{"id":45617,"date":"2019-08-09T21:28:12","date_gmt":"2019-08-09T20:28:12","guid":{"rendered":"http:\/\/localhost\/wordpress\/?page_id=2396"},"modified":"2019-09-16T08:57:58","modified_gmt":"2019-09-16T08:57:58","slug":"adverse-drug-reactions-2-drug-interactions","status":"publish","type":"page","link":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/","title":{"rendered":"Adverse Drug Reactions 2: Drug Interactions"},"content":{"rendered":"\n<div class=\"wp-block-cover alignfull has-background-dim\" style=\"background-image:url(https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/03125547\/Cells-dividing.jpg);background-position:48.5% 55.714285714285715%\"><div class=\"wp-block-cover__inner-container is-layout-flow wp-block-cover-is-layout-flow\">\n<h1 class=\"wp-block-heading\" style=\"text-align:right\">\n\nA\/Prof. Ken Rodgers School of Life Sciences\n\n<\/h1>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utshand-pills\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Learning Objectives<\/h2>\n\n\n\n<ul class=\"utsblack4 wp-block-list\"><li>Recognise health care costs associated with Adverse Drug Reactions (ADRs)<\/li><li>Outline the contribution of the following to the overall burden of preventable ADRs<ul><li>Age<\/li><li>Pharmacogenetics<\/li><li>Diseases<\/li><li>Idiosyncratic reactions<\/li><li>Drug interactions<\/li><\/ul><\/li><li>Identify mechanisms for specific clinically relevant drug interactions<\/li><li>Identify issues of polypharmacy in the elderly<\/li><li>Provide approaches to minimise ADRs<\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">References<\/h2>\n\n\n\n<ul class=\"utslightred wp-block-list\"><li>Rang and Dales&nbsp;<em>Pharmacology (8<\/em><em><sup>th<\/sup><\/em><em>&nbsp;ed)<\/em><ul><li>Chapters 11 and 57. Individual Variation and Drug Interactions. Harmful effects of drugs<\/li><\/ul><\/li><li>World Health Organisation<\/li><li>The Food and Drug Administration (FDA) Center for Drug Evaluation and Research<\/li><li>Therapeutic Goods Administration (TGA)<\/li><\/ul>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-cover alignfull\" style=\"background-image:url(https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/06122811\/UTS-blue-0f4beB.png)\"><div class=\"wp-block-cover__inner-container is-layout-flow wp-block-cover-is-layout-flow\">\n<h1 class=\"wp-block-heading\" style=\"text-align:left\" id=\"Intro\">Intro to Drug Interactions<\/h1>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utslightblue\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>A drug interaction is said to occur when the&nbsp;<strong>effects<\/strong>&nbsp;of one drug are changed by the presence of another&nbsp;<strong>drug<\/strong>,&nbsp;<strong>food<\/strong>,&nbsp;<strong>drink<\/strong>&nbsp;or by some&nbsp;<strong>environmental chemical<\/strong><\/li><li><strong>Drug-Drug Interaction<\/strong><ul><li>Occurs when effects of one drug are&nbsp;<strong>increased<\/strong>&nbsp;or&nbsp;<strong>decreased<\/strong>&nbsp;by previous or concurrent administration of another&nbsp;drug<\/li><\/ul><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utsclearpill\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Introduction<\/h2>\n\n\n\n<ul class=\"utsblack4 wp-block-list\"><li><strong>Contribution of Drug Interactions to the Overall Burden of Preventable ADRs<\/strong><ul><li>Drug interactions represent 3\u20135% of preventable in-hospital ADRs<\/li><li>Drug interactions are an important contributor to number of ER visits and hospital admissions<\/li><\/ul><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utslightblue\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Introduction<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>The administration of one drug (A) can alter the action of another (B) by:<\/strong><ul><li>Modification of the pharmacological effect of B without altering its conc (<strong>pharmacodynamic interaction<\/strong>)<\/li><li>Alteration of the conc of B that reaches its site of action (<strong>pharmacokinetic interaction<\/strong>)<\/li><li>&gt;6 medications = &gt;80% chance of interaction<\/li><li>Consequence: alter dose \/ change medication<\/li><\/ul><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Drug Interactions: Introduction<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>For pharmacokinetic interactions to be clinically important, it is also necessary that the dose-response curve is