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Geriatrics > Ger 7 Drug Interactions > Flashcards

Ger 7 Drug Interactions Flashcards

1
Q

What is a drug-drug interaction?

A

The effect that one drug has on another

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2
Q

What are the 2 types of drug-drug interactions?

A
  1. Pharmacokinetic (what the body does to the drug)

2. Pharmacodynamics (what the drug does to the body)

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3
Q

What is a pharmacokinetic drug interaction?

A

The effects of one drug on the absorption, distribution, metabolism, or excretion of another drug

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4
Q

What can pharmacokinetic drug interactions result in?

A

Changes in serum drug concentrations and might change clinical response

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5
Q

What is most frequently involved in pharmacokinetic drug interactions?

A
  1. CYP P450
  2. P-Glycoprotein
  3. Organic anion transporters
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6
Q

What is a pharmacodynamic drug interaction and what is the outcome?

A
  • Related to the pharmacological activity of interacting drugs
  • The outcome is an amplification or decrease in the therapeutic effects or side effects of a specific drug
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7
Q

What are other types of drug interactions?

A
  1. Drug-Food
  2. Drug-Alcohol
  3. Drug-Herbal Product
  4. Drug-Nutritional Status
  5. Drug-Disease or Drug-Patient interactions
    * Review Chart in Objectives for Specific Examples
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8
Q

When do drug-disease or drug-patient interactions occur?

A

They take place when a drug has the potential to exacerbate and underlying disease or medical disorder

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9
Q

What are the 3 new groups of patients at risk for drug-drug interactions?

A
  1. Organ transplant
  2. Mental-health problems
  3. HIV patients that survived to late life
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10
Q

What are 3 common drug interactions?

A
  1. Patients taking drugs with a narrow therapeutic index
  2. Patients taking drugs that are substrates, inhibitors, or inducers of CYP450 isoenzymes
  3. Drug-Disease Interactions
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11
Q

What are examples of drugs with a narrow therapeutic index involved in drug-drug interactions?

A
  1. Digoxin
  2. Phenytoin
  3. Warfin
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12
Q

What are examples of drugs that are substrates, inhibitors, or inducers, of CYP450 isoenzymes commonly involved in drug-drug interactions?

A
  1. CYP3A4

2. CYP2D6

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13
Q

What diseases are common to cause drug-disease interactions?

A
  1. Constipation
  2. Dementia
  3. Postural Hypotension
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14
Q

When are complex interactions seen?

A

Patients with 9 or more drugs and 5 or more comorbidities
-Although the choice of drugs individually makes sense to treat the patient, the total combination could yield unwanted results (drug-drug interactions and drug-disease interactions)

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15
Q

What is the increased risk of drug interactions due to in elderly patients?

A
  1. Patient factors
  2. Prescriber factors
  3. Difficulties within the health-care system (Inefficient communication between health professionals and patients)
    - All of these need to be considered for prescribing medications for elderly patients
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16
Q

What are patient factors that can increase the risk of drug interactions in elderly patients?

A

Age related pharmacokinetic and pharmacodynamic changes (these can potentially increase the risk of adverse effects from drug interactions)

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17
Q

What 3 things decrease as you age than can affect pharmacokinetics and pharnacodynamics?

A

Cellular, organ, and systems reserves

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18
Q

What results in heterogeneity between people as they age?

A

Individual genetics, lifelong living habits, and environment

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19
Q

Will all 85 year old women react to the same specific dose of a drug in the same way?

A

NO

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20
Q

Can you use a prototypical male (80kg) that models adult medicine in prediction of treatment for the elderly population?

A

No

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21
Q

What is a prescriber factor?

A
  • Physicians are often not aware of all the drugs that the elderly patients are taking
  • Physician was unaware that the patient was not following the doctor’s orders by not taking a drug prescribed to them
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22
Q

What is a big problem physicians face?

A

Incomplete documentation of past medical history and active drug profile

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23
Q

What happens as a result of incomplete documentation of past medical history and active drug profile?

A

EM physicians aren’t considering interactions as a possible cause of presenting complaints of patients
–> This results in a typical presentation of disease or vague presenting complaints such as confusion, falls, urinary incontinence, and weakness masking or confusing the detection of drug interactions

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24
Q

What are 2 of the difficulties within the health system?

A
  1. Receive prescriptions from several physicians

2. Take prescriptions to be filled at many pharmacies

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25
Q

What is the risk of receiving and inappropriate drug combination directly related to?

A

The number of physicians prescribing drugs for that elderly patient

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26
Q

Describe cascading interactions.

A
  • Prescribing cascade begins when an adverse drug reaction is misinterpreted as a new medical disorder
  • Another drug is then prescribed, and the patient is placed at risk of developing additional adverse effects related to this potentially unnecessary treatment
  • This can produce pharmacokinetic or pharmacodynamic interactions
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27
Q

With regards to cascading interactions, what are patients at increased risk of receiving who had dementia and were dispensed cholinesterase inhibitors?

A

An anticholinergic drug to manage new urinary incontinence

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28
Q

What is usually diagnostic with regards to drug interactions?

A

A complete and careful history of the onset of a patient’s symptoms and recent treatment changes are usually diagnostic

29
Q

What is the best elderly patient care?

A

Elderly patients usually do better when their care is managed by multidisiplinary team that practives the principles of geriatric care

30
Q

What is the optimum drug management tearm?

A

A physician (geriatrician), nurse, and pharmacist (communication between these professionals is crucial for success)

31
Q

What % of preventable prescribing errors detected in ambulatory patients involve drug interactions?

