Drug Interactions Workshop

Session Description
Case Authors and Reviewers
Workshop Facilitators and Manual Creators
Learning Objectives

The Drug Interactions Workshop was held on Thursday, May 3, 2018 from 12:00 to 17:00 in conjunction with the CAPhO Conference 2018.

In small groups, participants worked through four drug interaction cases with the support of expert facilitators. The cases were typical of clinically relevant drug interactions encountered in oncology pharmacy practice. Participants made a series of decisions including interpretation of the drug interaction resource information, development of a pharmaceutical care plan including a recommendation, clinical rationale, communication of the plan, and creation of a patient follow up and/or monitoring plan.

Session Description

Proton Pump Inhibitor (PPI) and Tyrosine Kinase Inhibitor (TKI) Interaction

Iryna Knyazevych, BSc, BScPharm, PharmD
This case focuses on discussion around co-administration of acid suppressive therapy with TKIs, particularly, dasatinib and the clinical significance of potential CYP 450 isoenzyme drug interactions with dasatinib.
Meet the patient
MK is a 47-year-old male. Over the last several months, MK has been feeling generally unwell, which prompted him to see his family doctor. A routine blood test was ordered as part of the investigation. Consequently, MK received a diagnosis of Philadelphia Chromosome positive chronic myelogenous leukemia (CML).
Recommended reading
  1. van Leeuwen RW, van Gelder T, Mathijssen RH, Jansman FG. Drug-drug interactions with tyrosine-kinase inhibitors: a clinical perspective.  Lancet Oncol. 2014 Jul;15(8):e315-26. www.ncbi.nlm.nih.gov/pubmed/24988935

QT Prolongation

Maria Anwar, BScPharm, ACPR
Workshop participants will use evidence-based clinical practice tools to identify and assess individual specific risk factors for QTc prolongation and Torsades de points (TdP), determine strategies to manage and minimize the risk of TdP, and discuss their clinical rationale and monitoring plan. Participants will also be provided with resources that can be implemented within their clinical practice in the future to help minimize and manage the risk of QTc prolongation.
Meet the patient
SM is a 68-year-old female with a 3-year history of chronic myelogenous leukemia (CML). Upon diagnosis, she was trialed on imatinib but experienced an intolerable skin rash. For the last 2 1/2 years, she has experienced a complete cytogenetic response (CCyR) and a major molecular response (MMR) with nilotinib 400 mg PO BID. SM presents to your Hematology clinic for ongoing follow up of her CML. Her main complaint in clinic today is increased vomiting, sporadically over the past few days, and decreased appetite due to a suspected GI illness she was exposed to through a household contact. She admits to poor oral intake over the last 3 days and says she started a new medication, ondansetron, which was prescribed by her family physician to help with the vomiting.
Recommended reading
  1. Tisdale J, Drug-induced QT interval prolongation and Torsades de pointes: Role of the pharmacist in risk assessment, prevention and management. CPJ 2016 May;149(3):139-52.
  2. Shah RR. Cardiovascular Safety of Tyrosine Kinase Inhibitors: With a Special Focus on Cardiac Repolarisation (QT interval). Drug Safety 2013 May; 36(5):295-316.
  3. Becker TK. Drug-induced QT interval prolongation in cancer patients. Oncology Review 2010; 4:223-232.
  4. Coppola C et al. Management of QT prolongation induced by anti-cancer drug: target therapy and old agents. Different algorithms for different drugs. Cancer Treatment Reviews 2017

Pharmacokinetic Drug Interaction

Erin Francis, BSc, BScPharm, ACPR
This case focuses on the assessment of a patient prior to BMT for identification and management of potential pharmacokinetic drug interactions.
Meet the patient
ME is a 60-year-old male with acute myeloid leukemia (AML). You are meeting him in the Bone Marrow Transplant (BMT) Planning Clinic to review his current medications for potential drug interactions with his myeloablative conditioning chemotherapy regimen consisting of busulfan and fludarabine prior to an allogeneic BMT. As he is receiving an allogeneic transplant, ME will be started on therapy for the prevention of Graft vs. Host Disease (GVHD) as well as opportunistic infections as part of his transplant protocol. After recovering from his previous induction chemotherapy, ME was found to have a fungal lung infection caused by aspergillosis. His fungal lung infection has now resolved and he is being followed by the Infectious Diseases healthcare team for management.

