Preskorn Sheldon H
PRESKORN: Kansas University School of Medicine-Wichita, Wichita, KS.
J Psychiatr Pract. 2019 Jul;25(4):290-297. doi: 10.1097/PRA.0000000000000399.
This column is the sixth in a series exploring drug-drug interactions (DDIs) with a special emphasis on psychiatric medications. The first 3 columns in this DDI series discussed why patients being treated with psychiatric medications are at increased risk for taking multiple medications and thus experiencing DDIs, how to recognize such DDIs, strategies for avoiding and/or minimizing adverse outcomes from such DDIs, and pharmacokinetic considerations concerning DDIs in psychiatric practice. The fourth and fifth columns in this series presented a pair of parallel tables, one of which outlined the primary, known mechanism(s) of action of all commonly used psychiatric medications and one of which summarized major types of pharmacodynamic DDIs based on mechanism of action. Clinicians can use these 2 tables together to predict pharmacodynamically mediated DDIs. This sixth column in the series discusses some key issues related to pharmacodynamic interactions involving commonly used psychiatric medications. The column first discusses 3 types of pharmacological agents that deserve special mention because of the widespread types of pharmacodynamic DDIs they can have with psychiatric and other medications: ethanol, opioids, and monoamine oxidase inhibitors, with a special focus on hypertensive crises and serotonin syndrome with monoamine oxidase inhibitors. The column also discusses DDIs in terms of effects on the cardiovascular system, including QTc prolongation, blood pressure and heart rate regulation, increased risk of bleeding and abnormal bleeding, and valvular heart disease, and on the central nervous system, including increased sedation, respiratory depression, body temperature regulation, and tardive dyskinesia. The overall goal of this series of columns is to present a simple way of conceptualizing neuropsychiatric medications in terms of their pharmacodynamics and pharmacokinetics to allow prescribers to take these facts into consideration when they need to use more than 1 drug in combination to optimally treat a patient.
本专栏是探讨药物相互作用（DDIs）系列文章中的第六篇，特别关注精神科药物。本DDIs系列的前三篇专栏文章讨论了接受精神科药物治疗的患者为何服用多种药物的风险增加，从而经历药物相互作用；如何识别此类药物相互作用；避免和/或最小化此类药物相互作用不良后果的策略；以及精神科实践中关于药物相互作用的药代动力学考虑因素。本系列的第四和第五篇专栏文章呈现了一对平行表格，其中一个概述了所有常用精神科药物的主要已知作用机制，另一个总结了基于作用机制的主要药效学药物相互作用类型。临床医生可以一起使用这两个表格来预测药效学介导的药物相互作用。本系列的第六篇专栏文章讨论了与常用精神科药物药效学相互作用相关的一些关键问题。该专栏首先讨论了三类因其与精神科药物和其他药物广泛存在的药效学药物相互作用类型而值得特别提及的药物：乙醇、阿片类药物和单胺氧化酶抑制剂，特别关注单胺氧化酶抑制剂引起的高血压危象和5-羟色胺综合征。该专栏还从对心血管系统的影响方面讨论了药物相互作用，包括QTc延长、血压和心率调节、出血风险增加和异常出血以及心脏瓣膜病，以及对中枢神经系统的影响，包括镇静作用增强、呼吸抑制、体温调节和迟发性运动障碍。本系列专栏文章的总体目标是以一种简单的方式从药效学和药代动力学方面对神经精神科药物进行概念化，以便开处方者在需要联合使用多种药物以最佳治疗患者时能够考虑到这些事实。
