scholarly journals Drug Interaction Management in Critically Ill Patient

Author(s):  
Hemraj Singh Rajput ◽  
Nirmal V. Shah

Drug interaction in critically ill patient is very common and affecting patients Physically, Mentally and Financially. There are various measures which has been taken to minimize this burden on patient, such as books being prepared which include various drug interaction, maintain websites and database that provides information regarding drug interactions. With the use of these website and databases the drug interaction can be managed. It is common practice that side effects of drug interaction are being managed by additional drugs, the main reason behind it could be non-availability of alternative drugs or costlier alternative. These factors remain the main cause of treatment failure in majority of patients leading to prolong. The current study was performed for the duration of 12 months, from this study it was identified that 113 types of major drug interactions commonly found in total 250 prescriptions which were evaluated and managed accordingly. Suggestions being prescribed by various sites were, avoid concomitant use of drug, use alternative therapy, and monitor closely for any adverse effect. During suggestion made by the Clinical Pharmacist, for the same drug interactions it was identified that more of drug therapy adjustment can be done then provided by the online database. The parameter on which the drug interactions management are being suggested were focused on just type of drug interaction and its effect, it does not include the actual pharmacodynamic and pharmacokinetic changes in therapy. The suggestion made by the clinical pharmacist were includes drug removal, drug dosage changes, alternative therapy, alternative route of administration, change in time interval etc. From this study it was concluded that the drug interaction management can be done at various stages of treatment with proper therapy modification by the clinical pharmacist, and if done properly it will improve the overall outcome of patient health care.

Hematology ◽  
2018 ◽  
Vol 2018 (1) ◽  
pp. 339-347 ◽  
Author(s):  
Sara R. Vazquez

Abstract Oral anticoagulants are commonly prescribed but high risk to cause adverse events. Skilled drug interaction management is essential to ensure safe and effective use of these therapies. Clinically relevant interactions with warfarin include drugs that modify cytochrome 2C9, 3A4, or both. Drugs that modify p-glycoprotein may interact with all direct oral anticoagulants, and modifiers of cytochrome 3A4 may interact with rivaroxaban and apixaban. Antiplatelet agents, nonsteroidal anti-inflammatory drugs, and serotonergic agents, such as selective serotonin reuptake inhibitors, can increase risk of bleeding when combined with any oral anticoagulant, and concomitant use should be routinely assessed. New data on anticoagulant drug interactions are available almost daily, and therefore, it is vital that clinicians regularly search interaction databases and the literature for updated management strategies. Skilled drug interaction management will improve outcomes and prevent adverse events in patients taking oral anticoagulants.


2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Md Jahidul Hasan ◽  
Raihan Rabbani ◽  
Sitesh C Bachar

Background: Critical care pharmacists (CCPs) have a key role in ensuring medication safety by screening drug-drug interactions (DIs) in polypharmacy prescriptions, mostly in critically ill patients. The drug-interaction checker mobile apps (DICMA) are freely available for smartphones. Objectives: The current study aimed to assess the utilization of smartphone-based free mobile apps by CCPs for ensuring drug-drug interaction-free polypharmacy prescriptions in critically ill patients. Methods: This observational study was conducted in an intensive care unit. Critical care pharmacists (CCPs) checked the medications of polypharmacy prescriptions to detect DIs or potential drug-drug interactions (PDIs) using free DICMA installed on their smartphones. DIs/PDIs were sent to physicians as suggestions, and the prescriptions were modified accordingly. Results: CCPs screened 2,967 prescriptions, where 11,128 and 3,932 DIs and PDIs were identified, respectively. Prescriptions with 6 to 10 medications and prescription with more than 10 medications, on average, had 3.28 and 7.53 DIs, respectively, and 1.42 and 4.7 PDIs, respectively. Physicians accepted 95.85% (n = 3,932) of PDI suggestions from CCPs and modified prescriptions, accordingly. CCPs reported a satisfaction level of 4 (on a scale of 5) concerning the use of free DICMA. Conclusions: Drug-drug interactions-free polypharmacy prescriptions can ensure medication safety in patients. CCPs are professionally responsible for this task, but resource-limited setups do not provide them scopes to accomplish this task efficiently. In this study, CCPs ensured medication safety in the prescriptions of critically ill patients efficiently using free DICMA installed on their smartphones.


Blood ◽  
2018 ◽  
Vol 132 (21) ◽  
pp. 2230-2239 ◽  
Author(s):  
Sara R. Vazquez

Abstract Oral anticoagulants are commonly prescribed but high risk to cause adverse events. Skilled drug interaction management is essential to ensure safe and effective use of these therapies. Clinically relevant interactions with warfarin include drugs that modify cytochrome 2C9, 3A4, or both. Drugs that modify p-glycoprotein may interact with all direct oral anticoagulants, and modifiers of cytochrome 3A4 may interact with rivaroxaban and apixaban. Antiplatelet agents, nonsteroidal anti-inflammatory drugs, and serotonergic agents, such as selective serotonin reuptake inhibitors, can increase risk of bleeding when combined with any oral anticoagulant, and concomitant use should be routinely assessed. New data on anticoagulant drug interactions are available almost daily, and therefore, it is vital that clinicians regularly search interaction databases and the literature for updated management strategies. Skilled drug interaction management will improve outcomes and prevent adverse events in patients taking oral anticoagulants.