A

13%

32
Q

In one of the studies presented, what % of elderly outpatients had at least 1 potential clinically significant drug-drug interaction and what % of these was regarded as high severity?

A

46%, 10%

33
Q

What % of elderly patients in the psyc ward were prescribed drugs involving cytochrome 2D6? 3A4? and what is the importance of this?

A

25% 2D6
11% 3A4
-These drugs allow the potential for drug-drug interactions to occur

34
Q

In the memory clinic study, what % of patients were using concomitant alcohol and alcohol-interactive prescription drugs?

A

9%

35
Q

In the study of frail elderly patients in the hospital, what % of patients had a potential drug-disease interaction

A

15-40%

36
Q

In the study of frail elderly patients in the hospital what there the 3 most common drug-disease interactions?

A
  1. Ca-Blockers in patients with heart failure
  2. B-Blockers in those with diabetes
  3. Aspirin in those with peptic ulcer disease
37
Q

What is significantly associated with having one or more potential drug-disease interactions?

A

Several drugs and high comorbidity index

38
Q

Why is it important to look at drug-drug results cautiously?

A

Large variability in how drug interactions are defines, their clinical importance, and the sources used to detect them

39
Q

Can potential drug interactions never lead to actual clinical effects?

A

YES

40
Q

In one study presented, what % of the study population have a potential high-risk drug-drug interaction, with not one adverse drug event that was identied being caused by a drug interaction?

A

31%

41
Q

Are drug-interaction databases geriatrics specific?

A

No

42
Q

Is the validity of criteria of drug-disease interactions (like B-blockers and diabetes) debatable?

A

Yes

43
Q

What can affect the outcomes of studies on drug interactions?

A

Studies enrolled patients with varying comorbidities

44
Q

What are 2 examples of drug-drug pharmacokinetic drug interactions?

A
  1. Gatifloxacin + caclium and Antacid

2. Ciprofloxacin + Olanzapine

45
Q

What is the MOA and outcome with Gatifloxacin+ calcium and Antacid?

A
  • Decrease in absorption of gatifloxacin

- Treatment failure

46
Q

What is the MOA and outcome with Ciprofloxacin+Olanzapine

A
  • Ciprofloxacin inhibits CYP1A2 leading to an increase in CP of olanzapine
  • Rigidity, Falls
47
Q

What are 2 examples of drug-drug pharmacodynamic interactions?

A
  1. Ciprofloxacin + glibenclamide

2. Anticholingeric drug + Donepezil

48
Q

What is the MOA and outcome with ciprofloxacin + glibenclamide?

A
  • Synergy (hypoglycaemic effect)

- Profound hypoglycaemia

49
Q

What is the MOA and outcome with Anticholingeric drug + donepezil?

A
  • Antagonism

- Decreased effect of donepezil

50
Q

What is an example of a drug-nutritional status interaction?

A

Low albumin + phytoin

51
Q

What is the MOA and outcome of low albumin + phenytoin?

A
  • Increase in free phenytoin concentration

- Confusion, somnolence, ataxia

52
Q

What is an example of a drug-herbal production interaction?

A

Gingko + Apsirin

53
Q

What is the MOA and outcome of gingko + Aspirin?

A
  • Decrease in platelet function and adhesion

- Increased risk of bleeding

54
Q

What is an example of a drug-alcohol interaction?

A

Alcohol + Chronic use of bromazepam

55
Q

What is the MOA and outcome of alcohol + Chronic use of bromazepam?

A
  • Synergy

- Increased risk of falls

56
Q

What is an example of a drug-disease or drug patient interaction?

A

Metoclopramide for gastric dysmotility in a patient with Parkinson’s disease

57
Q

What is the MOA and outcome for metoclopramide for gastric dysmotility in a patient with Parkinson’s disease

A
  • Increase in dopamine receptor blockade

- Worsening Parkinson’s disease

58
Q

What is the drug interaction between clarithromycin and warfarin?

A

Risk of increased anticoagulant effect

59
Q

What is the drug interaction between clarithromycin and ciclosporin?

A

Risk of increased concentrations of ciclosporin and nephrotoxicity

60
Q

What is the drug interaction between calcium carbonate and levothyroxine?

A

Decreased absorption of levothyroxine if given at the same time

61
Q

What is the drug interaction between ginkgo biloba and warfarin?

A

Increased risk of heaemorrhage

62
Q

What do donepezil, ciclosporin, and losaratn have in common?

A

All substrates of CYP3A4 (potential risk of interaction)

63
Q

What so losartan and gliclazide have in common?

A

Substrates of CYP2Cp (potential risk of interaction)

64
Q

What is clarithromycin an inhibitor of?

A

CYP3A4

65
Q

What 2 disease can prednisone cause a drug-disease interaction with?

A
  • Diabetes

- Congestive heart failure

66
Q

What SE can paroxetine and haloperidol cause and what are they substrates of?

A
  • Extrapyramidal side effect (can lead to tremors)

- Both substrates of CYP2D6

67
Q

What is the effect of paroxetine and haloperidol both being substrates of CYP2DP?

A

Haloperidol can inhibit paroxetine metabolism and increase the serum concentration of paroxetin (leading to side effects)

68
Q

What might you give for someone who had tremors (and you didn’t know they were from paroxetine and haloperidol)

A

Levodopa and carbidopa

69
Q

What might you give for CNS SE from levodopa and carbidopa?

A

Risperidone (which can cause extapyramidal SE)

-This is also a substrate of CYP2D6 like haloperidol and paroxetine

Geriatrics (15 decks)

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