Common and Life threatening Drug Interactions and Contraindications

week 1

drug-disease

ex. pseudoephedrine increases BP and not recommended in pts who alr have HBP

a drug interacts with or interferes with an existing med condition

drug-drug

ex. enalapril and amlodipine are both antihypertensive med, when taken tg the pt’s BP will be lower sig

• the effects of one drug are changed when taken in combination with another drug

drug-supplement

ex. calcium … decrease the absorption of many medications like tetracycline

• a supplement or vitamin interferes with the way a drug acts or is absorbed

drug-food

ex. grapefruit juice decreases the ability of statin drugs to be metabolized

the effects of a drug are changed when taken in combination with a particular food

drug-nutrient

ex. diuretics increase the amount of potassium excreted in the urine

a drug affects the way that the body absorbs, uses, or excretes a nutrient

drug-laboratory

ex. corticosteroids can elevate blood glucose lvls

a drug alters the results of lab tests

ANTICOAGULANTS AND ANTIPLATELETS

• blood thiners prevent blood clotting, their main side effect is ____

• DONT: combine multiple blood thinners tg bc increase blleding risk

• pts who are taking these should AVOID OTC ____ and _____ (ie ibuprofen, naproxen) bc these med can also thin blood

• pharmacist should examine the pt’s profile for any drug interactions that may put them at higher risk of bleeding

  • ESP with ____ bc it interacts with many antibiotics, antifungals, etc

    • pts avoiding … should avoid taking it with leafy green vegetables that are high in ____ ___

bleeding; aspirin; NSAIDS; warfarin; vitamin K

ANTIEPILEPTIC MEDICATIONS

• side effects: anxiety, suicidal thoughts, dry mouth, etc

• ______ and _____ (both end in -ine THEREFORE are AEDS) can cause a rare side effect called ______(=hinders the body’s ability to fight infection)

• divalproex and valproic acid are ____(=when taken during pregnancy, can cause birth defects)

• some _____, like ezogabine, increase the RISK of heart _____

• gabapentin, pregabalin, and levetiracetam are assocated with ___ adverse effects and ___ drug interactions

Drug Interactions:

• with ___, metformin, lithium, blood ____, rifampin, ____, anti_____, statins, and other antiepileptics

• carbamazepine, _____, fosphenytoin, primidone, and phenobarbital tend to speed up the _____ of other med and reduce their _____

  • this is CONCERN, when interacting with ____, ____, and hormonal birth control; THEREFORE using nonhormonal birth control like ___ is recommended

carbamazepine; oxcarbazepine; neutropenia; teratogenic; anticonvulsants; arrthymia; fewer; fewer; diuretics; thinners; digoxin; depressants; phenytoin; metabolism; effectiveness; warfarin; lithium; IUD

ANALGESIS - drug to relieve pain; include acetaminophen, NSAIDS, and opioids

1. acetaminophen aka ____ is metabolized in the ____ and therefore should be used judiciously in pts with ____ disease or a compromised …

2. NSAIDS can thin the blood and increase ____ risk; should NOT be given to pts with stomach ____ or who are taking other _____; ““ can also worsen ___ symptoms, ___ failure, and cause ____ retention

   1. ““ interact with ___, blood ___, ___ inhibitors, ___trexate, and ____

3. opioids relax ___ muscles and slow _____; they are contraindicated in pt with intestinal disorders or infection (ie _____ colitis and Clostridioides difficile); work on the NS and cause ___ depression, THEREFORE they interact with other NS drugs like anti____ and ____

   1. shd NOT be used in combination, bc adverse effects like ___ and ____ can worsen

   2. elderly pt should be more cautious bc they are more prone to the ___ effects

tylenol; liver; hepatic; bleeding; ulcers; anticoagulants; asthma; renal; fluid; diuretics; thinners; ACE; metho…, lithium; bowel; digestion; ulcerative; CNS; psychotics; alcohol; sedation; confusion; sedative

CARDIOVASCULAR DRUGS

1. beta blockers are contraindicated in pt with ____ bc can cause airway constriction

   1. should be avoided in diabetes bc they can mask the symptoms of ____

   2. should be avoided in pregnancy

   3. drug interactions include ____, ______, ____, ____, and ____

2. ACE inhibitors are contraindicated in ____ and pt with severe ___ impairment

   1. ____ also cause serious renal impairment, so avoid using TG

   2. ““ increase ___ levels aka hyperkalemia, they interact with some meds like diuretics

3. Calcium channel blockers should be avoided during ____; interact with digoxin, cyclo___, and _____ juice

   1. verapamil and diltiazem should be avoided in ____ failure and they interact with ___-blockers and statins

4. diuretics enhance water excretion THEREFORE they can cause ___ imbalances; should be avoided in pts w ____; they interact with ____, _____, ____, ___ inhibitors, and ____ drugs; triamterene(SPEC) interacts with metho___ and pheny___

