The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

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A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 27: Pharmacologic Interactions of Clinical SignificanceCONCLUSION■ Table 27-12 offers an extensive and exhaustive listing of potential drug-drug interactions involvingmedications that may be applied therapeutically to various organ systems during palliativeas well as early care of HIV disease.Table 27-13 presents a list of red-flag medications that should be discussed in counseling patientsbefore prescribing. With the increasing complexity of HIV therapy, the potential for druginteractions for patients in both active and palliative care is exceedingly high. Health careproviders must be committed to constantly monitoring their patients and applying strategies tominimize and/or circumvent harmful drug-drug interactions.With more than 30 new medications approved by the FDA each year for use in our therapeuticarmamentarium, the recognition and management of drug interactions has become an ongoingchallenge. While some pharmacokinetic and pharmacodynamic interactions can be favorableand clinically useful, many have the potential to be detrimental or to even lead to life-threateningtoxicities and/or therapeutic failures. Providers must, therefore, become familiar with thefundamental issues involved in drug-drug interactions, especially with the red-flag medications—usually the drugs in the patient’s regimen that are enzyme inducers or inhibitors, have a narrowtherapeutic index, or have specific absorption requirements—as well as with other medicationsthat require close patient monitoring and avoidance of certain groups of drugs.It is equally important that patients become active partners in their own care. Patients mustunderstand that many potential drug-drug interactions can be circumvented, as long as providersare made aware of all the medications and herbal remedies a patient is taking. Providersmay want to photocopy Table 27-14, Advice to Patients: Red Flag Medications, for discussionwith patients receiving active and/or palliative care therapies for HIV disease.572U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau
A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 27: Pharmacologic Interactions of Clinical SignificanceTable 27-12:26 picasDisease Statesand MedicationsCARDIOVASCLUARBeta BlockersSummary of Significant Drug-Drug Interactionsin Palliative Care of HIV DiseaseProtease InhibitorsRitonavir Indinavir Nelfinavir(Norvir) (Crixivan) (Viracept)↑ plasma conc. ofmetoprolol &timolol↓ plasma conc. ofthese drugsAntiarrhythmicsCa ++ ChannelBlockers↑ plasma conc. ofamiodarone &quinidineSerious arrhythmiaswith propafenone↑ plasma conc. ofecainide, mexilente,flecainide, &systemic lidocaine↑ plasma conc. ofnifedipine(Significant ↑ overall Ca ++ ChannelBlockers)↑ plasma conc. ofamiodarone &quinidine↑ plasma conc. ofamiodarone &quinidine↑ plasma conc. ofnifedipine↓ plasma conc. offelodipineAntihyperlipidemicsGASTROINTESTINALCisaprideRESPIRATORYAstemizole andterfenadineTheophyllineSignificant ↑ inlevels of simvastatin& lovastatin↑ in plasma conc.∴results in seriousor life-threateningarrhythmias(No longer onmarket)↑ in plasma conc.∴results in seriousor life-threateningarrhythmias↓ in plasma conc. oftheophyllineSignificant ↑ inlevels of simvastatin& lovastatin↑ in plasma conc.∴results in seriousor life-threateningarrhythmias(No longer onmarket)↑ in plasma conc.∴results in seriousor life-threateningarrhythmiasSignificant ↑ inlevels of simvastatin& lovastatin↑ in plasma conc.∴results in seriousor life-threateningarrhythmias(No longer onmarket)↑ in plasma conc.∴results in seriousor life-threateningarrhythmiasXXVIIU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 573
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DedicationA Clinical Guide to Suppo
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Lynn A Jansen, RN, PhDAssistant Res
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TABLE OF CONTENTSPart IChapter 1Cha
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IChapter 1.26 picasHIV and Palliati
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IA Clinical Guide to Supportive and
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A Clinical Guide to Supportive and
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IIIChapter 3.Assessment of Physical
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Chapter 6.26 picasPulmonary Symptom
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Chapter 8.26 picasOral ProblemsDavi
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Chapter 9.26 picasDermatologic Prob
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Chapter 10.26 picasPsychiatric Prob
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Chapter 11.26 picas Substance Use P
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Chapter 14.26 picasCulture and Care
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Chapter 15.26 picasSpecial Populati
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Chapter 17.26 picasEthical IssuesLy
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Chapter 18.26 picasLegal and Financ
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Chapter 19.Palliative 26 picas Care
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Chapter 25.26 picas Prevention of S
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Chapter 26.26 picasResourcesMagda B
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