Case Study 1 Medications
Medications
(brand name
and generic)
Multivitamins/
Minerals
Cyanocobalam
in (Vitamin
B12)
Used to treat?
Mechanism of Action
Nutritional Implications/Interactions
Vitamin and/or
mineral
deficiency8
Multiple vitamin/fluoride supplement8
May cause constipation, diarrhea, nausea,
vomiting, heartburn, stomach pain/upset, black
or dark-colored stools or urine, headache, or
unpleasant taste in mouth.9
Vitamin B12
deficiency/pernicio
us anemia8
Vitamin B12 is used in the body in two forms:
Methylcobalamin and 5-deoxyadenosyl
cobalamin. The enzyme methionine synthase
needs methylcobalamin as a cofactor. This
enzyme is involved in the conversion of the
amino acid homocysteine into methionine.
Methionine in turn is required for DNA
methylation. 5-Deoxyadenosyl cobalamin is a
cofactor needed by the enzyme that converts Lmethylmalonyl-CoA to succinyl-CoA. This
conversion is an important step in the extraction
of energy from proteins and fats. Furthermore,
succinyl CoA is necessary for the production of
hemoglobin, the substances that carries oxygen
in red blood cells.8
May cause chest pain, feeling short of breath,
swelling, rapid weight gain, nausea, diarrhea,
upset stomach, or dizziness.9
May cause low potassium levels in the blood.9
May contain albumin, which can infrequently
build up to dangerous levels in the body which
increases the risk in people with kidney
disease.9
Ferumoxytol
Sodium
Chloride
Iron deficiency
anemia8
Fluid and
electrolyte
balance, osmotic
pressure control,
and water
distribution8
Superparamagnetic iron oxide nanoparticle
coated with a low molecule weight semisynthetic carbohydrate. The iron is released from
the iron-carbohydrate complex within vesicles in
the macrophages. Iron then either enters the
intracellular storage iron pool (e.g., ferritin) or is
transferred to plasma transferrin for transport to
erythroid precursor cells for incorporation into
hemoglobin.8
Principal extracellular cation8
May cause nausea, vomiting, diarrhea, stomach
pain, constipation, headache, dizziness, or
swelling in hands or feet.9
May make hypotension worse.9
May reduce the absorption of concomitantly
administered oral iron preparations.9
May cause nausea, vomiting, stomach pain, or
swelling in hands, ankles, or feet .9
Be cautious of salt intake when taking this
medicine, especially with patients who have
high blood pressure, kidney or liver disease,
fluid retention, congestive heart failure, or are
on a low-salt diet.9
Contains aluminum which may build up with
prolonged usage and have harmful effects in
certain patients (kidney patients).9
Methylprednis
olone Sodium
Succinate
Used to treat
certain forms of
arthritis; skin,
blood, kidney, eye,
thyroid, and
intestinal
disorders; and
multiple sclerosis8
Unbound glucocorticoids cross cell membranes
and bind with high affinity to specific
cytoplasmic receptors, modifying transcription
and protein synthesis. By this mechanism,
glucocorticoids can inhibit leukocyte infiltration
at the site of inflammation, interfere with
mediators of inflammatory response, and
suppress humoral immune responses.8
May cause bowel/bladder dysfunction,
increased appetite, nausea, or malaise.9
May need to limit the amount of salt and
increase the amount of potassium in the diet.9
This medicine should not be taken with
grapefruit juice due to it increasing the levels of
this medication in the blood.9
Famotidine
(Pepcid)
Sodium
Phosphate
Potassium
Chloride
Insulin Aspart
(Novolog
Flexpen)
Treat and prevent
ulcers in the
stomach and
intestine8
Used to empty the
colon (large
intestine, bowel)
before a
colonoscopy8
Famotidine binds competitively to H2-receptors
located on the basolateral membrane of the
parietal cell, blocking histamine affects. This
competitive inhibition results in reduced basal
and nocturnal gastric acid secretion and a
reduction in gastric volume, acidity, and amount
of gastric acid released in response to stimuli
including food, caffeine, insulin, betazole, or
pentagastrin.8
As a laxative, exerts osmotic effect in the small
intestine by drawing water into the lumen of the
gut, producing distention and promoting
peristalsis and evacuation of the bowel.8
May cause headache, constipation, nausea,
vomiting, diarrhea, or dizziness.9
Avoid or minimize alcohol intake because side
effects from drinking alcohol may worsen when
taking this medicine.9
Can be taken with or without food.9
May cause nausea, vomiting,
stomach/abdominal pain or bloating, dizziness,
or headaches.9
Can take with or without food but if stomach
upset occurs, take with food.9
Used to prevent or
treat low blood
levels of
potassium8
Supplemental potassium in the form of high
potassium food or potassium chloride may be
able to restore normal potassium levels.8
Used to control
blood sugar in
those with
diabetes8
Rapid-acting insulin analog that is engineered
for mealtime use.8
Drink extra fluids while taking medication
because of increased risk of dehydration.9
May cause nausea, vomiting, flatulence,
abdominal pain, and diarrhea.9
Do not take together with dietary salt
substitutes or low salt milk products which
contain potassium. Taking these can increase
the level of potassium in the blood which can
cause muscle weakness or abnormal heart
rhythms.9
Use doctor recommendations when taking this
medicine with food. The amount of
carbohydrates eaten is directly correlated with
the amount of this medication taken. Recognize
the symptoms of hypoglycemia and
hyperglycemia.9
Alcoholic beverages can increase the risk of
low blood sugars or can cause increased blood
sugar due to extra caloric intake. Limit the
intake of alcohol. Monitor blood sugars
regularly.9
Levothyroxine
Sodium
(Synthroid)
Eliquis
Used to treat
hypothyroidism8
Used to prevent
stroke or blood
clots in people
with atrial
fibrillation8
Diffuse into the cell nucleus and bind to thyroid
receptor proteins attached to DNA. This
hormone nuclear receptor complex activates
gene transcription and synthesis of messenger
RNA and cytoplasmic proteins.8
Inhibits free and clot-bound FXa, and
prothrombinase activity. Apixaban has no direct
effect on platelet aggregation, but indirectly
inhibits platelet aggregation induced by
thrombin. By inhibiting FXa, apixaban decreases
thrombin generation and thrombus
development.8
Stop smoking or limit tobacco use because
tobacco can increase blood sugars which can
increase insulin amounts. Monitor blood sugars
regularly.9
May cause vomiting, diarrhea, appetite changes,
weight changes.9
Take this medication on an empty stomach 1
hour before eating/tube feedings or nutritional
supplement beverages because food can limit
the absorption of these hormones from the
stomach.9
Interacting foods include: soy protein, high
fiber foods, liquid nutrition shakes, and
walnuts.9
May cause constipation, nausea, vomiting,
diarrhea, abdominal pain upper, abdominal
pain, dyspepsia, gastritis, gastroenteritis.9
Can take medication with or without food,
usually twice daily.9
Ondanestron
Hcl (Zofran)
Used to treat
nausea and
vomiting caused
by cancer drug
treatment or after
surgery8
Inhibition of serotonin 5-HT3 receptors in turn
inhibits the visceral afferent stimulation of the
vomiting center, likely at the level of the area
postrema, as well as through direct inhibition of
serotonin activity within the area postrema and
the chemoreceptor trigger zone.8
May cause constipation, diarrhea, or headache9
Can take medication with or without food9
May contain phenylalanine; those with
phenylketonuria should not take this
medication.9