THERAPEUTIC INCOMPATIBILITIES o A combination of penicillin and streptomycin increases the

antibacterial activity
It is the modification of the therapeutic effect of one drug by the prior
concomitant administration of another. It may be as a result of - When two drugs are prescribed together, and they tend to decrease
prescribing certain drugs to a patient with the intention to produce a the activity of each other this is known as ANTAGONISM
specific degree of pharmacological action, but the intensity of the o Amphetamines show its antagonistic effect with the barbiturates.
action produced is different from that intended by the prescriber. TAKE NOTE
4. PRESCRIBING CONTRAINDICATED DRUGS
Causes: - There are certain drugs which may be contra-indicated in a particular
1. Wrong dose disease or a particular patient who is allergic to it
2. Wrong drug o Corticosteroids are contraindicated in the patients having peptic
3. Wrong dosage form ulcers.
4. Wrong route o The penicillin and sulfur drugs are contraindicated in patients who are
5. Synergism allergic
6. Antagonism o Vasoconstrictors are contraindicated in hypertensive patients
7. Contraindication o Barbiturates and morphine should not be given to asthmatic patients
8. Drug interactions
5. DRUG INTERACTIONS
Therapeutic incompatibilities occur due to the following reasons - The effect of one drug is altered by the prior or simultaneous
1. ERRORs IN DOSAGE administration of another drug.
- Many therapeutic incompatibilities result from errors in writing or
interpreting the prescription order. Therapeutic incompatibility may also be due to :
A) Medication errors
- The most serious type of the dosage error in the dispensing is overdose B) Drug interactions
of a medication.
Medication errors may be done by doctors, pharmacists, nurses &
2. WRONG DOSE OR DOSAGE FORM patients.
- Sometimes many drugs are available in different dosage forms and Medication errors can be categorized as –
hence, if the dosage form is not clearly mentioned on the prescription, 1. Prescription errors
it becomes necessary to seek clarification from the prescriber. 2. Dispensing errors
- The responsibility of the pharmacist is to check the prescription 3. Selection errors
intensively and if he finds these types of errors he should immediately 4. Bagging errors
consult the prescriber for clarification. 5. Administration errors

3. PRESCRIBING SYNERGISTIC OR ANTAGONISTIC DRUGS 1. Errors in prescription writing

- When two drugs are prescribed together, and they tend to increase The prescription should be neatly & correctly written by the medical
the activity of each other this is known as SYNERGISM. practitioner, otherwise it is major hassle for the pharmacists. Spelling
o A combination of aspirin and paracetamol enhances analgesic mistakes. Illegible handwriting.
activity
A. SALA Medicines(Sound Alike Look Alike): Tab. Dulcolax a laxative B. Drug interactions
tablet & Tab . Duoclox an antibacterial tablet. 1. Contra – indicated drugs:
There are certain drugs which may be contraindicated in a particular
B. Type of dosage form: Same drug can be available in tablet, capsule disease or a particular patient who is allergic to it. Example: the
or liquid oral dosage forms for adults, drops for pediatric patients. penicillin & sulpha drugs are contraindicated to the patients who are
Selection of dosage form is based on ability of patients to take that allergic to it.
medicines.
2.Synergistic & antagonistic drugs:
C. Strength of Medicines : Many drugs exhibit Synergism & Antagonism when administered in
Some medicines, especially those whose dosing is critical , are combination. When the two drugs are prescribed together, they tend
available in different strengths. Eg. Haloperidol , antipsychotic drug to increase the activity of each other, called as synergism. Example: A
available in the form of tablets of various strength viz. 0.25, 2mg, combination of aspirin & paracetamol increase the analgesic activity.
5mg,10mg, 20 mg. When two drugs having the opposing pharmacological effects are
called antagonism. Example: Acetyl salicylic acid and probenecid
D. Quantity to be dispensed: Pharmacists should check the dose & see
that the quantity of medicine is sufficient to complete a course. a)Unintentional drug interaction
The effect of one drug is altered by the prior or simultaneous
Pharmacists should check the dose, dosage regimen & direction to use. administration of another drug.
E. Dose & Direction: Pharmacists should check the dose, dosage
regimen & direction to use. Tetracycline hydrochloride mg
Direction –take one capsule with milk
2. Dispensing Errors: Poor handwriting Long prescription Tetracycline is inactivated by calcium which is present in milk.
Incomplete patient information Deviation in attention of pharmacist
Misunderstanding of verbal orders. b) Intentional drug interaction
Rx
While removing medicines from shelves pharmacist should be alert. Acetophenetidin mg
3. Selection of medicine While removing medicines from shelves Acetyl salicylic acid mg
pharmacist should be alert. He should remove the correct medicine. Caffeine mg
SALA medicines should not be kept adjacent to one another. Send 10 capsules.

4. Bagging Errors: After billing, dosage forms should be packed in Acetophenetidin & acetyl salicylic acid are analgesic.
appropriate bags or covers & handed over to the right person. Acetophenetidin depresses the CNS & this effect is undesirable.
Caffeine is CNS stimulant to neutralize the side effect of
5. Errors in administration acetophenetidin.
Breaking the coated or sustained release tablets. Suspension
administration without shaking. Taking medicament at wrong time
before or after meal.