Quiz 3: Biomedical Sciences (Shier)

What two nutrients were the most filled prescriptions in the US in 2023, and what conditions were they prescribed for?

Levothyroxine (hypothyroidism)

Vitamin D (rickets, osteomalacia, fractures, prediabetes prevention, autoimmunity, others)

What misconception do 75% of Americans have about their diet?

They think they eat healthy, but nutritionists estimate >80% actually don't

- explains the high burden of nutrition-related chronic disease in the US

Did improved nutrition drive most of the rise in US life expectancy over the last century?

No — most of the increase was due to antibiotics, sulfa drugs, and vaccines; nutrition's effect has plateaued

Since 2010, what has happened to US life expectancy compared to other countries?

It stalled and even declined (due to opioids, suicides, alcoholism, and COVID), while it continued rising elsewhere

What social factor strongly correlates with US life expectancy?

Educational attainment — college-educated adults can live up to 16 years longer than those with less education

What is the 2023 life expectancy at birth in the US?

77.5 years overall (74.8 for males, 80.2 for females)

Which US state ranks among the highest in life expectancy, and which among the lowest?

Minnesota (80.4 years) vs Mississippi (74.4 years)

How does immigrant life expectancy compare to US-born individuals?

Immigrants generally live longer; in 2017, 81.4 years (men) and 85.7 years (women), 6-7 years higher than native-born Americans

What role did food play in the Arab Spring (2011)?

Food riots began after staple food prices rose 37%, partly due to US ethanol policy diverting corn from food to fuel

Why was the USDA Food Guide Pyramid criticized and eventually replaced by "MyPlate"?

Because it was based on agricultural production groups, not true nutrition science, leading to public misinterpretation

What are the basic nutrient groups pharmacists should focus on?

Carbohydrates, lipids, proteins, minerals, trace elements, vitamins (fat- and water-soluble), and water

What does "nutrition is ADME (ADMET) for food" mean?

Like drugs, nutrients are ingested, digested, absorbed, transported, used, and excreted by cells; toxicity (T) also applies

What are examples of functional foods that regulate processes or treat disease?

Carb counting for diabetes, nutraceuticals (lycopene, limonene), ketogenic diet for epilepsy/obesity, oral rehydration salts for diarrhea

What follows from the concept that drugs act in a system designed for food?

Bioavailability differences, nutrient-drug interactions, drug-metabolizing enzymes originating from food defense, nutraceuticals, gut microbiome effects

How can drug absorption be altered by food?

↓ absorption (tetracyclines with Ca²⁺, iron); ↑ absorption (lipophilic drugs with fat)

Which drug class has reduced absorption when taken with dairy products?

Tetracyclines (due to chelation with Ca²⁺)

What are the 7 transporters involved in nutrient-drug and drug-drug interactions?

P-glycoprotein (P-gp, MDR1, ABCB1) – efflux transporter (gut, BBB, kidney, liver).

BCRP (Breast Cancer Resistance Protein, ABCG2) – efflux, overlaps with P-gp.

MRP2 (Multidrug Resistance-Associated Protein 2, ABCC2) – efflux of conjugated drugs.

OATP1B1 (Organic Anion Transporting Polypeptide 1B1, SLCO1B1) – hepatic uptake (statins).

OATP2B1 – intestinal/hepatic uptake (grapefruit juice interaction).

PEPT1 (Peptide Transporter 1, SLC15A1) – intestinal uptake of di/tripeptides, peptide-like drugs.

NTCP (Sodium Taurocholate Cotransporting Polypeptide, SLC10A1) – bile acid and drug hepatic uptake.

Which drug's absorption is dramatically increased by grapefruit juice?

Felodipine (and other CYP3A4 substrates)

What is the mechanism of grapefruit-drug interaction?

Grapefruit furanocoumarins inhibit intestinal CYP3A4 and P-gp, increasing drug bioavailability

What is the main metabolic pathway for ethanol?

Alcohol dehydrogenase (ADH) → acetaldehyde → acetate (via ALDH)

Which enzyme converts ethanol to acetaldehyde?

Alcohol dehydrogenase (ADH)

Which enzyme converts acetaldehyde to acetate?

Aldehyde dehydrogenase (ALDH)

What genetic variants affect alcohol metabolism?

ADH fast allele (↑ acetaldehyde) and ALDH2*2 allele (inactive enzyme, common in East Asians)

What nutrient deficiencies are associated with chronic alcoholism?

Folate, vitamin B1 (thiamine), vitamin B6, vitamin A, magnesium

Which disease results from thiamine deficiency in alcoholism?

Wernicke-Korsakoff syndrome

What functions does the gut microbiome have in human health?

Digestion, vitamin synthesis, immune modulation, drug metabolism

How can antibiotics affect nutrition?

They disrupt microbiota, leading to ↓ vitamin K synthesis and altered bile salt metabolism

What is an example of microbiome-drug interaction?

Digoxin inactivation by gut bacterium Eggerthella lenta

What is nutrigenomics?

nutrients affect gene expression

What is nutrigenetics?

genetic variation alters nutrient response

What is an example of nutrigenetics in lipids?

ApoE variants (E2/E3/E4) affect fat metabolism and response to diet

Why are food additives used?

Preservation, flavor, coloring, fortification

Which additive can cause reactions in asthma?

Sulfites

Which artificial sweetener is unsafe in PKU?

Aspartame

Which diet ↓ CVD risk?

Mediterranean diet (olive oil, nuts, fish, vegetables, moderate wine)

Which fats ↑ CVD risk?

Trans fats (↑ LDL, ↓ HDL)

Which gut metabolite promotes atherosclerosis?

TMAO (from choline/carnitine)

Which foods ↑ colon cancer risk?

Red/processed meats (nitrosamines, heterocyclic amines)

Which foods ↓ cancer risk?

Fruits, vegetables, fiber, antioxidants (carotenoids, flavonoids)

Which vitamin ↓ gastric cancer risk in deficiency-prone populations?

Vitamin C

What are the 8 most common food allergens?

Milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, soy

What immune mechanism drives food allergy?

IgE-mediated hypersensitivity

What is oral tolerance?

The normal immune non-response to food antigens; failure leads to allergy

What 3 food-related issues are most clinically significant for pharmacists?

Grapefruit juice interactions, ethanol-induced nutrient depletion, and microbiome-drug effects

What is the pharmacist's role regarding nutrition?

Recognize drug-nutrient interactions, counsel on diet and disease risks, and understand nutrigenomics/microbiome influences