This document discusses drug interactions, which can occur via pharmacokinetic or pharmacodynamic mechanisms. Pharmacokinetic interactions involve effects on absorption, distribution, metabolism, or excretion of one drug by another drug. Common examples include inhibition of cytochrome P450 enzymes, alteration of gut motility, and displacement from plasma protein binding sites. Pharmacodynamic interactions involve direct effects on physiological systems or receptor sites, and can result in synergism, antagonism, or unexpected toxicity. It is important for clinicians to be aware of potential drug interactions due to their impact on treatment outcomes and patient safety.
Introduction to dosage regimen and Individualization of dosage regimenKLE College of pharmacy
Introduction of Dosage regimen, Approaches for design of dosage regimen, Individualization, Advantages, Dosage in neonates, Geriatrics, Renal and Hepatic impaired Patients.
DRUG INTERACTIONS (MECHANISMS OF DRUG-DRUG INTERACTIONS)N Anusha
A Drug interaction is an interaction between a drug and some other substance, such as another drug or a certain type of food, which leads to interaction that could manifest as an increase or decrease in the effectiveness or an adverse reaction or a totally new side effect that is not seen with either drug alone that can be severe enough to alter the clinical outcome.
Every time a drug is administered with any other prescription medicine, OTC products, herbs or even food we expose ourselves to the risk of a potentially dangerous interaction.
Introduction to dosage regimen and Individualization of dosage regimenKLE College of pharmacy
Introduction of Dosage regimen, Approaches for design of dosage regimen, Individualization, Advantages, Dosage in neonates, Geriatrics, Renal and Hepatic impaired Patients.
DRUG INTERACTIONS (MECHANISMS OF DRUG-DRUG INTERACTIONS)N Anusha
A Drug interaction is an interaction between a drug and some other substance, such as another drug or a certain type of food, which leads to interaction that could manifest as an increase or decrease in the effectiveness or an adverse reaction or a totally new side effect that is not seen with either drug alone that can be severe enough to alter the clinical outcome.
Every time a drug is administered with any other prescription medicine, OTC products, herbs or even food we expose ourselves to the risk of a potentially dangerous interaction.
Pharmacokinetic concepts and principles in humans in order to design individualized dosage regimens which optimize the therapeutic response of a medication while minimizing the chance of an adverse drug reaction.
Definition of drug interaction ,types and factors contributing to drug interactions. Mechanisms of Drug Interaction. Absorption, Distribution, Metabolism and Excretion interactions with examples(ADME INTERACTIONS).Prevention of drug interaction.
Identify primary drug interaction concepts
Describe types and mechanisms of interactions
Identify drug interactions commonly encountered with antiretroviral drugs
Describe how to manage known interactions
A drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own.
Pharmacokinetic concepts and principles in humans in order to design individualized dosage regimens which optimize the therapeutic response of a medication while minimizing the chance of an adverse drug reaction.
Definition of drug interaction ,types and factors contributing to drug interactions. Mechanisms of Drug Interaction. Absorption, Distribution, Metabolism and Excretion interactions with examples(ADME INTERACTIONS).Prevention of drug interaction.
Identify primary drug interaction concepts
Describe types and mechanisms of interactions
Identify drug interactions commonly encountered with antiretroviral drugs
Describe how to manage known interactions
A drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own.
Pharmacokinetics variations in Disease States.Faizan Akram
The biggest issue in PK/PD and drug therapy is variability in
response. Variability factors that affect pharmacokinetics and pharmacodynamics influence clinical trials and dose regimen designs.
Mechanism of drug action (pharmacokinetic and pharmacodynamic )Ravish Yadav
The all the content in this profile is completed by the teachers, students as well as other health care peoples.
thank you, all the respected peoples, for giving the information to complete this presentation.
this information is free to use by anyone.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ocular injury ppt Upendra pal optometrist upums saifai etawah
drug interactions
1.
