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Clinphar Lab - K > Drug Interactions > Flashcards

Drug Interactions Flashcards

1
Q

Modification of the effects of one drug (object drug)
by the prior or concomitant administration of another
(precipitant drug

A

DRUG INTERACTION

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2
Q

Object + Precipitant

A

DRUG INTERACTION

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3
Q

Early recognition or detection can prevent:

A
  • Loss of therapeutic effect
  • Unexpected increases in pharmacologic activity
  • Toxicity
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4
Q

Aplastic Anemia, Asthma, Cardiac Arrythmia, Critical/ICU patients, Diabetes, Epilepsy, Hepatic Disease, Hypothyroidsim

A

High risk associated with SEVERITY of the disease state being treated

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5
Q

Autoimmune disorders, Cardiovascular Diseases,
GIT diseases, Infections, Psychiatric disorders, Respiratory disorders, Seizure disorders

A

High Risk Associated with Drug Interaction Potential of related therapy

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6
Q

DRUG INTERACTION MECHANISMS (In Vivo)

A

Pharmacokinetic
Pharmacodynamic

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7
Q

DRUG INTERACTION MECHANISMS (In Vitro)

A

Physicochemical (IV incompatibilities)

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8
Q

chemical or physical interactions that occur in vitro

A

PHARMACEUTICAL INTERACTIONS

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9
Q

aggregation, precipitation in solution, chemical deterioration or
decomposition

A

PHARMACEUTICAL INTERACTION

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10
Q

PHARMACEUTICAL INTERACTION:

Potassium phosphate and calcium chloride in total
parenteral nutrition preparations (TPN) may form ________________, which will result in a _________ in the intravenous fluid
bag

A

calcium
phosphate; precipitate

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11
Q

Drug disposition in the body

A

PHARMACOKINETICS

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12
Q

Effect of a drug on the
ADME of another drug

A

PHARMACOKINETICS

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13
Q

Seldom produces serious
clinical effects

A

PHARMACOKINETICS

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14
Q

Often associated with
changes in plasma drug
concentration and altered
clinical response

A

PHARMACOKINETICS

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15
Q

Most common Drug Interaction Mechanism

A

PHARMACOKINETICS

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16
Q

Related to the pharmacologic
activity of interacting drugs

A

PHARMACODYNAMICS

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17
Q

Amount of drug in blood
remains the same, but its effect
is altered

A

PHARMACODYNAMICS

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18
Q

Change in gastric pH (antacid, alcohol, and food)

A

Alteration of DRUG ABSORPTION

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19
Q

Changes in gastrointestinal motility/gastric
emptying time

A

DRUG ABSORPTION

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20
Q

Damaged gastrointestinal mucosa

A

DRUG ABSORPTION

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21
Q

Complexation and adsorption

A

DRUG ABSORPTION

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22
Q

Sodium Bicarbonate + Ketoconazole

A

ABSORPTION (Changes in gastric pH)

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23
Q

Sodium Bicarbonate + Ketoconazole

Object Drug:
Precipitant Drug:

A

Object Drug: Ketoconazole
Precipitant Drug: Sodium Bicarbonate

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24
Q

Cyclosporine + Metoclopramide

A

ABSORPTION (Changes in gastrointestinal motility or gastric emptying
time)

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25
Q

MANAGEMENT: Sodium Bicarbonate + Ketoconazole

A

Separation of doses by 2 or more hours

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26
Q

Cyclosporine + Metoclopramide

Object Drug:
Precipitant Drug:

A

Object Drug: Cyclosporine
Precipitant Drug: Metoclopramide

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27
Q

MANAGEMENT: Cyclosporine + Metoclopramide

A

Renal function, serum creatinine, and Cyclosporine levels should be
carefully monitored during concurrent therapy. Cyclosporine
dosage should be adjusted as needed. Patients should be advised
to notify their physician if they experience nausea, vomiting,
diarrhea, abdominal pain, dizziness, fatigue, or headache

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28
Q

Digoxin + Vincristine

A

Damaged gastrointestinal mucosa (Drug Induced) (ABSORPTION)

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29
Q

Digoxin + Vincristine

Object Drug:
Precipitant Drug:

A

Object Drug: Digoxin
Precipitant Drug: Vincristine (and other antineoplastic agents

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30
Q

MANAGEMENT: Digoxin + Vincristine

A

Digoxin serum levels and effectiveness should be monitored
closely following the initiation or discontinuation of antineoplastic
agents, and the dosage should be adjusted as necessary

31
Q

Ciprofloxacin + Aluminum Hydroxide

A

Complexation and Adsorption (ABSORPTION)

32
Q

Ciprofloxacin + Aluminum Hydroxide

Object Drug:
Precipitant Drug:

A

Object Drug: Ciprofloxacin
Precipitant Drug: Aluminum Hydroxide

33
Q

MANAGEMENT: Ciprofloxacin + Aluminum Hydroxide

A

Separation of two doses

34
Q

Aspirin + Phenytoin

A

Alteration of DRUG DISTRIBUTION:
displacement from protein binding sites

35
Q

MANAGEMENT: Aspirin + Phenytoin

A

No action is requireD

36
Q

Aspirin + Phenytoin

Object Drug:
Precipitant Drug:

A

Object Drug: Phenytoin
Precipitant Drug: Aspirin

37
Q

Phenobarbital
Carbamazepine
Phenytoin
Rifampicin
Tobacco smoke
Alcohol (chronic)

A

Enzyme Induction (DRUG METABOLISM)

38
Q

involves protein synthesis and
therefore needs up to 3 weeks to reach maximal
effect.

