Abstract:
:Medical therapy in patients with more than one pathology means using more pharmaceuticals, which results in a higher risk of drug interactions which are modifications in the action of one drug when it is administered in the presence of another. The consequences can be diminished therapeutic effect or increased adverse reactions. The pharmacological interactions can be either physico-chemical, pharmacokinetic or pharmacodynamic, on the basis of their mechanisms. Pharmacokinetic interactions are the most important and can emerge during various phases of absorption, distribution, metabolism and drug elimination. The absorption of many antimicrobial agents can be modified through various mechanisms. Some drugs (for example the anticholinergics and opiates) or food can slow gastric motility, slowing the absorption and reducing maximum concentrations of the antibiotic. Variations in gastric pH can alter the solubility or chemical stability of molecules such as the beta-lactams, the natural macrolides and some azoles. The bioavailability of these drugs can be reduced due to molecules used to raise gastric pH. Antibiotics such as tetracycline or the fluoroquinolones have reduced bioavailability due to chelation from bi- and trivalent cations. The primary number of clinically relevant pharmacological interactions is correlated with modifications of biotransformation of drugs due to Cytochrome P450 (CYP) hepatic enzymes which are involved in oxidative drug processes, including lipophilic antimicrobial drugs such as the macrolides, the fluoroquinolones (to be considered amphoteric) and the antifungal azole derivatives. CYP3A is probably one of the most important isoenzymes since it contributes to at least the partial transformation of 60% of drugs that undergo oxidation: erythromycin and clarithromycin are CYP3A4 substrates. Many isoenzymes can also be inhibited by antimicrobial drugs, including both antibacterials and antifungals (for example the macrolides, fluoroquinolones, metronidazole, sulfonamides and azole derivatives) with a consequent reduction in the metabolism of other drugs, thus increasing their blood concentrations and possible correlated adverse reactions. On the other hand, rifampicin, rifabutin and some anticonvulsants can induce enzymatic metabolism, causing reduced blood concentrations and lower AUC of itraconazole and voriconazole with possibly lower therapeutic efficacy. This brief review of pharmacological interactions among certain chemotherapeutic agents leads us to believe that this problem is destined to occur with more frequency in daily clinical practice. What is needed is basic knowledge of drug interactions on the part of all physicians who work in the fields of clinical therapeutics with the goal of reducing the high number of medical errors.
journal_name
Intern Emerg Medjournal_title
Internal and emergency medicineauthors
Mazzei Tdoi
10.1007/s11739-011-0680-xsubject
Has Abstractpub_date
2011-10-01 00:00:00pages
103-9eissn
1828-0447issn
1970-9366journal_volume
6 Suppl 1pub_type
杂志文章abstract:OBJECTIVE:Postprandial lipemia is generally studied after a test meal that provides most of the calories as fat and that does not reflect the common food intake. We investigated postprandial changes in serum triglycerides (TG) and in high-density lipoprotein (HDL) concentration and composition after a regular meal poor...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/BF02934762
更新日期:2006-01-01 00:00:00
abstract::This study aimed to compare the diagnostic accuracy of heart, lung and inferior vena cava (IVC) ultrasonography modalities, alone and combined, for possible added accuracy in diagnosing acute decompensated heart failure (ADHF), in a group of patients with the final diagnosis of ADHF based on plasma level of B-type nat...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-019-02233-x
更新日期:2020-04-01 00:00:00
abstract::The article Reversal agents for oral anticoagulant-associated major or life-threatening bleeding, written by Marco Moia, Alessandro Squizzato was originally published electronically on the publisher's internet portal (currently SpringerLink) on 24 August 2019 without open access. ...
journal_title:Internal and emergency medicine
pub_type: 杂志文章,已发布勘误
doi:10.1007/s11739-019-02232-y
更新日期:2020-06-01 00:00:00
abstract::International guidelines recommend the use of pharmacological prophylaxis in hospitalized medical patients at high risk of venous thromboembolism (VTE). The same international guidelines suggest the employment of standardized risk assessment models (RAMs) when evaluating the administration of pharmacological prophylax...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-018-1808-z
更新日期:2018-06-01 00:00:00
abstract::Iron deficiency anemia (IDA) is one of the most common complications of inflammatory bowel disease (IBD). We planned a prospective study to address tolerability and efficacy of sucrosomial iron, a new oral formulation of ferric pyrophosphate, in IBD patients. Thirty patients with a confirmed diagnosis of Crohn's Disea...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-018-1993-9
更新日期:2019-04-01 00:00:00
abstract::Despite its rarity, infliximab-related hepatitis constitutes a cutting edge and challenging problem. In December 2004, a drug warning was issued by the Food and Drug Administration to alert healthcare professionals to the risk of hepatotoxicity in course of infliximab therapy. Subsequently, several reports of probable...
