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PHAR 300 > drug interaction > Flashcards

drug interaction Flashcards

1
Q

Describe case study - set up

A

Elderly woman
71 years old
Paroxysmal atrial fibrillation being treated with warfarin
5 day history of increasing swelling in neck, sialorrhoea and difficulty swallowing = thougaht something wrong with dose of meds

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2
Q

Describe case study - results

A

Week earlier = started on flucunoazole bc of oral candidiases
Had a sublingual hematoma
Lab test = elevated c reactive protein, increase wbcs, reduced prothrombin activity, prolonged international normalized ratio

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3
Q

Describe case study - what happened

A

Fluconazole significantly rescued metabolic clearance of warfarain enantiomers, slowed down metabolism = effects fo drug lasted longer
Effected metabolism
P4502C9 catalyze 6- and 7- hydroxlyation of s warfarin, partway primarily responsible for termination of anticoagulant effect
Change in pharmacokinetics = increased magnitude and duration of warfarins hypoprothrombinemic effect
Need to be careful when have many drugs = understand pharmacokinetics well

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4
Q

What are adverse drug reactions

A

Another drugs altered way drug affects both = affects pharmacokinetics

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5
Q

What is one off leading causes of morbidity nd mortality in health care

A

Adverse drug reactions
Common in nursin homes, costly

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6
Q

Are adrs preventable

A

If understand mechanism of drug affects body and how bodies react to drug

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7
Q

Cost associated with adrs

A

Can prolong illness or cause another comorbidty = cost health care
136 billion yearly
Greater than cvs or diabetic care, mean length of stay cost and mortality double for that of control patients

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8
Q

When do drug drug interactions occurs

A

Multiple drugs to treat one disorder
Multiple dispersed require it diff drugs
OTC meds, caffeine, nicotine, Alcohol
Elderly patients have a high incidence drug interacts bc commonly take multiple meds and have age related changes in drug clearance

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9
Q

Name and describe consequences of drug drug interactions

A

Instsneification of effects = increase therapeutic or adverse effects
Reduced therapeutic effects
Creating of a unique response

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10
Q

Describe additive effects

A

Effect of 2 drugs given together equal to sum of responses to same doses given separately

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11
Q

Describe antagonism effects

A

Effect of drugs together is less than sum of responses to same doses given separately

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12
Q

Describe pharmacodynamic interaction

A

Change in pharmacodymsics of 1 drug causes by interacting drug - additive action of 2 drugs having similar effectsd

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13
Q

Describe pharmacokinetic interaction

A

Change in pharmacokinetics of 1 drug is caused by interacting drug - inducer of hepatic enzymes ex

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14
Q

What is synergism

A

The effect of 2 drugs given together greater than sum of the responses to same doses given sepratatelt

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15
Q

What is potentiaiton

A

One drug telos effect of other

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16
Q

Describe drug interactions

A

Pharmacokinetic = Adem
Or
Pharmacodynamic

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17
Q

How can absorption from gi tract be altered -

A

Agents that bind drugs = resins, antacids, calcium = if 2 drugs require same channel = incomplete
Agents that increase or decrease gi motility - metoclopramide (increases), antimuscarinics (decreases)
Drugs that alter p glycoprotein - organic anion transporters in intestine - concomitant use of antacids which increase gastric ph = can decrease gi absoritpn -

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18
Q

What is p glycoprotein

A

One of drug transporters that determine plasma and tissue concentrations of a drug

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19
Q

Describe what happens take epinephrine to oral anesthetic

A

Affect vasoconstriction = can affect distribution and absorption

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20
Q

How can gi absorption be infeucnes - drug transporter

A

In intestinal epithelium = may increase net abspoprtion food rugs that are normally expelled by transporter

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21
Q

How can absorption from gi be ifnelucnes - subcutaneous sites

A

Absorption from subcutaneous sites can be slowed predictably by vasoconstrictors given simultaneously
Local anesthetic and epi, and by cardiac depressants that decrease tissue perfusion, like beta blockers

