Question

Based on the prolog facts given below:

1.Given two medications, if they interact, tell what the effect of the interaction may be. Note there may be more than one result of the interaction.

2. Given a medical condition, list the drug interactions that may have caused it.

interacts(gatifloxacin,mometasone,asthma).

interacts(gatifloxacin,cisplatin,hyperglycaemia).

interacts(gatifloxacin,cisplatin,bone_marrow_failure).

interacts(gatifloxacin,montelukast,difficulty_breathing).

interacts(temazepam,thalidomide,neutropenia).

interacts(temazepam,thalidomide,thrombocytopenia).

interacts(temazepam,timolol,drowsiness).

interacts(temazepam,tizanidine,acid_reflux).

interacts(temazepam,tizanidine,heart_attack).

Answer 1

1. There can be multiple different effects of the drugs which interact with each other. They may affect absorption, distribution, metabolism or excretion (ADME characteristics) of each other.

Drug-Drug Interaction Drug Drug(s) Possible Effects Decrease Action of Drug(s) Increase Action of Drug(s) Cause Adverse Effects

^{Image adapted from https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/213/drug-drug-interaction}

• Additive effect - can result due to the simultaneous action of the two drugs, increasing their action on the patient.
• Synergistic effect - In this case, an effect greater than the sum of the individual effects of two or more drugs occur.
• Antagonistic effect - This interaction between two drugs result in diminishing or reducing the effect of each other on the patient.

2. Drug-drug interactions with their medical conditions:

• In asthma, the risk or severity of tendinopathy is found to be increased when Mometasone is combined with Gatifloxacin. - Syngeristic effect.

• Cisplatin has an antagonistic effect to Gatifloxacin, leading to the hyperglycaemia.

• No such interaction of gatifloxacin with montelukast has been found in the available literature.

• Temazepam may increase (additive effect) the central nervous system depressant activities of Thalidomide resulting in the bone marrow damage and hence, neutropenia (decrease in the levels of neutrophils).

• Due to the bone marrow damage cause by the additive interactions between Temazepam and Thalidomide, Thrombocytopenia (low levels of platlets) may also arise.

• It has been approved that Temazepam decrease the excretion rate of Timolol increasing its serum concentrations. Thus, Temazepam may act by increasing the levels of Timolol in the body, causing drowsiness.

• The risk or severity of adverse effects is increased when Temazepam is combined with Tizanidine, resulting in acid reflux.

• Due to the synergistic effects of temazepam and tizanidine, heart attack may also result.

Reference: https://www.drugbank.ca/drugs/DB00471