Podcast
Questions and Answers
What is a significant factor to consider when prescribing drugs for elderly patients?
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.
Pharmacodynamic interactions alter the concentration of a drug at its site of action.
False (B)
Name one dietary constituent that can interact with drugs.
Name one dietary constituent that can interact with drugs.
Grapefruit juice
One severe consequence of drug interactions can result in _____ or death.
One severe consequence of drug interactions can result in _____ or death.
Match the type of drug interaction to its description:
Match the type of drug interaction to its description:
Which of the following can contribute to drug interactions?
Which of the following can contribute to drug interactions?
Drug interactions have no impact on health care costs.
Drug interactions have no impact on health care costs.
What happens to patients who experience significant drug interactions according to research?
What happens to patients who experience significant drug interactions according to research?
Which group of patients may have an increased risk of drug interactions due to their age and physiological changes?
Which group of patients may have an increased risk of drug interactions due to their age and physiological changes?
Patients classified as extensive metabolizers are at a lower risk for drug interactions compared to slow metabolizers.
Patients classified as extensive metabolizers are at a lower risk for drug interactions compared to slow metabolizers.
What is a key characteristic of drugs that have a high risk of significant drug interactions?
What is a key characteristic of drugs that have a high risk of significant drug interactions?
Patients who consume ________ drugs may experience altered levels of metabolizing enzymes, increasing the risk of drug interactions.
Patients who consume ________ drugs may experience altered levels of metabolizing enzymes, increasing the risk of drug interactions.
Match the type of drug interaction with its description:
Match the type of drug interaction with its description:
Which of the following populations are at increased risk for drug interactions?
Which of the following populations are at increased risk for drug interactions?
Drugs acting on different receptors can only antagonize each other's effects.
Drugs acting on different receptors can only antagonize each other's effects.
Name one characteristic that increases the risk of drug interactions in obese patients.
Name one characteristic that increases the risk of drug interactions in obese patients.
Why is the combination of a PDE5 inhibitor and any nitrate contraindicated?
Why is the combination of a PDE5 inhibitor and any nitrate contraindicated?
Antagonistic interactions can lead to an increase in the effectiveness of one or both drugs involved.
Antagonistic interactions can lead to an increase in the effectiveness of one or both drugs involved.
What is the effect of corticosteroids on diabetic patients?
What is the effect of corticosteroids on diabetic patients?
Alzheimer dementia patients taking donepezil should avoid using the anticholinergic drug ______ due to potential treatment failure.
Alzheimer dementia patients taking donepezil should avoid using the anticholinergic drug ______ due to potential treatment failure.
Match the drug interactions with their effects:
Match the drug interactions with their effects:
Which of the following is a mechanism of receptor block antagonism?
Which of the following is a mechanism of receptor block antagonism?
Pharmacokinetic interactions do not involve the processes of absorption, distribution, metabolism, or excretion.
Pharmacokinetic interactions do not involve the processes of absorption, distribution, metabolism, or excretion.
Drug absorption primarily occurs in the ______ after oral administration.
Drug absorption primarily occurs in the ______ after oral administration.
Which of the following is NOT a phase I metabolic reaction?
Which of the following is NOT a phase I metabolic reaction?
Enzyme induction immediately increases the metabolism of a drug without any delay.
Enzyme induction immediately increases the metabolism of a drug without any delay.
Which of the following medications can decrease the absorption of drugs that require an acidic environment?
Which of the following medications can decrease the absorption of drugs that require an acidic environment?
What is the primary organ responsible for drug metabolism?
What is the primary organ responsible for drug metabolism?
All drugs are absorbed equally regardless of gastrointestinal motility.
All drugs are absorbed equally regardless of gastrointestinal motility.
Name one type of drug that can form complexes with other drugs, leading to reduced absorption.
Name one type of drug that can form complexes with other drugs, leading to reduced absorption.
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 __________.
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 __________.
Match the following drugs with their corresponding enzyme induction effects:
Match the following drugs with their corresponding enzyme induction effects:
_________ are known to increase the rate of drug absorption by enhancing gastrointestinal motility.
_________ are known to increase the rate of drug absorption by enhancing gastrointestinal motility.
Match the following drugs with their effect on gastrointestinal motility:
Match the following drugs with their effect on gastrointestinal motility:
Which CYP subfamily is primarily affected by chronic ethanol use?
Which CYP subfamily is primarily affected by chronic ethanol use?
Pharmacokinetic interactions involving drug metabolism typically do not affect drug efficacy.
Pharmacokinetic interactions involving drug metabolism typically do not affect drug efficacy.
What can increase digoxin concentration in the body?
What can increase digoxin concentration in the body?
Chelation has no significant impact on drug absorption.
Chelation has no significant impact on drug absorption.
Name one example of a drug that can induce cytochrome P450 isozymes.
Name one example of a drug that can induce cytochrome P450 isozymes.
What effect does altered intestinal bacterial flora have on drug metabolism?
What effect does altered intestinal bacterial flora have on drug metabolism?
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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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