2. -Modification or alteration of response of
one drug by another when administered
simultaneously or in quick succession
-Respose Qualitative( )
Quantitative (Abnormal)
3. -Synergistic action of
1.ACE inhibitors + diuretics(HT)
2.Sulfamethoxazole+Trimethoprim (bacterial
infection )
3.Furosemide + Amiloride (prevent
Hypokalaemia)
*These are well-recognized interactions and do
not pose any undue risk to the patient
4. Poly pharmacy
Multiple prescribers
Multiple pharmacies
Genetic make up
Specific population like- elderly, obese, criticaly
ill patient
Specific illness E.g. Hepatic disease,
Renal dysfunction,
Narrow therapeutic index drugs -
Digoxin, Lithium , Antidepressant, Warfarin
5. 1.Drugs affecting closely regulated body
functions e.g. antihypertensives,
antidiabetics, anticoagulants
2. Highly plasma protein bound drugs like
NSAIDs,oral anticoagulants, sulfonylureas
3.Drugs metabolized by saturation kinetics,
e.g. phenytoin, theophylline
6. 1)Loss of therapeutic effect
2)Toxicity
3)Unexpected increase in pharmacological activity
4)Beneficial effects e.g additive & potentiation
(intended) or antagonism (unintended)
5) Chemical or physical interaction
e.g I.V incompatibility in fluid or syringes mixture
8. -Alter the conc of the drug at its site of
action (and consequently the intensity of
response) by affecting its – ADME by:
Reduced rate and/or completeness of absorption
Altered bioavailabilty
Reduced plasma protein binding
Altered tissue distribution
Altered hepatic metabolism
Altered renal excretion
9. Potentiation/antagonism at target receptor
Potentiation at non-target receptor
Alteration of fluid/electrolyte environment
Interference with transport mechanisms
10. Interaction at the site of
absorption
1. Formation of drug Chelates or complexes.
2. Altered gut Flora
3. Altered GIT Motility
4. Altered PH
5. Drug induced Mucosal damage.
6. Malabsorption caused by other drugs
11. -Formation of insoluble and poorly absorbed
complexes in the gut lumen, as occurs between
tetracyclines and calcium/iron salts, antacids
or sucralfate
-Phenytoin absorption is decreased by sucralfate
due to binding in the g.i. lumen
-Minimized by administering the two drugs
with a gap of 2–3 hrs so that they do not
come in contact with each other in the g.i.t
12. 1. Direct chemical interaction in the gut and
formation of drug Chelates or complex
Calcium (milk), iron, anti acid (Al or Mg hydroxide)
+ Tetracyclin insoluble complex.
levothyroxine ,digoxine and some acidic drugs e.g
warfarine + Colestyramine decrease their
absorption.
13. 4. Altered PH.
The non-ionized form of a drug is more lipid soluble and
more readily absorbed from GIT than the ionized form
does
-Ketoconazole absorption is reduced by H2 blockers
and PPIs because they decrease gastric acidity which
promotes dissolution and absorption of ketoconazole
14. H-2 blockers, anta acid + ketoconazole
Decrease gastric acidity, dissolution of ketoconazole is
decreased, resulting in reduced absorption
Therefore, These drugs must be separated by at least
2h in the time of administration
15. 3. Antibiotics like ampicillin, tetracyclines,
cotrimoxazole markedly reduce gut flora that
normally deconjugates OC pills secreted in the
bile as glucuronides and permits their
enterohepatic circulation
*Several instances of contraceptive failure have
been reported with concurrent use of these
antibiotics due to lowering of the contraceptive
blood levels
16. Antibiotics and Oral Contraceptives
Antibiotics kill bacteria in gut
Oestrogen conjugates not hydrolysed
Conjugates not re-absorbed
Less oestrogen - loss of contraceptive effect
(No effect on progestogen component)
17. 3.Altered gut motility
Slowing of gastric emptying such as antimuscarinic
drugs and opiate analgesics
anticholinergics + acetaminophen
Impact: delay in absorption of acetaminophen
OR
Accelerated by drugs e.g metclopromide which
hasten gastric emptying
18. -Primarily due to displacement of one drug
from its binding sites on plasma proteins by
another drug
-Esp drugs with small volume of distribution
like oral anticoagulants, sulfonylureas,certain
NSAIDs and antiepileptics
-Displacing drug should bind to the same
sites on the plasma proteins with higher
affinity
19. -Displacement of bound drug will initially raise
the conc of the free and active form of the drug
in plasma that may result in toxicity brief,
because the free form rapidly gets distributed,
metabolized and excreted
-Such interactions are significant only when
displacement extends to tissue binding sites as
well, or is accompanied by inhibition of
metabolism and/or excretion.
