Mnemonic helps minimize drug reactions: Check for allergies, dependence issues.
Dr. Flockhart of Georgetown University in Washington outlined the following approach to taking a patient history:
* A. Does the patient have any Allergies?
* V. Is the patient taking any Vitamins or herbal supplements?
* O. What are the "Old" medications, or medications the patient has recently taken? Because of long half-lives, some medications taken a week or longer in the past may still have lingering effects.
* I. What are the known Interactions associated with the medication you would like to prescribe? Check interactions with medication databases, such as the Webbased tools described below.
* D. Does the patient have Dependence issues with any of his current medications?
* M. With Mendel in mind, ask your patient about family history. Have any family members experienced drug interactions or adverse side effects? This step can help predict which patients have genetic polymorphisms that can alter a patient's metabolism of a drug. Particularly challenging are polymorphisms of CYP2D6, the cytochrome P450 enzyme that catalyzes metabolism of several drugs, including the primary metabolism of codeine to morphine and tamoxifen to 4-hydroxy-tamoxifen.
In addition, Dr. Flockhart suggested the following four-step approach. The first step is to identify patients who are at high risk for adverse drug interactions, such as patients taking two or more drugs.
"Our literature is mostly single, one-on-one drug interactions, so clearly we don't have a lot of information on the effects of multiple medications," Dr. Flockhart explained. Patients at high risk for drug interactions also include those taking anticonvulsants, antibiotics, or drugs such as digoxin, warfarin, or amiodarone.
Second, check pocket references for known drug interactions. He suggested referring to the Web-based drug interaction database www.drug-interactions.com, which is published by Georgetown University and updated on a weekly basis.
The third step is to consult a pharmacist or drug information specialist. And fourth, keep informed about pharmacologic developments with resources like the Medical Letter (www.medicalletter.com), Clinical Pharmacology 2000 (www.gsm.com), and www.epocrates.com.
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|Publication:||OB GYN News|
|Date:||Jan 15, 2002|
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