QUIZ ADRA SHOW
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Repete
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Drug interactions
• I. Pharmaceutical interactions (incompatibilities)
• II. Pharmacological interactions
• [A] Pharmacokinetic drug interactions:
• Absorption:
• Change in GI pH: Raising gastric pH by cimetidine can markedly reduce the absorption of ketoconazole.
• Adsorption: Activated charcoal/many drugs. This is beneficial in management of toxicity.of overdosage.
• Chelation: Metalic ions (Ca++, Al+++) found in dairy products and antacids and iron form complex with tetracyclins that is poorly absorbed.
• Ddistribution:
• Alteration of plasma protein binding
• Phenylbutazone and aspirin displace warfarin → bleeding tendency
• Sulphonamides displace bilirubin → Kernicterus in newborn
• Phenylbutazone displace tolbutamide → risk of hypoglycemia
• Metabolism:
• Enzyme induction:
• Phenobarbitone induces metabolism of almost all drug metabolism by CYP450 as well as its own metabolism (auto-induction).
• Enzyme inhibition
• Cimetidine inhibits metabolism of carbamazepine, leading to elevation of its blood level.
• Grapefruit juice inhibits metabolism of CCBs. Thus, the juice increases the bioavailability
Excretion:
Probenecid inhibits active renal tubular secretion of many acidic drugs e.g. penicillin, leading to prolongation of its duration
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