Learning Outcomes
By the end of this section, you should be able to:
- 12.3.1 Identify drug-food interactions for their impact on treatments utilized for cardiovascular disorders.
- 12.3.2 Identify treatments and medications that can cause nutritional deficiencies in clients with cardiovascular disorders.
Drug-Food Interactions with Treatments for Cardiovascular Disorders
Nurses should be aware of the drug and food interactions that can occur with cardiac medications. This section will discuss some of the most common.
Warfarin and Vitamin K
Warfarin keeps blood from coagulating too quickly and is used for treatment of venous thromboembolism and for stroke prevention for certain conditions like atrial fibrillation or mechanical heart valves. Vitamin K works to assist in coagulation. Warfarin and vitamin K work in opposite ways, so the client must be aware that their normal, daily consumption of vitamin K should be consistent. Women typically need about 90 mcg of vitamin K daily; men typically need about 120 mcg. Green, leafy vegetables, Brussels sprouts, broccoli, asparagus, and green tea are all high in vitamin K (Mayo Clinic, 2022b). The clients can eat leafy greens, but they need to eat them in a consistent amount. When a client’s consumption of leafy greens fluctuates, it can cause fluctuations in the effects of warfarin.
Diuretics and Electrolytes
There are a variety of diuretics used for heart failure and a few for hypertension; the most common are the loop diuretics such as furosemide. Diuretic medications decrease the workload of the heart muscle and rid the body of excess fluid, which can cause fluctuations in electrolyte levels, particularly potassium. The nurse should assess the client for (and instruct the client to note signs of) hypokalemia—potassium levels less than 3.5 mEq/L. Symptoms of hypokalemia include constipation, muscle cramps, heart palpitations, and fatigue (Mayo Clinic, 2023a).
Although the loop diuretics are the most common diuretics that are associated with electrolyte imbalances, the clients who are taking other types of diuretics such as potassium-sparing diuretics need to be aware of the risk for hyperkalemia that can develop from the use of these medications (Knott, 2020). Hyperkalemia, or elevated potassium levels, can cause muscle fatigue, paralysis, arrhythmias, and nausea.
Since diuretics help the body to get rid of excess water, there is a risk that sodium—also an electrolyte—can be reduced too much and cause hyponatremia. The nurse should inform clients of signs and symptoms of hyponatremia: nausea and vomiting, weakness, and changes in level of consciousness; extremely low levels of sodium can cause seizures (Sterns, 2022).
Treatments and Medications That Can Cause Nutritional Deficiencies
Clients with cardiovascular disease frequently take one or more prescribed medications that can potentially cause nutritional deficiencies. Diuretics, for example, are used by clients with hypertension, heart-failure, and other cardiac-related conditions. Deficiencies of water-soluble vitamins are related to the use of diuretic therapy which causes increased excretion of these nutrients (Lennie et al., 2018). Other cardiovascular medications associated with nutrient deficiencies include statin medications used to treat hyperlipidemia. Studies have shown that levels of serum CoQ10, important for converting food into energy, decrease with the use of atorvastatin and similar medications (Chong et al., 2021).
Traditionally, sodium has been the focus of research examining the role of nutrition in the management of heart failure (Lennie et al., 2018). However, recent research has expanded the search for nutritional factors that influence the management of clients with heart failure and other cardiovascular diseases. Researchers have found that clients with heart failure frequently experience calcium, folate, magnesium, zinc, and vitamins C, D, E, and K deficiencies (Lennie et al., 2018). These deficiencies can be related not only to medication use, but also other factors. Another related factor to nutritional deficiencies among clients with heart failure is the lack of diet variety (Lennie et al., 2018). These clients frequently experience loss of appetite, feel full after eating only a small amount, and have limited energy to prepare and eat food. They are more likely to eat the same foods repeatedly, limiting their potential to consume a variety of needed nutrients (Lennie et al., 2018).
Unfolding Case Study
Part E
Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up from Case Study Parts A, B, C, and D.
Recently, Tara has noticed her legs are swelling and she has experienced some shortness of breath with activity, so she schedules an appointment with her primary care provider.
At Tara’s appointment, her provider takes her vital signs and finds her blood pressure is 165/85 mm Hg and her heart rate is 72 beats per minute. She is experiencing crackles in the base of her lungs and 2+ pitting edema to bilateral lower extremities.
The provider is concerned that Tara has developed heart failure and wants the nurse to educate Tara on healthy food choices. The provider places Tara on the diuretic furosemide to decrease Tara’s swelling and a potassium supplement. The provider orders laboratory work that includes a comprehensive metabolic panel and B-type natriuretic peptide.