journal_title:Internal and emergency medicine
pub_type: 杂志文章,评审
doi:10.1007/s11739-009-0342-4
更新日期:2010-06-01 00:00:00
abstract::The primary study objective is to compare the outcomes of patients taking oral anticoagulant medications in two distinct populations treated according to different management models (comprehensive vs. usual care). (Design: regional prospective cohort study; setting: hospital admission data from two regions). Eligible ...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-019-02148-7
更新日期:2019-11-01 00:00:00
abstract::Subclinical hyperthyroidism (SH) has been reported associated with atrial fibrillation (AF), heart failure (HF) and coronary heart disease events, including mortality. An expert opinion indicates that AF is the possible link between SH and the other important cardiovascular (CV) manifestations. We analyzed the data of...
journal_title:Internal and emergency medicine
pub_type: 杂志文章,评审
doi:10.1007/s11739-013-0913-2
更新日期:2013-04-01 00:00:00
abstract::The direct oral anticoagulants (DOACs) are drugs used in clinical practice since 2009 for the prevention of stroke or systemic embolism in non-valvular atrial fibrillation, and for the treatment and secondary prevention of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, a...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-017-1628-6
更新日期:2017-04-01 00:00:00
abstract::The treatment of polycythemia vera in young adults is challenging, requiring one to run a balance between the increased risk of vascular complications, if left untreated, versus the potential of promoting secondary leukemia/myelodysplasia or cancer, if actively managed with chemotherapy. We report the results of a 20-...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-010-0429-y
更新日期:2010-10-01 00:00:00
abstract::In patients with acute coronary syndrome, gamma-glutamyltransferase activity (GGT) proved to be an independent predictor of the development of major adverse cardiac events at early and long terms. No data are available on GGT in ST-elevation myocardial infarction (STEMI). We assessed, in 337 consecutive STEMI patients...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-010-0464-8
更新日期:2011-06-01 00:00:00
abstract::In chronic heart failure (CHF) due to systemic cardiovascular disease, obese patients have better survival. Bodyweight versus survival was analyzed post hoc in subjects with limited scleroderma (SSc) and isolated pulmonary artery hypertension (PAH), i.e. with CHF due to pulmonary vascular disease. Rheumatologists refe...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-016-1446-2
更新日期:2016-10-01 00:00:00
abstract::The objective is to describe the characteristics of mechanically restrained patients in the emergency department (ED) of a university hospital and to evaluate the quality of restraint documentation that was filled out according to the dedicated protocol with respect to the law on restraint. All adult patients (≥16 yea...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-017-1697-6
更新日期:2018-06-01 00:00:00
abstract::Atrial fibrillation is the most common arrhythmia and is associated with significant morbidity and mortality. The current therapeutic options for patients at high thromboembolic risk include the vitamin K antagonists and the direct oral anticoagulants. These novel agents have been evaluated in more than 40,000 patient...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-015-1277-6
更新日期:2015-09-01 00:00:00
abstract::Chronic thromboembolic pulmonary hypertension (CTPH) is a potential complication of pulmonary embolism (PE). Only few studies have assessed the role of brain natriuretic peptide (BNP) in patients with chronic pulmonary hypertension, and there are no data on the potential utility of BNP as a preclinical biomarker of CT...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-009-0231-x
更新日期:2009-04-01 00:00:00
abstract::Inflammation plays a pivotal role in all stages of atherosclerosis from endothelial dysfunction and plaque formation to plaque destabilization and disruption. Inflammatory biomarkers, originally studied to better understand the pathophysiology of atherosclerosis, have generated increasing interest among clinicians, be...
journal_title:Internal and emergency medicine
pub_type: 杂志文章,评审
doi:10.1007/s11739-010-0361-1
更新日期:2010-06-01 00:00:00
abstract::Although ketamine has been used for procedural sedation and analgesia, some researchers have assessed ketamine-propofol as a better alternative because of its reduced adverse events. The goal of this review was to compare adverse events between ketamine-propofol and ketamine for procedural sedation and analgesia in ch...
journal_title:Internal and emergency medicine
pub_type: 杂志文章,meta分析
doi:10.1007/s11739-019-02173-6
更新日期:2019-10-01 00:00:00
abstract::Assessing the effects of an antimicrobial stewardship program (ASP) implemented in a 78-bed Internal Medicine ward of an Italian mid-sized acute care hospital of 296 beds (26,820 bed days/year in 2015 and 26,653 in 2016). The ASP, implemented in May 2016, included: (a) formulation and dissemination of local guidelines...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-018-1916-9
更新日期:2018-12-01 00:00:00
abstract::The occurrence of heart failure during the whole pre-discharge course of coronary revascularization, as far as its influence on subsequent prognosis, is poorly understood. The present study examined the effect of transient heart failure (THF) developing in the acute and rehabilitative phase on survival after coronary ...