steep<\/strong><ul><li>A small reduction in plasma conc will lead to a substantial change in effect<\/li><\/ul><\/li><li><strong>For most drugs these conditions are not met since&nbsp;<\/strong><strong>therapeutic margin<\/strong><strong>&nbsp;is usually large (eg penicillin &gt;100)<\/strong><\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"1442\" height=\"224\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05125428\/therapeutic-margin.png\" alt=\"therapeutic margin\" class=\"wp-image-46373\" \/><\/figure><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\" style=\"text-align:left\">Repeated doses 2<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"1228\" height=\"858\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05125527\/Repeated-doses-2.png\" alt=\"Repeated doses concentration verse days\" class=\"wp-image-46374\" \/><\/figure><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utslightred\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Introduction<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Several drugs have a steep dose-response relationships and a narrow therapeutic margin<\/strong><\/li><li><strong>Drug interactions can cause major problems with these drugs<\/strong><ul><li><em>Antithrombotic drugs<\/em><\/li><li><em>Antiarrhythmic drugs<\/em><\/li><li><em>Antiepileptic drugs<\/em><\/li><li>Lithium<\/li><li>Several&nbsp;<em>antineoplastic drugs<\/em><\/li><li>Several&nbsp;<em>immunosuppressant drugs<\/em><\/li><\/ul><\/li><\/ul>\n\n\n\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-columns alignfull has-2-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Pharmacodynamic<\/h2>\n\n\n\n<p><strong>Pharmacodynamic<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Often predictable from the actions of the interacting drugs<\/strong><\/li><li><strong>Additive<\/strong><ul><li>Nephrotoxicity \u2013 cyclosporin and&nbsp;<em>aminoglycosides<\/em><\/li><li>Sedation \u2013&nbsp;<em>H<\/em><em><sub>1<\/sub><\/em><em>&nbsp;receptor antagonists<\/em>&nbsp;and alcohol<\/li><\/ul><\/li><\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<ul class=\"wp-block-list\"><li><strong>Synergistic (different mechanisms of action)<\/strong><ul><li>Bleeding risk \u2013 aspirin and warfarin<\/li><li>Rx of&nbsp;<em>Pneumocystis carinii<\/em>&nbsp;\u2013&nbsp;<em>sulfonamides<\/em>&nbsp;and trimethoprim<\/li><\/ul><\/li><li><strong>Antagonistic<\/strong><ul><li>Reduction of antihypertensive action \u2013&nbsp;<em>NSAIDs<\/em>and&nbsp;<em>diuretics<\/em><\/li><li>Bronchoconstriction \u2013&nbsp;\u03b2<em>-blockers<\/em>&nbsp;and salbutamol<\/li><li>Block of coagulation \u2013 warfarin and vitamin K-containing foods<ul><li>Beta2-adrenoceptor&nbsp;antagonist +&nbsp;agonist<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n<\/div>\n<\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Drug Interactions: Pharmacokinetic<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>2. Pharmacokinetic<\/strong><ul><li><strong>A<\/strong>bsorption of the drug into systemic circulation<\/li><li><strong>D<\/strong>istribution of the drug to the site of action and into tissues<\/li><li><strong>M<\/strong>etabolism of the drug to polar intermediates<\/li><li><strong>E<\/strong>limination of the drug from the body<\/li><\/ul><\/li><\/ul>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-cover alignfull\" style=\"background-image:url(https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/06122811\/UTS-blue-0f4beB.png)\"><div class=\"wp-block-cover__inner-container is-layout-flow wp-block-cover-is-layout-flow\">\n<h1 class=\"wp-block-heading\" style=\"text-align:left\" id=\"Absorption\">Absorption<\/h1>\n<\/div><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Drug Interactions: Absorption<\/h2>\n\n\n\n<p><strong>Absorption in the GI Tract<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"2134\" height=\"1112\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05125607\/Absorption-in-the-GI-Tract.png\" alt=\"Absorption in the GI Tract\" class=\"wp-image-46376\" \/><\/figure><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utspills\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Absorption<\/h2>\n\n\n\n<ul class=\"utsblack4 wp-block-list\"><li><strong>Absorption (non-GIT)<\/strong><ul><li>Prevented by complex formation with others substances<ul><li>Phenytoin precipitates in dextrose solutions (e.g. D5W)<\/li><li>Amphotericin precipitates in