Drug Interactions in Older Adults[老人药物相互作用](PPT33).ppt

druginteractionsinolderadults josepht hanlon pharmd ms learningobjectives attheconclusionofthistalktheparticipantshouldbeableto listthe4majortypesofdruginteractionsthatcanoccurintheelderlydiscusstheepidemiologyofthedifferenttypesofdruginteractionsintheelderlyimplementstrategiestoprevent managedruginteractionsintheelderly typesofdruginteractions drug drugpharmacokineticdrug drugpharmacodynamicdrug food nutrientdrug disease drug druginteractionsaffectingabsorptionanddistribution precipitantdrug s objectdrug s outcomeantacids irontetracycline ciprofloxacin abs chloralhydratewarfarin ppbgenerallyabsorptionanddistributiondrug drug interactionsarenotclinicallyimportant drugs12 485 94 hepaticmetabolism phasei cyp450 oxidationhydroxylationdealkylationsulfoxidationreductionhydrolysis phaseiiconjugationglucuronidationsulfationglycineacetylation cytochromep450phaseiisoenzymes totalandsubstrateexamples isoenzymes substratecyp1a217olanzapine theophyllinecyp2c9 1926phenytoin warfarincyp2d62 4codeine desipramine tramadolcyp2e19 10chlorzoxazone ethanolcyp3a435 45diazepam triazolam quinidine methadone carbamazepinewww drug inhibitorsofhepaticcytochromep450 1a22c9 192d63a4fluvoxamineamiodaronefluoxetineerythromycincimetidinefluconazoleparoxetineazoleantifungalciprofloxacinfluvastatinquinidinenefazodonefluoxetineritonavirclarithromycinisoniazidbupropionritonavirsertralinecimetidinecimetidineomeprazolecimetidinewww drug jpharmacolexpther1997 280 627 37 effectofageontheophyllinehepaticmetabolisminhibition drugsthatinteractwiththeophylline inhibitorscimetidinepropafenonemexiletinepropranololerythromycinciprofloxacinfluvoxaminedrugsaging 2003 20 71 84 inducersbarbituratesphenytoinsmokingrifampincarbamazepinejapha2004 44 142 51 drug druginteractionswithwarfarin interactingdrugmechanismanticoagulanteffectaspirinpd barbituratepk cimetidinepk dipyridamolepd fibratespd fluvoxaminepk macrolidespk phenytoinpk quinolonespk rifampinpk sulfinpyrazonepk pd thyroidhormonespd ticlopidinepd nengljmed 2003 14 349 675 83 japha2004 44 142 51 clinicallysignificantdrug druginteractionswithaeds objectdruginteractingdrugoutcomecarbamazepinedanazol cbzlevelcarbamazepinediltiazem cbzlevelcarbamazepinemacrolides cbzlevelcarbamazepinepropoxyphene cbzlevelcarbamazepineverapamil cbzlevelphenytoinamiodarone dphlevelphenytoincimetidine dphlevelphenytoinfluoxetine dphlevelphenytoininh dphlevelphenytoinomeprazole dphlevelneuropharmacology2002 5 280 9 inducersofhepaticcytochromep450 1a22c9 192d63a4smokingrifampinnonecarbamazepineomeprazolephenobarbitalphenytoinphenytoinphenytoinphenobarbitalrifampinst john swortwww drug effectofageontheophyllinehepaticmetabolisminductionbydph crowleyj jphamacolexpther1988 245 513 23 selectedphenytoininductioninteractions objectdruginteractingdrugcypisoenzymeinducedmethadonephenytoin3a4quinidinephenytoin3a4theophyllinephenytoin1a2warfarinphenytoin2c9neuropharmacology2002 5 280 9 selecteddrugssecretedbyrenaltubules basic cationic agentsamiodaronecimetidinedigoxinprocainamidequinidineranitidinetrimethoprimverapamil acidic anionic agentscephalosporinsindomethacinmethotrexatepenicillinsprobenecidsalicylatesthiazides drug druginteractionswithdigoxin interactingdrugeffectonlevelsamiodarone clarithromycin propafenone quinidine verapamil drugsaf 2000 23 509 32 japha2004 44 142 51 drugsthatinteractwithlithium diureticsace insaids pharmacokinetics pharmacodynamics dosageregimen effects plasmaconcentration siteofaction drug drugpdinteractions objectdruginteractingdrug s ace ik k sparingdiureticsbetablockersverapamildigoxindiureticsmaoissri