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	James L. Holly, M.D.

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EPM Tools - Drug Interactions Tutorial

The complexity of drug/drug interactions is growing so rapidly that it is virtually impossible for anyone to know all of the contraindications for the use of even the most common medications without considering those medications which are uncommonly used. This is such the case that the first “common clinical pitfall of monitoring drug interactions” listed below is, “Relying on memory as to which drugs interact.”

While NextGen EMR has a very complete drug/drug interaction check built into the medication module, the implications of the Cytochrome P450 system is such that special attention needs to be drawn to those drugs which are detoxified by this system.

SETMA’s Drug Interactions Suite of Templates has been built for the purpose of informing providers about this very important field which affects their daily prescriptive habits.

How to find the Drug Interactions Template

AAA Home

Drug Interactions

Master Tool Bar Icon

Drug Interactions

When the Template button is clicked you will be presented with the preference list.
If the Drug Interactions Template is listed as one of your preferences, select it.
If it is not one of your preferences, select the All radio button and scroll down until you find it in the list. Then you may select the template by either double-clicking on the name or single click on the name (so that it is highlighted in blue) and then click the OK button.

NOTE: For more on how to set up your preferences, Click Here

Drug Interactions Master Template

This template presents a brief introduction to the subject of the Cytochrome P-450 system.

At the bottom of the template, the following appears:

Cytochrome P450 Tutorial with the following parts:

Definitions
Highlights of Cytochrome P450
Humans and Cytochrome P450
Aging and Cytochrome P450
Phase 1 Metabolism
Factors Affecting P450 Metabolism
CYP3A4

Drug Interactions

To the right are seven navigation buttons to additional information about the system; they are:

Drug-Drug Interactions
Supplement-Drug Interactions
Common Clinical Pitfalls
Cytochrome P450 Interactions
P450 and the Statins
Managing Hepatic Enzyme
Grapefruit Juice

Drug Interactions

Below the navigation buttons are two documents entitled:

Cytochrome P450 Overview
Medications and Grapefruit Juice

Drug Interactions

Drug-Drug Interactions Template

Drug Interactions

This template displays information on “Some Classic Deadly Combinations” of medications.

Drug Interactions

At the bottom of the template are 8 documents on the following subjects:

Combining Serotonin Enhancing Drugs
Combinations that can Decrease Glycemic control
Combining Insulin-Enhancing Drugs
Combining Drugs that Affect Dopamine
Combining Vasodilators
Combinations That Interact with Glucophage
Drug Combinations that increase QT Interval
Drug Combinations that Cause CNS Depression

Drug Interactions

Dietary Supplements & Drug Interactions

Drug Interactions

This template identifies the drug/drug interactions of 28 commonly used supplements which are not FDA regulated. By clicking in the box, and selecting the supplement, a pop-up will appear which will give you information about potential problems with the selected supplement.

Drug Interactions

At the bottom of the template there are the following information pieces:

What Herbs Should I Avoid?
Warfarin and Supplements
Tricyclic Antidepressants and Supplements
SSRIs and Supplements
Statins and Supplements

Drug Interactions

Common Pitfalls Template

This template lists 12 common pitfalls which increase the probability of experiencing drug/drug interactions.

Drug Interactions

Then the template displays 5 ways to minimize the impact or frequency of interactions.

Drug Interactions

P450 Interactions Template

This template presents a list of 32 classes of drugs. When a class is marked, the box below will present a pick list of all of the drugs in that class which interact with the P450 system.

Drug Interactions

When a drug is selected, the following will be displayed:

Substrate – the selected drug. The Cytochrome P450 enzyme which affects the substrate, will be displayed.
Inhibitors – those drugs which will increase the concentration in the blood of the target.
Inducers -- those drugs which will decrease the concentration in the blood of the target drug.

Drug Interactions

Cytochrome P450 and the Statins

This template lists the common statins in order from those which are most sensitive to the Cytochrome P450 System down to those which are the least sensitive.

Drug Interactions

When you check the radial box next to the name of the statin, the P450 enzyme which detoxifies it, the inhibitors and the inducers will appear below. There is also a comment box.

Drug Interactions

Managing Hepatic Enzyme Induction Template

This template provides information on 4 principles of how to avoid problems with drug toxicity.

Drug Interactions

Grapefruit Juice Template

This template displays 5 important facts about grapefruit juice and the Cytochrome P450 systems.

Drug Interactions

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