saline<\/li><\/ul><\/li><li>Prevented by complex formation with others drugs<ul><li><strong>Thiopentone and suxamethonium&nbsp;<\/strong>shouldn\u2019t be mixed in same syringe<\/li><li>Gentamicin complexes with beta-lactams and certain plastics \u2013 loss of antibiotic effect<\/li><\/ul><\/li><li>Slowed by drugs that cause vasoconstriction at injection site<ul><li>Adrenaline and&nbsp;<em>local anaesthetics<\/em><\/li><\/ul><\/li><\/ul><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-cover alignfull\" style=\"background-image:url(https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/06122811\/UTS-blue-0f4beB.png)\"><div class=\"wp-block-cover__inner-container is-layout-flow wp-block-cover-is-layout-flow\">\n<h1 class=\"wp-block-heading\" style=\"text-align:left\" id=\"Distribution\">Distribution<\/h1>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utslightblue\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Distribution<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Distribution<\/strong><ul><li>Displacement of plasma protein bound drug is seldom clinically important<\/li><li>Only transient increase in free [drug] due to increase in elimination<\/li><li>Problem where displacement and a reduction in elimination occur simultaneously<ul><li><strong>Phenylbutazone displaces warfarin<\/strong>&nbsp;from albumin and inhibits metabolism of warfarin to increase bleeding<\/li><li><strong><em>Salicylates<\/em>&nbsp;displace methotrexate&nbsp;<\/strong>from albumin and reduce its secretion into the nephron by competing for the anion secretory carrier<\/li><li><strong><em>Antiarrhythmics<\/em>&nbsp;(quinidine, verapamil, amiodarone) displace digoxin&nbsp;<\/strong>from tissue-binding sites and reduce its renal excretion to cause severe arrhythmias through digoxin toxicity<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-cover alignfull\" style=\"background-image:url(https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/06122811\/UTS-blue-0f4beB.png)\"><div class=\"wp-block-cover__inner-container is-layout-flow wp-block-cover-is-layout-flow\">\n<h1 class=\"wp-block-heading\" style=\"text-align:left\" id=\"Metabolism\">Metabolism<\/h1>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-columns alignfull has-2-columns utsclinic is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Metabolism<\/h2>\n\n\n\n<ul class=\"utsblack4 wp-block-list\"><li><strong>Drugs can either inhibit or induce drug-metabolising enzymes<\/strong><\/li><li><strong>Enzyme induction<\/strong><ul><li>Over 200 drugs can cause enzyme induction<\/li><li>Eg rifampicin given for 3 days reduces effectiveness of warfarin as an anticoagulant<\/li><\/ul><\/li><\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"481\" height=\"288\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05130928\/Metabolism-2.jpeg\" alt=\"prothrombin time\" class=\"wp-image-46380\" \/><\/figure><\/div>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"481\" height=\"400\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05130926\/Metabolism-01.jpeg\" alt=\"plasma warfarin concentration over time\" class=\"wp-image-46379\" \/><\/figure><\/div>\n\n\n\n<p><\/p>\n<\/div>\n<\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\" style=\"text-align:center\">Drug Interactions: Metabolism<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"1206\" height=\"674\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05131013\/Metabolism-03.png\" alt=\"Drug Interactions\" class=\"wp-image-46382\" \/><\/figure><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Drug Interactions: Metabolism<\/h2>\n\n\n\n<p><strong>Prodrugs<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"2224\" height=\"928\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05131031\/Prodrugs.png\" alt=\"prodrugs\" class=\"wp-image-46384\" \/><\/figure><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Drug Interactions: Metabolism<\/h2>\n\n\n\n<p><strong>Toxic metabolites<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"2042\" height=\"456\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05131119\/Toxic-metabolites.png\" alt=\"Toxic metabolites\" class=\"wp-image-46385\" \/><\/figure><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utslightred\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Metabolism<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>Nearly always due to interaction at Phase I enzymes, rather than Phase II<\/li><li>Phase