Complimentary and alternative medicine (CAM) Interaction

Mark Diachinsky, BScPharm
This case identifies some of the complexities of available natural health products in combination with chemotherapy and specifically with children who have cancer. After reviewing the case, practitioners should be able to identify some of the potential interactions that may occur, potential harm and/or benefits, appropriate monitoring parameters, and how to communicate these findings to the patient and other healthcare providers.
Meet the patient
CD is a 9-year-old boy who was diagnosed with high-risk acute lymphoblastic leukemia (ALL) approximately 2 years ago. He underwent chemotherapy as per protocol AALL1131, and is currently in cycle 6 of maintenance therapy consisting of mercaptopurine, methotrexate and pulse courses of prednisone with vincristine. CD is seen in clinic once monthly for a physical examination prior to his vincristine dose. He comes into clinic today for a physical examination and to begin cycle 7 of maintenance. He is being seen by the Oncology healthcare team. His Mother asks about starting a new supplement called ‘Happy Feeling Greens’ powder (the ingredient list is below). She would like to add ½ scoop to a fruit smoothie once daily. She has brought the product in with her and would like to know if it is safe to give to CD. She read online that it would provide a boost to his energy and help reverse the toxic effects from his chemotherapy.
Recommended reading
  1. Gilmour J, Harrison C, Asadi L, Cohen MH, Vohra S. Natural Health Product−Drug Interactions: Evolving Responsibilities to Take Complementary and Alternative Medicine Into Account. Pediatrics. 2011; 128: S155
  2. Latte-Naor S, Sidlow R, Sun L, Li QS, Mao JJ. Influence of family on expected benefits of complementary and alternative medicine (CAM) in cancer patients. Supportive care in Cancer (2018), www.doi.org/10.1007/s00520-018-4053-0

Case Authors and Reviewers

Maria Anwar, Alberta Health Services, South Health Campus, Alberta

Maria graduated with her Bachelors of Pharmacy from the University of Alberta and then went on to complete a hospital residency at London Health Sciences Center in London, Ontario. She is currently a clinical practice leader in Calgary, Alberta and maintains a clinical practice in the Cardio-oncology Clinic and Cardiology Ward at the South Health Campus. She enjoys engaging with patients and their families to help meet their care needs, supporting pharmacy learners and conducting pharmacy practice research. She also has an interest in health promotion, understanding health change behaviours and disease prevention, and leadership and is currently pursuing an executive MBA.

Mark Diachinsky, BScPharm, Clinical Practice Leader – North Zone, Pharmacy Services, Alberta Health Services, Alberta

Mark is a pediatric oncology clinical pharmacist at the Stollery Children’s Hospital in Edmonton, Alberta. He received his BScPharm from the University of Alberta in 2011 and has been practicing in pediatric oncology since graduation. He has practiced in a variety of pediatric settings including neonatal intensive care, cardiology and medicine, although he has primarily specialized in pediatric oncology for the last 7 years. He has developed a knowledge in complementary and alternative medicine as it is a common area of interest for many families. He is currently the Vice-chair of the Education Committee for the CSHP Alberta Branch.

Erin Francis, BSc, BScPharm, ACPR, Pharmacist-Blood and Marrow Transplant and Gynecologic Oncology, Pharmacy Department, The Ottawa Hospital, Ontario

Erin is a clinical pharmacist at The Ottawa Hospital, Ottawa, Ontario. Her current practice is shared between blood and marrow transplant and gynecologic oncology. She completed her Bachelor of Science in Pharmacy at Dalhousie University in 2012 followed by hospital residency training at The Ottawa Hospital in 2013. She is currently completing a Masters of Science in Epidemiology at the University of London-School of Hygiene and Tropical Medicine.   

Iryna Knyazevych, BSc, BScPharm, PharmD, Pharmacy Educator, Cross Cancer Institute, Alberta Health Services, Alberta

Iryna is a pharmacy educator at the Cross Cancer Institute in Edmonton, Alberta. She received her BScPharm from the University of Alberta in 2013 at which point she pursued a career in community pharmacy, followed by hospital practice. Iryna completed her PharmD at the University of Alberta in 2016. Her areas of interest include chronic pain management and palliative care. Iryna enjoys facilitating practice labs and giving lectures at the University of Alberta; she also enjoys precepting students and residents. Iryna is a member of CAPhO Drug Interaction Task Force.

