Podcast
Questions and Answers
What are the two main groups of drug transporter proteins?
What are the two main groups of drug transporter proteins?
- P-glycoprotein and solute carrier superfamily
- ATP-binding cassette family and solute carrier superfamily (correct)
- P-glycoprotein and OATP
- ATP-binding cassette family and P-glycoprotein
How does the inhibition of P-glycoprotein in enterocytes affect drug availability?
How does the inhibition of P-glycoprotein in enterocytes affect drug availability?
- Does not affect drug absorption
- Decreases oral bioavailability
- Increases oral bioavailability (correct)
- Reduces systemic absorption
What major adverse effects were identified with the drug cisapride?
What major adverse effects were identified with the drug cisapride?
- Severe allergic reactions
- Liver toxicity
- Venticular arrhythmias (correct)
- Kidney damage
What is one of the key mechanisms through which drug interactions can occur?
What is one of the key mechanisms through which drug interactions can occur?
Which factor can lead to the discontinuation of a drug like cisapride in the United States?
Which factor can lead to the discontinuation of a drug like cisapride in the United States?
What does the inhibition of P-glycoprotein in the liver or kidney typically result in?
What does the inhibition of P-glycoprotein in the liver or kidney typically result in?
How can potentially clinically relevant drug-drug interactions be identified?
How can potentially clinically relevant drug-drug interactions be identified?
What affects the amount of drug entering hepatocytes during metabolism?
What affects the amount of drug entering hepatocytes during metabolism?
What is polypharmacy typically defined as?
What is polypharmacy typically defined as?
Which step in the deprescribing process involves assessing each medication for potential drug-related harm?
Which step in the deprescribing process involves assessing each medication for potential drug-related harm?
What are clinical pharmacists encouraged to monitor after discontinuing medications?
What are clinical pharmacists encouraged to monitor after discontinuing medications?
Which patient characteristic is a risk factor for polypharmacy?
Which patient characteristic is a risk factor for polypharmacy?
What is one of the negative consequences of polypharmacy?
What is one of the negative consequences of polypharmacy?
What should clinical pharmacists consider in patients with new symptoms potentially indicative of an adverse drug reaction?
What should clinical pharmacists consider in patients with new symptoms potentially indicative of an adverse drug reaction?
When targeting medications for deprescribing, which should be prioritized?
When targeting medications for deprescribing, which should be prioritized?
Which statement best describes the role of clinical pharmacists in relation to polypharmacy?
Which statement best describes the role of clinical pharmacists in relation to polypharmacy?
What is a significant risk factor for drug interactions in older adults?
What is a significant risk factor for drug interactions in older adults?
What steps should be taken to prevent potential drug interactions?
What steps should be taken to prevent potential drug interactions?
What is defined as polypharmacy?
What is defined as polypharmacy?
What should you do after obtaining a complete medication list from the patient?
What should you do after obtaining a complete medication list from the patient?
Which of the following increases a patient's drug interaction risk?
Which of the following increases a patient's drug interaction risk?
What should be monitored when discontinuing a medication?
What should be monitored when discontinuing a medication?
Which of the following is NOT a suggested method for managing drug interaction risk?
Which of the following is NOT a suggested method for managing drug interaction risk?
What is an appropriate action if a patient cannot recall their natural product use?
What is an appropriate action if a patient cannot recall their natural product use?
What is an example of altered absorption due to changes in GI pH?
What is an example of altered absorption due to changes in GI pH?
What mechanism describes the interaction when one drug binds to another and reduces its absorption?
What mechanism describes the interaction when one drug binds to another and reduces its absorption?
What is the outcome of induction of drug transporter proteins?
What is the outcome of induction of drug transporter proteins?
In which type of drug interaction does competition for serum protein binding sites occur?
In which type of drug interaction does competition for serum protein binding sites occur?
What effect does carbamazepine have on simvastatin metabolism?
What effect does carbamazepine have on simvastatin metabolism?
An example of enzyme inhibition affecting drug metabolism is:
An example of enzyme inhibition affecting drug metabolism is:
How does metoclopramide affect cyclosporine absorption?
How does metoclopramide affect cyclosporine absorption?
What is a consequence of increased first-pass metabolism?
