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Murder
Auto-cash Fatal, unexpected drug reaction
Theophylline (Aminophylline)
Warfarin
Pharmacokinetics
Drug in gut
Absorption
Drug in blood
Distribution
Drug metabolites
Drug in tissues
Drug in urine/bile
Pharmacodynamics
Desired response
Drug at receptor
No response
Unwanted response
Pharmacodynamic interactions
Unknown Mechanisms
Not all interactions can be predicted based upon readily recognizable mechanism Be wary of new combinations where literature is sparse or non-existent
Meropenem and Valproic Acid
VPA concentration can drop 3 to 5 fold in 24 hrs after adding Meropenem Mechanism ?
Pharmacodynamic interactions
Receptor interaction Competitive Non-competitive Sensitivity of receptor Number of receptor Affinity of receptor Alter neurotransmitter release /drug transportation Alter water/electrolyte balance
Answer Increase digitalis effect due to diuretic induce hypokalemia therefor increase sensitivity of myocardium to digitalis
Physiological interactions
Drug A and Drug B bind to different receptors on the same tissue but give opposite or similar effect Aspirin (anti-platelet) +Warfarin/Coumarin (anticoagulant)
Increase bleeding
Pharmaceutical interactions
Interactions that occur prior to systemic administration. For example incompatibility between two drugs mixed in an IV fluid. These interactions can be physical (e.g. with a visible precipitate) or chemical with no visible sign of a problem
Antagonism
Beta blockers used with terbutaline