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Drug - Drug Interaction of pulmonary concern

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Drug - Drug Interaction of pulmonary concern

  1. 1. DRUG-DRUG INTERACTION OF PULMONARY CONCERN By Mahmoud E. Abou El-Magd
  2. 2. INTRODUCTION • An interaction occurs when the effects of one drug are changed by another drug, food, drink or exposure to an environmental chemical. • A drug interaction occurs when two or more drugs interact in such a way that the effectiveness or toxicity of one or more of the drugs is altered. • Interactions can be harmful, either by increasing the toxicity of a drug or by reducing its efficacy. However, some drug interactions can also be beneficial . DRUG - DRUG INTERACTIONS 2
  3. 3. RISK FACTORS • Genetic make up . • Multiple prescribers . • Multiple pharmacies . • Specific population like e.g, females , elderly, obese, criticaly ill patient , trasplant recipient . • Specific illness E.g. Hepatic disease, Renal dysfunction . • Narrow therapeutic index drugs as warfarin , digoxin , theophyllin . DRUG - DRUG INTERACTIONS 3
  4. 4. OUTCOMES OF DRUG INTERACTIONS 1) Loss of therapeutic effect . 2) Toxicity . 3) Beneficial effects e.g additive & potentiation (intended) or antagonism (unintended). 4) Chemical or physical interaction e.g I.V incompatibility in fluid or syringes mixture . DRUG - DRUG INTERACTIONS 4
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  6. 6. Mechanisms DRUG - DRUG INTERACTIONS 6
  7. 7. TYPES OF PHARMACOKINETIC INTERACTION. DRUG - DRUG INTERACTIONS 7
  8. 8. ALTERED GIT ABSORPTION. •Altered pH •Altered bacterial flora • formation of drug chelates or complexes • drug induced mucosal damage • altered GIT motility. DRUG - DRUG INTERACTIONS 8
  9. 9. TYPES OF PHARMACOKINETIC INTERACTION. DRUG - DRUG INTERACTIONS 9
  10. 10. CYP450 ISOENZYMES • Present in lipid layer of the endoplasmic reticulum of hepatocytes . • Major enzymes involved in metabolism and bioactivation . • About 75% of reactions . DRUG - DRUG INTERACTIONS 10
  11. 11. CYTOCHROME P450 (CYP450) • Inducer • Speeds up metabolism • Decreases substrate level (lack of efficacy is concern) • Gradual onset/offset • Inhibitor • Slows metabolism • Increases substrate level (toxicity is concern) • Quick onset/offset DRUG - DRUG INTERACTIONS 11
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  14. 14. PHARMACODYNEMIC INTERACTION It means alteration of the dug action without change in its serum concentration by pharmacokinetic factors. These are of two types 1.direct pharmacodynamic interactions. 2.Indirect pharmacodynamic interactions DRUG - DRUG INTERACTIONS 14
  15. 15. 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. DRUG - DRUG INTERACTIONS 15
  16. 16. INDIRECT PHARMACODYNAMIC INTERACTION: In which both the object and the precipitant drugs have unrelated effects.but the latter in Some way alerts the effects of the former. Example: salicylatesdecrease the ability of the platelets to aggregate thus impairing the Homeostasis if warfarin indused bleeding occurs. DRUG - DRUG INTERACTIONS 16
  17. 17. 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 . DRUG - DRUG INTERACTIONS 17
  18. 18. Examples DRUG - DRUG INTERACTIONS 18
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  26. 26. MISCELLANEOUS ANTIBACTERIAL ANTIBIOTICS DRUG - DRUG INTERACTIONS 26
  27. 27. ANTIMYCOBACTERIAL AGENTS DRUG - DRUG INTERACTIONS 27
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  29. 29. ANTICOAGULANTS/THROMBOLYTIC AGENTS DRUG - DRUG INTERACTIONS 29
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  33. 33. ANTICONVULSANTS DRUG - DRUG INTERACTIONS 33
  34. 34. ANTINEOPLASTIC AGENTS DRUG - DRUG INTERACTIONS 34
  35. 35. BRONCHODILATORS DRUG - DRUG INTERACTIONS 35
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  38. 38. CORTICOSTEROIDS DRUG - DRUG INTERACTIONS 38
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  45. 45. FOOD-DRUG INTERACTIONS… • -Advise patients to take medication with a full glass of water. • -Do not take vitamin pills at the same time you take medication (i.e, take medication 1 hour after taking vitamins). • -Not mix medication into hot drinks, because the heat from the drink may destroy the effectiveness of the drug. • -Never take medication with alcoholic drinks. DRUG - DRUG INTERACTIONS 45
  46. 46. 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.  Diet also may influence urinary pH values. Lime juice is most acidic Milk products alter pH DRUG - DRUG INTERACTIONS 46
  47. 47. DRUG INDUCED NUTRITIONAL EFICIENCIES DRUG ANTIEPILECTIC DRUGS (phenytion , phenobarbitone, primidone, valproic acid) AFFECTED NUTRIENTS POSSIBLE MECHANISM EFFECT Folate Vitamin D Vitamin E Zinc Decreased absorption Enzyme induction Excess utilization ? Chelation Selenium Vitamin K Peroxide damage ? Megaloblastic anemia Osteomalacia Haemolysis Anorexia , celebellar dysfunction Hepatotoxicity Hemorrhage ANTIFOLATE DRUGS (e.g. methotrexate, pyrimethamine, trimethamine, trimethoprim) Folate Dihydrofolate reductase inhibition Megaloblastic anemia, cytopenia CEPHALOSPORINS (Cefamendole, cefoperazone, latamoxef) Vitamin K Decreased prothrombin synthesis Bleeding episodes DRUG - DRUG INTERACTIONS 47
  48. 48. DRUG AFFECTED NUTRIENTS POSSIBLE MECHANISM EFFECT CORTICOSTEROIDS Calcium Decreased Ca, vitamin D metabolism Bone disorders COUMARIN ANTICOGULANTS Vitamin K ? Hemorrhage DIURETICS Zn , Ca, K, Mg Urinary loss depression Weakness , electrolyte imbalance DRUG AFFECTED NUTRIENTS POSSIBLE MECHANISM EFFECT ISONIAZED (INH) Pyridoxine Complex formation Peripheral neuropathy, Convulsions, psychatric manifestation DRUG - DRUG INTERACTIONS 48
  49. 49. DRUG AFFECTED NUTRIENTS POSSIBLE MECHANISM EFFECT PARA – AMINO SALICYCLIC (PAS) Vitamin B12 decreased absorption Megaloblastic anaemia POTASSIUM CHLORIDE Vitamin B12 decreased ileal Ph Decreased absorption RIFAMPCIN Vitamin D Enzyme induction Osteomalacia SALICYLATES Vitamin C, Folate Increased excretion, decreased uptake Anemia ,infection DRUG - DRUG INTERACTIONS 49
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  51. 51. INFLUENCE OF SMOKING ON DRUG INTERACTIONS ?!! DRUG - DRUG INTERACTIONS 51
  52. 52. INFLUENCE OF ALCOHOL ON DRUG INTERACTION ?!! DRUG - DRUG INTERACTIONS 52
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