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22
Q

Describe absorption overview

A

Antacid affect drug absorption = then can influence distribution of ciprofloxacin = needs to be absorbed by gut, changes acidity of gut
Iron and levothyroxine, ciproflaxin and antacid
= taken at same time = bind together an form clusters
Also when meds reduce activity of stomach - ppl = certain meds not well absorbed = dabigatran

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23
Q

Describe interactions based on distibrution and binding

A

Distribution altered by other drugs that compete for binding sites on psalm proteins = alter binding

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24
Q

Giv ex interactions based on distribution and bidnidnhg

A

Antibacterial sulfonamides = can displace methotrexate, phenytoin, sulfonylureas and warfarin from binding sites on albumin = need to bind albumin to distribute to site

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25
Q

When can changes in drug distribution occur

A

One agent alters size of physical compartment in which another drug distributes

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26
Q

Describe interaction based on distribution and binding ex = diuretics

A

Diuretic = reduce total body’ water = increase plasma levels of amino glycosides and lithium = possibly enhancing drug toxic ties = differences in drug absptoptn

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27
Q

Describe Metabolism

A

Major group enzymes that metabolize = in liver
Cytochrome p450 fam of enzymes
Drugs/vitamins/supplements or diseases that effect this fam =- have effects on metabolism

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28
Q

Describe p450 isoforms

A

Pharmacogenietcis
Ppl hav edify expression
Many differences - if metabolize faster
If give multiple drugs = complex since person already has differences in ability to absorb dru

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29
Q

Describe p4502d6 - genetic variations

A

Absent in 7% Caucasians
1-2% in non csuaisns
Hyperactive in up to 30% of East Africans
Catalyze primary metabolism of Codiein, many b blockers, many tricyclic antidepressants
Inhibited by fluzetine, haloperidol, paroxetinem quinidine

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30
Q

Describe p450 3a

A

Responsible for metabolism of
Most calcium channel blocks
Benzos
Most hiv pro taste inhibitors =ppl with chronic illness, affects drug they take
Present in gi tract and liver

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31
Q

Describe cyp3a inhibitors

A

If take any of these drugs = inhibit, need to thin about other drugs that require this enzyme
Ketoconazole
Itraconazole
Fluconazole
Cimetidine
Calrithromycin
Erythromycin
Troleandromycin
Grape fruit juice

32
Q

Describe interactions based on metabolism cleanrce

A

Drugs that reduce hepatic blood flow (eg., propranolol) may reduce the clearance of other drugs metabolized in the liver, especially those subject to flow limited hepatic clearance such as morphine and verapamil.
Affects hepatic blood flow = slows it down, reduces ability of body to eliminate other drug
Can cause toxicity if not metabolizing proreply = not properly eliminated = effects frequency of drug and will last for longe time

33
Q

Describe metabolism of many drugs that can be increased by other agents

A

Increase efficacy p450s isozymes
Chronic admin of barbiturates, carbamazepine, ethanol, phenytoin, rifampin

34
Q

Describe metabolism fo some drugs may be decrease by other drugs

A

Inhibit drug metabolize ezznyems
Cimetidine, disulfram, erythromycin, furanocoumarins - in grapefruit juice
Ketocaonzaole,quininde, ritonasviry, sulfonamides

35
Q

Describe interactions based on metabolism Clarence - Moais

A

Monoamine oxidase inhibitors (MAOIs) were the first type of antidepressant develope not on market anymore since cause cardiac arrhythmias

People taking MAOIs generally need to change their diets to limit or avoid foods and beverages containing tyramine, which is found in products such as cheese, soy sauce, and salami. If large amounts of tyramine are consumed, they may suffer a hypertensive crisis, which can be fatal.
= limits bodies ability to eliminate tyramine, displaces norepinephrine = can cause vasoconstriction arrhythmia = heat bests faster and affects ability to breathe

36
Q

WHAT DOES TYRMAINE DO

A

Tyramine displaces norepinephrine, epinephrine, and dopamine from pre-synaptic storage vesicles. The release of these neurotransmitters, particularly norepinephrine, is responsible for vasoconstriction, increased heart rate, and a rise in blood pressure. Therefore, tyramine functions as an indirect sympathomimetic by causing the release of presynaptic endogenous neurotransmitters. Tyramine acts as a substrate for monoamine oxidase, further limiting the breakdown of monoamine neurotransmitters.