2020 ◽  
Vol 11 (9) ◽  
pp. 416-421
Author(s):  
Courtney Waxman

Kirby's Rule of 20 is a patient checklist including 20 parameters that should be checked daily in the critically ill patient. It reviews the established evidence-based information regarding patient checklist use in veterinary emergency and critical care medicine. The list of 20 will be discussed over a four-part series to give an appropriate level of information and attention to each patient parameter. Part 4 includes: wound healing, drug dosage and metabolism, pain control, nursing care, tender loving care.


2019 ◽  
Vol 8 (2) ◽  
pp. 55-58
Author(s):  
Havizur Rahman ◽  
Teresia Anggi Octavia

Diabetes melitus merupakan penyakit degeneratif kronis yang apabila tidak ditangani dengan tepat, lama kelamaan bisa timbul berbagai komplikasi, ini cenderung menyebabkan pasien mendapatkan banyak obat dalam satu resep yang dapat menimbulkan interaksi antar obat. Tujuan dari penelitian ini adalah mengetahui persentase terjadinya interaksi obat metformin secara teori serta mengkaji efek yang mungkin timbul dan solusinya. Teknik pengambilan data dengan purpossive sampling, yaitu resep pasien rujuk balik yang menderita diabetes mellitus yang menggunakan metformin. Data yang diperoleh ditemukan bahwa obat yang berinteraksi dengan metformin dengan tingkat keparahan minor ialah sebesar 60%. Kemudian untuk tingkat keparahan moderat ialah sebesar 20%. Sedangkan untuk tingkat keparahan mayor tidak ditemukan. Dari tabel diatas juga dapat diketahui bahwa terdapat 4 obat yang saling berinteraksi dengan metformin, sedangkan untuk obat yang tidak saling berinteraksi dengan metformin terdapat 9 obat. Jumlah obat yang berinteraksi secara teori sebesar 6,85% dan yang tidak berinteraksi 93,15%. Terdapat interaksi obat metformin dengan beberapa obat yaitu furosemid, lisinopril, acarbose dan ramipril.   Kata kunci: interaksi obat, metformin, diabetes mellitus   STUDY OF METFORMIN INTERACTION IN MELLITUS DIABETES PATIENTS   ABSTRACT Mellitus is a chronic degenerative disease which if not handled properly, over time can arise various complications, this tends to cause patients to get many drugs in one recipe that can cause interactions between drugs. The purpose of this study is to determine percentage of metformin drug interactions in theory and examine the effects that may arise and solutions. Data collection techniques using purposive sampling, which is a recipe for reconciliation patients who suffer from diabetes mellitus using metformin. The data obtained it was found that drugs that interact with metformin with minor severity were 60%. Then for moderate severity is 20%. Whereas the major severity was not found. From the table above it can also be seen that there are 4 drugs that interact with metformin, while for drugs that do not interact with metformin there are 9 drugs. The number of drugs that interacted theoretically was 6.85% and 93.15% did not interact. An interaction of the drug metformin with several drugs namely furosemide, lisinopril, acarbose and ramipril.   Keywords: drug interaction, metformin, diabetes mellitus


ORL ro ◽  
2017 ◽  
Vol 2 (35) ◽  
pp. 20
Author(s):  
Liliana Mirea ◽  
Raluca Ungureanu ◽  
Daniel Mirea ◽  
Mirela Țigliș ◽  
Ioana Cristina Grințescu ◽  
...  

2020 ◽  
Vol 21 ◽  
Author(s):  
Xuan Yu ◽  
Zixuan Chu ◽  
Jian Li ◽  
Rongrong He ◽  
Yaya Wang ◽  
...  

Background: Many antibiotics have a high potential for having an interaction with drugs, as perpetrator and/or victim, in critically ill patients, and particularly in sepsis patients. Methods: The aim of this review is to summarize the pharmacokinetic drug-drug interaction (DDI) of 45 antibiotics commonly used in sepsis care in China. Literature mining was conducted to obtain human pharmacokinetics/dispositions of the antibiotics, their interactions with drug metabolizing enzymes or transporters, and their associated clinical drug interactions. Potential DDI is indicated by a DDI index > 0.1 for inhibition or a treated-cell/untreated-cell ratio of enzyme activity being > 2 for induction. Results: The literature-mined information on human pharmacokinetics of the identified antibiotics and their potential drug interactions is summarized. Conclusion: Antibiotic-perpetrated drug interactions, involving P450 enzyme inhibition, have been reported for four lipophilic antibacterials (ciprofloxacin, erythromycin, trimethoprim, and trimethoprim-sulfamethoxazole) and three lipophilic antifungals (fluconazole, itraconazole, and voriconazole). In addition, seven hydrophilic antibacterials (ceftriaxone, cefamandole, piperacillin, penicillin G, amikacin, metronidazole, and linezolid) inhibit drug transporters in vitro. Despite no reported clinical PK drug interactions with the transporters, caution is advised in the use of these antibacterials. Eight hydrophilic antibacterials (all β-lactams; meropenem, cefotaxime, cefazolin, piperacillin, ticarcillin, penicillin G, ampicillin, and flucloxacillin), are potential victims of drug interactions due to transporter inhibition. Rifampin is reported to perpetrate drug interactions by inducing CYP3A or inhibiting OATP1B; it is also reported to be a victim of drug interactions, due to the dual inhibition of CYP3A4 and OATP1B by indinavir. In addition, three antifungals (caspofungin, itraconazole, and voriconazole) are reported to be victims of drug interactions because of P450 enzyme induction. Reports for other antibiotics acting as victims in drug interactions are scarce.


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