Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Whenever two or more drugs are being taken, there is a chance that there will
be an interaction among the drugs. The interaction may increase or decrease the
effectiveness of the drugs or the side effects of the drugs. The likelihood of
drug interactions increases as the number of drugs being taken increases.
Therefore, people who take several drugs are at the greatest risk for
interactions. Drug interactions contribute to the cost of healthcare because of
the costs of medical care that are required to treat problems caused by changes
in effectiveness or side effects. Interactions also can lead to psychological
suffering that can be avoided. This review discusses the issue of drug
interactions and several ways to avoid them.
What are drug interactions?
A drug interaction can be defined as an interaction between a drug and
another substance that prevents the drug from performing as expected. This
definition applies to interactions of drugs with other drugs (drug-drug
interactions), as well as drugs with food (drug-food interactions) and other
substances.
How do drug interactions occur?
There are several mechanisms by which drugs interact with other drugs, food,
and other substances. An interaction can result when there is an increase or
decrease in:
the absorption of a drug into the body;
distribution of the
drug within the body;
alterations made to the drug by the body (metabolism);
and
elimination of the drug from the body.
Most of the important drug
interactions result from a change in the absorption, metabolism, or elimination
of a drug. Drug interactions also may occur when two drugs that have similar
(additive) effects or opposite (canceling) effects on the body are administered
together. For example, there may be major sedation when two drugs that have
sedation as side effects are given, for example, narcotics and antihistamines. Another
source of drug interactions occurs when one drug alters the concentration of a
substance that is normally present in the body. The alteration of this substance
reduces or enhances the effect of another drug that is being taken. The drug
interaction between warfarin (Coumadin) and vitamin K-containing products is a
good example of this type of interaction. Warfarin acts by reducing the
concentration of the active form of vitamin K in the body. Therefore, when
vitamin K is taken, it reduces the effect of warfarin.
Change in absorption
Most drugs are absorbed into the blood and then travel to their site of
action. Most drug interactions that are due to altered absorption occur in the
intestine. There are various potential mechanisms through which the absorption
of drugs can be reduced. These mechanisms include:
an alteration in blood flow to
the intestine;
change in drug metabolism (breakdown) by the intestine;
increased
or decreased intestinal motility (movement);
alterations in stomach acidity, and
a change in the bacteria that reside in the intestine.
Drug absorption also can
be affected if the drug's ability to dissolve (solubility) is changed by another
drug or if a substance (for example, food) binds to the drug and prevents its
absorption.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Migraine is usually periodic attacks of headaches on one or both sides of the head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances, and other symptoms. Treatments for migraine headache include therapies that may or may not involve medications.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
Patients who have infrequent, mild bouts of asthma attacks may use over-the-counter (OTC) medications to treat their asthma symptoms. OTC asthma medicines are limited to epinephrine and ephedrine. These OTC drugs are best used with the guidance of a physician, as there may be side effects and the drugs may not be very effective.
Insomnia is difficulty in falling or staying asleep, the absence of restful sleep, or poor quality of sleep. Insomnia is a symptom and not a disease. The most common causes of insomnia are medications, psychological conditions, environmental changes and stressful events. Treatments may include non-drug treatments, over-the-counter medicines, and/or prescription medications.
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC drugs like Primatene Mist and Bronkaid.
Before we present the typical symptoms of asthma, we should dispel some
common myths about this condition. This is best achieved by conducting a short
true or false quiz.
T or F - Asthma is "all in the mind."
T or F - You will "grow out of it."
T or F - Asthma can be cured, so it is not serious and nobody dies from it.
T or F - You are likely to develop asthma if someone in your family has it.
T or F - You can "catch" asthma from someone else who has it.
T or F - Moving to a different location, such as the desert, can cure
asthma.
T or F - People with asthma should not exercise.
T or F - Asthma is best controlled when one has an asthma management plan designed by your doctor. This should include the medications used for quick relief as well as maintenance therapy.
T or F - Medications used to treat asthma are habit...
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