer 1

1 . precautions which I will suggest for medication Aleve is -
Caution is warranted in patients with cardiac disease, hypertension, GI disease, impaired hepatic or renal function, and those using anticoagulants concurrently. Aleve crosses the placenta and is distributed in breast milk, warranting caution in lactation. Aleve should not be used during the third trimester of pregnancy because it may cause adverse effects in the fetus, such as premature closing of the ductus arteriosus. The safety and efficacy of Aleve have not been established in children younger than 2 yr. Children older than 2 yr are at an increased risk for developing a rash during Aleve therapy. In elderly patients, GI bleeding or ulceration is more likely to cause serious complications, and age-related renal impairment may increase the risk of hepatotoxicity and renal toxicity; a reduced dosage is recommended. Cardiovascular event risk may be increased with duration of use or preexisting cardiovascular risk factors or disease. Use caution in patients with fluid retention, heart failure, or hypertension. Use lowest effective dose. Risk of myocardial infarction and stroke may be increased following CABG surgery. Do not administer within 4-6 half-lives before surgical procedures. Because the drug may cause dizziness, do not perform tasks requiring mental concentration or motor skills until the effects of the drug are known.
Notify the physician if black or tarry stools, persistent headache, rash, visual disturbances, or weight gain occurs. CBC (particularly hemoglobin, hematocrit, and platelet count), BUN level, serum alkaline phosphatase, bilirubin, creatinine, AST (SGOT), and ALT (SGPT) levels to assess hepatic and renal function, and pattern of daily bowel activity and stool consistency should be assessed during therapy. Therapeutic response, such as decreased pain, stiffness, swelling, and tenderness; improved grip strength; and increased joint mobility, should be evaluated.

2.

DASH DIETDash Diet Tips

Add a serving of vegetables at lunch and at dinner.
Add a serving of fruit to your meals or as a snack. Canned and dried fruits are easy to use, but check that they don't have added sugar.
Use only half your typical serving of butter, margarine, or salad dressing, and use low-fat or fat-free condiments.
Drink low-fat or skim dairy products any time you would normally use full-fat or cream.
Limit meat to 6 ounces a day. Make some meals vegetarian.
Add more vegetables and dry beans to your diet.
Instead of snacking on chips or sweets, eat unsalted pretzels or nuts, raisins, low-fat and fat-free yogurt, frozen yogurt, unsalted plain popcorn with no butter, and raw vegetables.
Read food labels to choose products that are lower in sodium.For instance, start by limiting yourself to 2,400 milligrams of sodium per day (about 1 teaspoon). Then, once your body has adjusted to the diet, cut back to 1,500 milligrams of sodium per day (about 2/3 teaspoon).

3.

1. vit k rich foods :Since vitamin K and warfarin work against each other, the amount of vitamin K in your diet can change
warfarin’s effects. It is important to keep your dietary intake of vitamin K consistent. Foods such as green
leafy vegetables and certain oils have higher contents of vitamin K. (See the next page for a chart of vitamin
K content in selected foods). If you DECREASE your intake of vitamin K (eat fewer foods containing
vitamin K) your dose of warfarin may need to be lowered to prevent bleeding. If you INCREASE your
intake of vitamin K, your dose of warfarin may need to be increased to prevent blood clots. A MAJOR
change in your vitamin K intake can affect your PT/INR, but normal daily variation in the foods you eat is
okay. You DON’T have to avoid foods that are high in vitamin K, just keep your diet consistent. You
should let your healthcare professional know if there is going to be a major change in your diet, so your
PT/INR can be closely monitored.

2.Alcohol:Interactions between alcohol and warfarin have
been reported. There are two possible
mechanisms of interaction with alcohol: alteration
of protein binding and inhibition or induction of
CYP2C9 isoenzyme.

Acute alcohol consumption can
decrease warfarin metabolism and increase
warfarin effect, whereas chronic alcohol
consumption can induce warfarin metabolism and
decrease warfarin effect.12 Due to the increased
risk of bleeding with acute alcohol consumption,
patients should be advised to avoid or limit
alcohol consumption while on warfarin.

3.High protein diet:

The diets instruct patients to
increase dietary intake of protein and decrease
intake of carbohydrate-containing foods. Both
diets have an induction phase, where patients are
to eliminate almost all carbohydrates from their
diet for at least two weeks.Warfarin is a medication that is highly protein
bound.1 The decreased INR in patients following
initiation of a high-protein, low-carbohydrate diet
may be related to the effect of protein intake on
albumin level.5
An increase in albumin level
appears to occur within ten days of initiating a
high-protein, low-carbohydrate diet.5 The increase
in albumin level causes an increase in warfarin
binding to albumin, making less free warfarin
available for anticoagulant effect.

