Drug Interactions Overview
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Questions and Answers

What is a significant factor to consider when prescribing drugs for elderly patients?

  • Poly-pharmacy (correct)
  • Regular exercise
  • High metabolism
  • Low blood pressure
  • Pharmacodynamic interactions alter the concentration of a drug at its site of action.

    False

    Name one dietary constituent that can interact with drugs.

    Grapefruit juice

    One severe consequence of drug interactions can result in _____ or death.

    <p>severe morbidity</p> Signup and view all the answers

    Match the type of drug interaction to its description:

    <p>Pharmacodynamic interaction = Modification of the pharmacological effect of a drug without altering its concentration Pharmacokinetic interaction = Alteration of the concentration of a drug reaching its site of action Poly-pharmacy = Concurrent use of multiple medications Therapeutic range = The range between a drug's effective dose and its toxic dose</p> Signup and view all the answers

    Which of the following can contribute to drug interactions?

    <p>Herbal remedies</p> Signup and view all the answers

    Drug interactions have no impact on health care costs.

    <p>False</p> Signup and view all the answers

    What happens to patients who experience significant drug interactions according to research?

    <p>They may have longer and more costly hospitalizations.</p> Signup and view all the answers

    Which group of patients may have an increased risk of drug interactions due to their age and physiological changes?

    <p>Elderly patients</p> Signup and view all the answers

    Patients classified as extensive metabolizers are at a lower risk for drug interactions compared to slow metabolizers.

    <p>False</p> Signup and view all the answers

    What is a key characteristic of drugs that have a high risk of significant drug interactions?

    <p>Narrow therapeutic index</p> Signup and view all the answers

    Patients who consume ________ drugs may experience altered levels of metabolizing enzymes, increasing the risk of drug interactions.

    <p>multiple</p> Signup and view all the answers

    Match the type of drug interaction with its description:

    <p>Pharmacokinetic = Involves drug absorption, distribution, metabolism, and excretion Pharmacodynamic = Involves additive or antagonistic effects between drugs Additive = Combined effects of two drugs enhancing each other's effects Synergistic = Effects of two drugs acting on different receptors to create a greater effect</p> Signup and view all the answers

    Which of the following populations are at increased risk for drug interactions?

    <p>Critically ill patients</p> Signup and view all the answers

    Drugs acting on different receptors can only antagonize each other's effects.

    <p>False</p> Signup and view all the answers

    Name one characteristic that increases the risk of drug interactions in obese patients.

    <p>Altered levels of metabolizing enzymes</p> Signup and view all the answers

    Why is the combination of a PDE5 inhibitor and any nitrate contraindicated?

    <p>They have additive effects on cGMP.</p> Signup and view all the answers

    Antagonistic interactions can lead to an increase in the effectiveness of one or both drugs involved.

    <p>False</p> Signup and view all the answers

    What is the effect of corticosteroids on diabetic patients?

    <p>Corticosteroids can cause hyperglycemia.</p> Signup and view all the answers

    Alzheimer dementia patients taking donepezil should avoid using the anticholinergic drug ______ due to potential treatment failure.

    <p>tolterodine</p> Signup and view all the answers

    Match the drug interactions with their effects:

    <p>Corticosteroids = Hyperglycemia in diabetic patients Mirtazapine = Loss of hypertensive control NSAIDs = Increase in blood pressure β-Adrenoceptor antagonists = Diminished effectiveness of agonists</p> Signup and view all the answers

    Which of the following is a mechanism of receptor block antagonism?

    <p>Reversible competitive antagonism</p> Signup and view all the answers

    Pharmacokinetic interactions do not involve the processes of absorption, distribution, metabolism, or excretion.

    <p>False</p> Signup and view all the answers

    Drug absorption primarily occurs in the ______ after oral administration.

    <p>proximal small intestine</p> Signup and view all the answers

    Which of the following is NOT a phase I metabolic reaction?

    <p>Glucuronidation</p> Signup and view all the answers

    Enzyme induction immediately increases the metabolism of a drug without any delay.

    <p>False</p> Signup and view all the answers

    Which of the following medications can decrease the absorption of drugs that require an acidic environment?

    <p>Cimetidine</p> Signup and view all the answers

    What is the primary organ responsible for drug metabolism?

    <p>Liver</p> Signup and view all the answers

    All drugs are absorbed equally regardless of gastrointestinal motility.

    <p>False</p> Signup and view all the answers

    Name one type of drug that can form complexes with other drugs, leading to reduced absorption.

    <p>Cholestyramine</p> Signup and view all the answers

    Drugs that cause enzyme inhibition can lead to an increase in the concentration of the target drug, resulting in increased toxicity. This process is called __________.

