Question 1

Consequences of Drug-Drug Interactions

Accepted Answer

1) Intensification of effects
2) Reduction of effects
3) Creation of a unique response

Question 2

Intensification of Effects

Accepted Answer

1) Increased therapeutic effects - good
2) Increased adverse effects - bad

Question 3

Reduction of Effects

Accepted Answer

1) Inhibitory: interactions that result in reduced drug effects
2) Reduced therapeutic effects - bad (propranalol + albuteral)
3) Reduced adverse effects - good (naloxone to treat morphine OD)

Question 4

Creation of a Unique Response

Accepted Answer

Disulfram makes drinking alcohol very unpleasant

Question 5

4 Basic Mechanisms of Drug-Drug Interactions

Accepted Answer

1) Direct chemical or physical interaction
2) Pharmacokinetic interaction
3) Pharmacodynamic interaction
4) Combined toxicity

Question 6

Direct Chemical or Physical Interaction

Accepted Answer

Because drugs can interact in solution, never combine 2 or more drugs in the same container unless you are certain that a direct interaction will not occur

Question 7

Pharmacokinetic Interactions

Accepted Answer

1) Altered absorption
2) Altered distribution
3) Altered renal excretion
4) Altered metabolism
5) Interactions that involve P-glycoprotein

Question 8

Altered Absorption

Accepted Answer

1) Elevated gastric pH (antacids)
2) Laxatives (poop it out)
3) Drugs that depress peristalsis (++absorption)
4) Drugs that induce vomiting (puke it out)
5) Adsorbent drugs (bind other drugs)
6) Drugs that reduce regional blood flow

Question 9

Altered Distribution

Accepted Answer

1) Competition for protein binding
2) Alteration of extracellular pH

Question 10

Altered Renal Excretion

Accepted Answer

1) Altered Filtration
2) Altered Reabsorption
3) Altered Active Secretion

Question 11

Altered Metabolism

Accepted Answer

Most important & most complex
1) Inducing agents (increase metabolism)
2) Inhibition of CYP isoenzymes (decreased metabolism increases blood levels)

Question 12

Interactions That Involve P-Glygoproteins

Accepted Answer

Most drugs that affect CYP also affect PGP

Question 13

2 Types of Pharmacodynamic Interactions

Accepted Answer

1) Interacting drugs act at the same site
2) Interacting drugs act at separate sites
(Pharmacodynamic interactions may be potentiative or inhibitory)

Question 14

Combined Toxicity

Accepted Answer

Drugs with overlapping toxicities should not be used together (Tylenol + Alcohol = BAD!)

Question 15

Clinical Significance of Drug-Drug Interactions

Accepted Answer

1) Higher risk the more drugs patient is taking
2) Especially important in drugs with low T.I.
3) Many interactions yet to be identified - be on the lookout for unusual Sx
4) Responses can be increased or reduced

Question 16

Minimizing Drug-Drug Interactions

Accepted Answer

1) Minimize # drugs pt taking
2) Take thorough Hx (inc. illicit drugs)
3) Adjust when taking metabolizing inducers
4) Monitor signs of toxicity
5) Careful with low T.I. drugs

Question 17

Food on Rate of Absorption

Accepted Answer

Delays onset of effects

Question 18

Food on Extent of Absorption

Accepted Answer

Reduces peak therapeutic responses

Question 19

Food on Absorption in General

Accepted Answer

Can increase or decrease absorption (sometimes food is necessary for drug to work)

Question 20

Grapefruit Juice

Accepted Answer

Increases drug metabolism for certain drugs for 3 days by inhibiting CYP3A4 - the more you drink the greater the effects

Question 21

Food on Drug Toxicity

Accepted Answer

Food may increase drug toxicity. The combo of an MAOI with tyramine-rich food (aged cheese, chianti, yeast exctracts) is classic example.

Pharmacology Ch 6

Pharmacology

Question	Answer
Consequences of Drug-Drug Interactions	1) Intensification of effects 2) Reduction of effects 3) Creation of a unique response
Intensification of Effects	1) Increased therapeutic effects - good 2) Increased adverse effects - bad
Reduction of Effects	1) Inhibitory: interactions that result in reduced drug effects 2) Reduced therapeutic effects - bad (propranalol + albuteral) 3) Reduced adverse effects - good (naloxone to treat morphine OD)
Creation of a Unique Response	Disulfram makes drinking alcohol very unpleasant
4 Basic Mechanisms of Drug-Drug Interactions	1) Direct chemical or physical interaction 2) Pharmacokinetic interaction 3) Pharmacodynamic interaction 4) Combined toxicity
Direct Chemical or Physical Interaction	Because drugs can interact in solution, never combine 2 or more drugs in the same container unless you are certain that a direct interaction will not occur
Pharmacokinetic Interactions	1) Altered absorption 2) Altered distribution 3) Altered renal excretion 4) Altered metabolism 5) Interactions that involve P-glycoprotein
Altered Absorption	1) Elevated gastric pH (antacids) 2) Laxatives (poop it out) 3) Drugs that depress peristalsis (++absorption) 4) Drugs that induce vomiting (puke it out) 5) Adsorbent drugs (bind other drugs) 6) Drugs that reduce regional blood flow
Altered Distribution	1) Competition for protein binding 2) Alteration of extracellular pH
Altered Renal Excretion	1) Altered Filtration 2) Altered Reabsorption 3) Altered Active Secretion
Altered Metabolism	Most important & most complex 1) Inducing agents (increase metabolism) 2) Inhibition of CYP isoenzymes (decreased metabolism increases blood levels)
Interactions That Involve P-Glygoproteins	Most drugs that affect CYP also affect PGP
2 Types of Pharmacodynamic Interactions	1) Interacting drugs act at the same site 2) Interacting drugs act at separate sites (Pharmacodynamic interactions may be potentiative or inhibitory)
Combined Toxicity	Drugs with overlapping toxicities should not be used together (Tylenol + Alcohol = BAD!)
Clinical Significance of Drug-Drug Interactions	1) Higher risk the more drugs patient is taking 2) Especially important in drugs with low T.I. 3) Many interactions yet to be identified - be on the lookout for unusual Sx 4) Responses can be increased or reduced
Minimizing Drug-Drug Interactions	1) Minimize # drugs pt taking 2) Take thorough Hx (inc. illicit drugs) 3) Adjust when taking metabolizing inducers 4) Monitor signs of toxicity 5) Careful with low T.I. drugs
Food on Rate of Absorption	Delays onset of effects
Food on Extent of Absorption	Reduces peak therapeutic responses
Food on Absorption in General	Can increase or decrease absorption (sometimes food is necessary for drug to work)
Grapefruit Juice	Increases drug metabolism for certain drugs for 3 days by inhibiting CYP3A4 - the more you drink the greater the effects
Food on Drug Toxicity	Food may increase drug toxicity. The combo of an MAOI with tyramine-rich food (aged cheese, chianti, yeast exctracts) is classic example.

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