Melanie Danilak, BScPharm, ACPR, MEd, Pharmacy Clinical Practice Leader, Alberta Health Services, Alberta

Marcel Romanick, BScPharm, Clinical Practice Leader, Pharmacy Services, Alberta Health Services, Alberta

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Workshop Facilitators and Manual Creators

Tara Leslie, BSP, BCOP, Clinical Pharmacist and Clinical Assistant Professor, Tom Baker Cancer Centre, and Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Alberta

Tara attained her Bachelor of Science in Pharmacy (BSP) degree from the University of Saskatchewan in 1997, obtained her Board Certification in Oncology Pharmacy (BCOP) in 2010, and acquired her Additional Prescribing Authority (APA) in 2013. She holds positions as Clinical Pharmacist at the Tom Baker Cancer Centre in Calgary and Clinical Assistant Professor with Experiential Education at the Faculty of Pharmacy, University of Alberta.  Tara maintains a clinical practice within the Ambulatory Lymphoma and Chronic Leukemia Clinics and is actively involved with student education as a preceptor and instructor for malignant hematology and oncology complications.  She is an active member of CAPhO and ISOPP serving as Chair of the CAPhO Pharmacist Education Committee and Co-Chair of the ISOPP 2017 Symposium Annual Program Task Force. 

Glenn Myers, BScPharm, ACPR, Clinical Oncology Pharmacist, Ambulatory Oncology, Horizon Health Network, New Brunswick

Glenn is a clinical pharmacist in outpatient oncology and emergency medicine at the Moncton Hospital in Moncton, New Brunswick. Glenn completed a BSc (Pharmacy) at Dalhousie University in 2011 and subsequently went on to complete his hospital residency at the Saint John Regional Hospital in Saint John, New Brunswick. Glenn has been in oncology for 4 years and specializes in assessment and management of chemotherapy and immune-related adverse effects. 

Tiffany Nguyen, BScPharm, ACPR, BCOP, Clinical Pharmacist, Bone Marrow Transplant Program, The Ottawa Hospital, Ontario

Tiffany completed her Pharmacy degree at Dalhousie University and then completed a pharmacy hospital residency at The Ottawa Hospital. She has experience in radiation oncology, hematology, and now has been practicing in the Bone Marrow Transplant Area for approximately 2 years. Tiffany has completed her certification to become a board-certified oncology pharmacist. Tiffany is involved with research in hematology, bone marrow transplant and in clinical key performance indicators for pharmacists.       

Jason Wentzel, BScPharm, ACPR, BCOP, Clinical Pharmacist, Medical Oncology, The Ottawa Hospital, Ontario

Jason completed his Pharmacy degree at Dalhouise University and his Pharmacy Residency at The Ottawa Hospital. He has been practicing as an inpatient medical oncology pharmacist for 6 years and is a board-certified oncology pharmacist. Jason is the pharmacist representative in the Ottawa Hospital Cardio-Oncology Clinic and is involved in research in the areas of cardio-oncology, integration of pharmacy learners into practice, simulation education, oral anticancer therapy and clinical key performance indicators for pharmacists. He is currently the local pharmacist representative for the CAPhO 2018 Conference in Ottawa and is the Regional Clinical Coordinator for the University of Waterloo PharmD program.
Facilitator Manual Creators

Tara Leslie, BSP, BCOP, Clinical Pharmacist and Clinical Assistant Professor, Tom Baker Cancer Centre, and Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Alberta

Glenn Myers, BScPharm, ACPR, Clinical Oncology Pharmacist, Ambulatory Oncology, Horizon Health Network, New Brunswick


Workshop Learning Objectives

  • Assessing patient information and evaluating drug interaction resource materials to identify and prioritize drug interactions commonly seen in oncology practice.
  • Integrating critical thinking and “shared decision making” into drug interaction assessment to develop appropriate recommendations and create suitable monitoring plans. 
  • Articulating drug interaction issues with patients and/or care team providers.
  • Documenting drug interaction assessments, recommendations, and monitoring plans in the permanent patient record.


The Drug Interactions Workshop was accredited by the Canadian Council on Continuing Education in Pharmacy (CCCEP). CCCEP is a national organization established to accredit continuing pharmacy education programs intended to be delivered to pharmacy professionals from more than one province or nationally. CCCEP accreditation is recognized by the pharmacy regulatory authorities in all provinces and territories of Canada.

CEU Credits: 4.2

Accredited by: Canadian Council on Continuing Education in Pharmacy

Expiration Date: May 7, 2018

Pharmacists: #1152-2018-2351-C-P
Technicians: #1152-2018-2352-C-T