EVALUATION OF PRESCRIPTIONS GENERATED IN HOSPITAL FOR DRUG INTERACTIONS AND FIND OUT THE SUITABLE MANAGEMENT

1. UNDER GUIDENCE OF
Dr. RAMESH GANIPISETTI
DEPARTMENT OF PHARMACY PRACTICE
BY:
CHINTA INDU RADHA
15AB1T0004
IVth PHARM D
EVALUATION OF PRESCRIPTIONS GENERATED IN HOSPITAL
FOR DRUG INTERACTIONS AND FIND OUT THE SUITABLE
MANAGEMENT

2. S.NO DRUGS ROA DOSE FREQUENCY
1 T.PANTOCID PO 40mg OD
2 T.REVIOR PO 300mg OD
3 T.DYTOR PLUS-10 PO 10mg OD
4 T.SHELCAL-HD PO 1 tab OD
5 T.OROFER –XT PO 1 tab OD
6 INJ. H. MIXTARD SC 10-10-10 BID
7 T. NORFLOX PO 400mg OD
8 T.RIFAGUT PO 550mg BID
9 SYP.CREMAFFIN PO 15ml OD
10 T.SUPRADYN PO 1 tab OD
CASE-I
A 57 year old male came to the hospital with weakness since 3 days, associated with abdominal
discomfort
DIAGNOSIS: Severe anemia, HBV related cirrhosis of liver decompensated with ascites, Hyper-
splenism (Enlarged spleen), type-II DM
The medications prescribed are:

3. ✤ DRUG INTERACTION:
TYPE: DRUG-DRUG INTERACTION
✰ INTERACTION:
Precipitant drug: T. NORFLOXACIN
Objective drug: INJ. H. MIXTARD
➢CLINICAL OUTCOME: Medications like norfloxacin can sometimes affect blood glucose levels. Both
hyperglycemia (high blood glucose) and, less frequently, hypoglycemia (low blood glucose) have been reported.
Severe cases of hypoglycemia have resulted in coma and even death, especially in the elderly and patients with
kidney problems or severe infections using insulin or other diabetes medications that can commonly cause
hypoglycemia.
►MANAGEMENT: Blood glucose should be closely monitored whenever quinolones are prescribed to diabetic
patients, especially if they are elderly, have renal impairment, or are severely ill. Due to the risk of profound and
potentially life-threatening hypoglycemia, particular caution is advised during concomitant use of insulin and
insulin secretagogues (e.g., sulfonylureas, meglitinides). Patients should also be apprised of the increased risk of
hypoglycemia and be alert to potential signs and symptoms such as headache, dizziness, drowsiness, nervousness,
confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia. If hypoglycemia occurs, patients
should initiate appropriate remedial therapy immediately, discontinue the quinolone, and contact their physician.
Alternative antibiotics may need to be considered.

4. CASE-II
A 55kg male patient have been diagnosed with Hepatocellular carcinoma.
The medications prescribed are:
S.NO DRUGS ROA DOSE FREQUENCY
1 C.BECOZINC PO 1 CAP OD
2 T.GLYCOMET PO 500 mg OD
3 T.ATORVASTATIN PO 40mg OD
4 T.NITROGLYCERIN PO 2.5mg OD
5 T.PANTOP PO 40mg OD
6 T.METOPROLOL PO 25mg BID
7 T.ECOSPIRIN PO 150mg OD
8 T.CLOPIDOGREL PO 75mg OD
9 I.ACTRAPID SC 10-10-10 SC
✤DRUG INTERACTION:
TYPE: DRUG-DRUG INTERACTION
☆INTERACTION:
Precipitant drug: PANTOP
Objective drug: ATORVASTATIN
➣MECHANISM OF INTERACTION: Pharmacokinetic.

