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Principles of Disease > Drug Interactions and Therapeutic Drug Monitoring > Flashcards

Drug Interactions and Therapeutic Drug Monitoring Flashcards

1
Q

What is the medical importance of drug interactions in terms of morbidity and mortality

A

Costs to healthcare is high due to increased hospitalisation and administration of drugs to resolve it

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2
Q

Factors that may predispose a patient to a drug interactions

A 
The number of medications
Elderly
Young
Critically ill
Patients undergoing complicated surgery
Patients with chronic conditions:
Liver disease
Kidney impairment
Diabetes mellitus
Epilepsy
Asthma
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3
Q

Classification of Drug-Drug interactions

A

Pharmacodynamic: Direct antagonism, synergistic, indirect agonist, indirect antagonism
Pharmacokinetic: Absorption, Distribution, Metabolism and Elimination

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4
Q

Importance of Therapeutic drug monitoring

A

Drugs have small therapeutic index

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5
Q

Precipitant

A

The agent which precipitates out in such an interaction

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6
Q

Drugs involved with serious interactions and why?

A 
Warfarin
Gentamicin
Erythromycin
Linezolid
These drugs have a narrow therapeutic index which means that a small change in blood plasma levels can induce prodounf toxicity
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7
Q

Food that interact with Warfarin

A

Vegetables like: Asparagus, Broccoli, Cabbage, Kale, Lettuce, Onions, Spinach, Watercress
Herbals like: Ginseng, Green tea
Miscellaneous: Avocado, Fish oils, Liver, Soya beans

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8
Q

Food that interact with Warfarin

A

Vegetables like: Asparagus, Broccoli, Cabbage, Kale, Lettuce, Onions, Spinach, Watercress
Herbals like: Ginseng, Green tea
Miscellaneous: Avocado, Fish oils, Liver, Soya beans

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9
Q

Direct Antagonism

A

beta-blockers will block actions of agonists

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10
Q

Synergistic Interaction

A

Two drugs with the same pharmacological effect acting on the same receptor given concurrently

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11
Q

Indirect Agonism

A

Warfarin and NSAIDs, Atenolol and Verapamil

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12
Q

Indirect Antagonism

A

NSAIDs and anti-hypertensiive medication and NSAIDs and treatment for heart failure

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13
Q

Drug-drug interactions in Absorption

A

Formation of insoluble complexes
Altered PH
Altered bacterial flora
Altered GI motility

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14
Q

Drug-drug interactions in Distribution

A

Protein binding displacement

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15
Q

Drug-drug interactions in Metabolism

A

Occurs when one drug induces or inhibits the metabolism of another

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16
Q

Drug-drug interactions in Elimination

A

Inhibit secretion

Increase tubular reabsorption

17
Q

Tetracyclin and erythromycin complex with _________ to form insoluble complexes

A

Magnesium, iron and calcium

18
Q

__________ reduce H+ and increase____

A

H2 antagonist, proton pump blockers and antacids and PH

19
Q

__________ destroy normal gut flora leading to

A

Broad spectrum antibiotics and failure of oral contraceptive or digoxin toxicity

20
Q

Oral medicines are mostly absorbed in the ______ and ______ is the limiting step and increase leads to_______

A

small intestine and gastric emptying and increased absorption

21
Q

Anticholinergics delays_____

A

Gastric emptying

22
Q

If a drug is 99% bound displacement of 1% leads to______

A

Doubling of free plasma levels

23
Q

2 most important proteins are_____

A

Albumin and alpha-1 glycoprotein

24
Q

Drugs with 99% protein binding

A

Ibruprofen, naproxen, Warfarin, Valproic acid, Phenytoin

25
Q

Drug-Drug interactions that affect metabolism normally occur in the _____

A

Liver via the cytochrome P450

26
Q

Drugs that inhibit the metabolism of drugs metabolised by the P450 system

A

Cimetidine (warfarin, diazepam), Metronidazole (Warfarin, alcohol), Omeprazole (phenytoin, warfarin)

27
Q

Drugs that induce cytochrome P450

A

Barbiturates, Carbamazepine, Phenytoin (warfarin, steroid, OC), Rifampacin (warfarin, OC) and tobacco smoke

28
Q

How long does enzyme induction take

A

2-3 weeks

29
Q

Rifampicin___

A

Increases metabolism of ciclosporin by inducing CYP 3A4

30
Q

St John’s Wort_____

A

Increases metabolism of ciclosporin by inducing CYP 3A4

31
Q

Verapamil/diltiazem and digoxin____

A

Inhibit secretion

32
Q

Loop diuretic and lithium

A

Increase tubular reabsorption

Principles of Disease (32 decks)

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