    <p>enzyme inhibition</p> Signup and view all the answers

    Match the following drugs with their corresponding enzyme induction effects:

    <p>Rifampicin = CYP3A4 Carbamazepine = CYP2C19 Ethanol (chronic use) = CYP2E1 Phenytoin = CYP3A4, CYP2C19</p> Signup and view all the answers

    _________ are known to increase the rate of drug absorption by enhancing gastrointestinal motility.

    <p>Pro-kinetic drugs</p> Signup and view all the answers

    Match the following drugs with their effect on gastrointestinal motility:

    <p>Narcotics = Slow GI motility Metoclopramide = Increase GI motility Anticholinergic drugs = Slow GI motility Laxatives = Increase GI motility</p> Signup and view all the answers

    Which CYP subfamily is primarily affected by chronic ethanol use?

    <p>CYP2E1</p> Signup and view all the answers

    Pharmacokinetic interactions involving drug metabolism typically do not affect drug efficacy.

    <p>False</p> Signup and view all the answers

    What can increase digoxin concentration in the body?

    <p>Antibiotics killing intestinal flora</p> Signup and view all the answers

    Chelation has no significant impact on drug absorption.

    <p>False</p> Signup and view all the answers

    Name one example of a drug that can induce cytochrome P450 isozymes.

    <p>Barbiturates</p> Signup and view all the answers

    What effect does altered intestinal bacterial flora have on drug metabolism?

    <p>It can metabolize some drugs, affecting their concentration and efficacy.</p> Signup and view all the answers

    Study Notes

    Drug Interactions Overview

    • Drug interactions occur when the simultaneous use of multiple medications alters drug efficacy or safety.
    • Particularly significant in elderly patients with chronic conditions, as they often require multiple medications (poly-pharmacy).
    • Acute events may lead to additional drug use, heightening the potential for interactions.

    Mechanisms of Drug Interactions

    • Drug interactions can be classified into two main categories:
      • Pharmacodynamic interactions: Alter the effects of a drug without changing its concentration.
      • Pharmacokinetic interactions: Alter the concentration of a drug at its action site, affecting absorption, distribution, metabolism, or excretion.

    Consequences of Drug Interactions

    • Effects can range from benign to severe (e.g., morbidity or death).
    • Physicians may face legal consequences from adverse patient outcomes due to known interactions.
    • Increased healthcare costs are associated with diagnosing and treating patients affected by drug interactions.
    • The pharmaceutical industry may suffer financial loss if a drug is removed from the market due to safety concerns.

    Risk Factors for Drug Interactions

    • Multiple Prescribers/Pharmacies: Creates fragmented medical records, increasing the likelihood of unnoticed interactions.
    • Age: Elderly patients are at higher risk due to poly-pharmacy and physiological changes.
    • Genetic Factors: Individual variations in drug-metabolizing enzymes impact susceptibility to interactions.
    • Health Conditions: Patients with chronic illnesses, obesity, malnutrition, or undergoing critical care have heightened risks.
    • Drug Properties: Medications with a narrow therapeutic index, steep dose-response curves, or strong pharmacological effects are particularly prone to interactions.

    Pharmacodynamic Interactions

    • Can result in additive, antagonistic, or synergistic effects when two drugs are taken together.
    • Additive effects: Both drugs enhance each other's pharmacological effects (e.g., benzodiazepines and barbiturates).
    • Synergistic effects: Different receptors lead to a pronounced effect (e.g., nitrates with sildenafil).
    • Antagonistic effects: One drug reduces the effectiveness of another (e.g., corticosteroids worsening blood glucose control in diabetics).

    Pharmacokinetic Interactions

    • Four main areas of pharmacokinetics that may be affected:
      • Absorption: Changes in gastrointestinal (GI) motility, pH, or presence of other substances can influence drug absorption.
      • Metabolism: Predominantly occurs in the liver through cytochrome P-450 enzymes; affected by enzyme induction and inhibition.
      • Distribution: Altered plasma protein binding may impact the drug available for action.
      • Excretion: Renal function can influence how drugs are eliminated, impacting overall pharmacokinetics.

    Altered Absorption

    • Gastric pH: Drugs requiring acidic conditions (e.g., ketoconazole) may have reduced absorption when combined with pH-raising agents.
    • Complexation/Chelation: Agents like cholestyramine can bind drugs, lowering absorption rates (e.g., warfarin).
    • GIT Motility: Both positive and negative effects on GI transit can alter drug absorption significantly.
    • Intestinal Flora: Altered gut bacteria from antibiotics can impact drug metabolism and absorption (e.g., digoxin).

    Altered Metabolism

    • Enzyme Induction: Certain drugs can increase metabolic enzymes, reducing the effectiveness of other concomitant medications (e.g., barbiturates).
    • Enzyme Inhibition: When one drug decreases the metabolism of another, leading to increased drug concentrations and potential toxicity.

    Conclusion

    • Understanding drug interactions is crucial for safe prescribing practices, especially in populations at higher risk.
    • Continuous evaluation of patient medication regimens can prevent adverse effects and improve therapeutic outcomes.

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    Description

    This quiz delves into the complexities of drug interactions and how they can affect patient responses to medications. It is particularly relevant for individuals managing chronic conditions with multiple drug regimens. Test your understanding of the importance of monitoring these interactions in pharmacology.

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