Anaesthetics is a good example of multiple drug therapy, because from premedications of your patient until he/she is transferred out of the OR, they will definitely be administered nearly 10 drugs for general anaesthetics. In other patients when you decide to give your patients a multiple pharmacologic regimen, you do have to weigh the benefits of doing so against the risk of what would happen after doing so. Normally, it approximately happens around 3-5% but will dramatically increase to 20% if there are more than 10 drugs administered for him.
Therefore, when you consider to use multidrug regimen for your patient, you have to recalculate the dose of each drug while the combined drug would have a well-maintained effectiveness. One thing has to be kept in mind would be when you include the drug which has a narrow therapeutic index; such as digoxin, you have to use with caution because it would create this drug interactions more easily.
Patients at risk for the development of drug interaction are obesity because their tissues are increased and their hepatic enzyme function is altered as well, the patients having organ transplantation with immunosuppressive agents in place, the HIV positive patients who are receiving antiretroviral agent; reverse transcriptase inhibitors because these organ transplant and HIV patients the added drug will have inhibitory effects on the function of CYP, cytochrome P450 activity, therefore the other drugs metabolised by the inhibited enzymes would create drug overdosage then toxicity would arise. Besides these patient groups, patients with an infection or sepsis are prone to develop this problem as well because the enzyme CYP activity is also depressed during infection.
Therefore, when you consider to use multidrug regimen for your patient, you have to recalculate the dose of each drug while the combined drug would have a well-maintained effectiveness. One thing has to be kept in mind would be when you include the drug which has a narrow therapeutic index; such as digoxin, you have to use with caution because it would create this drug interactions more easily.
Patients at risk for the development of drug interaction are obesity because their tissues are increased and their hepatic enzyme function is altered as well, the patients having organ transplantation with immunosuppressive agents in place, the HIV positive patients who are receiving antiretroviral agent; reverse transcriptase inhibitors because these organ transplant and HIV patients the added drug will have inhibitory effects on the function of CYP, cytochrome P450 activity, therefore the other drugs metabolised by the inhibited enzymes would create drug overdosage then toxicity would arise. Besides these patient groups, patients with an infection or sepsis are prone to develop this problem as well because the enzyme CYP activity is also depressed during infection.
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