I commonly due to interaction at cytochrome P450 enzymes \u2013 some of which are genetically absent<\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"1186\" height=\"459\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05131135\/Drug-Oxidation.png\" alt=\"\" class=\"wp-image-46386\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Metabolism<\/h2>\n\n\n\n<p><strong>Phase I Drug Oxidation<\/strong><\/p>\n\n\n\n<p>a microsomal mixed function oxidation system<\/p>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utspinkpills\" style=\"grid-template-columns:auto 25%\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"472\" height=\"698\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05131148\/Cytochrome-P450.png\" alt=\"\" class=\"wp-image-46387\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Metabolism<\/h2>\n\n\n\n<ul class=\"utsblack4 wp-block-list\"><li><strong>Cytochrome P450 Nomenclature<\/strong><ul><li>12 families of enzymes of which 3 are involved in drug metabolism (CYP1, CYP2, CYP3)<\/li><li>Each family has ~5 subfamilies (A, B, C, D, E)<\/li><li>Individual isoenzymes are identified by a number (eg. CYP3A4, CYP2D6)<\/li><li>Individual isoenzymes are responsible for specific metabolic steps for particular drugs<ul><li>codeine to morphine CYP2D6<\/li><li>tamoxifen to desmethyltamoxifen CYP3A4<\/li><li>tamoxifen to 4-hydroxytamoxifen CYP2D6<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utslightred\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Metabolism<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>CYP2Cs<\/strong><ul><li>Major substrates include some&nbsp;<em>nonsteroidal anti-inflammatory drugs<\/em>, warfarin, phenytoin,&nbsp;<em>PPIs<\/em><\/li><li>Dramatic interracial polymorphism e.g.&nbsp;CYP2C19<ul><li>CYP2C19 activity is genetically determined, and its genetic polymorphism shows marked interracial difference.<\/li><li>The incidence of the poor metaboliser phenotype is markedly higher in Asian populations (13\u201323%) than in white populations (2\u20135%) (de Morais et al., 1994)<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utslightblue\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Metabolism<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>See&nbsp;<a href=\"http:\/\/medicine.iupui.edu\/flockhart\/\">http:\/\/medicine.iupui.edu\/flockhart\/<\/a><\/li><li>Many, constantly changing<\/li><li>Need to be aware of inhibitors, inducers and substrates and how to interpret a situation of multiple drugs<\/li><li>Drug interactions (at least metabolic interactions) can be predicted based on knowledge of the characteristics of the particular drugs involved<\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-cover alignfull\" style=\"background-image:url(https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/06122811\/UTS-blue-0f4beB.png)\"><div class=\"wp-block-cover__inner-container is-layout-flow wp-block-cover-is-layout-flow\">\n<h1 class=\"wp-block-heading\" style=\"text-align:left\" id=\"CYP3A\">CYP3A<\/h1>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignwide has-media-on-the-right utscolor-pills\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\" style=\"text-align:center\">Drug Interactions:&nbsp;CYP3A<\/h2>\n\n\n\n<ul class=\"utsblack4 wp-block-list\"><li><strong>Responsible for metabolism of&nbsp;<\/strong><strong>greatest number of drugs:<\/strong><ul><li>Not polymorphic but activity can vary &gt; 50 fold<\/li><li>Most&nbsp;<em>calcium channel blockers<\/em><\/li><li>Most&nbsp;<em>benzodiazepines<\/em><\/li><li>Most&nbsp;<em>HIV protease inhibitors<\/em><\/li><li>Most&nbsp;<em>HMG-CoA-reductase inhibitors<\/em><\/li><li>Most non-sedating&nbsp;<em>antihistamines<\/em>&nbsp;eg terfenadine<\/li><li><em>Antiarrhythmics<\/em>&nbsp;eg quinidine<\/li><li><em>Immune modulators<\/em>&nbsp;eg. Cyclosporine<\/li><\/ul><\/li><li><strong>Present in GI tract and liver<\/strong><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Drug Interactions: CYP3A<\/h2>\n\n\n\n<p><strong>CYP3A Inhibitors<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"1784\" height=\"1124\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05131244\/CYP3A-Inhibitors.png\" alt=\"CYP3A Inhibitors\" class=\"wp-image-46390\" \/><\/figure><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Common inducers include:<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>Broccoli<\/li><li>Brussels sprouts<\/li><li>Char-grilled