dextromethorphan pseudoephedrine anorexiantsmeperidinemaoihydroxyinethioridazine drug tcapdinteractions concurrentusewithanyotherdrugswithantimuscarinicpropertiesconcurrentmaoitypeiantiarrhythmicsclonidineguanadrelguanethidine drug nsaidpdinteractions objectdruginteractingdrugoutcomeantihypertensivesnsaids bpcorticosteroidsnsaids riskofpuddiureticsnsaids diureticeffecttriamtereneindomethacin k warfarinnsaids anticoagulanteffect cnspolypharmacyandfallsinelderlypersons weinerd etal gerontol1998 44 217 21 drug food nutrientinteractions clinicallysignificantdrug st johnwortinteractions objectdrugoutcomeantidepressantsserotonergicsyndromecyclosporine levels transplantrejectiondigoxin digoxinlevelsestrogenbreakthroughbleedingindinavir indinavirlevelsmethadonewithdrawalsx stacrolimus levelstheophylline theophyllinelevelswarfarin inrcpt2004 75 1 12 otherclinicallysignificantherb druginteractions objectdruginteractingdrugoutcomeanticonvulsantswormwood seizurethresholdanticonvulsantsgingkobiloba seizurethresholddigoxinhawthorne digoxinactivitysaquinavirgarlic saquinavirlevelswarfarinfeverfew riskofbleedingwarfaringarlic riskofbleedingwarfaringinger riskofbleedingwarfaringinkgo riskofbleedingwarfaringinseng anticoagulantlancet2000 355 134 8 clinicallyimportantdrug diseaseinteractionsdeterminedbyexpertpanelconsensus drugdiseaseanticholinergicsbph constipation dementiaantiarrhythmics type1a chf systolicdysfunction amphetamineshtn insomniaaspirinpudatypicalantipsychoticsdmbarbituratesdepressionbenzodiazepinescopd dementia fallsbeta blockerscopd dm syncopeccb1stgenerationchf systolicdysfunction chlorpromazineposturalhypotension seizuresclozapineseizurescorticosteroidsdm puddecongestantsinsomniadigoxinheartblocklindbladc hanlonjetal abstract jamgeriatrsoc2004 52 s135 clinicallyimportantdrug diseaseinteractionsdeterminedbyexpertpanelconsensus drugdiseasemetoclopramideparkinson sdiseasenitrofurantoinchronicrenalfailurenon aspirinnsaidscrf chf htnnon aspirin non coxiinsaidspudopioidanalgesicsbph constipation dementiasedative hypnoticsfallsskeletalmusclerelaxantsbphssrisfallstheophyllineinsomniathioridazineposturalhypotension seizuresthorazineseizurestricyclicantidepressantsarrhythmias bph constipationdementia falls heartblockposturalhypotensiontypicalantipsychoticsfalls learningobjectives attheconclusionofthistalktheparticipantshouldbeableto listthe4majortypesofdruginteractionsthatcanoccurintheelderlydiscusstheepidemiologyofthedifferenttypesofdruginteractionsintheelderlyimplementstrategiestoprevent managedruginteractionsintheelderly epidemiologyofdrug drugordrug diseaseinteractions incidenceofpotentialdrug druginteractionsrangesfrom2 17 ofallrx sandupto6 42 ofelderlypatients incidenceofpotentiallyclinicallysignificantdruginteractionsislowintheelderly usuallymustinvolvenarrowtherapeuticrangedrugandinhibitor inducerofdrugmetabolismorrenalexcretion thereisevidencesuggestingthatadversehealthoutcomesassociatedwithdrug druginteractionsisinfrequent drug diseaseinteractionsoccurin6 2 40 ofelderlypatientsdrugdiseaseinteractionsmayresultinhigherriskofadverseoutcomes e g declineinfunctionalstatusandincreasedhealthservicesuse duetoalterationsinhomeostaticmechanismsanddiminishedfunctionalreserve druginteractionsareavoidable gosneyetal lancet1984 2 564 strategiestoprevent managedruginteractions 1 encouragepatientstoreportallprescription over the counterandcomplementaryandalternativedrugsateveryhealthcareencounter 2 supporttheimplementationofelectronicprescribingand ortheusebypatientsofonepharmacywithupdateddruginteractionsoftware 3 workwithpharmacistsandbefamiliarwithdruginterac