Managing Drug Interactions & ADR's: Pharmacist’s Role Flashcards
what is the first step in managing a drug interaction?
The first step in managing drug interactions is to be aware of potentially interacting drugs
- Then assess clinical significance and risk to patient
what can be done after an adverse drug interaction has been spotted?
1) Avoid the combination
2) Adjust the dose
3) Monitor the patient
4) Continue medication as before
- Alert prescriber / patient as appropriate
explain when the pharmacist would choose to avoid the combination if a drug interacts?
If the potential hazards of adding an interacting drug outweigh the benefit, an alterative drug should be chosen
explain when the pharmacist would choose to Adjust the Dose if a drug interacts. use examples
1) Amiodarone – enzyme inhibitor – increase plasma concentration of digoxin – halve digoxin dose
2) Fibrates, amiodarone, amlodipine, verapamil, diltiazem – interact with Simvatatin to increase the risk of myopathy – reduce simvastatin dose to 10mg or 20mg daily
how can a pharmacist monitor the Patient if an interaction has been spotted?
1) Clinical monitoring to detect any adverse effects
- e.g. monitor blood pressure
2) Measurements of drug levels
- e.g. digoxin, theophylline, ciclosporin
3) Measurement of markers for an interaction
- e.g. INR
when would a pharmacist Continue Medication as Before if an interaction has been spotted?
1) If interaction not clinically significant
2) If interacting drugs are the optimal therapy for a condition
what questions should pharmacists ask when assessing the Clinical Significance and Risk To Patient of a drug interaction?
1) Is the interaction clinically significant or not?
2) Can we stop /change the drug ?
- Are there other options for the treatment?
3) Can the dose be increased or decreased?
4) How do we monitor the effect of the drug?
What is an Adverse Drug Reaction?
An ADR is an unwanted or harmful reaction experienced following the administration of a drug or a combination of drugs, and is suspected to be related to the drug
what is the Pharmacist’s role in managing ADRs?
1) Identify patients at risk of ADRs
2) Identify drugs known to produce ADR and monitor patient appropriately
3) Avoid use of drugs causing ADRs where an equally effective and safer alternative exists
4) Review patient’s medicines: stop unnecessary medicines, check for interactions and contraindications
5) Ensure patient are counselled on the correct use of their medicines and possible side effects
6) Reporting ADRs
list the patients at risk of ADRs
1) Extremes of age
2) Gender:Females
3) Polypharmacy
4) Incurrent diseases
5) A history of intolerance or hypersensitivity
list the top 5 drugs known to produce ADRs
1) NSAIDs: 29.6%
2) Diuretics: 27.3%
3) Warfarin: 10.5%
4) ACEIs/A2RAs: 7.7%
5) Antidepressants and lithium: 7.1%
6) Beta-blockers: 6.8%
7) Opioids: 6.0%
8) Digoxin: 2.9%
9) Prednisolone: 2.5%
10) Clopidogrel: 2.4%