journal_title:Internal and emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11739-013-1006-y
更新日期:2014-09-01 00:00:00
abstract::Increasing evidence shows an association between high lipoprotein(a) [Lp(a)] levels and atherothrombotic diseases. Lp(a) trait is largely controlled by kringle-IV type 2 (KIV-2) size polymorphism in LPA gene, encoding for apo(a). Environmental factors are considered to determinate minor phenotypic variability in Lp(a)...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-020-02276-5
更新日期:2020-10-01 00:00:00
abstract::The recent position paper of the European Society of Cardiology (ESC) on cardiovascular toxicity of cancer treatments has attracted considerable interest by healthcare professionals, since it is the first concrete help in the difficult task of monitoring and approaching cardiovascular side effects of anticancer treatm...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-017-1755-0
更新日期:2018-01-01 00:00:00
abstract:INTRODUCTION:Oral anticoagulants (OAs) are significantly more effective than Aspirin in the prevention of cerebrovascular accidents among patients with atrial fibrillation (AF). Several studies, however, showed OAs to be widely underused in these patients. OBJECTIVE:To assess the appropriateness of antithrombotic ther...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-007-0005-2
更新日期:2007-03-01 00:00:00
abstract::Non-alcoholic fatty liver disease is recognized as the most common and emerging chronic liver disease in western countries. The disease has been traditionally interpreted as a possibly progressing condition to liver fibrosis and cirrhosis. However, recently, a large number of publications have demonstrated that people...
journal_title:Internal and emergency medicine
pub_type: 杂志文章,评审
doi:10.1007/s11739-012-0819-4
更新日期:2012-10-01 00:00:00
abstract::This study aims at evaluating the prevalence of left ventricular diastolic dysfunction in a group of 319 hypertensive patients with stage 3b-4-5 chronic kidney disease (according to Kidney Disease Improving Global Outcomes classification), compared with 216 patients with essential hypertension and normal renal functio...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-019-02028-0
更新日期:2019-09-01 00:00:00
abstract::The high cardiovascular risk burden in low- and middle-income countries is expected to lead to an explosive increase in chronic kidney disease (CKD). However, population data on CKD from these countries are scarce. Therefore, we assessed kidney health in Suriname. In the Healthy Life in Suriname (HeliSur) study, a ran...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-018-1962-3
更新日期:2019-03-01 00:00:00
abstract::Cirrhosis is characterized by a complex coagulation defect leading to the prolongation of the prothrombin and activated partial thromboplastin times (PT and APTT). Arbitrary PT cut-off values are still used as a yardstick to guide treatment with fresh-frozen plasma (FFP) or other pro-coagulant agents in patients under...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-011-0528-4
更新日期:2012-04-01 00:00:00
abstract::A meta-analysis to determine the impact of gender on mortality in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS): PubMed, EMBASE, and Cochrane Library, was systematically searched. Two investigators independently reviewed retrieved articles and assessed eligibility. Unadjusted mortality rat...
journal_title:Internal and emergency medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s11739-017-1684-y
更新日期:2018-03-01 00:00:00
abstract:OBJECTIVE:To determine the feasibility of using the internet to track the spread of emergency medicine internationally. METHODS: OVERVIEW:This was an attempt to perform a descriptive cross-sectional study employing a web-based survey. SUBJECTS:Potential respondents were identified from multiple sources. OBSERVATION...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-007-0083-1
更新日期:2007-12-01 00:00:00
abstract::Antimicrobial therapy has been the main stay of therapy of community-acquired aspiration pneumonia (CAAP), but the duration of treatment has not been established. The objective of this study was to describe the time to reach clinical stability in patients with aspiration pneumonia compared to community-acquired pneumo...
journal_title:Internal and emergency medicine
pub_type: 杂志文章
doi:10.1007/s11739-012-0764-2
更新日期:2014-03-01 00:00:00
abstract::Unconscious patients admitted to critical care units after out-of-hospital cardiac arrest are at high risk for death, and neurologic deficits are common among those who survive. The target temperature management (TTM), 33 vs. 36 °C, after out-of-hospital cardiac arrest trial was conducted to assess the benefits and ha...
journal_title:Internal and emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11739-014-1100-9
更新日期:2014-09-01 00:00:00