meat<\/li><li>Chronic alcohol use<\/li><li>Cigarette smoke<\/li><\/ul>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Drug Interactions: CYP3A<\/h2>\n\n\n\n<p><strong>CYP3A Inducers<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"1798\" height=\"1134\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05131305\/P3A-Inducers.png\" alt=\"CYP3A Inducers\" class=\"wp-image-46392\" \/><\/figure><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Drug Interactions: Grapefruit Juice<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Grapefruit juice inhibits CYP3A4<\/strong><ul><li>Present in the GUT wall&nbsp;&nbsp;leads to drug metabolism during absorption (it will normally reduce the levels of drug that reach the systemic circulation)<\/li><li>Leads to an increase in plasma concentration (Cp) of susceptible drugs<\/li><li>Those affected<ul><li>Mainly metabolised by CYP3A4<\/li><\/ul><\/li><li>Examples<ul><li><em>Calcium channel blockers<\/em>&nbsp;and&nbsp;<em>statins<\/em><\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Drug Interactions: Grapefruit Juice<\/h2>\n\n\n\n<p><strong>Effects of grapefruit juice on felodipine pharmacokinetics and pharmacodynamics<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"1444\" height=\"572\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05131424\/grapefruit-.png\" alt=\"Effects of grapefruit juice\" class=\"wp-image-46394\" \/><\/figure><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-cover alignfull\" style=\"background-image:url(https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/06122811\/UTS-blue-0f4beB.png)\"><div class=\"wp-block-cover__inner-container is-layout-flow wp-block-cover-is-layout-flow\">\n<h1 class=\"wp-block-heading\" style=\"text-align:left\" id=\"CYP2D6\">CYP2D6<\/h1>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utsbackground-red\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions:&nbsp;CYP2D6<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Absent in 7% of Caucasians,1\u20132% non-Caucasians<\/strong><\/li><li><strong>Hyperactive in up to 30% of East Africans<\/strong><\/li><li><strong>Catalyzes primary metabolism of:<\/strong><ul><li>Codeine<\/li><li>Many&nbsp;\u03b2<em>-blockers<\/em><\/li><li>Many&nbsp;<em>tricyclic&nbsp;<\/em><em>antidepressants<\/em><\/li><\/ul><\/li><li><strong>Inhibited by:<\/strong><ul><li>Fluoxetine<\/li><li>Haloperidol<\/li><li>Paroxetine<\/li><li>Quinidine<\/li><\/ul><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<figure class=\"wp-block-image alignwide\"><img loading=\"lazy\" decoding=\"async\" width=\"944\" height=\"747\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05131526\/www.drug-interactions.com_.jpg\" alt=\"drugs metabolized by known P450's 2000\" class=\"wp-image-46396\" \/><\/figure>\n\n\n\n<p style=\"text-align:center\"><a href=\"http:\/\/www.drug-interactions.com\/\"><strong>www.drug-interactions.com<\/strong><\/a><\/p>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utssamples\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Abrupt smoking cessation can affect the metabolism of drugs<\/h2>\n\n\n\n<ul class=\"utsblack4 wp-block-list\"><li>Smoking induces the activity of human CYP1A2 and CYP2B6.<\/li><li>These enzymes metabolise clozapine, olanzapine and methadone.<\/li><li>Decreased CYP1A2 activity after smoking cessation increases the risk of adverse drug reactions, with reports of increased toxicity from clozapine and olanzapine.<\/li><li>Replacement therapy does not influence CYP1A2 activity (chemicals in smoke involved).<\/li><\/ul>\n\n\n\n<p class=\"utsblack4\"><em>CYP1A2 activity is significantly higher in heavy smokers (more than 20 cigarettes\/day) than in non- smokers. This is likely to be clinically relevant for some drugs which have a narrow therapeutic index and are metabolised by CYP1A2&nbsp;<\/em>(Australian prescriber June 2013)<\/p>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-cover alignfull\" style=\"background-image:url(https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/06122811\/UTS-blue-0f4beB.png)\"><div class=\"wp-block-cover__inner-container is-layout-flow wp-block-cover-is-layout-flow\">\n<h1 class=\"wp-block-heading\" style=\"text-align:left\" id=\"Excretion\">Excretion<\/h1>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utslightred\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Excretion<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>One drug can