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    Drug Interactions: Digvijaya Lecturer School of Medical & Allied Sciences GD Goenka University

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    Digvijaya
    Drug interactions can occur when two drugs are taken together and one alters the effects of the other. There are several types of interactions, including pharmaceutical, pharmacokinetic, and pharmacodynamic. Pharmacokinetic interactions involve changes to absorption, distribution, metabolism, or excretion of a drug. Multiple drug therapies, diseases, and patient factors can contribute to interactions, which may increase or decrease a drug's effects and potentially cause harm. Careful review of a patient's medication history can help reduce risks from interactions.

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    Drug Interactions: Digvijaya Lecturer School of Medical & Allied Sciences GD Goenka University

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    60 views28 pages
    Drug interactions can occur when two drugs are taken together and one alters the effects of the other. There are several types of interactions, including pharmaceutical, pharmacokinetic, and pharmacodynamic. Pharmacokinetic interactions involve changes to absorption, distribution, metabolism, or excretion of a drug. Multiple drug therapies, diseases, and patient factors can contribute to interactions, which may increase or decrease a drug's effects and potentially cause harm. Careful review of a patient's medication history can help reduce risks from interactions.

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    Drug interactions_Digvijaya

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    Drug interactions can occur when two drugs are taken together and one alters the effects of the other. There are several types of interactions, including pharmaceutical, pharmacokinetic, and pharmacodynamic. Pharmacokinetic interactions involve changes to absorption, distribution, metabolism, or excretion of a drug. Multiple drug therapies, diseases, and patient factors can contribute to interactions, which may increase or decrease a drug's effects and potentially cause harm. Careful review of a patient's medication history can help reduce risks from interactions.

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    Download as pptx, pdf, or txt
    60 views28 pages

    Drug Interactions: Digvijaya Lecturer School of Medical & Allied Sciences GD Goenka University

    Uploaded by

    Digvijaya
    Drug interactions can occur when two drugs are taken together and one alters the effects of the other. There are several types of interactions, including pharmaceutical, pharmacokinetic, and pharmacodynamic. Pharmacokinetic interactions involve changes to absorption, distribution, metabolism, or excretion of a drug. Multiple drug therapies, diseases, and patient factors can contribute to interactions, which may increase or decrease a drug's effects and potentially cause harm. Careful review of a patient's medication history can help reduce risks from interactions.

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    of 28

    DRUG

    INTERACTIONS
    Digvijaya
    Lecturer
    School of Medical & Allied Sciences
    GD Goenka University
    DEFINITION

    • Drug interaction is defined as the pharmacological


    activity of one drug is altered by the concominant use of
    another drug or by the presence of some other
    substance.
    • The Drug whose Activity is effected by such an
    Interaction is called as a “Object drug.”
    • The agent which precipitates such an interaction is
    refered to as the “Precipitant”.
    Types of drug Interactions

    1.Drug-drug interactions.
    2.Drug-food interactions.
    3.Chemical-drug
    interactions.
    4.Drug-laboratory test
    interactions. 5.Drug-disease
    interactions.
    The Net effect of a Drug Interaction is:

    •Generally quantitative i.e.increased or decreased effect.

    •Seldom qualitative i.e.rapid or slower effect.

    •Precipitation of newer or increased adverse effect.


    Drug interactions are thus-
    • Mostly undesirable
    • Rarely desirable(beneficial): for eg.,enhancement of activity
    of penicillins when administered with probenecid.
    Factors contributing to drug interactions:
    1.Multiple drug therapy.
    2.Multiple prescribers.
    3.Multiple pharmacological effects of drug.
    4.Multiple diseases/predisposing illness.
    5.Poor patient compliance.
    6.Advancing age of
    patient. 7.Drug-related
    factors.
    Mechanisms of drug interactions:
    The three mechanisms by which an interaction
    can develop are-

    1.Pharmaceutical interactions.

    2.pharmacokinetic interactions.

    3.Pharmacodynamic

    interactions.
    Pharmaceutical interactions:
    Also called as incompatibility.it is a physicochemical
    interaction that occous when drugs are mixed in i.v . Infusions
    causing precipitation or inactivation of active principles .

    Example:-
    Ampicillin ,chlorpromazine &barbituates interact with
    dextran in solutions and are broken down or form chemical
    compounds.
    Pharmacokinetic Interactions:

    “These interactions are those in which adme properties


    of the object drug is altered by the precipitant and hence
    such interactions are also called as ADME
    interactions”.

