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2060 Pharmacology > Module 11 Drug Interactions > Flashcards

Module 11 Drug Interactions Flashcards

1
Q

Drug Interaction

A
  • Two or more drugs taken
  • Drug/food only 1 drug
  • Affecting pharmacokinetics (ADME)
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2
Q

Consequences

A
  • Increase/decrease effects
  • Generate new effect
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3
Q

Increased Therapeutic Effects

A
  • Ampicillin & sulbactam
  • Increase therapeutic activity of ampicillin
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4
Q

Ampicillin

A
  • Antibiotic
  • Inactivated by bacterial enzymes
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5
Q

Sulbactam

A
  • Inhibitor of bacterial enzymes
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6
Q

Increased Adverse Effects

A
  • Warfarin & aspirin
  • Bleeding
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7
Q

Warfarin

A
  • Anticoagulant
  • Thin blood
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8
Q

Aspirin

A
  • Analgesic
  • Thin blood
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9
Q

Reduced Therapeutic Effects

A
  • Clopidogrel & omeprazole
  • Insufficient anticoagulation
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10
Q

Clopidogrel

A
  • Anticoagulant
  • Pro-drug
  • CYP2C19 activation
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11
Q

Omeprazole

A
  • Stomach ulcer treatment
  • Inhibits CYP2C19
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12
Q

Reduced Adverse Effects

A
  • Morphine & naloxone
  • Overdose treatment
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13
Q

Generation of New Effect

A
  • Uncommon
  • Disulfiram & alcohol
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14
Q

Disulfiram

A
  • Chronic alcoholism treatment
  • Inhibits acetaldehyde metabolism
  • Severe hangover symptoms instantly
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15
Q

Interaction Types

A
  • Direct physical
  • Pharmacokinetic
  • Pharmacodynamic
  • Combined toxicity
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16
Q

Direct Physical Interaction

A
  • 2+ IV solutions mix
  • Forming precipitate
  • Compatibility chart before mixing solutions
  • Diazepam problematic
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17
Q

Pharmacokinetic Interaction

A
  • Alter absorption, excretion, metabolism, distribution
  • Common type of interaction
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18
Q

Altered pH (Absorption)

A
  • Gastric/intestinal pH alter absorption
  • Antacids increase gastric pH & absorption
19
Q

Chelation/Binding (Absorption)

A
  • Drugs bind together within intestine
  • Formation of insoluble complexes, no absorption
20
Q

Bile Acid Sequestrates

A
  • Bind intestinal bile acids
  • Prevent intestine absorption
  • Only free drug can be absorbed
  • Excreted in feces
21
Q

Altered Blood Flow (Absorption)

A
  • Decrease flow = decreased absorption
22
Q

Epinephrine & Anesthetic

A
  • Causes vasoconstriction
  • Decreases anesthetic absorption
  • Allows anesthetic to stay at injection site
  • Preventing pain sensation
23
Q

Gut Motility (Absorption)

A
  • Increased motility = decreased absorption
  • Opiate drugs decrease motility
  • Laxatives increase motility
24
Q

Vomiting (Absorption)

A
  • Decrease absorption
  • Monitor nausea/vomit side effects
  • 20-30min after admin = incomplete absorption
  • Drug must enter intestine before vomit
25
Q

Intestinal Bacteria Killing (Absorption)

A
  • Enterohepatic recycling
  • Decrease deconjugation & absorption
  • Decrease plasma drug conc
26
Q

Altering pH (Distribution)

A
  • Influence ionization of other drugs
  • pH partitioning changes extracellular pH
  • Draw drug outside cell
27
Q

Protein Binding (Distribution)

A
  • Drugs bound to same plasma protein site
  • Competition for binding
  • Lower affinity drug becomes free
  • Increase therapeutic effect, toxicity, excretion
28
Q

CYP Induction (Metabolism)

A
  • Increase synthesis of CYP enzymes
  • Increase metabolism
  • Delay induction (2-10 days)
  • Inducer stopped CYP levels return to normal (7-10 days)
29
Q

CYP Inducers

A
  • Cigarettes/marijuana
  • Rifampin (induces CYP3A4)
  • Phenobarbital (various)
  • BBQ food (induces CYP1A2)
  • Alcohol (induces CYP2E1)
30
Q

CYP Inhibition (Metabolism)

A
  • Intestine/liver
  • Decrease metabolism
  • Increase plasma conc
  • Pro-drug decreases metabolic activity
31
Q

CYP Inhibitors

A
  • Antibiotics/anti-fungal (CYP3A4)
  • HIV protease (CYP3A4)
  • Omeprazole (CYP2C19)
  • Serotonin reuptake (CYP2D6)
  • Fluvoxamine (CYP1A2)
  • Grapefruit juice (CYP3A4)
32
Q

Altered Blood Flow (Excretion)

A
  • Decrease renal flow = decrease glomerular filtration
  • Decrease renal excretion
  • Increase plasma drug conc
33
Q

Decreasing Renal Flow

A
  • Non-steroidal anti-inflammatory drugs (NSAIDS)
  • Beta blockers
34
Q

Altered pH (Excretion)

A
  • pH partitioning & ion trapping
  • Alter excretion
  • Overdose treatment
35
Q

Tubular Secretion

A
  • Mediated by proximal tubule transporters
  • Block transporter
  • Block drug secretion into lumen
  • Decrease excretion
  • Increase plasma conc
36
Q

Pharmacodynamic Interaction Types

A
  • Same receptor
  • Different sites
37
Q

Same Receptor Interaction

A
  • Antagonist blocking action of agonist
  • Decrease therapeutic effects
  • Decrease toxicity (OD)
38
Q

Different Site Interaction

A
  • Drugs produce same physiological response
39
Q

Combined Toxicity

A
  • Multiple drugs produce same toxic effect
40
Q

Monoamine Oxidase (MAO) BAD Food Interactions

A
  • Cheese
  • Yeast
  • Red wine
  • Sauerkraut
  • Cured meat
41
Q

MAO Inhibitors

A
  • Inhibit tyramine breakdown
  • Strict dietary restrictions
42
Q

Tyramine

A
  • Increased norepinephrine release
  • Peripheral nerve terminals
  • Hypertensive crisis
43
Q

Hypertension Signs

A
  • Tachycardia
  • Headache
  • Nausea/vomit

2060 Pharmacology (18 decks)

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