The use of medications is a significant component in medical therapy for treating and managing many diseases. Given that there is a plethora of drugs on the market, both prescription and over-the-counter, understanding how drugs work, their side effects, any potential drug-drug/drug-nutrient interactions, and their overall nutritional implication is valuable to our career as future registered dietitians.
DISCLAIMER: This resource was developed by students as part of a needs assessment and research process within a pre-internship professional practice course. The information here is not guaranteed to be applicable to all settings. Anyone wishing to cite references on this topic should consult formal sources.
Medication Classification by Name Ending
A medication’s purpose can be determined using its name, since many from the same class will have similar endings. Here are some examples:
|Name Ending||Example||Function||Potential Side Effects||Drug-Nutrient Interactions|
|-olol||propranolol||Beta blocker (cardiac)||Upset stomach, diarrhea, constipation||Can cause hyperkalemia; avoid taking supplements containing potassium|
|-pril||captopril||ACE inhibitor (blood pressure)||Fatigue||Can cause hyperkalemia; avoid taking supplements containing potassium|
|-prazole||omeprazole||Proton pump inhibitor (PPI)||Few short-term side effects||Impaired absorption of vitamins and minerals|
|-statin||atorvastatin||Cholesterol lowering||Increased risk of developing type 2 diabetes||Avoid grapefruit or grapefruit juice throughout treatment|
|-sone||prednisone||Corticosteroid||Increased appetite and weight gain||Decreased absorption and increased excretion of calcium|
|-mycin||erythromycin||Macrolide antibiotic||Abdominal pain, diarrhea, nausea/vomiting||May interact with vitamin B6, vitamin K, calcium, and folic acid|
|-artan||losartan||Angiotensin II receptor blocker (blood pressure)||Diarrhea (rare)||Can cause hyperkalemia; avoid taking supplements containing potassium|
|-dipine||felodipine||Calcium channel blockers (cardiac)||Constipation, nausea, edema||Avoid grapefruit or grapefruit juice throughout treatment|
|-ine/one||hydromorphone||Narcotic (opioid pain reliever)||Constipation||Avoid alcohol|
What to Consider When Assessing Patients/Clients?
Medication and Client Assessment
- What is the role of the medication?
- Why is this medication relevant to the persons' medical/nutritional status?
- Have they been given/started taking the medication?
- Are they taking the medications according to what has been prescribed?
- Have they missed any doses?
- How does the medication affect their clinical status?
- How does the medication affect their nutritional status?
- Are there any food-drug interactions with this medication?
- What are the major side effects of this medication?
- What’s the client's clinical picture/current status? Ex. Are they vomiting? What are their bowel movements like?
- Are they limiting their food intake? If so, why?
Application to the Nutrition Care Plan
Step 1. Assess Abnormal Lab Values
- Look at lab values, do any of his lab values have any nutritional implications, need to be addressed?
Step 2. Assess Client Status to Determine the Etiology of Abnormal Lab Values
Step 3. Evaluate the Medications (see questions above)
- Is this medication relevant to the nutrition care plan? Does this medication have an impact on the client's nutrition care plan?
- How will this medication be incorporated into the client's nutrition care plan? Will the nutrition care plan need to be adjusted in any way?
Step 4. Create a PES Statement
- Look at the client's diet history, what are your primary concerns with their food intake?
Step 5. Form a Nutrition Care Plan
- Prioritizing: What will be the main focus of the counselling session with the client?
- What main points do you want to get across?
Responses from RDs:
1. Expectations for Internship
Q: In regards to medication knowledge, what are the expectations of students upon entering internship?
- Dietitian #1: There are no set expectations; however, the clinical portion of internship is a very steep learning curve. The more medication, labs, and details of disease states information, including nutritional implications of all of these, that students bring, the easier time that they have with regards to the overall internship because you don’t have to spend hours looking everything up to find out if it is relevant or not.
- Dietitian #2: When you first start internship, most dietitians will want you to be able to identify the function of a medication and whether or not there are nutritional implications. For example, diuretics, anti-hyperglycemic agents, motility agents, antibiotics, anti-emetics, bowel meds, PPIs, narcotics. You won’t need to know the exact mechanism of how these medications work, but you will need to know why they are being given and if it is relevant to your assessment and intervention.
- Dietitian #3: I would not expect students to have existing knowledge about various medications as this is not a topic we really focus on in school. However, once in the internship rotations, I do expect interns to look up and learn about the various medications that apply to each area and then subsequently be able to apply it in practice. This is a very steep learning curve once in your rotations, so I recommend interns take the time at night to review the medications they are not familiar with and write down the function of the medication and the nutritional implications so that they can refer back to it.