5. Nitrates interact with ___ drugs (like sildenafil); both nitrates and sidenafil ___BP so avoid using tg or can cause severe hypotension

asthma; hypoglycemia; verapamil; diltiazem; amiodarone; clonidine; digoxin; pregnancy; renal; NSAIDs; potassium; pregnancy; …sporine; grapefuit; heart; beta; electrolyte; gout; lithium; digoxin; NSAIDs; ACE; diabetes; trexate; toin; ED; lower

STATINS

• aka ___ ___ reductase inhibitors treat ___ cholesterol

• should be avoided in ____ ppl and pt with __ failure

• interact with warfarin, ____, ___ antivirals, cyclosporine, and macrolide antibiotics

• can increase the effects of the anticoagulant warfarin and the risk of bleeding

  • drugs can b taken tg but warfarin monitoring and blood tests should be done

• ___fibroxil and ___fibrate can increase the lvls of statin drugs in the body and increase the risk of getting muscle symptoms(aka ____)

  • HIV antivirals, cyclosporine, and macrolide antibiotics also increase statin lvls and risk of myopathy

• statin drugs SHOULD NOT BE TAKEN with _____ antibiotics bc the risk outweighs the benefits

HMG CoA; high; pregnant; liver; fibrates; HIV; gem; feno; myopathy; macrolide

ANTIBIOTICS

• allergy history shd b taken before giving to pt

  • if pt has ___ allergy DONT TAKE penicillin antibiotics AND _____, and ____ antibiotics due to high risk of cross-reactivity

• many antibiotics are contraindicated during _____

  • ____ antibiotics are contraindicated in ____

  • tetracyclines should NOT be given to children

  • alcohol use should be avoided with ANY antibiotic, ESP for ____

• most ““ increase effects of ____ so extra monitoring

• ““ can decrease effectiveness of contraceptives, so another birth control method shd be used

• tetracyclines and quinolones cannot be taken with ___, antacids, or vitamins

penicillin; cephalosporins; carbapenem; pregnancy; quinolone; metronidazole

ANTIVIRALS AND ANTIFUNGALS

• most ““ are metabolized in the ___, so they require dosage adjusments OR avoidance in pts with … impairment

• most antivirals increase the action of other drugs, making pts more prone to adverse effects

  • ie antihistamines, benzodiazepines, CCBs, antiepileptics, etc

• antifugnal drugs are metabolized in the ____ and are contraindicated in liver failure

  • many ““ increase the effects of other meds

    • _____ should NOT be taken with alochol or antacids

liver; liver; amphotericin

DIABETES TXTS

• diet has a huge impact on diabetes and blood glucose lvls

• alcohol increases the effects of ___ and lows blood ____ lvls, putting the pt at greater risk of hypoglycemia

  • if diabetic drinks alcohol, they should inject ___ insulin or eat more carbohydrates

• insulin interacts with oral ____ antidiabetic drugs, so AVOID this combo

• effects of insulin and oral sulfonylurea antidiabetic drugs are _____ by corticosteroids and diuretics

• MOST oral antidiabetic med should be avoided in pregnancy and severe ____ impai9rment

insulin; glucose; less; sulfonylurea; reduced

PARKINSON’S DISEASE and ALZHEIMER’S DISEASE TXTS

• parkinson’s disease aka __ is defined by low ____ levels most txt options aim to boost it

  • antipsychotic drugs are no go for txt

• anticholinergic meds are indicated in the txt of parkinsonian tremors by blocking _____

• metoclopramid, an anti____ medication, should be avoided in PD as it can worsen tremors

• most PD drugs ___ BP, so they enhance the effects of anti____ meds

• Alzheimer drugs aim to increase ___ lvls; THEREFORE they interact with anticholinergic meds that block it

  • TCAs, antipsychotic, antiepileptics, IBS, urinary incontinence interact with AD drugs

PD; dopamine; acetylcholine; nausea; lower; hypertensive; acetylcholine

ANXIETY and INSOMNIA TXTS

• ALL psychological drugs interact with alcohol, opoids, and antihistamines

1. antidepressants increase the risk of ___, so avoid with antiepileptic drugs

   1. are contraindiciated in ___ disease bc can cause sig ___tension and increase the risk of arrthymia

   2. should be avoided in bipolar pts

   3. ____ oxidase inhibitors are a class of antidepressant that are rarely used now bc invovled in many drug-drug and drug-food interactions

2. antipsychotics should b avoided for pts with cardiac ____, ___ impairments. epilepsy, PD, and hypotension

3. sedatives like ____ and __-drugs used to treat anxiety and insomnia; tolerance develops quickly with these schedule IV meds; should be used short term or for sporadic use

epilepsy; cardiac; hypo; monoamine; arrthymias; liver; benzodiazepines; Z

INHALED MEDS FOR ASTHMA AND COPD

• COPD stands for ___ ___ ____ disease

• both are diseases where airway is inflamed, constricted, and block