    • The resultant effect is altered plasma concentration of


    the object drug.

    •These are classified as:


    1.Absorption interactions
    2.Distribution interactions
    3.Metabolism
    Absorption interactions

    Are those where the absorpt.ion of the object drug is altered.


    The net effect of such an interaction is:

    • Faster or slower drug absorption.

    • More, or, less complete drug absorption.


    Major mechanisms of absorption
    interactions are:
    1. Complexation and adsorption.

    2.Alteration in GI pH.

    3.Alteration in gut motility.

    4.Inhibition of GI enzymes.

    5.Alteration of GI micro flora.

    6.Malabsorption syndrome.
    OBJECT DRUG PRECIPITANT DRUGS INFLUENCE ON OBJECT DRUG
    ABSORPTION INTERACTION
    1.COMPLEXATION & ADSORPTION
    ANTACIDS,FOOD & MINERALS FORMATION OF POORELY SOLUBLE
    CEPHROFLOXACINE SUPPLEMENTS CONTAINING AND UNABSOBABLE COMPLEX WITH
    , PENCILLAMINE AL,Mg,Fe,Zn & Ca IONS SUCH HEAVY METAL IONS.

    2.ALTERATION OF GI PH
    ANTACIDS ENHANCED DISSOLUTION AND
    SULPHONAMIDES, ABSORPTION RATE.
    ASPIRIN
    FERROUS SODIUM DECREASED DISOLLUTION AND
    SULPHATE BICARBONATE,CALCIU HENCE
    M CARBONATE ABSORPTION.

    3.ALTERATION OF GUT MOTILITY


    ASPIRIN DIAZEPAM, RAPID GASTRIC
    LEVODOPA, METOCLOPRAMIDE EMPTYING,INCREASED RATE
    MEXILETINE OF ABSORPION.
    LEVODOPA, LITHIUM DELAYED GASTRIC
    CARBONATE, ANTI CHOLINERGICS EMPTYING;DECREASED RATE
    MEXILETINE OF ABSORPTION.
    OBJECT DRUG PRECIPITANT DRUGS INFLUENCE ON OBJECT
    DRUG
    4.ALTERATION OF GI MICROFLORA
    INCREASED BIOAVAILABILITY
    DUE TO DESTRUCTION OF
    DIGOXIN ANTI BIOTICS BACTERIAL FLORA THAT
    INACTIVATES DIGOXIN IN
    LOWER INTESTINE.
    5.MALABSORPTION SNDROME
    VITAMIN NEOMYCIN INHIBITION OF ABSORPTION
    A,B12,DIGOXIN DUE TO MAL.
    Distribution interactions

    Are those where the distribution pattern of the object drug is


    altered :
    • The major mechanism for distribution interaction is
    alteration in protein-drug binding.

    Competitive displacement interactions


    Displaced drug Displacer
    Phenylbutazone, Increased clotting tme.
    Anti coagulants chloral hydrate increased risk of
    hemorrhage.

    Increased hypoglycemic
    Tolbutamide Sulphonamides effect.
    METABOLISM
    INTERACTIONS:
    Are those where the metabolism of the object drug is altered.

    Mechanisms of metabolism interactions include:

    1.Enzyme induction:
    Increased rate of metabolism.

    2.Enzyme inhibition:
    Decreased rate of metabolism. It is the most significant interaction in
    comparison to other interactions and can be fatal.
    METABOLISM INTERACTIONS
    1.ENZYNE INDUCTION
    CORTICOSTEROIDS, ORAL DECREASED PLASMA
    CONTRACEPTIVES, BARBITURATES LEVELS; DECREASED
    COUMARINS, PHENYTOIN EFFICASY OF OBJECT DRUGS
    ORAL CONTRACEPTIVES, RIFAMICIN DECREASED PLASMA
    ORAL LEVELS
    HYPOGLYCAEMICS
    2.ENZYME INHIBITION
    ENHANCED ABSORPTION OF
    TYRAMINE RICH FOOD MAO INHIBITORS UN METABOLISED
    TYRAMINE.
    COUMARINS METRANIDAZOLE INCREASED ANTI
    PHENYL BUTAZONE COAGULANT ACTIVITY.
    ALCOHOL DISULPHIRAM, INCREASED IN PLASMA
    METRONIDAZOLE ACETALDEHYDE LEVELS
    EXCRETION
    INTERACTIONS
    Are these where the excretion pattern of the object drug
    is
    altered. Major mechanisms of excretion interactions are-