2. Common Medications
Q: What are the 5 most common medications seen in the clinical setting?
- Dietitian #1: I can’t pick just 5 because there are lots. The most common meds are to do with bowel protocol, diabetes meds, fluid balance/HTN meds, and GI meds for nausea and motility.
- Dietitian #2: That’s tough to narrow down and depends on the area you are working in/patient population. Some that are common across all settings include lasix (furosemide), maxeran (metoclopramide), gravol (dimenhydrinate), piptazo (piperacillin/tazobactam), and sennosides.
- Dietitian #3: There are not any 5 most common medications seen in the clinical setting. Every clinical setting is very different from each other (i.e. renal versus diabetes versus heart disease versus long term care) and will have different pertinent medications that interns will need to become familiar with.
3. Scope of RD
Q: What is the scope of the RD in terms of medications?
- Dietitian #1: If you are seeing someone for liver failure, you would need to know the key medications to manage this disease and what typical interventions are done. That way, you can quickly assess that they are on the right type of therapy. But then the next step is what are the side effects or nutritional implications for this medication.... Dosing is also sometimes required. Practicing RDs often make dosing recommendations for electrolyte repletion, prokinetics, anti-nausea medications, diabetes medications, etc.
- Dietitian #2: RDs need to know why a medication is being given and if it will have an impact on nutritional care in order to make recommendations for diet modifications, tube feed formula selection, parenteral nutrition prescription, or micronutrient supplementation. For example, patients on prednisone therapy require magnesium and calcium supplementation and may develop diabetes requiring diet/medication control. We are also responsible for providing recommendations for changes or additions of medications for managing nutrition related issues such as nausea/vomiting, diarrhea, constipation, and gastric motility. For example, when bowel protocols are not working we often are asked for suggestions of how to escalate the interventions to ensure patients have regular BMs. We also need to know when the impact of a medication requires nutritional intervention or not, for example low potassium due to diuretics does not require a high potassium diet, if they are on a diuretic you shouldn’t be pushing fluids, narcotics will cause nausea and constipation and this requires medical intervention not dietary intervention, antibiotics are often the cause of diarrhea not tube feeds.
- Dietitian #3: It is important for the RD to understand what the medication does (i.e. why would they be given this medication) and what the nutritional implications are of that medication. Medications may be one of the causes of the nutritional complications (i.e. antibiotics causing diarrhea) so it is important to be able to understand this so that you can create an appropriate intervention or plan.
4. Advice for Future Interns
Q: In terms of medication knowledge, what is one piece of advice you have for students regarding preparation for internship?
- Dietitian #1: Ask your site early if there is a list of medications that you should study and get on it. Then, add to that list as you read about others. Keep this with you through your clinical internship as a quick resource which will help you memorize more of them.
- Dietitian #2: Focus on bowel meds, anti-emetics, prokinetics, diabetes meds, narcotics, and the implications for patients.
- Dietitian #3: Be aware that this can be a steep learning curve and to help with this, it can be very useful in each placement to write down a list of medications that you are unfamiliar with. Then to take this and review each medication and list what the function is and the possible nutritional implications. This can be a great resource to have with you while in a rotation because it will be tailored to you and help you remember those medications that you just can’t seem to remember. It can also be helpful if you ask your preceptor what are the resources they use to look up medication information, as they may have some great resources you are not familiar with. Finally, don’t be afraid to look up something if you are not familiar with it or ask your preceptor.
Responses from 2015 Dietetic Interns:
1. How to Prepare for Internship
Q: In regards to medication knowledge, how did you prepare for internship?
- Intern #1: I didn't know much about medications prior to starting internship. I started writing down the medications in my notebook as I went through internship. I got in touch with a previous intern and she sent me a list of common medications with their function/definition and if there were any food-drug interactions with them. I then used that list as a starting point for my internship.
- Intern #2: The truth, I did not prepare for this part of internship other than completing the pre-placement assignments for clinical given to me by my preceptor. I had to fill out a chart of common medications. I think it would be helpful for fourth year dietetics students to have a blank chart and fill it out themselves! I wish I knew these meds going into my clinical rotation.
- Intern #3: I actually didn't do much to prepare regarding medication information before internship started.
2. What to Prepare for Internship
Q: What did you wish you had known or prepared prior to internship relating to medications?
- Intern #1: I think having a list to go to would have been helpful. I didn't have this list until a bit into internship, so maybe a list of common medications that future interns can use as a resource or to print off and carry around with them would be great. I don't think you can prepare for it unless you have taken the course and I don't recommend spending your summer studying medications because you will learn them in internship and you always have the time to look them up.
