[DISPENSING] Therapeutic Incompatibilities & Drug Interactions

a. Drug interaction

Situation in which the pharmacologic effects of one drug are altered by prior or concurrent administration of another substance.

a. Drug interaction

b. Therapeutic incompatibility

c. Physicochemical incompatibility

d. Adverse drug reaction

c. Therapeutic incompatibility

Results in potentiation of therapeutic effects

a. Physical incompatibility
b. Chemical incompatibility
c. Therapeutic incompatibility
d. Biological incompatibility

c. Therapeutic incompatibility

[THERAPEUTIC INCOMPATIBILITIES]

Results in destruction of effectiveness of one or more ingredients

a. Physical incompatibility
b. Chemical incompatibility
c. Therapeutic incompatibility
d. Biological incompatibility

c. Therapeutic incompatibility

[THERAPEUTIC INCOMPATIBILITIES]
Results in occurrence of toxic manifestations in patients.

a. Physical incompatibility
b. Chemical incompatibility
c. Therapeutic incompatibility
d. Biological incompatibility

a. Object Drug

[THERAPEUTIC INCOMPATIBILITIES]
Affected by the interaction

a. Object Drug

b. Precipitant Drug

b. Precipitant Drug

[THERAPEUTIC INCOMPATIBILITIES]
Caused the interaction

a. Object Drug

b. Precipitant Drug

b. Tetracycline

[THERAPEUTIC INCOMPATIBILITIES]
In the example Tetracycline + Antacids, which is the object drug?

a. Antacids
b. Tetracycline
c. Both
d. Neither

b. Antacids

[THERAPEUTIC INCOMPATIBILITIES]
In the example Tetracycline + Antacids, which is the precipitant drug?

a. Tetracycline

b. Antacids

c. Both

d. Neither

c. Chelation reaction

[THERAPEUTIC INCOMPATIBILITIES]

The interaction between Tetracycline and Antacids results in which type of reaction?

a. Oxidation

b. Hydrolysis

c. Chelation reaction

d. Racemization

c. Chelate complex (macromolecule)

[THERAPEUTIC INCOMPATIBILITIES]

Tetracycline will bind to the antacid forming a ______

a. Oxidation

b. Hydrolysis

c. Chelate complex (macromolecule)

d. Racemization

b. Inactivation of tetracycline = ↓ absorption ↓ effect ↓ BA

[THERAPEUTIC INCOMPATIBILITIES]

Chelation between Tetracycline and Antacids results in:

a. Increased absorption

b. Inactivation of tetracycline = ↓ absorption ↓ effect ↓ BA

c. Increased potency

d. No change in effect

• Polypharmacy

• Multiple prescribers secondary to polypharmacy

• Multiple pharmacological effects of drugs (e.g. off label effects)

• Multiple diseases/predisposing illness

• Poor patient compliance

• Age of patient

• Drug related factors

Risk Factors Contributing to Drug Interactions

a. Established

[CLASSIFICATION OF DRUG INTERACTIONS]

A drug interaction supported by well-proven clinical studies

a. Established

b. Probable

c. Suspected

d. Possible

e. Unlikel

b. Probable

[CLASSIFICATION OF DRUG INTERACTIONS]

A drug interaction that is very likely but might not be proven clinically

a. Established

b. Probable

c. Suspected

d. Possible

e. Unlikel

c. Suspected

[CLASSIFICATION OF DRUG INTERACTIONS]

A drug interaction that might occur

a. Established

b. Probable

c. Suspected

d. Possible

e. Unlikely

c. Suspected

[CLASSIFICATION OF DRUG INTERACTIONS]

Some data might be available

a. Established

b. Probable

c. Suspected

d. Possible

e. Unlikely

d. Possible

[CLASSIFICATION OF DRUG INTERACTIONS]

A drug interaction that could occur

a. Established

b. Probable

c. Suspected

d. Possible

e. Unlikely

d. Possible

[CLASSIFICATION OF DRUG INTERACTIONS]

