Risk factors of drug-induced diseases. Part 2. Comorbid diseases and lifestyle factors


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Abstract

Comorbid diseases increase the likelihood of developing drug-induced diseases, altering the pharmacokinetics and pharmacodynamics of drugs. It is necessary to consider the pharmacokinetics and pharmacodynamics of each drug. In patients with kidney diseases, widely used drugs such as в-blockers, diuretics, insulin, angiotensin-converting enzyme (ACE) inhibitors, acetylsalicylic acid, warfarin, clopi-dogrel can cause side effects. In addition, kidney disease alters the absorption, distribution, and clearance of drugs. Moreover, chronic renal failure has been shown to significantly reduce the nonrenal clearance and alter bioavailability of drugs metabolized by the liver. Liver failure leads not only to a decrease in the clearance and elimination of drugs, but also disrupts the binding of drugs to blood plasma proteins, changing the processes of distribution and excretion, the activity of various enzymes of cytochrome P450. Obesity is another widespread problem. Many questions require further study. However, it is known that obesity affects many physiological processes, changes hemodynamics (including cardiac output), intestinal permeability, liver and kidney function. Therefore, these patients need assessment of risk factors and personalized dosing. Despite reports of an increased level of glomerular filtration rate (GFR) in obese patients, renal drug clearance does not necessarily increase. Glomerular hyperfiltration is a compensatory mechanism that develops due to an increased metabolic demand. In the long term, increased intraglomerular pressure leads to decline in GFR and chronic kidney disease. There are also other modifiable risk factors for the development of drug-induced diseases, including bad habits: smoking, alcohol consumption, abuse substance. The constituents of tobacco smoke can accelerate the metabolism of many drugs, which leads to a decrease drug concentration in whole blood and a decrease in their effectiveness. The intake of alcohol and illegal drugs is associated not only with the development of many well-known diseases but also drug-induced diseases. It is imperative to inform patients about the possible consequences, as well as to increase adherence to a healthy lifestyle.

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About the authors

D. A Sychev

Russian Medical Academy of Continuing Professional Education

Moscow, Russia

Olga D. Ostroumova

Russian Medical Academy of Continuing Professional Education

Email: ostroumova.olga@mail.ru
Dr. Sci. (Med.), Professor, Head of the Chair of Therapy and Polymorbid Diseases n.a. Academician M.S. Vovsi Moscow, Russia

A. P Pereverzev

Russian Medical Academy of Continuing Professional Education

Moscow, Russia

A. I Kochetkov

Russian Medical Academy of Continuing Professional Education

Moscow, Russia

M. V Klepikova

Russian Medical Academy of Continuing Professional Education

Moscow, Russia

E. Yu Ebzeeva

Russian Medical Academy of Continuing Professional Education

Moscow, Russia

V. A De

Russian Medical Academy of Continuing Professional Education

Moscow, Russia

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