PPI Drug Interactions
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, · Drug interactions with PPIs relate to their use of the CYP450 enzyme
system for metabolism and the change in bioavailability of concurrently
administered drugs requiring an acid environment for absorption. PPIs may
decrease the effects of atazanavir, indinavir, and nelfinavir, and
coadministration of these medications with PPIs is not recommended. All
PPIs may interfere with absorption of drugs given orally that depend on an
acidic gastric pH to be effective. These drugs include ketoconazole, esters
of ampicillin, digoxin, and iron salts. Increased monitoring of a patient's
international normalized ratio (INR) is required if warfarin is administered
with PPIs.
· Clopidogrel (Plavix) has a black box warning regarding poor metabolizers
of CYP2C19 and concurrent administration of medications that interfere
with CYP2C19. Coadministration of clopidogrel and omeprazole has been
shown to decrease the active metabolite of clopidogrel by 46%, leading to
decreased effectiveness. Clinically, a decrease in the antiplatelet effect of
clopidogrel may lead to increased clot formation. The official labeling of
clopidogrel recommends avoiding concomitant use with the PPIs
omeprazole or esomeprazole due to reduced antiplatelet activity of
clopidogrel caused by impaired CYP 2C19 function.
Prescribing
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•Ensure that prescribing practices meet current standards of medical care.
•Maintain accurate and thorough documentation of prescribing practices.
•Engage in informative and interactive informed consent discussions that
allocate appropriate responsibility between physician and patient.
•Evaluate split treatment arrangements and supervisory settings to ensure
that your supervisees have the training, ability, and resources to provide
high-quality medical care.
•Your State Practice Act-What are your limits in prescribing?
•Your State Board of Nursing
•Your Role and Licensure
•National Certification and Credentialing
*Prescribing a drug results from clinical judgment based on a thorough
assessment of the patient and the patient's environment, the determination
of medical and nursing diagnoses, a review of potential alternative
, therapies, and specific knowledge about the drug chosen and the disease
process it is designed to treat. In general, the best therapy is the least
invasive, least expensive, and least likely to cause adverse reactions.
Frequently, the best choice is to have lifestyle, nonpharmacological, and
pharmacological therapies working together.
BB effect on whole body
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*Opposite of an adrenaline rush slows everything down.
*Beta-1 receptors: Located primarily in the heart.
*Beta-2 receptors-Located in the smooth muscle of lungs, uterus, and
other organs.
Ringworm Treatment
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(Tinea Corporis) miconazole, Nystatin or clotrimazole.
Absorption and Distribution
Topical Antifungals
Topical antifungals are poorly absorbed from intact skin. Nystatin is not
absorbed from intact skin or mucous membranes.
Systemic Antifungals
Griseofulvin and terbinafine are the two systemic antifungals that are
primarily used in dermatological diseases.
Griseofulvin is poorly absorbed; therefore, oral formulations have been
developed in an attempt to increase bioavailability.
Terbinafine, when administered orally, is well absorbed from the gut. It is
, unknown whether terbinafine crosses the placenta, but it is excreted in the
breast milk of nursing mothers with a milk/plasma ratio of 7:1.
Ringworm Treatment Adverse Drug Reactions
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Topical Antifungals
Adverse reactions are minimal with topical antifungal medications. Nystatin
may cause mild skin irritation when applied topically to some patients,
usually related to the preservatives (parabens) in the formulation. The
topical azoles may all cause itching, stinging, burning, or general skin
irritation.
Systemic Antifungals
The most common adverse reaction with griseofulvin is hypersensitivity
such as skin rashes, urticaria, and rarely, angioedema. Less commonly
reported adverse reactions are oral thrush, nausea, vomiting, epigastric
distress, and diarrhea. Several CNS effects have been reported. Headache
occurs frequently in the beginning of therapy but often disappears with
continued therapy. Other CNS adverse effects include fatigue, dizziness,
insomnia, confusion, and impaired performance of routine activities.
Hepatitis and elevated hepatic enzymes have been reported in a few
patients after prolonged use or high doses of griseofulvin. A rare adverse
effect of granulocytopenia or of leukopenia has been reported from
prolonged use of high doses of griseofulvin. It should be discontinued if
the patient exhibits these conditions. When rare serious reactions occur
with griseofulvin, they are usually associated with high doses or long
periods of therapy.
The most common adverse reactions with oral terbinafine are
gastrointestinal (GI) symptoms such as diarrhea, dyspepsia, abdominal
pain, nausea, headache, fever, rash, elevated liver enzymes, and taste
disturbance. Rare but serious adverse reactions observed with oral
terbinafine include serious skin reactions (Stevens-Johnson syndrome and
toxic epidermal neurolysis). Rare cases of blood dyscrasias have been
reported with terbinafine use. Severe neutropenia, lymphopenia,
thrombocytopenia, and agranulocytosis have all been reported. In clinical
trials (Novartis Pharmaceuticals, 2017), 1% to 2% of patients treated with oral
Give this one a try later!