37
Q

What can happen to metabolism

A

Can be inhibited = ex = Sentra may inhibit warfarin, increasing risk of toxicity or bleeds
Metabolism induced = ex = rifampin may induce warfarin metabolism
Competitive substrates = 2 meds metabolized by same enzyme = competes binding, sometimes only 1 drug effect seen or not drug effect = outcompete each other and don’t bind enzyme

38
Q

Describe interactions based on renal function

A

Excretion of drugs by the kidney can be changed by drugs that reduce renal blood flow (eg, β blockers) or inhibit specific renal transport mechanisms (eg, the action of aspirin on uric acid secretion in the proximal tubule).
Drugs that alter urinary pH can alter the ionization state of drugs that are weak acids or weak bases, leading to changes in renal tubular reabsorption.
= affect ability to eliminate
Can result in toxic effects from accumulation fo broken down drug

39
Q

Give ex elimation drug interaction

A

Penicillin and probenecid
Penicillins taken every 6 hrs, up to 4 times daily = maintain adequate concentration in body
If taken with probenicid = where elimination reducers = can be given once daily and maintain good concentration
Bc elimination effected

40
Q

Describe pharmacodynamic interactions

A

How drug interacts with receptors

41
Q

Describe antagonism - interactions based on opposing actions or effects = BRONCHODILATING EX

A

BRONCHODILATING effects of β2 adrenoceptor activators used in asthma is to be anticipated if a β blocker is given for another condition.
If taken together = no effect = giv b2 agonist to stop bronchial obstruction, usually inhaled, helps, if have anxiety = give b blockers = will interact with asthma meds - counter effect

42
Q

Describe antagonism - interactions based on opposing actions or effects = cetecholamine EX

A

action of a catecholamine on heart rate (via βadrenoceptor activation) is antagonized by an inhibitor of acetylcholinesterase that acts through acetylcholine (via muscarinic receptors).
Drug that inhibits muscarinin = helps airway constritrcition but if taking another drug at hot turns on muscarinicn = counter each other

43
Q

Describe antagonism by mixed atomistic agonist drugs

A

Antagonism by mixed agonistant agonist drugs (eg, pentazocine) or by partial agonists (eg, pindolol) is not as easily predicted but should be expected when such drugs are used with pure agonists. Some drug antagonisms do not appear to be based on receptor interactions. For example, nonsteroidal anti- inflammatory drugs (NSAIDs) may decrease the antihypertensive action of angiotensin converting enzyme (ACE) inhibitors by reducing renal elimination of sodium.
When given with another drug = can go ether way, complex to uderstsnd, must do studies

44
Q

Describe interactions based on additive effects -gen

A

Additive interaction describes 2 drugs may or may not act on same receptor to produce such effects

45
Q

Describe interactions based on additive effects -ex tricyclic antidepressant

A

The combination of tricyclic antidepressants with diphenhydramine or promethazine (anti-histamines) predictably causes excessive atropine like effects: These include dryness of the mouth, blurred vision, dry eyes, photophobia, confusion, headache, dizziness, fatigue.
* becausethesedrugshavesignificant muscarinic receptor blocking actions
Drugs work on diff receptor but have similar additive effect - negative together

46
Q

Describe interactions based on additive effects -anticoagulant

A

Additive effects of anticoagulant drugs can lead to bleeding complications. In the case of warfarin, the potential for such adverse effects is enhanced by aspirin (via an antiplatelet action), thrombolytics (via plasminogen activation), and the thyroid hormones (via enhanced clotting factor catabolism).

