Side Effects, Interactions, and Dietary Supplements

Adverse drug reaction

Unintended side effect of a medication that is negative or in some way injurious to a patient’s health

Anaphylactic shock

Potentially fatal hypersensitivity reaction producing severe respiratory distress and cardiovascular collapse

Resistance

reduction of a drug’s effectiveness

Carcinogenicity

having the potential to cause cancer: hormones (birth control) and biologic drugs (produced using living organsims)

Teratogenicity

having the potential to cause abnormal fetal development: analgesics, acne meds, antiseizure, antidepressants, statins

Hepatotoxicity

having the potential to damage the liver: analgesics, cardiac meds, antiseizure, statins, arthritis, antifungal

Nephrotoxicity

having the potential to cause harm to the kidney: ACE inhibitors, NSAIDs

Hematological effects

increased risk of blood clots, decreased platelets, blood and bone marrow disorders: hormones and anticancer drugs

Gastrointestinal effects

having the potential to cause anorexia, nausea, vomiting, constipation, heartburn, and diarrhea

Adverse gastrointestinal effect of aspirin and potassium chloride

esophageal ulcer

Adverse gastrointestinal effect of NSAIDs and theophylline

Esophageal reflux

Adverse gastrointestinal effect of NSAIDs

gastritis

Adverse gastrointestinal effect of iron and calcium supplements

constipation

Adverse gastrointestinal effect of antibiotics such as clindamycin and augmentin

diarrhea

Narrow therapeutic index

drugs where small differences in dose or blood concentration may lead to toxic drug concentrations in the blood, serious therapeutic failures or adverse drug reactions

What are some examples of NTI drugs?

warfarin, carbamazepine, digoxin, theophylline, levothyroxine, lithium carbonate, phenytoin, fentanyl

Additive drug interaction

occurs when two or more drugs combine to produce and effect greater than the effect of each drug taken alone

Antagonistic drug interaction

one drug may block the effectiveness of one or more other drugs

Potentiation drug interaction

one drug prolongs or increases the effect of another drug

Synergistic drug interaction

occurs when the combined effect of two drugs is greater than the sum of each drug’s individual activity

How do antacids affect cimetidine, ketoconazole, and tetracycline?

Antacids decrease the absorption of all three

How does iron tablets affect the effects of levothyroxine?

Iron tablets decrease the absorption of levothyroxine

How does aspirin, tylenol, and NSAIDs affect Warfarin?

They increase the absorption of warfarin

How do antibiotics affect oral contraceptives?

Antibiotics decrease the effects of oral contraceptives

How do bactrim and amiodarone affect warfarin?

They increase the effects of warfarin

How does vitamin K affect warfarin?

It decreases the effect of warfarin

If a patient takes antacids, what disease/condition can occur?

Kidney disease (may accumulate aluminum and magnesium)

If a patient takes NSAIDs, what disease/condition can occur?

kidney disease, cardiovascular disease, gastrointestinal disease

If a patient takes antitussives, what disease/condition can occur?

glaucoma, or difficulty in urination due to enlarged prostate

If a patient takes beta blockers, what disease/condition can occur?

asthma

If a patient takes nasal decongestants (pseudophedrine), what disease/condition can occur?

heart disease, high blood pressure, thyroid disease, diabetes, or difficulty in urination due to enlarged prostate

If a patient takes nicotine replacement products, what disease/condition can occur?

asthma, depression, high blood pressure, irregular heartbeat, or myocardial infarction

If a patient takes nighttime sleep aids, what disease/condition can occur?

memory problems, glaucoma, or difficulty in urination due to enlarged prostate

If a patient takes black cohosh with estrogens, what interaction could occur?

May increase estrogen activity

If a patient takes ginkgo biloba with NSAIDs, clopidogrel, or warfarin, what interaction could occur?

May increase the risk of bleeding

If a patient takes St. John’s Wort with acetaminophen, what interaction could occur?

may increase risk of liver damage

If a patient takes St. John’s Wort with warfarin, what interaction could occur?

may decrease effectiveness of warfarin

If a patient takes St. John’s Wort with cyclosporine or estorgens, what interaction could occur?

May decrease the levels of both drugs

If a patient takes St. John’s Wort with HIV antiviral drugs, what interaction could occur?

may decrease blood concentration and effectiveness in treating HIV

If a patient takes St. John’s Wort with paroxetine, what interaction could occur?

may increase paroxetine’s pharmacological effects and risks of toxicity

If a patient takes St. John’s Wort with venlafaxine, what interaction could occur?

may increase risk of toxicity

If a patient takes Grapefruit juice with alprazolam, amiodarone, cholesterol lowering, calcium channel blockers, or carbamazepine, what interaction could occur?

Grapefruit juice increases the effects of all these drugs

If a patient takes caffeine with central nervous system stimulants (methylphenidate), what interaction could occur?

increase effects of central nervous system stimulants

Vitamin A

retinol, prevents keratomalacia (eye disorder)

Vitamin D2

ergocalciferol, prevents rickets in small children

Vitamin D3

cholecalciferol, prevents bone loss

Vitamin E

tocopherols, antioxidant

Vitamin K

phytonadione, formation of prothrombin (blood thickener)

Vitamin B1

thiamine, helps body change carbohydrates into energy

Vitamin B2

riboflavin, helps with cellular function

Vitamin B6

pyridozine, maintains the health or nerves, skin, and red blood cells

Vitamin B9

folic acid, red blood cell formation and crucial in pregnancy to prevent birth neural tube defects

Vitamin B12

cyanocobalamin, red blood cell formation (deficiency leads to pernicious anemia)

Vitamin C

ascorbic acid, antioxidant, supports immune system