Notre Dame of Jolo College

Health Sciences Department

Pharmacy Program
Clinical Pharmacy with Pharmacotherapeutics 1

Name: ______________________________________ Date Performed _________________________

Course/Year/Section __________________________ Date Submitted: _________________________
Group No: __________________________________ Name of Instructor: R. Jairi, RPh

WORKSHEET NO. 5
DRUG INTERACTIONS

INTRODUCTION:

Drug interactions occur when the effect of a particular drug is altered when it is taken with
another drug or with food. Generally, drug interactions should be avoided because they are usually
unwanted and sometimes harmful but there are instances that is deliberately used.
The effects of drug interactions are usually unwanted and sometimes harmful. Interaction may
increase or decrease the actions of one or more drugs or it may produce new effect that neither produces
on its own; resulting in side effects of failed treatment.

Drug interactions may be the result of several of processes, like:

1. Alterations in the PHARMACOKINETICS of the drug which include:
 Absorption
 Distribution
 Metabolism
 An enzyme system compromising the CYP450 oxidases, may be affected by
either enzyme induction or enzyme inhibition:
o Enzyme Induction
 Drug A induces the body to produce more of an enzyme which
metabolizes drug B. This reduces the effective concentration of
drug B, which may lead to loss of effectiveness of drug B. there
is no alteration in the effectiveness of Drug A.
o Enzyme Inhibition
 Drug A inhibits the production of the enzyme metabolizing drug
B, thus an elevation of drug B occurs possibly leading to an
OVERDOSE.
o Bioavailability
 Drug A influences the absorption of drug B.
 Excretion
2. Result of the PHARMACODYBANIC properties of the drug
 Co-administration of a receptor antagonist and an agonist for the same receptor.

Types of Drug Interaction:

1. Drug-drug interaction
2. Drug-nutrient interaction
3. Drug-disease interaction

1. Drug-Drug Interaction
Drug-drug interaction involve another drug the patient is taking, can involve prescription
or nonprescription (over-the-counter) drugs.
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Clinical Pharmacy with Pharmacotherapeutics 1

Types of drug-drug interactions:

a. Duplication
b. Opposition (antagonism)
c. Alteration of what the body does to one or both drugs
a. Duplication
When two drugs with the same effect are taken, their side effects may be intensified.
Duplication may occur when people inadvertently take two drugs (often at least one is an
over-the-counter drug) that have the same active ingredient.

Examples of duplication:
A patient may take:
 A cold remedy and a sleep aid, both of which contain Diphenhydramine.
 A cold remedy and a pain reliever, both of which contain Acetaminophen.
 Two different drugs with the same effect. This is most likely to occur when people see
several doctors, obtain prescriptions at more than one pharmacy, or both. Doctors who
are not aware of what others have prescribed may inadvertently prescribe similar drugs. It
is helpful to keep an up-to-date written list of all drugs being taken and to bring the list
along on each doctor visit. Also, people should not take previously prescribed drugs
(such as a sleeping pill or pain reliever) without checking with the doctor or pharmacist
because that drug may duplicate or otherwise interact with one of their current drugs.

b. Opposition (Antagonism)
Two drugs with opposing actions can interact, thereby reducing the effectiveness of one
or both.

Examples of opposition:

A patient may take:

 NSAID (Non-steroidal Anti-inflammatory Drugs) like Ibuprofen and Diuretics, such as
hydrochlorothiazide, furosemide.
o The NSAID may reduce the diuretic’s effectiveness.
 Certain beta-blockers like Propranolol (taken to control high blood pressure and heart
disease), counteract beta-adrenergic stimulants, such as Albuterol (taken to manage
asthma).
o Both types of drugs target the same cell-receptors-beta-2 receptors (but one type
blocks them, and the other stimulates them).

c. Alteration:

One drug may alter how the body absorbs, distributes, metabolizes, or excrete another drug.

Many drugs are broken down and inactivated (metabolized) by certain enzymes in the liver. Some drugs
affect these liver enzymes, either increasing or decreasing their activity, and may cause another drug to be
inactivated more quickly or more slowly than usual.

Some drugs affect the rate at which the kidneys excrete another drug.

Example of Alteration:
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Health Sciences Department
Pharmacy Program
Clinical Pharmacy with Pharmacotherapeutics 1

A patient may take:

 Acid-blocking drugs like Histamine-2 (H 2) blockers and proton pump inhibitors (raise the pH of
the stomach) decrease absorption of some drugs like Ketoconazole a drug for fungal infections.
 Barbiturates like Phenobarbital increasing the activity of liver enzymes cause Warfarin
(anticoagulant) to be inactivated more quickly and thus to be less effective when taken during the
same time period. (Erythromycin decreases the activity of the enzyme system).
 Ciprofloxacin can increase the activity of Warfarin increases risk of bleeding.
 When drugs that affect liver enzymes are used in people taking warfarin, doctors monitor the
people more closely and adjusted again when other drugs are stopped. Many other drugs affect
liver enzymes.
 Chemicals in cigarette smoke may increase the activity of some liver enzymes. As a result,
smoking decreases the effectiveness of some drugs, including Propoxyphene (an analgesic) and
theophylline (a drug that widens the airways called a bronchodilator).
 Large doses of vitamin C increase the urine’s acidity and thus may change the rate of excretion
and activity of certain drugs. Like the rate of excretion may be decreased for acidic drugs such as
aspirin but may be increased for basic drugs such as Pseudoephedrine.