affect the renal excretion of another by:<\/strong><\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li>Inhibition of tubular secretion<\/li><li>Altered protein binding and filtration<\/li><li>Altering urine flow or urine pH<\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utslightblue\" style=\"grid-template-columns:auto 39%\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"1136\" height=\"1128\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05131552\/Renal-Excretion-05.png\" alt=\"\" class=\"wp-image-46397\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Excretion<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Renal Excretion<\/strong><ul><li>Clearance of some drugs is directly related to GFR<ul><li>digoxin, methotrexate, gentamicin<\/li><\/ul><\/li><li>Inhibiting tubular secretion<ul><li>See table<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\" style=\"text-align:left\">Drug excretion 1<\/h2>\n\n\n\n<div class=\"wp-block-image utsblack3\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"1946\" height=\"1256\" src=\"https:\/\/wordpress-futures-prod.s3.ap-southeast-2.amazonaws.com\/wp-content\/uploads\/sites\/8\/2019\/09\/05131608\/Drug-excretion-1.png\" alt=\"Drug excretion via urine\" class=\"wp-image-46399\" \/><\/figure><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Drug Interactions: Excretion<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Diuretics and drug excretion:<\/strong><\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li>Diuretics tend to increase the excretion of other drugs<\/li><li>Lithium is an exception since it gets treated like Na<sup>+<\/sup>. Initially Na<sup>+<\/sup>&nbsp;is lost when diuretics are given but within a few days there is a compensatory Na<sup>+<\/sup>&nbsp;(and Lithium) retention in proximal tubule.<\/li><\/ul>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right utslightblue\" style=\"grid-template-columns:auto 10%\"><figure class=\"wp-block-media-text__media\"><img decoding=\"async\" src=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" alt=\"\" class=\"wp-image-2271\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading\">Drug Interactions: Stepwise Approach<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>1. Take a good medication history<\/strong><\/li><li><strong>2. Remember high risk patients and drugs<\/strong><ul><li>Any patient taking &gt;2 medications<\/li><li><em>Anticonvulsants<\/em>,&nbsp;<em>antibiotics<\/em>, digoxin, warfarin, amiodarone, etc<\/li><\/ul><\/li><li><strong>3. Check pocket reference<\/strong><\/li><li><strong>4. Consult pharmacists\/drug info specialists<\/strong><\/li><li><strong>5. Check up-to-date computer program, e.g.<\/strong><ul><li><a href=\"http:\/\/medicine.iupui.edu\/flockhart\/\">http:\/\/medicine.iupui.edu\/flockhart\/<\/a><\/li><li>www.drug-interactions.com<\/li><li><a href=\"http:\/\/www.clinicalpharmacologyonhand.com\/marketing\/about_cpoh.html\">www.clinicalpharmacologyonhand.com\/marketing\/about_cpoh.html<\/a>&nbsp;(available on PDA)<\/li><li><a href=\"http:\/\/www.epocrates.com\/\">www.epocrates.com<\/a>&nbsp;(available on PDA)<\/li><li>eMIMS&nbsp;(available on PDA)<\/li><\/ul><\/li><\/ul>\n<\/div><\/div>\n\n\n\n<ol class=\"wp-block-list\"><li>one<ol><li>tedft<\/li><li>tyyjty<\/li><\/ol><\/li><li>ghhj<\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Learning Objectives Recognise health care costs associated with Adverse Drug Reactions (ADRs) Outline the contribution of the following to the overall burden of preventable ADRs Age Pharmacogenetics Diseases Idiosyncratic reactions Drug interactions Identify mechanisms for specific clinically relevant drug interactions Identify issues of polypharmacy in the elderly Provide approaches to minimise ADRs References Rang and [&hellip;]<\/p>\n","protected":false},"author":4934,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-template\/generic-template.