Transcript Rash
Medication Interactions Elizabeth Rash PhD, ARNP, FNP-C UCF College of Nursing CFP Physicians Group Medication Interactions • Good and Bad – Synergism • Ex. Codeine + acetaminophen or ibuprofen = increased pain relief – Adverse drug events (ADEs) A B Unidirectional A B Bidirectional Adverse Drug Events (ADEs) • The numbers (U.S. Prescribing 2003) • 3.4 billion Rx filled –10.1 million/yr for <65y –23.5 million/yr for >65y Adverse Drug Events (ADEs) • 701,547 patients treated for ADEs in EDs (2004-2005) – 116,318 hospitalized – 1/3 2o allergic reactions – 1/3 2o unintentional overdose – 2/3rds considered to be potentially preventable Adverse Drug Events (ADEs) • Most ADEs 2o 5 classes of drugs: – Insulins – Opioids (narcotics) – Anticoagulants – Amoxicillin containing antibiotics – Antihistamine containing cold products JAMA 2006 Adverse Drug Events (ADEs) • 21.3% > 65yr (community dwelling) at least 1 inappropriate Rx drug • 23% of nursing home admissions due to medication problems (J. Am. Pharm. Assoc.:Nov 2002) Polypharmacy vs. Polymedicine : increased number of drugs for increased number of medical problems (may be appropriate) – Ex. Treating high blood pressure or diabetes with drugs with different mechanisms of action inappropriate use of drugs – Ex. Medication duplication or treating the side effects of one drug with another Drug Interactions: What? • Other drugs – Coumadin® and Erythromycin increase bleeding • Food – Grapefruit and Verapamil increase toxicity • Herbs and supplements – St. John’s Wort and Zoloft® increase serotonin crisis risk • Other medical conditions or diseases – Prednisone® and Diabetes increase blood sugar Drug Interactions: How? • Absorption –Can slow down or speed up how rapidly the drug gets into the blood stream • Ex. antacids + tetracycline Drug Interactions: How? • Metabolism enzymes – Inducers: speed the metabolism of another drug and can cause ineffectiveness – Inhibitors: slow the metabolism of another drug and can cause toxicity or ineffectiveness • Plavix® and PPIs (Prilosec®) – PPI inhibits the action of Plavix® a Prodrug that does not work until it Is metabolized Drug Interactions: How? • Receptors – Some drugs block the tissue receptors that stop other drugs or chemicals from having action on that tissue • Could be good or bad – Ex. Antihistamines (Claritin®) block allergens on the histamine receptors stopping allergic reactions – Ex. Antihistamines (Ditropan®) block the cholinergic receptors and interfere with Alzheimer’s drugs like Aricept from working Drug Interactions: How? • Elimination – Taking an aspirin (acidic pH) with Zegerid® (basic pH) may cause more rapid elimination of the aspirin and decrease its effect Drug Interactions: How? • Timing – NSAIDs (Motrin®) interfere with the platelet benefits of a preventive Aspirin. • If taking both, take the aspirin first and wait at least 2 hours before taking the Motrin® Common Drug Interactions • Antifungal drugs that end in "-azole”, Itraconazole or Sporanox®) • Some antibiotics (end in "-mycin” Erythromycin®) • Antacids cimetidine (Tagamet®) • Drugs that prevent convulsions, (Dilantin® and Tegretol®). • Cholesterol drugs such as statins (Lipitor®) • Blood thinning drugs (Coumadin®) Drug Interactions: Preventing ADEs • • • • • Brown bag or drug list to all providers ID bracelets Use 1 pharmacy Pharmacist consultation Communicate side effects and don’t stop abruptly without discussing with provider • Follow instructions Questions? Thank you! CFP Physicians Group 985 SR 436 Casselberry Fl 32707 (407) 831-5252 http://cfpphysiciansgroup.com/