This document contains several case studies of patients who were prescribed multiple medications. For each case study, it identifies potential drug-drug interactions between the prescribed medications based on their mechanisms and effects. It provides the management recommendations to address each interaction, such as using caution, monitoring for specific adverse effects, or considering dose adjustments. The goal is to evaluate prescriptions for drug interactions and determine suitable management approaches to address any safety risks.

1. EVALUATION OF PRESCRIPTIONS
GENERATED IN HOSPITAL FOR DRUG
INTERACTIONS AND FIND OUT THE
SUITABLE MANAGEMENT
SUBMITTED BY UNDER THE GUIDANCE OF
KHANDKER FATIMA FARAH HASSAN Dr. G. RAMESHPHARM. D
15AB1T0012 D DEPARTMENT OF
IV PHARM. D PHARMACY PRACTICE
VIGNAN PHARMACY COLLEGE
(Approved by AICTE & PCI Affiliated to JNTU KAKINADA)
VADLAMUDI, GUNTUR DIST, ANDHRA PRADESH, INDIA, PIN: 522 213

2. CASE STUDY
Yellowish green (Gilions ) vomiting for about 6-7 times since one day
(morning of 6/8/18) i.e 6.00 AM occasionally blood stained.
Diagnosis: Acute gastroenteritis, Acute mild hepato renal dysfunction.

3. The medications prescribed are:
S. No DRUGS ROA DOSE FREQUENCY
1 Inj. Ondansetron IV 4mg BID
2 Trenexa IV 500mg BID
3 Thyronorm PO 25mcg OD
4 K. Bind PO 1 BID
5 Nebasthalin PN 1 TID
6 Cintapro Oral 1mg -
7 Domstal Oral 1 BID
8 Gavison Oral 2 tablets BID
9 Perinorm IM 1cc SOS

4. DRUG INTERACTION
• TYPE: DRUG-DRUG INTERACTION
• INTERACTION:
• Precipitant drug: Ondansetron
• Objective drug: domiperidone
• MECHANISM OF INTERACTION: Pharmacodynamic
• CLINICAL OUTCOME: Concurrent use of DOMPERIDONE and ONDANSETRON may result
in increased risk of QT interval prolongation.
• MANAGEMENT: Use caution when coadministering domperidone and ondansetron as
this may increase the risk of serious cardiac effects, including torsades de pointes,
particularly at domperidone doses greater than 30 mg/day, and in patients older than 60
years. If coadministration is necessary, domperidone should be initiated at the lowest
possible dose and titrated with caution. Discontinue domperidone if the patient
experiences dizziness, palpitations, syncope, or seizure. If coadministration cannot be
avoided, monitor ECG for signs of QT interval prolongation.

5. CASE STUDY
Left leg venous ulcer size 3 months. Patient also complaints of chest
pain left side associated with left upper limb mild pain.
Diagnosis: Left leg cellulitis with arterial Ulcer.

6. The medications prescribed are:
S. No DRUGS ROA DOSE FREQUENCY
1 ECOSPRIN PO 75mg OD
2 CARDALE PO 5mg BID
3 CARDIVAS PO 40mg OD
4 EPLEHEF PO 50mg OD
5 ROSUVAS PO 20mg OD
6 PLACEBO PO - BID
7 MONTLUKAST PO - OD
8 MONOCER IV 1gm BID
9 TRAMADOL IV 1 Amp BID

7. DRUG INTERACTION:
• TYPE: DRUG-DRUG INTERACTION
• INTERACTION:
• Precipitant drug: Eplehef
• Objective drug: Ecosprin
• MECHANISM OF INTERACTION: Pharmacokinetic
• CLINICAL OUTCOME: Concurrent use of NSAIDS and POTASSIUM-SPARING
DIURETICS may result in reduced diuretic effectiveness, hyperkalemia, or
possible nephrotoxicity.
• MANAGEMENT: Concomitant use of NSAIDs and diuretics may increase the
risk of renal toxicity. Severe hyperkalemia has been reported with use of
NSAIDs (eg, indomethacin) and potassium-sparing diuretics. The diuretic,
antihypertensive, and natriuretic effect of the diuretic may be reduced in
some patients by concurrent use with an NSAID. When concomitant use is
necessary, monitor for signs of worsening renal function and assure diuretic
efficacy, including appropriate effects on blood pressure. Consider
monitoring serum potassium levels.

8. CASE STUDY
Breathless since 1 week II III occasional PND, No pedal edema, Dry
cough.
• Diagnosis: Restrictive Cardiomyopathy

9. The medications prescribed are:
S. No DRUG ROA DOSE FREQUENCY
DYTOR IV 20mg BID
DILTIAZEM PO 90mg OD
PANTAPRAZOLE PO 40mg OD
APIXABAN PO 2.5mg BID
ALDACTONE PO 2.5mg OD
MONTELEUKAST
ASCORIL PO 10ml BID
LINCTUS
COREX PO 10ml BID
DYTOR PO 40mg BID

10. DRUG INTERACTION:
• TYPE: DRUG-DRUG INTERACTION
• INTERACTION:
• Precipitant drug: Syrup COREX
• Objective drug: Diltiazem
• MECHANISM OF INTERACTION: Pharmacokinetic
• CLINICAL OUTCOME: Concurrent use of CODEINE and CYP3A4
INHIBITORS may result in increased codeine and morphine
concentrations.
• MANAGEMENT: Concomitant use of codeine with CYP3A4 inhibitors
may result in increased codeine and morphine concentrations. If
concomitant use is needed, closely monitor patients for respiratory
depression and sedation, and consider dose reduction of codeine
until stable drug effects have been observed. If a CYP3A4 inhibitor is
being discontinued, monitor patients for signs of opioid withdrawal,
and consider increasing dose of codeine until stable drug effects
have been observed.

11. THANK YOU