     Alteration in renal blood flow


     Alteration of urine PH
     Competition for active secretions
     Forced diuresis
    EXCRETION INTERACTIONS
    1.CHANGES IN ACTIVE TUBULAR SECRETION
    PENCILLIN,CEPHALOSP PROBENICID ELEVATED PLASMA
    ORINS,NALIDIXIC LEVELS OF ACIDIC DRUGS
    ACID
    2.CHANGES IN URINE PH
    INCREASED PASSIVE
    AMPHETAMINE ANTACIDS,THIAZIDESA REABSORPTION OF BASIC
    CETAZOLAMIDE DRUGS.INCRESED RISK
    Of TOXICITY
    3.CHANGES IN RENAL BLOOD FLOW
    DECREASED RENAL
    LITHIUM NSAIDS CLEARANCEOF
    BICARBONAT LITHIUM.RISK OF
    E TOXICITY
    Pharmacodynamic interactions:

    Are those in which the activity of the object drug at its


    site of action is altered by the precipitant. Such interactions
    may be direct or indirect.

    1.These are of two types1.direct


    pharmacodynamic interactions.
    2. Indirect pharmacodynamic interactions.
    DIRECT PHARMACODYNAMIC
    INTERACTIONS:

    In which drugs having similar or opposing pharmacological


    effects are used concurrently.

    The three consequences of direct interactions are

    1.Antagonism.

    2.Addition or summation.

    3.Synergism or
    potentiation.
    Antagonism
    :
    The interacting drugs have opposing actions
    Example: Acetylcholine and noradrenaline have opposing effects on
    heart rate.
    Addition or summation:
    The interacting drugs have similar actions and the resultant
    effect is the some of individual drug responses
    Example:CNS depressants like sedatives and hypnotics,…
    etc
    Synergism or potentiation:
    It is an enhancement of action of one drug by another
    Indirect pharmacodynamic interaction:

    In which both the object and the precipitant drugs have unrelated
    effects.but the latter in Some way alerts the effects but latter in some
    way alerts the effectsof the former.

    Example: salicylatesdecrease the ability of the platelets to


    aggregate thus impairing the Homeostasis if warfarin indused
    bleeding occurs.
    CONSEQUENCES OF
    DRUG
    INTERACTIONS:
    The consequences of drug interactions may be:

    •Major: Life threatening.

    •Moderate: Deteriotion of patients status.

    •Minor: Little effect.


    REDUSING THE RISK OF DRUG
    INTERACTIONS:
    1.Identify the patients risk factors.
    2.Take through drug history.
    3.Be knowledge about the actions of the drugs being used.
    4.Consider therapeutic alternatives.
    5Avoid complex therapeutic regiments when possible.
    6.Educate the patient.
    7.Monitor therapy.
    INFLUENCE OF SMOKING ON DRUG
    INTERACTIONS:

    •Smoking increases the activity of drug metabolizing enzymes in


    the liver, With the result that certain therapeutic agents.

    •Example: Diazepam, propoxyphene, theophylline, olanzapine.


    Are metabolized more rapidly,and their effect is decreased.
    INFLUENCE OF ALCOHOL ON DRUG
    INTERACTION:
    Chronic use of alcohol beverages may increases the rate of
    metabolism of drugs such as warfarin and phenytoin, probably by
    increasing the activity of hepatic enzymes.

    •Acute use of alcohol by non alcoholic individuals may cause


    an
    inhibition of hepatic enzymes.

    •Use of alcoholic beverages with sedatives and other


    depressants
    INFLUENCE OF FOOD ON DRUG
    INTERACTION:
    Food effects the rate and extent of absorption of drugs from the
    GI tract.
    Example: Many anti biotics should be given atleast 1hr before or 2hr
    after meals to achieve Optimal absorption.
    • The type of food may be important with regard to the absorption of
    concurrently administered Drugs.
    Example: Dietary items such as milk and other dairy products that
    contain calcium may decrease .
    The absorption of tetracycline and flouroquinolone
    derivatives.
    •Diet also may influence urinary pH values.
    THANK YOU

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