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-45617","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Adverse Drug Reactions 2: Drug Interactions - UTS Pharmacology<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Adverse Drug Reactions 2: Drug Interactions - UTS Pharmacology\" \/>\n<meta property=\"og:description\" content=\"Learning Objectives Recognise health care costs associated with Adverse Drug Reactions (ADRs) Outline the contribution of the following to the overall burden of preventable ADRs Age Pharmacogenetics Diseases Idiosyncratic reactions Drug interactions Identify mechanisms for specific clinically relevant drug interactions Identify issues of polypharmacy in the elderly Provide approaches to minimise ADRs References Rang and [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/\" \/>\n<meta property=\"og:site_name\" content=\"UTS Pharmacology\" \/>\n<meta property=\"article:modified_time\" content=\"2019-09-16T08:57:58+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/\",\"url\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/\",\"name\":\"Adverse Drug Reactions 2: Drug Interactions - UTS Pharmacology\",\"isPartOf\":{\"@id\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/#primaryimage\"},\"thumbnailUrl\":\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\",\"datePublished\":\"2019-08-09T20:28:12+00:00\",\"dateModified\":\"2019-09-16T08:57:58+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/#primaryimage\",\"url\":\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\",\"contentUrl\":\"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Adverse Drug Reactions 2: Drug Interactions\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/#website\",\"url\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/\",\"name\":\"UTS Pharmacology\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/educationexpress.uts.edu.au\/pharmacology\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Adverse Drug Reactions 2: Drug Interactions - UTS Pharmacology","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/","og_locale":"en_US","og_type":"article","og_title":"Adverse Drug Reactions 2: Drug Interactions - UTS Pharmacology","og_description":"Learning Objectives Recognise health care costs associated with Adverse Drug Reactions (ADRs) Outline the contribution of the following to the overall burden of preventable ADRs Age Pharmacogenetics Diseases Idiosyncratic reactions Drug interactions Identify mechanisms for specific clinically relevant drug interactions Identify issues of polypharmacy in the elderly Provide approaches to minimise ADRs References Rang and [&hellip;]","og_url":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/","og_site_name":"UTS Pharmacology","article_modified_time":"2019-09-16T08:57:58+00:00","og_image":[{"url":"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png","type":"","width":"","height":""}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/","url":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/","name":"Adverse Drug Reactions 2: Drug Interactions - UTS Pharmacology","isPartOf":{"@id":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/#website"},"primaryImageOfPage":{"@id":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/#primaryimage"},"image":{"@id":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/#primaryimage"},"thumbnailUrl":"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png","datePublished":"2019-08-09T20:28:12+00:00","dateModified":"2019-09-16T08:57:58+00:00","breadcrumb":{"@id":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/#primaryimage","url":"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png","contentUrl":"http:\/\/localhost\/wordpress\/wp-content\/uploads\/2019\/08\/clear-1024x576.png"},{"@type":"BreadcrumbList","@id":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/adverse-drug-reactions-2-drug-interactions\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/"},{"@type":"ListItem","position":2,"name":"Adverse Drug Reactions 2: Drug Interactions"}]},{"@type":"WebSite","@id":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/#website","url":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/","name":"UTS Pharmacology","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/wp-json\/wp\/v2\/pages\/45617","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/wp-json\/wp\/v2\/users\/4934"}],"replies":[{"embeddable":true,"href":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/wp-json\/wp\/v2\/comments?post=45617"}],"version-history":[{"count":26,"href":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/wp-json\/wp\/v2\/pages\/45617\/revisions"}],"predecessor-version":[{"id":46651,"href":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/wp-json\/wp\/v2\/pages\/45617\/revisions\/46651"}],"wp:attachment":[{"href":"https:\/\/educationexpress.uts.edu.au\/pharmacology\/wp-json\/wp\/v2\/media?parent=45617"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}