, · Drug interactions with PPIs relate to their use of the CYP450 enzyme
system for metabolism and the change in bioavailability of concurrently
administered drugs requiring an acid environment for absorption. PPIs may
decrease the effects of atazanavir, indinavir, and nelfinavir, and
coadministration of these medications with PPIs is not recommended. All
PPIs may interfere with absorption of drugs given orally that depend on an
acidic gastric pH to be effective. These drugs include ketoconazole, esters
of ampicillin, digoxin, and iron salts. Increased monitoring of a patient's
international normalized ratio (INR) is required if warfarin is administered
with PPIs.
· Clopidogrel (Plavix) has a black box warning regarding poor metabolizers
of CYP2C19 and concurrent administration of medications that interfere
with CYP2C19. Coadministration of clopidogrel and omeprazole has been
shown to decrease the active metabolite of clopidogrel by 46%, leading to
decreased effectiveness. Clinically, a decrease in the antiplatelet effect of
clopidogrel may lead to increased clot formation. The official labeling of
clopidogrel recommends avoiding concomitant use with the PPIs
omeprazole or esomeprazole due to reduced antiplatelet activity of
clopidogrel caused by impaired CYP 2C19 function.
Prescribing
Give this one a try later!
•Ensure that prescribing practices meet current standards of medical care.
•Maintain accurate and thorough documentation of prescribing practices.
•Engage in informative and interactive informed consent discussions that
allocate appropriate responsibility between physician and patient.
•Evaluate split treatment arrangements and supervisory settings to ensure
that your supervisees have the training, ability, and resources to provide
high-quality medical care.
•Your State Practice Act-What are your limits in prescribing?
•Your State Board of Nursing
•Your Role and Licensure
•National Certification and Credentialing
*Prescribing a drug results from clinical judgment based on a thorough
assessment of the patient and the patient's environment, the determination
of medical and nursing diagnoses, a review of potential alternative
, therapies, and specific knowledge about the drug chosen and the disease
process it is designed to treat. In general, the best therapy is the least
invasive, least expensive, and least likely to cause adverse reactions.
Frequently, the best choice is to have lifestyle, nonpharmacological, and
pharmacological therapies working together.
BB effect on whole body
Give this one a try later!
*Opposite of an adrenaline rush slows everything down.
*Beta-1 receptors: Located primarily in the heart.
*Beta-2 receptors-Located in the smooth muscle of lungs, uterus, and
other organs.
Ringworm Treatment
Give this one a try later!
(Tinea Corporis) miconazole, Nystatin or clotrimazole.
Absorption and Distribution
Topical Antifungals
Topical antifungals are poorly absorbed from intact skin. Nystatin is not
absorbed from intact skin or mucous membranes.
Systemic Antifungals
Griseofulvin and terbinafine are the two systemic antifungals that are
primarily used in dermatological diseases.
Griseofulvin is poorly absorbed; therefore, oral formulations have been
developed in an attempt to increase bioavailability.
Terbinafine, when administered orally, is well absorbed from the gut. It is
, unknown whether terbinafine crosses the placenta, but it is excreted in the
breast milk of nursing mothers with a milk/plasma ratio of 7:1.
Ringworm Treatment Adverse Drug Reactions
Give this one a try later!
Topical Antifungals
Adverse reactions are minimal with topical antifungal medications. Nystatin
may cause mild skin irritation when applied topically to some patients,
usually related to the preservatives (parabens) in the formulation. The
topical azoles may all cause itching, stinging, burning, or general skin
irritation.
Systemic Antifungals
The most common adverse reaction with griseofulvin is hypersensitivity
such as skin rashes, urticaria, and rarely, angioedema. Less commonly
reported adverse reactions are oral thrush, nausea, vomiting, epigastric
distress, and diarrhea. Several CNS effects have been reported. Headache
occurs frequently in the beginning of therapy but often disappears with
continued therapy. Other CNS adverse effects include fatigue, dizziness,
insomnia, confusion, and impaired performance of routine activities.
Hepatitis and elevated hepatic enzymes have been reported in a few
patients after prolonged use or high doses of griseofulvin. A rare adverse
effect of granulocytopenia or of leukopenia has been reported from
prolonged use of high doses of griseofulvin. It should be discontinued if
the patient exhibits these conditions. When rare serious reactions occur
with griseofulvin, they are usually associated with high doses or long
periods of therapy.
The most common adverse reactions with oral terbinafine are
gastrointestinal (GI) symptoms such as diarrhea, dyspepsia, abdominal
pain, nausea, headache, fever, rash, elevated liver enzymes, and taste
disturbance. Rare but serious adverse reactions observed with oral
terbinafine include serious skin reactions (Stevens-Johnson syndrome and
toxic epidermal neurolysis). Rare cases of blood dyscrasias have been
reported with terbinafine use. Severe neutropenia, lymphopenia,
thrombocytopenia, and agranulocytosis have all been reported. In clinical
trials (Novartis Pharmaceuticals, 2017), 1% to 2% of patients treated with oral