20. Effect of drug distribution
Eg:-Sodium valproates displaces
phyentoin from its binding site on
plasma albumin in addition to inhibit
its metabolism.
21. -Binding Quinidine with digoxin and cause
increase concentration of free digoxin in
addition to impair renal excretion
-Quinidine has been shown to reduce the
binding of digoxin to tissue proteins as well
as its renal and biliary clearance by inhibiting
the efflux transporter P-glycoprotein,
resulting in nearly doubling of digoxin blood
levels and toxicity
22. Altered drug Metabolism
The liver is the major site of drug metabolism
CYP450 family is the major metabolizing enzyme in
phase I (oxidation process).
23. They affect:-
- the bioavailability (if the drug
undergoes extensive first pass metabolism in
liver)
- the plasma half-life of the drug (if the
drug is primarily eliminated by metabolism)
24. Eg:-Macrolide antibiotics, azole antifungals,
chloramphenicol, omeprazole, SSRIs, HIV-
protease inhibitors, cimetidine, ciprofloxacin
and metronidazole
-They compete for the same CYP450 isoenzyme
or cofactor and attain clinical significance
mostly for drugs that are metabolized by
saturation kinetics
-They inhibit the metabolizing enzymes and raise
chances of toxicity of the drug
25. -Barbiturates,phenytoin, carbamazepine, rifampin,
cigarette smoking, chronic alcoholism and pollutants
-They induce microsomal drug metabolizing enzymes
and enhance biotransformation of several drugs
(including their own in many cases)
-Involves gene mediated increased synthesis
of certain CYP450 isoenzymes; takes 1–2 weeks
(contrast inhibition of metabolism which develops
quickly) and regresses gradually over 1–3 weeks after
discontinuation of the inducer.
26. 1.Decreased intensity and/or duration of action
of drugs
e.g. failure of contraception with oral
contraceptives
2. Increased intensity of action of drugs that
are activated by metabolism.
Eg:-Acute paracetamol toxicity is due to one of
its metabolites—toxicity occurs at lower doses in
patients receiving enzyme inducers
27. 1. Congenital nonhaemolytic jaundice: It is due
to deficient glucuronidation of bilirubin;
Phenobarbitone hastens clearance of jaundice
2. Cushing’s syndrome: phenytoin may reduce
the manifestations by enhancing degradation
ofadrenal steroids which are produced in
Excess
3. Chronic poisonings: by faster metabolism of
the accumulated poisonous substance
4. Liver disease.
28. -Important mostly in case of drugs actively
secreted by tubular transport
e.g.
a) probenecid inhibits tubular secretion of
penicillins and cephalosporins and prolongs their
plasma t½
Utility:-For the single dose treatment of
gonorrhoea
.
29. b)Aspirin blocks the uricosuric action of probenecid
and decreases tubular secretion of methotrexate
c)Change in the pH of urine can also affect
excretion of weakly acidic or weakly basic drugs.
