DRUGI

NTERACTI
ONS
1.
PENI
CILLI
N/CEPHALOSPORI
N+GENTAMYCI
N(CARDNO-
21/
22)
Thesedr
ugt
oget
hershowaddi
ti
vesy
ner
gism.

Peni
ci
ll
i
n/Cephal
ospor
in–cel
lwal
li
nhi
bit
orI
nhi
bit
or

Sot
heyenhancepenet
rat
ionofAmi
nogl
ycosi
desi
ntoBact
eri
um

Ami
nogl
ycosi
desbi
ndt
o30sand50sr
ibosomeandI
nhi
bit
sPr
otei
nSy
nthesi
s

HenceBact
eri
cidal
eff
ectofAmi
nogl
ycosi
desi
sincr
ease.

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2.
AMOXI
CILLI
NANDCLAVULI
NICACI
D(CARDNO.8)

AMOXI
CILLI
N–I
tisbet
alact
am ant
ibi
oti
c

CLAVULANICACID–I ti
sbet
alact
amasesi
nhi
bit
or(
classI
ItoI
V).I
thasno
ant
ibact
eri
alact
ivi
ty

REASONFORCOMBI NATION–Combinat
ioniscall
edcoamoxi
clav
.T1/
2is1hrf
or
bot
handtissuedi
str
ibut
ionmat
chesf
orbothofthem.

MECHANI SM –Amoxi
cil
l
inisbetalact
am ant
ibioti
c,i
twor
kbystoppi
ngt
hegrowt
h
ofbact
eri
a.Bacter
iadevel
opresist
anttoamoxi ci
l
li
nbypr
oduci
ngbetal
act
amase
enzyme,whi
chdest
royamocil
li
nbyopeni ngr
ing.

Clav
ulani
caci
ddest r
oybet
alactamaseenzy
mepr
oducedbybact
eri
a,t
huspr
event
bacter
iaf
rom dest
royi
ngamoxicil
l
in.
Therefor
eadditi
onofcl avul
ani
cacidwithamoxi
cil
li
nre-
establ
ishesacti
vi
tyof
amoxicil
li
nagainstβ-l
actamaseproduci
ngresi
stantSt
aph.aureus(butnotMRSA
thathavealt
eredPBPs) ,H.i
nfl
uenzae,
N.gonorr
hoeae,E.col
i,
Pr ot
eus,Kl
ebsi
ell
a,
Salmonell
aandShi gel
la.

Bact.Fragi
li
sandBranhamel
l
acatarrhal
i
sar
enotr
esponsi
vet
oamoxi
cil
l
inal
one,
theyareinhi
bit
edbythecombinat
ion.

LEVODOPA AND BENSERAZI

DE
Levodopa:ItisaDopami neprecursor.I
tisinact
ivebyitsel
f,buti
sthei mmediate
precursorofthet r
ansmitt
erDA.Mor ethan95%ofanor aldoseisdecarboxyl
atedin
theperipheralti
ssues(mainl
ygutandl iver
).DAt husformedi sf
urthermetaboli
zed,
andt heremai ni
ngactsonhear t
,bloodvessels,otherperi
pheral
organsandonCTZ.

About1–2%ofadmi
nist
eredlevodopacrossestot
hebr
ain,
istakenupbythe
surv
ivi
ngdopami
ner
gicneurones,conv
ertedtoDAwhi
chisstoredandr
eleasedasa
tr
ansmitt
er.

Benserazi
de:I
tisperipheraldecarboxy
laseinhi
bit
or.Admi
nist
eredalongwith
l
evodopa,theyincreaseitst½int heperi
pheryandmakemor eofitavai
labl
etocr
oss
bl
ood-brai
nbarrierandr eachitssit
eofacti
on.

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3.
AMOXYCI
LLI
N+O.
C.P(CARDNO.5)
Amoxy
cil
l
ini
sanant
ibi
oti
c.

Inter
rupt
ionofent
erohepat
icci
rcul
ati
onofest
rogenl
eadst
ofai
l
ureof
contr
acepti
on

al
ter
nat
ivecont
racept
ioni
sadv
ised.

4.
ERYTHROMYCI
NANDCI
SAPRI
DE(
CARDNO-
13)

Er
ythr
omy
cinact
sasaCYP3A4i
nhi
bit
or
 I
ncr
easei
nthel
evel
sofCi
sapr
ide(
asCi
sapr
idei
smet
abol
i
zedbyCYP3A4)

Athi
ghconcent
rat
ionsCi
sapr
idebl
ocksdel
ayedr
ect
if
ierK+channel
sinhear
t

Pr
olongsQTci
nter
val
andpr
edi
sposestot
orsadesdepoi
ntes/
vent
ri
cul
ar
fi
bri
ll
ati
on

5.
DIGI
OXI
N&QUI
NIDI
NE(
CARDNO18)

Qui
nidi
ne

Reducesbi
ndi
ngofDi
goxi
ntot
issuepr
otei
ns

aswellasi
tsr
enal
andbi
l
li
arycl
ear
ancebyi
nhi
bit
ingef
fl
uxoft
ranspor
terP-
gl
ycopr
otei
n

Pl
asmaconcent
rat
ionofdi
goxi
nisdoubl
ed

Toxi
cit
ycanoccur

NOTE:
-

 Ver
apemi
l

 Di
l
tiazem

 Capt
opr
il Al
soi
ncr
easespl
asmadi
goxi
nconcent
rat
iont
osome
 ext
ent

 Ami
odar
one

 Pr
opaf
enone

SoItisprudentt
omonitorser
um digoxi
nconcent
rat
ionsduri
ngconcomitant
qui
nidinetr
eatmentandtoadj
ustthedigoxi
ndoseaccordi
ngtotheresul
ts.

