ROLE OF

PHARMACIST IN

PREVENTION &

MANAGEMENT

OF DRUG INTERACTIONS

BY: Komal Haleem

Pharm-D

DRUG

INTERACTIONS

The modulation of the pharmacologic activity of

one drug (i.e. the object drug) by the prior or

concomitant administration of

•Food

•Another drug or

•Herbal product.

ROLE OF PHARMACIST IN

PREVENTIONOF DRUG INTERACTIONS

CASE STUDY:

A patient named G.W.

He was prescribed the following medications by 4 different

physicians:

•Inderal and Lasix for high blood pressure. (Internal)

•Tricyclic antidepressants, for depression. (Psychiatrist)

•Xanax for sleep. (Family Doctor)

•Propoxyphene for chronic pain. (Orthopedist)

•Prilosec for stomach irritation. (Internal)

•Over-the-counter Tylenol from time to time. (Self)

•Recently he was prescribed Ultram (analgesic for moderate

pain) by a second opinion orthopedist.

Suffered major automobile

accident due to excessive

dizziness and drowsiness

resulting from drug

interaction between

ultram and xanax

1. Take a MEDICATION HISTORY(AVOID

mistakes)

2. Remember high risk patients

•Any patient taking 2 medications

•Anticonvulsants, antibiotics, digoxin, warfarin,

amiodarone, etc

3. Check pocket reference

4. Check up-to-date computer program

5. Documenting the care delivered

6. COUNSELING the patients

7. Monitoring and evaluating the patient’s

response to therapy

8. Work with health care practitioners to

eliminate unnecessary medications

9.Maintaining patient data base

including:

•patient’s gender,

•age,

•vital signs,

•medical diagnosis(es),

•drug allergies,

•relevant laboratory tests,

•a complete listing of medication being taken

routinely or taken on an as-needed basis

•Allergies?

•Vitamins and herbs?

•Old drugs & OTC? as well as current

•Interactions?

•Dependence?

•Mendel: family history of benefits or

problems with any drugs?

1. Only take medication that has been specifically prescribed for you by your physician;

2. Medication must be taken properly to ensure its safety and effectiveness;

3. Unless otherwise instructed, take medicine on an empty stomach to achieve a faster onset of action;

4. When taking medicine with food or around a meal time is not recommended, take medicine one hour before meal/food or two hours after meals or eating food;

5. Take your medicine with a full glass (1 cupful or 8 oz.) of water;

6. Avoid concurrent use of alcohol with medicine;

7. Avoid consuming excessive quantities of chocolate and beverages containing caffeine (coffee, tea, colas);

8. If you have any questions / concerns about your

medicine or you believe you are having an adverse

drug reaction or drug interaction, consult your

pharmacist or physician immediately. If there is a

problem, your pharmacist can contact your physician,

who can prescribe other medication to avoid the risk

ROLE OF PHARMACIST IN

MANAGEMENTOF DRUG INTERACTIONS

Avoiding the combination entirely

Adjusting the dose of the object drug

Spacing dosing times to avoid the interaction

Monitoring for early detection

Provide information on patient risk factors that increases the chance of an adverse outcome

Improve computerized screening systems

Excessive number of drug interactions on the

systems

Drug class differences not handled correctly

•http://www.fda.gov/drugs/developmentapprovalprocess/developmentreso

urces/druginteractionslabeling/ucm110632.htm

•http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964764/

•http://legacy.uspharmacist.com/oldformat.asp?url=newlook/files/Feat/mar

00druginteractions.cfm&pub_id=8&article_id=522

•http://online.wsj.com/article/SB1000142405270230476530457748303361

4613256.html

•http://www.environmentaldiseases.com/article-drug-interactions.html