A

Enzyme Induction

39
Q

example of Enzyme Induction:

A

CYP450 enzymes

40
Q

___________ is the major metabolizing
enzyme in Phase 1 Metabolism (Oxidation Process).

A

Cytochrome P450 enzyme

41
Q

Paracetamol (prolonged use) + Carbamazepine

A

Enzyme Induction

42
Q

Paracetamol (prolonged use) + Carbamazepine

Object:
Precipitant:

A

Object Drug: Paracetamol
Precipitant Drug: Carbamazepine

43
Q

Management: Paracetamol (prolonged use) + Carbamazepine

A

Monitor for decreased effectiveness of Paracetamol and signs
of hepatotoxicity if Carbamazepine is used concomitantly,
especially for patients receiving high-dose and/or chronic
Paracetamol therapy

44
Q

Cimetidine
Erythromycin
Ketoconazole

A

Enzyme Inhibition

45
Q

may be due to competition on
binding sites, so the onset of action is short (within
24 hours)

A

Enzyme Inhibition:

46
Q

Fluconazole + Warfarin

A

. Enzyme Inhibition

47
Q

Fluconazole + Warfarin

Object:
Precipitant:

A

Object Drug: Warfarin
Precipitant Drug: Fluconazole

48
Q

Management: Fluconazole + Warfarin

A

Consider 10-20% reduction in Warfarin dose with increased
monitoring of anticoagulant response such as INR to guide
further dose adjustment. Watch out for signs of bleeding.

49
Q

Alteration of DRUG EXCRETION

A

a. Passive tubular reabsorption
b. Competition at active transport site

50
Q

Excretion and reabsorption of drugs occur in the tubules
by passive diffusion, which is regulated by concentration
and lipid solubility

A

PASSIVE TUBULAR REABSORPTION

51
Q

Excretion and reabsorption of drugs occur in the tubules
by passive diffusion, which is regulated by ________
and __________

A

concentration; lipid solubility

52
Q

Aspirin + Sodium Bicarbonate

A

Passive Tubular Reabsorption

53
Q

Aspirin + Sodium Bicarbonate

Object
Precipitant

A

Object Drug: Aspirin
Precipitant Drug: Sodium Bicarbonate

54
Q

MANAGEMENT: Aspirin + Sodium Bicarbonate

A

Patients treated chronically with urinary alkalinizers and large
doses of salicylates (i.e. 3 g/day or more) should be monitored
for potentially-diminished or inadequate analgesic and antiinflammatory effects, and the salicylate dosage adjusted if
necessary.

55
Q

Competition at the active transport site:

Active tubular secretion occurs in the_________

A

proximal tubules

56
Q

Competition at the active transport site:

When another drug has a competitive reactivity ot the
protein responsible for active transport of another drug, it may
_______________ that drug’s excretion, ___________ its reabsorption and
concentration, and hence its toxicity.

A

reduce; increasing

57
Q

Probenecid + Methotrexate

A

Competition at the active transport site

58
Q

Probenecid + Methotrexate

Object:
Precipitant:

A

Object Drug: Methotrexate
Precipitant Drug: Probenecid

59
Q

MANAGEMENT: Probenecid + Methotrexate

A

a reduction in methotrexate
dosage may be needed, and the patient should be closely
monitored for signs and symptoms of bone marrow suppression,
hepatotoxicity, and nephrotoxicity. Patients should be advised to
promptly report symptoms including fever, chills, sore throat,
bruising, bleeding, stomatitis, malaise, shortness of breath,
lower extremity edema, jaundice, or change in stool or urine
color to their physician.

60
Q

Most significant are those involving drug _____________ and
the least significant are those involving drug ____________.

A

metabolism; distribution

61
Q

INCREASE in drug concentration = __________

A

TOXICITY

62
Q

DECREASE i drug concentration = __________

A

TREATMENT FAILURE

63
Q

Increase in bioavailability, effect of an enzyme inhibiting drug,
____________ in excretion

A

decrease

64
Q

Decrease in bioavailability, effect of an enzyme inducing drug,
_____________ in excretion

A

increase

65
Q

PHARMACODYNAMIC INTERACTIONS

A
  1. Additive/Synergistic effect
  2. Antagonistic effects
  3. Indirect effects
66
Q

Benzodiazepines + Sedating antihistamines

A

Additive/Synergistic effects

67
Q

Propranolol + B2 Agonist

A

Antagonistic effects

68
Q

Digoxin + Loop Diuretics

A

Indirect effects

69
Q

Contraindicated/ Avoid combination

A

X

70
Q

Major/ Consider therapy monidfication

A

D

71
Q

Moderate/ Monitor therapy

A

C

72
Q

Minor/ No action needed

A

B

73
Q

Unknown/No known interaction

A

A

Clinphar Lab - K (9 decks)

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