to understand about drug interaction in every day practice, and to refresh our memory to most common...
TRANSCRIPT
To understand about drug interaction in every day practice, and to refresh our
memory to most common and important interactions
Many drug interactions are harmless and many of those which are potentially harmful only occur in a small proportion of patients
Pharmacodynamic interactions Pharmacokinetic interactions
Absorption Distribution Metabolism Excretion
Resources available
BNF web bnf.org FDA web fda,gov MHRA web mhra.gov.uk EMC web emc.medicines.org.uk CKS web cks.nhs.uk
Casescenario 1
65 years old male with known stable angina and hypertension and is on aspirin, simvastatin, verapamil and GTN spray PRN( he has not used for a year)
Recently was diagnosed with glaucoma and was started on timoptol eye drop ,he presented with dizzy spells and collapsed once
βBlockers
beta-blocker and verapamil beta-blocker and amiodarone beta-blocker and digoxin beta-blocker and diltiazem Other contraindication of BB Asthma , COPD ,PVD
A year later he was admitted with fast Atrial fibrillation and was started on digoxin 125 mcg daily and was discharged. two weeks later he came to surgery complaining ofnausea, vomiting, anorexia, dizziness, fatigue, visual disturbances, abdominal pain and diarrhea.
Now he is complaining of having knee pains which are worse at the end of the day, he has tried oral codydramol tablets which did not help much. he asks for ibuprofen ?
Aspirin and Ibuprofen COX1 inhibitor
Aspirin and Methotrexate NSAIDs delay the excretion of methotrexate
Clopidogrel and PPI inhibition of the CYP2C19 isoenzyme
Case Scenario 2
55 years old male known diabetic with IHD and hypertension, on metformin ,gliclazide , Atrovastatin , aspirin , Lisinopril, bendroflumethazide and GTN spray
He is complaining of impotence that has been going on for 6 months otherwise he is well.
Two month later he presentedwith symptoms of lower respiratory tract infection, he is allergic to penicillin , you decided that he needs antibiotics, so he wasstarted on Erythromycin , whatwould you advice him?
Statin and myopathy Increased plasma concentration of statin e.g.
erythromycin Additive effect e.gfibrate Statin and Amiodarone Increase risk of myopathy
Statin and warfarin Increase INR
Case Scenario 3
34 years old female with known depressionand has been on fluoxetine 20 mg daily.
Recently patient diagnosed with migraine and was treated with Imigran (sumatriptan ), she has also been taken St John’s wort ,
She has been having frequent episodes of headache ,now she present with restlessness, nausea ,diarrhea, hallucinations, loss of coordination
Take home message
Always review medication if patient presented with new sx
Prescribe new medications only when necessary
Be familiar with important drug interaction
Is the patient taken non prescribed medication