Guidelines on how to reduce the risk of drug-drug interaction:

a. Consult the doctor or pharmacist before taking any new drugs, including over-the-counter
drugs and dietary supplements, such as medicinal herbs.
b. Keep a list of all drugs being taken. Periodically discuss this list with the doctor or
pharmacist.
c. Keep a list of all disorders. Periodically discuss this list with the doctor.
d. Select a pharmacy that provides comprehensive services (including checking for possible
interactions) and that maintains a complete drug profile for each person. Have all
prescriptions dispensed in this pharmacy.
e. Learn about the purpose and actions of al drugs prescribed.
f. Learn about the possible side effects of the drugs.
g. Learn how to take the drugs, what time of day they should be taken, and whether they can
be taken during the same time period as other drugs.
h. Review the use of over-the-counter drugs with the pharmacist. Discuss any disorders
present and any prescription drugs being taken.
i. Take the drugs as instructed.
j. Report to the doctor or pharmacist any symptoms that might be related to the use of a
drug.
k. If seeing more than one doctor, make sure each doctor knows all the drugs being taken.

2. Drug-Nutrient Interactions (drug-food Interactions)

Nutrients include food, beverages (including alcohol), and dietary supplements the patient is
consuming during therapy. Consumption of these substances may alter the effects of drugs the person
takes.

Food:
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Clinical Pharmacy with Pharmacotherapeutics 1

Just like any other food, drugs taken by mouth must be absorbed through the lining of the
stomach or the small intestine. The presence of food in the digestive tract may reduce absorption of a drug
such effect can be avoided by taking the drug 1 hour before or 2 hours after eating.

Dietary Supplements:
Dietary Supplements, including medicinal herbs, are products (not tobacco) that contain a
vitamin, mineral, herb, or amino acid and that are intended as a supplement to the normal diet.
Supplements are regulated as foods, not as drugs, so they are not tested as comprehensively.
People who take dietary supplements should tell their doctors and pharmacists because they may interact
with prescription or over-the-counter drugs.

Alcohol:
Even if alcohol is not considered as nutrient, it affects body processes and interacts with many
drugs.
Taking alcohol with the antibiotic Metronidazole can cause flushing, headache, palpitations, and
nausea and vomiting.
Doctors or pharmacists can answer questions about possible alcohol and drug interactions.

3.Drug-disease interactions

There are cases where drugs that are helpful in one disease are harmful in another disorder. Patients
should tell their doctor all of the disease they have before the doctor prescribes a new drug.

Diabetes, high or low blood pressure, an ulcer, glaucoma, an enlarged prostate, poor bladder
control, and insomnia are particularly important, because patients with such diseases are more likely to
have a drug-disease interaction.

Drug-disease interactions can occur in any occur in any age group but are common among older
people, who tend to have more diseases.

Examples of drug-disease interactions:

A patient may take:
 Some beta-blockers taken for heart disease or high blood pressure can worsen asthma and make
it hard for patients with diabetes to tell when their blood sugar is too low.
 Some drugs taken to treat a cold may worsen glaucoma.
Procedure:
1. Prior to this activity, the procedure should be discussed within the glass.
2. Each student will make an interview with 3 households at the nearby place. Preferably, a family
with a member who takes regular medicine.
3. Identify:
a. The medicines available in each household. With permission, organize their
medicines. Expired medicines should be separated and instruct them what to do.
b. Data about the person who takes certain medicine or group of medicines like
gender, age, name of medicine, its dose and frequency.
4. Ask for another appointment to discuss the medicines and assure the family that the data collected
will be treated with confidentiality.
5. Make a research on the collected data.
6. Discuss the medicines and possible drug interactions to the patient.
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Health Sciences Department
Pharmacy Program
Clinical Pharmacy with Pharmacotherapeutics 1

Data:

Conclusion:

WORKSHEETS

DRUG INTERACTION

Name of Interviewer: ______________________________________________________

Address of Interviewer: _____________________________________________________
Address of Respondent: ____________________________________________________
Total member of the household: ____________________________________________
Medicines available in the household: _______________________________________
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Family member 1: Gender __________________ Age __________________
Medicines taken: Dose: Frequency: Use/s
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Health Sciences Department
Pharmacy Program
Clinical Pharmacy with Pharmacotherapeutics 1

Family member 2: Gender ___________________ Age ________________

Medicines taken: Dose: Frequency: Uses/s
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Family member 3: Gender ___________________ Age ________________

Medicines taken: Dose: Frequency: Uses/s
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Family member 4: Gender ___________________ Age ________________

Medicines taken: Dose: Frequency: Uses/s
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Family member 5: Gender ___________________ Age ________________

Medicines taken: Dose: Frequency: Uses/s
1.
2.
3.
4.
 Notre Dame of Jolo College
Health Sciences Department
Pharmacy Program
Clinical Pharmacy with Pharmacotherapeutics 1

5.
6.
7.
8.
9.
10.

Documentations:

Conclusion:
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Health Sciences Department
Pharmacy Program
Clinical Pharmacy with Pharmacotherapeutics 1

Questions:
1. Write the type of drug interaction encountered during the interview, how it is explained to the
patient.

2. What are the different means in identifying drug interactions?

3. Why is it necessary for pharmacists to identify any drug interactions?

4. Give atleast 2 examples of drug interactions that are deliberately used because of its advantage.
 Notre Dame of Jolo College
Health Sciences Department
Pharmacy Program
Clinical Pharmacy with Pharmacotherapeutics 1