3 stages of drug interaction pharmaceutical pharmacodynamic pharmacokinetic Alcohol and benzodiazepine interaction What is co-amoxiclav/amoxiclavin?

Why are imipenem and cilastin co-administered e.g. in septicemia, lung and kidney infections? How does saquinavir increase bioavailability F go ritonavir? Ritonavir inhibits GI CYP3A and blocks P-glycoprotein Sulfamethoxazole and trimethoprim? Pneumocystis carinii/jiroveci Cisplatin and paclitacel synergistic In order to isoniazid neuropathy -> pyridoxine deficiency helps in prophylaxis Peripheral dopa decarboxylase inhibitor e.g. cardiodopeallows lower dose of levodope reduces side effects nausea and vomiting Reverse neuromuscular block = cholinesterase inhibitor Naloxone in opioid overdose Drugs with negative inotropic effects can precipitate HF e.g. beta-blockers plus verapamil -> if used in IV with supracentricular tachycardia Adverse warfarin and aspirin -> inhibition of coagulation plus inhibition of platelet aggregation -> aspirin risk factor in peptic ulcer gastric -> direct irruption and inhibition of pGE2 synthesis in gastric mucosa Diuretic use e.g. loop / thiazide -> digoxin toxicity in diuretic-induced hypokalemia But potassium-sparing diuretics can cause hyperkalemia if administered with potassium supplements and/or ACE inhibitors (enalapril) -> decreases circulating aldosterone e.g. in renal insufficiency Phenytoin reduces effectiveness of ciclosporin - because in reduces its absorption Enzyme inducers - barbiturates, carbamazepine and rifampicin -> special attention when using warfarin, phenytoin, oral contraceptives, glucocorticoids or immunesuppressants CYP450 of other enzyme inhibition Isoniazid, cimetidine, chloramphenicaol inhibit phenytoin -> phenytoin intoxication Allopurinol, metronidazole, phenybutazone, co-trimoxazole -> warfarin increase => hemorrhage Allopurinol increases Azathioprine and 6-MP -> bone-marrow suppression - blood element production depends on xanthin oxifase Cimetiidne, erythromycin increase theophylline erythromycin and ketoconazole increase cisapride ->ventricular tachycardia Enzyme induction Barbiturates, ethanol and rifampicin decrease warfarin

Rifampin decreases oral contraceptives anticnvulsants decrease prednisoline/ciclosporin -> reduced immunosuppression = graft rejection Smoking induces theophyllin metabolism lidocaine - undergoes liver metabolism and has a high extraction ratio, so any substance reducing hepatic blood flow e.g. negative inotrope reduces hepatic clearance of lidocaine -> leading to accumulation i.e. toxicity with bet-bloicking drugs MAO inhibitors and tyramine = cheese reaction Excretion Renal - probenecid reduces penicillin elimination Asprin and NSAIDS inhibit methotrexate secretion in urine, they also displace it form protein-bindin sites -> leading ot emthoctraexated toxicity Many diuretics reduce NA absorption in loop of Henle/distal tubule -> indirectly triggers proximal tubular reasboroption of monovalent cations Increased proximal tubule reabsorption of lithium -> accumulation ad toxicity Spironolactone, verapamil and amiodarone decrease digoxin excretion -> some tissuebinding site displacemtn/ digozin elimination Changes in urinary Ph alter drug excretion if they are weak acids/bases -> e.g. salicylate execration increased via alkaline urine