Dietetics:Medication

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.

Dietitian Q&A

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.

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.

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.

Resources

• 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.