Aspirin and warfare = can have both anticoagulant effects but work through diff mechanism and pathways but same outcome

47
Q

Describe interactions based on additive effects - supra additive

A

Supraadditive (Synergistic)
interactions and potentiation appear to be much less common than antagonism and the simple additive interactions described previously.
* result of interaction is greater than the sum of the drugs used alone

48
Q

Describe interactions based on additive effects - supra additive Ex

A

the best example is the therapeutic synergism of certain antibiotic combinations such as sulfonamides and dihydrofolic acid reductase inhibitors such as trimethoprim. Potentiation is said to occur when a drug’s effect is increased by another agent that has no such effect.
Each works bit on own but when combine = works v well

49
Q

Describe interaction of herbal meds with other drugs

A

Because of the marked increase in use of herbal medications, more interactions of these agents with purified drugs are being reported.
Several herbals listed are known to enhance the actions of anticoagulants. Many other herbs, or edible plants, also contain compounds with anticoagulant or antiplatelet potential, including anise, arnica, capsicum, celery, chamomile, clove, feverfew, garlic, ginger, horseradish, meadowsweet, onion, passion flower, turmeric, and wild lettuce.
Can cause excessive bleeding

50
Q

What are antibiotics

A

Ingested, topic, eye drops
inhibits the growth and replication of a bacterium or kills it outright can be called an antibiotic. Antibiotics are a type of antimicrobial designed to target bacterial infections within (or on) the body.

51
Q

What are antiseptics/disinfectants

A

Antiseptics are used to sterilise surfaces of living tissue when the risk of infection is high, such as during surgery.
* Disinfectants are non-selective antimicrobials, killing a wide range of micro-organisms including bacteria. They are used on non-living surfaces, for example in hospitals.
Usually have alcohol = does not inject antiseptics

52
Q

Describe antibiotics nomeanlcature

A

term antibiotic was used to refer to substances produced by microorganisms that suppress the growth of other microorganisms
Antibacterial was more encompassing and used to describe not only natural antibiotics produced by microorganisms but also drugs synthesized in the laboratory.
The distinction between these compounds is somewhat blurred today, and both terms are often used interchangeably to refer to any synthetic, semisynthetic, or natural compound used in medicine to eradicate or injure bacteria.

53
Q

Describe bacteria

A

Bacteria are single celled microorganism.
* The cell structure is simpler than that of other organisms as there is no nucleus or membrane bound organelles.
Can see without microscope
Replicated by asexual reproduction - male or female

54
Q

Describe bacteria classsifcation

A

five groups according to their basic shapes: spherical (cocci), rod (bacilli), spiral (spirilla), comma (vibrios) or corkscrew (spirochaetes). They can exist as single cells, in pairs, chains or clusters.
Also classified by cell structure
When sick = look kinds of bacteria under microscope = morphology, shape hints at type of bacteria

55
Q

Describe good vs bad bacteria

A

In gut = live in symbiosis and help you metabolize and energy and protect from infections
Most antibiotics also clear good bacteria = bad

56
Q

What bacteria causes diseases - name all

A
  • Escherichia coli and Salmonella cause food poisoning.
  • Helicobacter pylori cause gastritis and ulcers.
  • Neisseria gonorrhoeae causes the sexually transmitted disease gonorrhea.
  • Neisseria meningitidis causes meningitis.
  • Staphylococcus aureus causes a variety of infections in the body, including boils, cellulitis, abscesses, wound infections, toxic shock syndrome, pneumonia, and food poisoning.
  • Streptococcal bacteria cause a variety of infections in the body, including pneumonia, meningitis, ear infections, and strep throat.
57
Q

Describe bacteria type s

A

Gram neg = usually rods, pink
Gram pos = positive for stain, usually cocci= purple

58
Q

Describe antibiotics types

A

Can have antibiotics v good at killing gram neg or pos = good since only clearing that type fo bacteria, not all bacteria from gut microbiome
Broad spectrum = can kill both gram neg and pos

59
Q

Describe bacterial resistance - gen

A

Drug resistance can be defined as the ability of bacteria to withstand the effects of an antibacterial agent.
* Each year in the U.S., at least 2.8 million people are infected with antibiotic- resistant bacteria, and more than 35,000 people die as a result.
Many antibiotics not effective anymore
Many drug developments = stopped for antibiotics but bad since resistance now

