What are the guidelines to counsel medicated patient?

 

Guidelines for counselling medicated patients

The following guidelines provide information about potential food-medication interactions. 

1. Pertinent medication information: The name of the drug, drug interaction, and duration of therapy

eg Ciprofloxacin (cipro) , antibiotic, 10 day therapy.

2. When and how to take a drug:  eg take the drug in the A.M, P.M 6h before bed time; on an empty stomach; 1 h before or 2h after meals; or with food, meals or specific beverages. eg Food decrease absorption of bisphosphonate Alendronate (fosamax) 

MNT: Take at least 30 min before ant food or beverages except water.

3. Expected side effects and dietary suggestion to relieve symptoms of side effects.

4. Nutritional problem that may arise from medication use, especially if dietary intake is inadequate.

eg potassium- depleting  diuretics eg furosemide (Lasix) may cause hypokalemia, hypomagnesemia, or hyponatremia.

MNT: increase intake of high potassium and high magnesium foods. Avoid low Na diet if hyponatremia occur.

5. Dietary changes that may alter drugs action( particularly after drug has reached steady state):eg inconsistent intake of vitamin K containing foods may effect the anti-coagulant effect of Warfarin(coumadin).

MNT: Maintain consistent intake of food high in vitamin K.

6.Foods and beverages to avoid or limit while taking the drug : eg To prevent a hypertensive crises, avoid food high in tyramine or other pressor amines with an MAOI such as Phenelzine sulfate (Nardil).

7.Advice on alcohol ingestion: Concurrent intake of some medication with beer, wine, other alcoholic beverages or alcohol used in cooking modify the effect of both or may produce undesirable side effects.

eg A disulfiram like reaction result from concurrent alcohol and metronidazole (flagyl) 

8. Possible interactions between medication and vitamins, minerals and other food supplements: eg concurrent administration of calcium supplements or other divalent/trivalent cation and an antibiotic such as tetracycline or ciprofloxacin may impair absorption of both calcium and antibiotics.

MNT: Take antibiotics 2h before or 6h after ingestion of divalent/trivalent cation eg: Ca, Mg or Fe.

eg ST Johns wort induce CYP3A4, lowering cyclosporine , simvastatin blood level/effectiveness.

MNT: Do not take ST john wort  while taking effected drug.

9. The importance of following special diet prescription for treatment of medical condition: eg Antihyperlipidemic drug, eg atorvastatin therapy is an adjunct to a low cholesterol, low fat diet.

eg A prescribed diabetic diet  is an adjunct to antidiabetic medication such as insulin and metformin.

10. A personal dietary prescription pertains to that person only. Do not follow dietary suggestion of others: Dietary restriction with potassium-sparing diuretics differ from those with potassium-depleting diuretics.

11. Before modifying a diet or dietary prescription the prescribing physician must be consulted.

12. For in-depth nutritional information, consult a registered dietitian.

13. For question regarding drug action or possible side effects , consult a registered pharmacist.

What are the guidelines to counsel medicated patient?

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