4.cranberry juice :
The potential interaction is
suspected to be due to flavonoids found in
cranberry. It is theorized that the flavonoids in
cranberry might inhibit CYP2C9 metabolism of
warfarin, and therefore, increase INR.7,8 Another.theoretical mechanism of interaction is the
antiplatelet effect of the cranberry constituent,
salicylic acid.8 Cranberry juice contains
approximately 7 mg of salicylic acid per liter.
Drinking three 250 mL servings of cranberry juice
daily for two weeks increases serum salicylate
levels.8
Theoretically, the salicylic acid in
cranberry could potentiate warfarin’s
anticoagulant effect.

5 . Caffeine:Caffeine is a substrate
for CYP1A2 and theoretically may compete with
R-warfarin for metabolism.2 The hydrocarbons of
charbroiled food can induce CYP1A2, therefore
can theoretically increase R-warfarin metabolism
and decrease warfarin effect.2 Due to the lack of
evidence of these interactions, the best advice
right now is to tell warfarin patients to keep their
caffeine consumption consistent and limit
consumption of charbroiled foods.

Here we can conclude that Drug- interactions with warfarin can
potentially lead to hemorrhage or
thromboembolism. Therefore, it is important that
healthcare professionals are aware of the potential
implications of these drug-food interactions with
warfarin. Patients should be aware that changes
in dietary habits can sometimes affect warfarin
efficacy and should be advised to consult their
healthcare professional prior to making major
changes in their diet.

3.now daitery restrictions for Raymond is Avoid consuming foods that are high in tyramine if you take an MAOI. You may need to continue following a low-tyramine diet for a few weeks after you stop the medication.

Examples of foods high in tyramine include:

Strong or aged cheeses, such as aged cheddar, Swiss and Parmesan; blue cheeses such as Stilton and Gorgonzola; and Camembert. Cheeses made from pasteurized milk are less likely to contain high levels of tyramine — for example, American cheese, cottage cheese, ricotta, farmer cheese and cream cheese.
Cured meats, which are meats treated with salt and nitrate or nitrite, such as dry-type summer sausages, pepperoni and salami.
Smoked or processed meats, such as hot dogs, bologna, bacon, corned beef or smoked fish.
Pickled or fermented foods, such as sauerkraut, kimchi, caviar, tofu or pickles.
Sauces, such as soy sauce, shrimp sauce, fish sauce, miso and teriyaki sauce.
Soybeans and soybean products.
Snow peas, broad beans (fava beans) and their pods.
Dried or overripe fruits, such as raisins or prunes, or overripe bananas or avocados.
Meat tenderizers or meat prepared with tenderizers.
Yeast-extract spreads, such as Marmite, brewer's yeast or sourdough bread.
Alcoholic beverages, such as beer — especially tap or homebrewed beer — red wine, sherry and liqueurs.
Combination foods that contain any of the above ingredients.
Improperly stored foods or spoiled foods. While you're taking an MAOI, your doctor may recommend eating only fresh foods — not leftovers or foods past their freshness dates.

Physiological problem duo to intake of tyramine-Tyramine is physiologically metabolized by monoamine oxidases (primarily MAO-A), FMO3, PNMT, DBH, and CYP2D6.Human monoamine oxidase enzymes metabolize tyramine into 4-hydroxyphenylacetaldehyde If monoamine metabolism is compromised by the use of monoamine oxidase inhibitors (MAOIs) and foods high in tyramine are ingested, a hypertensive crisis can result.

Tyramine Reaction Tyramine 1 Norepinephrine — Hypertensive crisis MAO-A MAO-A Inhibitors + Tyramine-rich foods Cheese Wine Meats Chocolate Smoked/pickled foods

4.Mr. Carl is is adviced for nutrition-related side effects :Nausea, vomiting, heartburn, headache, dizziness, trouble sleeping, appetite changes, increased sweating, acne, or pain/redness/swelling at the injection site may occur.

5.most studies have included only males, leaving the question of whether oxytocin also reduces food intake in females unclear.oxytocin effects intake of lipid emulsions others have demonstrated that oxytocin suppresses consumption of high-fat diets.

Furthermore, oxytocin might affect appetite indirectly by altering levels of other appetite-regulating hormones .

Evidence increasingly suggests that in humans, oxytocin is involved in normal and aberrant eating behaviours.