60
Q

Describe bacterial resistance- bacteria

A

Asexual and no nuclei = spread antibiotic resistance genes very effective

61
Q

Who is more at risk of bacterial resistance

A

No one can completely avoid the risk of resistant infections, but some people are at greater risk than others (for example, people with chronic illnesses).
Usually bc these ppl t get eprscribed antibiotics frequently = bacteria developers more resistance genes, the more they are exposed to antibiotics

62
Q

Why antibiotics resistance v bad

A
  • If antibiotics lose their effectiveness, then we lose the ability to treat infections and control public health threats.
  • Many medical advances are dependent on the ability to fight infections using antibiotics, including joint replacements, organ transplants, cancer therapy, and treatment of chronic diseases like diabetes, asthma, and rheumatoid arthritis.
63
Q

How does antibiotic resistance occur

A

Some bacteria in human body drug resistant- usually just one bacteria having resistant then spread to colon and replicate fast and can also spread to other species bacteria = cocci to rods

64
Q

Reasons for concurrent use of more tha one Antimicrobial agent

A

Use multiple to help clear infection
Initiate through t = provide coverage of mutiple causative organisms
Prevent anti optics resistance
Achieve Synergy
Permit use of lower doses drugs
If clear them out = cannot spread ability of antibiotic resistance gene

65
Q

How to over come resistance

A

Same state goes = synergistic, antagonistic, additive effects

66
Q

Describe synergism - antibiotic resistant

A

Synergism is present if the activity of the combined antimicrobial agents is greater than the sum of the independent activities.

67
Q

Describe indifferent effects

A

Indifferent effects are present if the combined activity of the antimicrobial agents is similar to the greatest effect produced by an individual drug alone.

68
Q

Describe antagonism

A

Antagonism is present when the activity of the combination is less than what
could have been achieved by using the agents separately.
Not better than individual one alone

69
Q

Describe penicillin and amino glycoside

A

Penicillin = cell wall inhibitor, inhibits ability of bacteria o make cell way = destroys integrity of cell bacterial die
Aminoglycosisdes = protein synthesis inhibitor, must reach ribosomes, affect ability fo drug to replicate, bacterial wont produce enzymes that stope penicilin
Works synergsitcial
= can use 1/2 dose each

70
Q

Describe pseudomonas aeruginosa

A
  • Gram-negative opportunistic pathogen= rod
  • Pneumoniainventilatedpatients = skin infection, eye infections too
  • ESKAPE
  • Multi-drugresistant -= to many antibiotics available
71
Q

Describe type 3 secretion system

A

Ways for it to grow in body

  • Type 3 “Injectisome” : Injects multiple virulence factors into host cells.
  • Used for pore formation in the host cell
    Allows syringe to inject toxin into body
72
Q

Describe ppl - expolysaccharides

A

Highly expressed, polysaccharide expressed on surface
*Abundant, serotype independent exopolysaccharide.
*Promotes bacterial aggregation & tissue adherence (colonization)
*Component in biofilm formation & maintenance (persistence) *Implicated in immune evasion

73
Q

Describe pseudomonas therapeutic antibodies

A

Anti - per v = blocks t3s function
Anti psl = blocks exopopolysaccraride psl function
= targets secretion system and polysaccharide and blocks function of the. 2 molecules
Inject mouse with antibody = attaché and helps phagocytosis cell like macrophages or neutrohpiels to recognize pseudomonas and clear it

74
Q

Describe Synergistic affect of BiS4alphaPa + Antibiotics when given together in subtherapeutic doses = gen

A

Meropenem (MEM) is a broad- spectrum carbapenem antibiotic. It is active against Gram-positive and Gram- negative bacteria. Meropenem exerts its action by penetrating bacterial cells readily and interfering with the synthesis of vital cell wall components, which leads to cell death.

75
Q

Describe Synergistic affect of BiS4alphaPa + Antibiotics when given together in subtherapeutic doses = graph

A

Pseudomonas = resistant to almost all classes antibiotic
Control = no treatment
Mem - most very sick
BiS4alPHA P = 0.2pk = antibiotic = gave sub therapeutic dose
If combine = BiS4alPHA Mem = mouse survives
Combo of 2= works

PHAR 300 (22 decks)

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