{[ promptMessage ]}

Bookmark it

{[ promptMessage ]}

7601 - Drug Interactions Pharm 560 2 October 2002 Philip D...

Info iconThis preview shows pages 1–12. Sign up to view the full content.

View Full Document Right Arrow Icon
Drug Interactions Pharm 560 2 October 2002 Philip D. Hansten, PharmD Professor, School of Pharmacy University of Washington
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Drugs Removed from the Market Due  to Drug-Drug Interactions Cerivastatin (Baycol): Rhabdomyolysis when  combined with gemfibrozil Terfenadine (Seldane): Ventricular arrhythmias  with CYP3A4 inhibitors Astemizole (Hismanal): Ventricular  arrhythmias with CYP3A4 inhibitors Cisapride (Propulsid): Ventricular arrhythmias  with CYP3A4 inhibitors Mebefradil (Posicor): Rhabdomyolysis when  combined with simvastatin
Background image of page 2
Hospital Admissions due to Drug  Interactions in Elderly (France) Prospective study of 1000 patients > 70 yo  admitted to geriatric unit 538 patients exposed to DDIs 130 patients developed ADIs Most common drugs involved were  cardiovascular and psychotropic Doucet J et al. J Am Geriatr Soc. 1996;44:944-948.
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Severe Cimetidine Adverse Drug  Interactions Are Rare VA Hospital switched from ranitidine to cimetidine  as cost-saving measure Retrospective study of 4570 patients on cimetidine  (10% got interacting drugs) Only 4 patients had adverse interactions 2 theophylline (nausea, vomiting, arrhythmia) 1 procainamide (arrhythmia) 1 warfarin (fatal intracerebral hemorrhage) Scott MA et al. Am J Health-Syst Pharm. 1999;56:1890-91.
Background image of page 4
  Uncommon  Adverse Drug Interactions For an adverse drug interaction that  occurs once in 1000 cases, one would have  to study 3000 cases to have a 95% chance  of observing the event.
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
David Hume (1711-1776)  Scientific certainty is not possible  using induction “All swans are white.” Absence of proof is not proof of  absence “Bigfoot does not exist.” “Those drugs do not interact.”
Background image of page 6
NO ADR  OBSERVED Drug A + Drug B Assessing Drug Interactions Using  Induction 25 Patients Usual Conclusion : This interaction is not  clinically important.
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
NO ADR  OBSERVED Drug A + Drug B 25 Patients Correct Conclusion : Available  information is insufficient to determine  clinical importance. Assessing Drug Interactions Using  Induction
Background image of page 8
Prescriber’s Knowledge Computer Screening  Pharmacist’s Knowledge Patient Risk Factors Patient Education Monitoring ADR Drug Interaction Defenses Hansten PD, Horn JR. Modified from: James Reason, Human Error, 1990 Drug Administration Pharmacogenetics Drug A + Drug B Defenses
Background image of page 9

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Prescriber’s Knowledge Computer Screening  Pharmacist’s Knowledge Latent Failures Patient Risk Factors Patient Education Monitoring ADR A + B Drug Interactions:     “When the  Holes Line Up” Defenses Hansten PD, Horn JR. Modified from: James Reason, Human Error, 1990 Drug Administration
Background image of page 10
Prescriber’s Knowledge
Background image of page 11

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 12
This is the end of the preview. Sign up to access the rest of the document.

{[ snackBarMessage ]}