Posted: January 4th, 2023

A 60-year-old White woman with newly diagnosed peptic ulcer disease

Impact of Drug Interactions and Adverse Events on Therapeutic

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Impact of Drug Interactions and Adverse Events on Therapeutic

A 60-year-old White woman with newly diagnosed peptic ulcer disease, generalized anxiety disorder, and iron deficiency anemia. She also has a long history of asthma and depression. She is a strong believer of herbal medicine. She takes St. John’s wort for her depression, iron pills for her anemia, and alprazolam (Xanax) as needed for her anxiety. During her asthma exacerbation, she is instructed to take prednisone for at least 5 days. She also takes esomeprazole (Nexium) for her peptic ulcer disease. Three months later, she experienced severe fatigue, shortness of breath, dizziness, and swelling/soreness in the tongue. Her asthma is well controlled with the occasional use of albuterol (Proventil) inhaler. During her physical exam, her physician suspected that she had bacterial vaginosis and gave her a prescription for a 1-week course of metronidazole (Flagyl). She drinks at least two to three cans of beer per day.

Diagnosis: Drug–Drug Interactions

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1. St. John’s wort is known to inhibit which of her medication that is known to be metabolized by cytochrome P-450 (CYP3A4) and could potentially cause her to experience significant fatigue? (100 words)

2. Which of her medication could interfere with the absorption of her iron pills? (50 words)

3. Which of her medication could potentially cause her to develop vitamin B12 deficiency? (50 words)

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4. How does metronidazole interfere with alcohol? (75 words)

5. If she was given a prescription for ketoconazole, which of her medication could interfere with its absorption? (75 words)
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Study notes:
St. John's wort is known to inhibit the metabolism of medications that are metabolized by the CYP3A4 enzyme, such as alprazolam (Xanax). This could potentially cause the woman to experience significant fatigue due to the increased levels of alprazolam in her system.
The woman's iron pills could potentially be interfered with by her esomeprazole (Nexium) medication, as proton pump inhibitors like esomeprazole can decrease the absorption of iron in the gut.
The woman's long-term use of proton pump inhibitors like esomeprazole (Nexium) could potentially cause her to develop vitamin B12 deficiency, as these medications can decrease the absorption of vitamin B12 in the gut.
Metronidazole (Flagyl) can interfere with alcohol by causing severe nausea, vomiting, and abdominal pain if the woman consumes alcohol while taking the medication or within the first three days after she finishes the course of treatment.
If the woman was given a prescription for ketoconazole, her esomeprazole (Nexium) medication could potentially interfere with the absorption of ketoconazole, as proton pump inhibitors like esomeprazole can decrease the absorption of other medications in the gut.

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