Module 11 Drug Interactions Flashcards
(43 cards)
1
Q
Drug Interaction
A
- Two or more drugs taken
- Drug/food only 1 drug
- Affecting pharmacokinetics (ADME)
2
Q
Consequences
A
- Increase/decrease effects
- Generate new effect
3
Q
Increased Therapeutic Effects
A
- Ampicillin & sulbactam
- Increase therapeutic activity of ampicillin
4
Q
Ampicillin
A
- Antibiotic
- Inactivated by bacterial enzymes
5
Q
Sulbactam
A
- Inhibitor of bacterial enzymes
6
Q
Increased Adverse Effects
A
- Warfarin & aspirin
- Bleeding
7
Q
Warfarin
A
- Anticoagulant
- Thin blood
8
Q
Aspirin
A
- Analgesic
- Thin blood
9
Q
Reduced Therapeutic Effects
A
- Clopidogrel & omeprazole
- Insufficient anticoagulation
10
Q
Clopidogrel
A
- Anticoagulant
- Pro-drug
- CYP2C19 activation
11
Q
Omeprazole
A
- Stomach ulcer treatment
- Inhibits CYP2C19
12
Q
Reduced Adverse Effects
A
- Morphine & naloxone
- Overdose treatment
13
Q
Generation of New Effect
A
- Uncommon
- Disulfiram & alcohol
14
Q
Disulfiram
A
- Chronic alcoholism treatment
- Inhibits acetaldehyde metabolism
- Severe hangover symptoms instantly
15
Q
Interaction Types
A
- Direct physical
- Pharmacokinetic
- Pharmacodynamic
- Combined toxicity
16
Q
Direct Physical Interaction
A
- 2+ IV solutions mix
- Forming precipitate
- Compatibility chart before mixing solutions
- Diazepam problematic
17
Q
Pharmacokinetic Interaction
A
- Alter absorption, excretion, metabolism, distribution
- Common type of interaction
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
Intestinal Bacteria Killing (Absorption)
- Enterohepatic recycling
- Decrease deconjugation & absorption
- Decrease plasma drug conc
26
Altering pH (Distribution)
- Influence ionization of other drugs
- pH partitioning changes extracellular pH
- Draw drug outside cell
27
Protein Binding (Distribution)
- Drugs bound to same plasma protein site
- Competition for binding
- Lower affinity drug becomes free
- Increase therapeutic effect, toxicity, excretion
28
CYP Induction (Metabolism)
- Increase synthesis of CYP enzymes
- Increase metabolism
- Delay induction (2-10 days)
- Inducer stopped CYP levels return to normal (7-10 days)
29
CYP Inducers
- Cigarettes/marijuana
- Rifampin (induces CYP3A4)
- Phenobarbital (various)
- BBQ food (induces CYP1A2)
- Alcohol (induces CYP2E1)
30
CYP Inhibition (Metabolism)
- Intestine/liver
- Decrease metabolism
- Increase plasma conc
- Pro-drug decreases metabolic activity
31
CYP Inhibitors
- Antibiotics/anti-fungal (CYP3A4)
- HIV protease (CYP3A4)
- Omeprazole (CYP2C19)
- Serotonin reuptake (CYP2D6)
- Fluvoxamine (CYP1A2)
- Grapefruit juice (CYP3A4)
32
Altered Blood Flow (Excretion)
- Decrease renal flow = decrease glomerular filtration
- Decrease renal excretion
- Increase plasma drug conc
33
Decreasing Renal Flow
- Non-steroidal anti-inflammatory drugs (NSAIDS)
- Beta blockers
34
Altered pH (Excretion)
- pH partitioning & ion trapping
- Alter excretion
- Overdose treatment
35
Tubular Secretion
- Mediated by proximal tubule transporters
- Block transporter
- Block drug secretion into lumen
- Decrease excretion
- Increase plasma conc
36
Pharmacodynamic Interaction Types
- Same receptor
- Different sites
37
Same Receptor Interaction
- Antagonist blocking action of agonist
- Decrease therapeutic effects
- Decrease toxicity (OD)
38
Different Site Interaction
- Drugs produce same physiological response
39
Combined Toxicity
- Multiple drugs produce same toxic effect
40
Monoamine Oxidase (MAO) BAD Food Interactions
- Cheese
- Yeast
- Red wine
- Sauerkraut
- Cured meat
41
MAO Inhibitors
- Inhibit tyramine breakdown
- Strict dietary restrictions
42
Tyramine
- Increased norepinephrine release
- Peripheral nerve terminals
- Hypertensive crisis
43
Hypertension Signs
- Tachycardia
- Headache
- Nausea/vomit
