Question

1. Explain how patient compliance, pathologic state, and drug interaction might alter the effects of a drug.
   1. Patient compliance:
2. 2. Pathologic state:
3. 3. Drug interaction:

Answer 1

Patient compliance : failure to adhere to the prescription can worsen the disease leading to death of patient, the causes for nonadherence are follows

-Demographic factors such as age, ethnicity, gender, education, marriage status.

-Psychosocial factors: beliefs, motivation, attitude.

-Patient-prescriber relationship.

-Health literacy.

-Patient knowledge.

-Physical difficulties.

-Tobacco or alcohol intake.

-Forgetfulness.

The drugs are effective only when taken in adequate quantity in the required time.

Pathological state:

The activity of microsomal drug-metabolizing enzymes is altered by several pathological or abnormal physiological states, such as changes in nutritional status, liver, heart or kidney diseases, hormonal disturbances, pregnancy, tumour-bearing state, adjuvant arthritis, changes in reticuloendothelial system and environmental factors (stress, irradiation, heavy metals).

GIT : absence of HCL, leads to reduced aspirin absorption,

NSAIDS: lead to formation of peptic ulcer disease,

Coeliac disease : the absorption of amoxcillin is Decreased but absorption of cephalosporin is adequate, so drugs to be chosen in the pathological condition should be careful.

Drug interaction :

When two three drugs are prescribed for a person it is very important to be careful for the effectiveness of drug, if one drug increases the elimination of another drug, the dose of the drug need to be increased.

If two drug combination can lead to bone marrow suppression it is better to avoid the drug.

For eg: 1) Quinolones + Acitrom: it increases the effect of sitting by decreasing VIt K production  

This Increases INR within three days leading to bleeding.

2)Cephalosporin and acitrom: synergism

That is increase the effectiveness of each drug

Decreasing prothrombin activity