This has been utilized in the treatment of
poisonings (Q.Explain why)
d)Diuretics and to some extent tetracyclines, ACE
inhibitors and certain NSAIDs have been found to
raise steady-state blood levels of lithium by
promoting its tubular reabsorption
30. This principle is utilized for facilitating elimination of
the drug in poisoning,
i.e. urine is alkalinized in barbiturate and salicylate
poisoning
-Though elimination of weak bases (morphine,
amphetamine) can be enhanced by acidifying
urine, this is not practiced clinically, because
acidosis can induce rhabdomyolysis, cardiotoxicity
and actually worsen outcome
-The effect of changes in urinary pH on drug
excretion is > for those having pKa values between 5 –
8, becoz only in their case pH dependent passive
reabsorption is significant
pka-> ph at which 50% of drug is ionized
31. -These are independent of a change in its
conc
-Derived from modification of the action of
one drug at the target site by another drug
- This may result in an enhanced response
(synergism), an attenuated response
(antagonism) or an abnormal response
32. Drugs Effects
DZP+Antihistaminic+Neu
rolept+opoiod+alcohol
Excessive sedation,
respiratory
depression,motor
incordination
Αlpha1 blocker+ACE
inhibitor+vasodilator?Hig
h ceiling
diuretics/cardiac
depressants
Excessive fall in BP,
fainting
Propranolol+insulin/sulph
onureas in DM
Pronounced+asymptomat
ic hypoglycaemia
Blockade of beta
receptors contributes
to recovery from
hypoglycaemia+ its
sympyoms
Ceftriaxone/cefoperazo
ne+oral anticoagulent
Prolonged prothrombin
time
Aspirin/clopedogril/ticlo
pidine+carbenicillin
Excessive platelet
inhibition+bleeding
33. Drugs Effects
Organic
nitrates+sildenafil
Ppt fall in BP & MI Becoz nitrates cGMP &
sildenafil prevents its
degradation by inhibiting
PDE5
ACEI+K Sparing agents Severe hyperkalemia
Aminogly+furosemide Additive ototoxicity
ACEI/beta
blockers/diuretics+NSAI
Ds
Attenuation of
antihypertensive effect
of
Due to inhibition of renal
PG synthesis
Levodopa+neurolept/meto
clopramide
Anti-DA action
Alcohol+metronidazole/ce
foperazone
Disulfuram like effect Distressing effects
34. -Certain drugs react with each other and get
inactivated if their solutions are mixed before
administration
-In combined oral or parenteral formulations, the
manufacturers take care that such
incompatibilities do not take place
*In vitro interactions occur when injectable
drugs are mixed in the same syinge or infusion
bottle
35. Eg:-
1.Penicillin G or ampicillin mixed with gentamicin or
another aminoglycoside antibiotic
2. Thiopentone sodium when mixed with succinylcholine or
Morphine
3. Heparin when mixed with Penicillin /gentamicin /
Hydrocortisone
4. Noradrenaline when added to sodium bicarbonate solution.
*In general, it is advisable to avoid mixing of any two or more
parenteral drugs before injecting
36. Grapefruit juice and Terfenadine
Grapefruit juice and cyclosporin
Grapefruit juice and felodipine
Grapefruit contains : furanocoumarin compounds
that can selectively inhibit CYP3A4
37. -Certain varieties of cheese, beer,wines, pickled meat and
fish, yeast extract contain large quantities of tyramine,
dopa, etc
-In MAO inhibited patients these indirectly acting
sympathomimetic amines escape degradation in the
intestinal wall and liver → reaching into systemic
circulation they displace and release large amounts
of NA from transmitter loaded adrenergic nerve endings
→ hypertensive crisis, cerebrovascular accidents
-When such a reaction occurs, it can be treated by i.v.
injection of a rapidly acting α blocker, e.g. phentolamine.
Prazosin or chlorpromazine are alternatives.
38. Dose related events may be managed by
changing the dose of the affected drug.
Eg.,when miconazole oral gel causes an increase
in bleeding time of warfarin then reducing the
warfarin dose will bring the bleeding time back
into range and reduce the risk of haemorrhage
It is important to retitrate the dose of
warfarin when the course of miconazole is
complete.
39. The potential severity of some interaction require
immediate cessation of the combination
Eg:combination of erythromycin and terfenadine can
produce high terfenadine level with the risk of developing
Torsades de Pointes
Dose spacing is appropriate for interaction involving the
inhibition of absorption in the GI tract .
Eg.,avoid the binding of ciprofloxacin by ferrous salts
40. Interactions are easily forgotten when
prescribing
Interactions are difficult to remember
Pharmacodynamic interactions can often
be predicted across drug classes
Pharmacokinetic interactions can not be
predicted – experiments needed
Many interactions probably remain
undescribed – so look out for them
The chances of interaction are 60 times
higher in a patient taking 5 drugs than in
one taking 2.
42. Mechanisms of drug interactions
Pharmacokinetics Pharmacodynamics
Pharmacokinetics involve the effect of a drug on another drug kinetic that
includes absorption ,distribution , metabolism
and excretion.
Pharmacodynamics are related to the pharmacological activity of
the interacting drugs
E.g., synergism , antagonism, altered cellular transport effect
on the receptor site.
43. Alteration of gut motility by atropinic drugs,
TCAs, opioids and prokinetic drugs like
metoclopramide or cisapride can also
affect drug absorption.