Limited data are available

a. Established

b. Probable

c. Suspected

d. Possible

e. Unlikely

e. Unlikely

[CLASSIFICATION OF DRUG INTERACTIONS]

A drug interaction that is doubtful

a. Established

b. Probable

c. Suspected

d. Possible

e. Unlikely

e. Unlikely

[CLASSIFICATION OF DRUG INTERACTIONS]

No good evidence of an altered clinical effect is available

a. Established

b. Probable

c. Suspected

d. Possible

e. Unlikely

a. True

[DRUG-HERB INTERACTIONS]

St. John's wort decreases blood levels of Digoxin, reducing its efficacy.

a. True

b. False

a. True

[DRUG-HERB INTERACTIONS]

St. John's wort is an enzyme inducer that decreases Digoxin blood levels.

a. True

b. False

a. True

[DRUG-HERB INTERACTIONS]

Garlic, Ginkgo, and Ginger interact with Warfarin or Heparin to cause additive anticoagulation and bleeding.

a. True

b. False

a. True

[DRUG-HERB INTERACTIONS]

Warfarin + Asian ginseng results in decreased warfarin activity and increased coagulation.

a. True

b. False

a. True

[DRUG-HERB INTERACTIONS]

Sedative + Valerian results in double sedation (additive effect).

a. True

b. False

a. True

[DRUG-HERB INTERACTIONS]

Hypoglycemic agents + Ginseng increase hypoglycemic effect.

a. True

b. False

a. True

[DRUG-HERB INTERACTIONS]

Anti-HTN agents + Licorice result in poorly managed hypertension.

a. True

b. False

b. Ginseng

[HERBAL PREPARATIONS]

Adaptogen.

a. Echinacea
b. Ginseng
c. Ginkgo
d. Valerian

c. Echinacea

[HERBAL PREPARATIONS]

Used for cold symptoms.

a. Ginseng
b. Milk Thistle
c. Echinacea
d. St. John's Wort

b. Ginkgo

[HERBAL PREPARATIONS]

Memory aid that increases brain circulation.

a. Valerian
b. Ginkgo
c. Saw Palmetto
d. Feverfew

c. Milk Thistle

[HERBAL PREPARATIONS]

Hepatoprotection.

a. St. John's Wort
b. Echinacea
c. Milk Thistle
d. Ginseng

d. St. John's Wort

[HERBAL PREPARATIONS]

Uplifts mood (Hypericin)

a. Valerian
b. Saw Palmetto
c. Feverfew
d. St. John's Wort

d. St. John's Wort

[HERBAL PREPARATIONS]

Contains hypericin

a. Valerian
b. Saw Palmetto
c. Feverfew
d. St. John's Wort

b. Valerian

[HERBAL PREPARATIONS]

Sleeping aid.

a. Ginkgo
b. Valerian
c. Ginseng
d. Echinacea

c. Saw Palmetto

[HERBAL PREPARATIONS]

Used for enlarged prostate.

a. Feverfew
b. Milk Thistle
c. Saw Palmetto
d. St. John's Wort

c. Feverfew

[HERBAL PREPARATIONS]

Used for migraines/fever.

a. Ginkgo
b. Valerian
c. Feverfew
d. Ginseng

d. Rifampicin + Urinalysis

Causes masking of color.

a. Ascorbic Acid + Glucose Test

b. Allopurinol + Cholesterol Level

c. Vitamin B7 + Troponin-based Assays

d. Rifampicin + Urinalysis

b. Rifampicin

[DRUGS THAT CHANGE URINE COLOR]

Drug that turns urine orange.

a. Chloroquine
b. Rifampicin
c. Metronidazole
d. Riboflavin

c. Chloroquine

[DRUGS THAT CHANGE URINE COLOR]

Drug that turns urine brown.