- Intern #2: I would also suggest knowing the different types of insulin, their onset, their peak and their duration. BC Children's has some great handouts. I like this handout: Comparison of Available Insulins. You can find other handouts here: Diabetes handouts. Insulin is a tough one but it is nice to start getting your head wrapped around it.
- Intern #3: It would have been nice to know a bit more about the classes of drugs and which ones may be nutritionally relevant, especially when it comes to enteral and parenteral nutrition (e.g. certain drugs interact with enteral formulas so the enteral feeds must be held for a certain amount of time before and after the drug is given).
3. Learning During Internship
Q: What process do you use now to learn about new medications during internship (what resources do you use to find new information)?
- Intern #1: One of my preceptors gave me a cheat sheet of how to recognize different medications. For example, if they end in 'olol', they're for high blood pressure. This helped when I was faced with a new medication and I could figure out what type of medication it is from the ending. Other than that, at Island Health we have access to "UptoDate", where you can look up any drug with its description. I just looked them up on there and added new medications to my list for future reference. Also, most of my preceptors had the Food Medication Interaction book, which was a great resource too.
- Intern #2: Be prepared to look up a lot of things in internship. Keep a running list every day of new meds you come by and look them up at the end of the day. Through my clinical rotations I have compiled a "medication dictionary" and keep it in my clinical binder. It is in the same format as the table I attached but has many more meds. I must admit I am not looking things up anymore and do not look at my medication dictionary very frequently, but it helped me learn my meds faster!
- Intern #3: I'm with Fraser Health (FH) right now, and we have electronic patient charts which include a patient's medication list. The electronic med list gives the drug class next to the name of the drug, which helps a lot when it comes to having a basic idea of a drug's uses and whether it belongs to a class of drugs that has nutritional relevance. At a lot of the sites I was in, there was usually a copy of 'Food Medication Interactions', which is a book that lists drugs and their nutritional relevance. If there was a new drug that I was unsure of, I would look it up. Also, especially when I was in my earlier placements my preceptors would usually catch a nutritionally relevant drug if I missed it so I learned a lot from them. You can always ask too if you're unsure.
4. Advice for Future Interns
Q: If you could give Year 4 Dietetics students any advice about medications during internship, what would you say?
- Intern #1: I would recommend writing down medications that you come across during internship and keep them all in one place. It would be good to save them on a document so you can have a printed copy as you go further into your internship. There are only a few medications that you will see often and you'll eventually remember them, but having a cheat sheet always helps just in case you don't. Again, you can always look things up and pharmacists are usually around on the ward, you can speak with them too. If you're able to learn the different medication categories based on their endings, it is a very quick way of learning them.
- Intern #2: Overall, I think getting a good base knowledge of meds before internship (or before your clinical rotation starts) is important, but recognize that you will never be able to know all of the meds and you do not need to memorize each one (that would be impossible). It is good to know the ones that can have a nutritional impact (i.e. insulin, diabetes oral meds, PPIs, prokinetics, anti-emetics, diuretics (especially lasix/furosemide) and statins).
- Intern #3: If you're unsure of a drug always ask or look it up. Take time, especially in your earlier placements, to do this because preceptors recognize that this is new to you so they usually don't mind if you're taking a bit longer because of this. The more you learn about different drugs in your earlier placements, the quicker you'll be in later placements at recognizing them. That being said, you'll learn about new drugs and interactions throughout your internship so even in later placements, be sure to take the time to find out about a drug if you're unsure.
- Keep a “Learning Gaps” binder to write down any lab values, medications, general assessments, words, requirements, tube feed how to’s, and any other things you are unfamiliar with, and look these up later when you get home for the next day - this will become your internship cheat sheet
- Write down a list of medications you don’t understand
- Classify your running list of medications into different categories
- Familiarize yourself with the medication categories applicable to the topic you are working in
- Create your own medication cheat sheet
- Don’t be afraid to ask questions!
- Start compiling your medications list early!
- Drugs.com: Peer-reviewed information on more than 24,000 prescription drugs, over-the-counter medicines, and natural products.
- DrugBank.ca: Drug and drug target database supported by the Canadian Institutes of Health Research and other organizations.
- HealthLink BC: An A to Z resource that details how it works, why it works, side effects, and what to think about.
- Natural Medicines: An impartial, peer-reviewed resource on dietary supplements, natural medicines, and complementary alternative and integrative therapies.
- Medline Plus: Health information from the National Library of Medicine. Browse by generic name or brand name.
- Rx List: Founded by pharmacists. Use a Drug A to Z list or enter drug name in the search box to find out more.
- UBC Library Pharmacy/Pharmaceutical Sciences: Drug Information: A research guide that lists various other online resources. Some require a CWL login.
- UpToDate: An evidence-based clinical decision support resource. Requires a subscription.