What is a consequence of increased first-pass metabolism?
Which mechanism is involved in the increased exposure of drugs in the CNS due to drug interactions?
Which mechanism is involved in the increased exposure of drugs in the CNS due to drug interactions?
What happens when drug binding sites on serum proteins are competed for?
What happens when drug binding sites on serum proteins are competed for?
What type of information is primarily included in Specialty Drug Interaction Resources?
What type of information is primarily included in Specialty Drug Interaction Resources?
What severity level category describes an interaction with limited clinical effects?
What severity level category describes an interaction with limited clinical effects?
Which authors are known for the textbook 'Drug Interactions, Analysis and Management'?
Which authors are known for the textbook 'Drug Interactions, Analysis and Management'?
What resource provides a focus on both professional and consumer data regarding drug interactions?
What resource provides a focus on both professional and consumer data regarding drug interactions?
Which of the following interactions does Gold Standard monitor?
Which of the following interactions does Gold Standard monitor?
What kind of data does Hansten and Horn's 2019 book include?
What kind of data does Hansten and Horn's 2019 book include?
What is the primary focus of the open access site mentioned for clinical pharmacists?
What is the primary focus of the open access site mentioned for clinical pharmacists?
Which resource is specifically noted for providing thorough reference data on drug interactions?
Which resource is specifically noted for providing thorough reference data on drug interactions?
Study Notes
Common DDI mechanisms
- One drug can change the pH of the GI tract and alter the absorption of another drug - For example posaconazole suspensions absorption can be reduced when taken with PPIs.
- Drug absorption can be reduced by adsorption, chelation, or complexing of one drug with another where the combination is poorly soluble. For example tetracycline absorption is reduced when taken with antacids
- Changes in GI motility can affect the absorption of drugs. Increased motility from metoclopramide can enhance cyclosporine exposure
- Drug transporter proteins in the gastrointestinal tract can lead to changes in the absorption of a drug. For example, rifampin, increases the activity of P-glycoprotein, decreasing the absorption of disoxin
- Drug interactions can also occur when two drugs compete for the same protein binding sites. Valproic acid can displace warfarin from its binding sites, leading to increased warfarin exposure
Mechanism of drug interactions and distribution
- Drug interactions can occur during distribution when a drug changes the uptake of another drug to a site of action. For example, ketoconazole can inhibit P-glycoprotein leading to an increase of ritonavir in the CNS.
- Drug interactions can affect metabolism through changes to first-pass metabolism. For example, verapamil can increase dofetilide concentrations, which can lead to serious heart complications.
- Drugs can induce the production of enzymes that metabolize other drugs. For example, carbamazepine can increase the activity of CYP3A4, decreasing the concentration of simvastatin.
- Drugs can inhibit the activity of the enzymes that metabolize other drugs. For example, amiodarone can inhibit the activity of CYP2C9, CYP3A4, and CYP1A2, increasing the concentration of warfarin.
Drug transporter proteins
- Drug transporter proteins affect the pharmacokinetics of drugs within the body through uptake and efflux actions.
- Important examples of drug transporter proteins include the ATP-binding cassette family and the solute carrier superfamily
Polypharmacy
- Polypharmacy is the routine administration of five or more medications.
- Polypharmacy is growing and leads to:
- reduced quality of life
- increased risk of adverse events
- increased risk of mortality
- increased healthcare costs
Deprescribing
- Deprescribing is the process of discontinuing medications.
- It is considered to be a risk reduction and management strategy used in polypharmacy.
Drug interaction resources
- Clinical pharmacists can use several resources to help identify and manage drug interactions. This includes:
- Hansten and Horn’s Drug Interactions
- Stockley’s Drug Interactions
- Drugs.com
- Gold Standard
Using resources and patient management
- Clinical pharmacists need to consider several factors when using drug interaction resources:
- Type and extent of information in each resource
- Target audience of the resource
- Consumer focused vs. Healthcare professional focused
- Drug interaction details
- Clinical management, including appropriate monitoring.
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Description
This quiz explores common mechanisms of drug-drug interactions, focusing on how one drug can impact the absorption and efficacy of another. Key concepts include changes in pH, GI motility, transporter proteins, and protein binding sites. Test your knowledge on these crucial pharmacological principles.