a. Rifampicin
b. Vitamin B2
c. Chloroquine
d. Metronidazole

c. Vitamin B2 / Riboflavin

[DRUGS THAT CHANGE URINE COLOR]

Drug that turns urine intense yellow.

a. Rifampicin
b. Chloroquine
c. Vitamin B2 / Riboflavin
d. Metronidazole

d. Metronidazole

[DRUGS THAT CHANGE URINE COLOR]

Drug that turns urine gray.

a. Rifampicin
b. Chloroquine
c. Vitamin B2
d. Metronidazole

a. Ascorbic Acid + Glucose Test

[DRUG-LAB TEST INTERACTIONS]

Causes false increase of glucose

a. Ascorbic Acid + Glucose Test

b. Allopurinol + Cholesterol Level

c. Vitamin B7 + Troponin-based Assays

b. Allopurinol + Cholesterol Level

[DRUG-LAB TEST INTERACTIONS]

Causes false increase of cholesterol

a. Ascorbic Acid + Glucose Test

b. Allopurinol + Cholesterol Level

c. Vitamin B7 + Troponin-based Assays

c. Vitamin B7 + Troponin-based Assays

[DRUG-LAB TEST INTERACTIONS]

Causes false low results

a. Ascorbic Acid + Glucose Test

b. Allopurinol + Cholesterol Level

c. Vitamin B7 + Troponin-based Assays

a. True

[DRUG-FOOD INTERACTIONS]

Quinolone / Tetracycline + Ca-rich foods results in decreased absorption.

a. True
b. False

a. True

[DRUG-FOOD INTERACTIONS]

Warfarin + green leafy vegetables (Vitamin K) results in decreased warfarin activity

a. True
b. False

a. True

[DRUG-FOOD INTERACTIONS]

Warfarin + green leafy vegetables (Vitamin K) results in antagonism

a. True
b. False

a. True

[DRUG-FOOD INTERACTIONS]

Warfarin + green leafy vegetables (Vitamin K) results in decreased anticoagulant effect

a. True
b. False

a. True

[DRUG-FOOD INTERACTIONS]

Warfarin + green leafy vegetables (Vitamin K) results in increased risk of MI and stroke.

a. True
b. False

a. True

[DRUG-FOOD INTERACTIONS]

Drug + grapefruit results in decreased metabolism.

a. True
b. False

a. True

[DRUG-FOOD INTERACTIONS]

Metronidazole + alcohol results in a disulfiram-like reaction (idiosyncratic reaction, Type B ADR).

a. True
b. False

a. True

[DRUG-FOOD INTERACTIONS]

MAOIs + tyramine-rich food results in hypertensive crisis.

a. True
b. False

a. True

[DRUG-FOOD INTERACTIONS]

Anti-HTN agents + licorice results in poorly managed hypertension.

a. True

b. False

a. True

[DRUG-FOOD INTERACTIONS]

Spironolactone + K-rich food results in hyperkalemia.

a. True

b. False

a. True

[DRUG-FOOD INTERACTIONS]

Griseofulvin + fatty food results in increased absorption.

a. True

b. False

a. True

[DRUG-FOOD INTERACTIONS]

Bisphosphonate + food / mineral water results in decreased bioavailability (BA).

a. True

b. False

a. True

[DRUG-FOOD INTERACTIONS]

Statins + red yeast rice results in additive lipid-lowering effect

a. True

b. False

a. True

[DRUG-FOOD INTERACTIONS]

Statins + red yeast rice results in additive side effects (SE)

a. True
b. False

a. True

[DRUG-FOOD INTERACTIONS]

Statins + red yeast rice results in a higher risk than benefit.

a. True
b. False

a. True

[DRUG-FOOD INTERACTIONS]

Antihistamines + apple/orange juice results in decreased absorption (idiosyncratic reaction).

a. True
b. False

a. True

[DRUG-FOOD INTERACTIONS]

Digoxin + oatmeal results in decreased absorption.

a. True
b. False