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6.METRONI
DAZOLEANDALCOHOL

Met
roni
dazol
e

I
nhi
bit
sAl
dehy
dedehy
drogenase

Accumul
ati
onofAcet
aldehy
de

Mayl
eadt
osev
eredi
str
essi
ngsy
mpt
omsknonwnasDi
sul
fi
ram l
i
ke

r
eact
ions(
li
kef
lushi
ng,
headache,
vomi
ti
ng,
vi
sual
dist
urbances&ment
alconf
usi
on)

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7.
SILDENAFI
LANDNI
TRATES(
CARDNO.
7)
Si
l
denaf
ili
sPDE5i
nhi
bit
or,
admi
nist
rat
ionf
ort
het
reat
mentofer
ect
il
edy
sfunct
ion

.
Nit
ri
coxidecausesmoot
hmuscl
erel
axat
ionbygener
ati
onCGMPi
ntr
acel
l
ular
ly
whi
chthen

pr
omotedephosphor
yal
ti
onofmy
osi
nli
ghtchai
nki
nsasesot
hatmy
osi
nfai
lto
i
nter
actwi
thacti
n.

Inhi
bitionofPDE5, t
heCGMPdegr adedi
soenzymeincav
er nosalandsmooth
muscl e,r
esulti
naccumul ati
onofCGMPandmar kedpotentiat
ionofNO
acti
on. si
ldenaf
ilactbyselect
ivel
yinhi
bit
ingPDE5andenhanci ngNOacti
onincor
pus
cavernosum.

Si
l
denafi
lmarkedl
ypot
ent
iat
ethev
asodi
l
atoract
ionofni
tr
ates,
preci
pit
atef
all
in
B.
P,MIcanoccur.

Sil
denafi
lcont
rai
ndicat
edinpati
entofCHDandt hosetaki
ngni
tr
ates.si
l
denaf
il
remainseff
ect
ivefor<8hr
,i
tisadvi
sedthatni
tr
atesareavoi
dedfor24hrs.

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8.
AMI
TRYPTYLI
NEANDMAOI
NHI
BITOR(
CARDNO.
17)
Ami
tr
ypt
yli
nei
sat
ri
cycl
i
cant
idepr
essantwhi
chi
saNA+5HTr
eupt
akei
nhi
bit
or

MAOinhibi
tor
sinhi
bitt
hemitochondr
ialenzymemonoamineoxi
dasei
nvol
vedi
n
oxi
dat
ivedeaminat
ionofbi
ogenicamines(Adr,
NA,
DA,5HT)

Whenpat
ientonMAOi
nhi
bit
orgi
venami
tr
ypt
yli
ne

I
nit
ial
NAr
eleasi
ngorupt
akebl
ocki
ngact
ion

Exci
tement,
risei
nBPandt
emper
atur
e

LEVODOPAANDCARBI
DOPAI
NPARKI
NSON’
SDI
SEASE
Lev
odopai
sadopami
nepr
ecur
sor
.

Morethan95%ofor
all
yadmi
nist
eredl
evodopai
sdecar
boxy
lat
edbydopa-
decar
boxyl
ase

i
nper
ipher
alt
issues.

Car
bidopai
saper
ipher
aldecar
boxy
lasei
nhi
bit
oranddonotpenet
rat
eBBB.

Whencar
bidopai
sadmi
nist
eredwi
thl
evodopa

Pr
event
ionofper
ipher
aldecar
boxy
lat
ionofl
evodopa

I
ncr
easedpl
asmahal
fli
feofl
evodopa

I
ncr
easedl
evodopacr
ossest
heBBBf
ordecar
boxy
lat
iont
odopami
nei
nbr
ain

↓
I
ncr
easedt
her
apeut
icef
fectf
orpar
kinsoni
sm

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9.
TETRACYCLI
NESANDI
RONSALT(
CARDNO.
4)

Tet
racy
cli
ne'
sar
ebr
oadspect
rum ant
ibi
oti
cs.

Tetr
acycl
inehavechelati
ngpr opert
yformi
nsol
ubl
eandunabsorbabl
ecomplexes
wit
hcalci
um andothermet als.Milk,
ir
onpr
epar
ati
on,
nonsystemicantaci
dsand
sucr
alf
atereducestheirabsorpti
on.

Administ
rat
ionofthesesubstanceandt
etr
acy
cli
neshoul
dbest
agger
ed,
ift
hey
cannotbeavoidedtoget
her.

PROBENECI
DANDPENI
CILLI
NS

Probeneci
dhighl
yli
pidsol
ubleor
gani
caci
ddevelopedt
oinhi
bitrenalt
ubul
ar
secret
ionofpeni
cil
l
insothati
tsdur
ati
onofact
ioncoul
dbeprolonged.

Pr
obeneci
dispredominantl
ysecret
edbytheproximaltubul
es,i
tsabsor
pti
oni
s
mi
nimal.
netef
fectofprobeneci
disinhi
bit
ionofpeni
cil
l
inexcret
ion;mor
esust
ained
bl
oodl
evel
sar
eachi
eved.
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