Drug to Drug Interactions
Drug to drug interactions are among the major causes of medicine-induced harm in patients with various diseases. According to recent statistics, the problem occurs in over 1.9 million of individuals annually and results in up to 220.000 emergency department referrals per year (Scheife et al., 2015). Therefore, not only it is important to prevent drug-induced harm associated with medical errors within the hospitals but also educate patients with polypharmacy about the risks associated with the intake of several medicines at once.
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A number of the Centers for Disease Control and Prevention (CDC) guidelines is devoted to the treatment of opportunistic conditions in HIV-positive individuals. For instance, the pharmaceutical intervention of the infection requires a particular attention in those patients because some of the drugs used for HIV intervention are not compatible with medicines used against tuberculosis. Namely, the interaction between antiretrovirals, such as efavirenz or nevirapine, and rifamycins, which is proved to be effective against the infection, is very complex (CDC, 2014).
Due to rifamycins’ impact on metabolic processes, they may result in a reduced concentration of antiretrovirals in the plasma and lead to HIV treatment failure (CDC, 2014). Therefore, it is essential to be aware of optimal dosage and the period of drug administration, as well as possible side effects, to avoid substantial harm to patients’ health.
Like in the case of the CDC guideline related to the treatment of HIV-related tuberculosis, the information provided in other guidelines may be used to inform patients regarding the risks of polypharmacy. Researchers note that patients’ age, dosage forms, causes of admission, timing, and type of medicines are the main factors defining the extent of health risks linked to drug-drug interactions (Haji Aghajani et al., 2013). Thus, nurses should assess patients’ awareness of drug-drug interactions based on the given criteria and then develop individual self-management protocols considering specific patient needs and using the CDC guidelines to derive evidence.
Drug to Food Interactions
Food is an intrinsic component of every person’s lifestyle. However, when a patient takes drugs, food intake may require some interventions because bioactive compounds contained in foods may interact with medicines in a way that can reduce treatment efficacy or lead to various adverse side effects. At the same time, some food-drugs interactions may contribute to better patient outcomes. Thus, in patient education, nurses should consider both risks and benefits of foods’ influence on the course of treatment.
The CDC reports that people of 18 to 34 years old commonly engage in binge drinking on a regular basis (Edmunds, Mayhew, & Setter, 2014). The alcohol is one of the food types which, in drug interactions, impacts the treatment adversely. For instance, alcohol increases the sedative effect of codeine resulting in severe respiratory depression and even death in some cases (Edmunds et al., 2014). Thus, patients who are prone to alcohol abuse should be consulted prior to the administration of codeine. Moreover, sometimes healthcare providers should consider alternative methods of treatment if a high risk of adverse effect is identified.
As stated by Choi and Ko (2017), “interactions between drugs and food products occur in various ways and in various steps ranging from ingestion, absorption, metabolism, and excretion of both the drug and food product” (p. 6). The most common effects of food to drug interactions include the increase in the blood drug level which may potentially improve therapeutic benefits (Choi & Ko, 2017). At the same time, some drug-food interactions can be detrimental. Nurses thus should consider multiple facets of the process and use the guidelines to design individualized dietary interventions for patients and educate them about all possible risks and benefits related to the issue.
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Centers for Disease Control and Prevention. (2014). Managing drug interactions in the treatment of HIV-related tuberculosis. Web.
Choi, J. H., & Ko, C. M. (2017). Food and Drug Interactions. Journal of Lifestyle Medicine, 7(1), 1–9.
Edmunds, M. W., Mayhew, M. S., & Setter, S. M. (2014). Pharmacology for the primary care provider. St. Louis, MO: Elsevier Mosby.
Haji Aghajani, M., Sistanizad, M., Abbasinazari, M., Abiar Ghamsari, M., Ayazkhoo, L., Safi, O., … Kouchek, M. (2013). Potential drug-drug interactions in post-CCU of a teaching hospital. Iranian Journal of Pharmaceutical Research: IJPR, 12(1), 243–248.
Scheife, R. T., Hines, L. E., Boyce, R. D., Chung, S. P., Momper, J., Sommer, C. D., … Malone, D. C. (2015). Consensus recommendations for systematic evaluation of drug-drug interaction evidence for clinical decision support. Drug Safety, 38(2), 197–206.