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Clinical PK > Drug-Drug Interaction > Flashcards

Drug-Drug Interaction Flashcards

1
Q

Define interaction

A

An altercation in the effects of one drug due to prior or concomitant administration of another drug/substance or alterations in physiologic state

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2
Q

What are some alterations in effects?

A

Size and Duration

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3
Q

Name 6 types of drug interactions

A 
Drug - drug
Drug - food
Drug - supplements
Drug - alcohol
Drug - disease
Drug - genetic
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4
Q

What are some mechanism drug interactions that affect absorption (A in ADME)?

A
  • Alteration of gastric pH
  • Formation of drug complexes that reduce absorption
  • Inhibition/induction of GI transporters (e.g., PGP)
  • Enterohepatic recycling
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5
Q

What are some mechanism drug interactions that affect distribution (D in ADME)?

A
  • Displacement from circulating proteins

- Inhibition/induction of tissue transport proteins

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6
Q

What are some mechanism drug interactions that affect metabolism (M in ADME)?

A
  • Inhibition/induction of metabolizing enzymes (e.g., CYPs)
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7
Q

What are some mechanism drug interactions that affect excretion (E in ADME)?

A
  • Induction/inhibition of transporters
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8
Q

What does P-gp stand for?

A

P - glycoprotein

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9
Q

How do P-gp’s work?

A

Work to pump drug out of the body or away from tissues

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10
Q

How do P-gp’s in the gut work?

A

Pumps out into the lumen

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11
Q

How do P’gp’s in the brain work?

A

Pumps away from the brain into circulation

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12
Q

How do P-gp’s in the kidney’s work?

A

Pumps out of the circulation into urine

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13
Q

What does OAT stand for?

A

Organic anion transporter

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14
Q

What does OCT stand for?

A

Organic cation transporter

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15
Q

How do OATs and OCTs work?

A

Transports drug into hepatocytes and renal cells for further elimination

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16
Q

Where are OATs and OCTs mainly found?

A

Liver, kidney, and brain

17
Q

Define metabolism-related interactions

A

One drug alters the concentration of another drug

18
Q

(T/F) - Induction decreases metabolism

A

FALSE - increases metabolism

19
Q

(T/F) - Inhibition decreases metabolism

A

TRUE

20
Q

(T/F) - Substrates are broken down by liver enzymes

A

TRUE

21
Q

What is a pharmacodynamic interaction?

A

Administration of one drug alters the action of another drug

22
Q

Does a pharmacodynamic interaction affect drug pharmacokinetics?

A

NO

23
Q

What would be affected in a pharmacodynamic interaction?

A

Desired response could increase/decrease

Adverse response could increase/decrease

24
Q

Give two drug interaction scenarios

A
  1. Clinician plans to combine two drugs –> predict

2. Clinician observes an unexpected patient response –> explain

25
Q

What drug examples can affect absorption? Would this be an interaction in pharmacodynamic (PD) or pharmacokinetic (PK)?

A

Erlotinib and pantaprazole
Calcium and ciprofloxacin
Cholestyramine and warfarin
This is a PK interaction

26
Q

What drug examples can affect distribution? Would this be an interaction in PD or PK?

A

Methotrexate and ibuprofen

This is a PK interaction

27
Q

What drug examples can affect metabolism? Would this be an interaction in PD or PK?

A

Simvastatin and grapefruit juice

This is a PK interaction

28
Q

What drug examples can affect elimination? Would this be an interaction in PD or PK?

A

Methotrexate and penicillin

This is a PK interaction

29
Q

What are some examples of P-gp interactions?

A

Edoxaban and azithromycin

Dabigatran and verapamil

30
Q

What are some examples of OAT and OCT interactions?

A

Gemfibrozil and pravastatin

31
Q

What are CYP3A4 subtrates?

A

Simvastatin, atorvastatin
Alprazolam
Cyclosporine, tacrolimus
Warfarin

32
Q

What are CYP3A4 inducers?

A

Carbamazepine
Phenytoin
Phenobarbital
Rifampin

33
Q

What are CYP3A4 inhibitors?

A 
Clarithromycin
Itraconazole, Posaconazole
Diltiazem
Verapamil
Ritonavir

Clinical PK (11 decks)

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