5. ❒CLINICAL OUTCOME: A case report suggests that co-administration with esomeprazole may increase the
plasma concentrations of atorvastatin and the associated risk of myopathy. The proposed mechanism is
competitive inhibition of intestinal P-glycoprotein, resulting in decreased drug secretion into the intestinal
lumen and increased drug bioavailability. Another, perhaps minor mechanism is competitive inhibition of
CYP450 3A4 metabolism. The interaction was suspected in a patient treated with atorvastatin (more than 1
year) and esomeprazole (6 weeks) who developed rhabdomyolysis with AV block two days after the addition
of clarithromycin. The patient reported experiencing symptoms of increased fatigue, mild chest pain, and
shortness of breath that coincided with the initiation of esomeprazole approximately six weeks prior to
admission. Theoretically, the interaction may also occur with other proton pump inhibitors like lansoprazole,
omeprazole, and pantoprazole and HMG-CoA reductase inhibitors like lovastatin and simvastatin, since these
drugs are all substrates of P-glycoprotein and CYP450 3A4.
MANAGEMENT: Because of the increased risk of musculoskeletal toxicity associated with high levels of
HMG-CoA reductase inhibitory activity in plasma, patients treated with atorvastatin, lovastatin, simvastatin,
and red yeast rice (which contains lovastatin) should be monitored more closely during concomitant use of
proton pump inhibitors. All patients treated with HMG-CoA reductase inhibitors should be advised to
promptly report to their physician any unexplained muscle pain, tenderness, or weakness, particularly if
accompanied by malaise or fever. Therapy should be discontinued if creatine kinase is markedly elevated or if
myopathy is suspected or diagnosed.

6. S.NO DRUGS ROA DOSE FREQUENCY
1 INJ.CITICHOLINE IV 500mg BID
2 INJ.PANTOPRAZOLE IV 40mg OD
3 TAB.ASPIRIN PO 350mg STAT
4 T.ASPISOL PO 150mg OD
5 T.CLOPIDOGREL PO 75mg OD
6 T.ROSUVASTATIN PO 40mg H/S
7 INJ.LANCTUS SC 14units H/S
8 INJ.ACTRAPID SC 6units ½ BEFORE BED
9 T.TELMISARTAN PO 40mg OD
10 INJ.OPTINEURON IV 1amp OD
11 INJ.EMESET IV 4mg STAT
12 SY.DEXORANGE PO 10ml TID
13 SY.CREMAFFIN PO 15ml H/S
14 TAB.MET-XL PO 50mg OD
15 TAB.PANTOP PO 40mg BID
CASE-III
A 72 year old female came to the hospital with the chief complaints of right side weakness of upper and lower limbs and also facial d
He has a past medical history of Type-II DM, Hypertension since 15 years and dyslipidemia.
DIAGNOSIS: Acute ischemic stroke.
The medications prescribed are:

7. DRUG INTERACTION-I:
TYPE: DRUG-DRUG INTERACTION
INTERACTION:
Precipitant drug: PANTOPRAZOLE
Objective drug: T. CLOPIDOGREL
MECHANISM OF INTERACTION: Pharmacodynamics
CLINICAL OUTCOME: Co-administration of clopidogrel with pantoprazole does not appear to
significantly alter the systemic exposure to the active metabolite of clopidogrel or the drug's effect on
platelet inhibition. Combining these medications may reduce the effectiveness of clopidogrel in
preventing heartattack or stroke. The interaction is most likely to occur if you are using a higher dosage
of pantoprazole than recommended or if you are using it too frequently.
o MANAGEMENT: According to the product labeling for pantoprazole, no dosage adjustment of
clopidogrel is necessary when administered with an approved dosage of pantoprazole. However, it may
be advisable to closely monitor the therapeutic efficacy of clopidogrel during concomitant treatment. An
H2-receptor antagonist may be substituted if an interaction is suspected.

8. • DRUG INTERACTION-II: TELMISARTAN+FOOD
• TYPE: DRUG-FOOD INTERACTION
• CLINICAL OUTCOME: Moderate-to-high dietary intake of potassium,
especially salt substitutes, may increase the risk of hyperkalemia in some patients
who are using angiotensin II receptor blockers (ARBs). ARBs can promote
hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion.
Patients with diabetes, heart failure, dehydration, or renal insufficiency have a
greater risk of developing hyperkalemia.
MANAGEMENT: Patients should receive dietary counseling and be advised to
not use potassium-containing salt substitutes or over-the-counter potassium
supplements without consulting their physician. If salt substitutes are used
concurrently, regular monitoring of serum potassium levels is recommended.
Patients should also be advised to seek medical attention if they experience
symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion,
tingling of the extremities, or feelings of heaviness in the legs.

9. Thank you