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PCEUT 510 > #4 PD Interactions > Flashcards

#4 PD Interactions Flashcards

1
Q

What are the TWO types of MAOI interactions?

A
  1. Indirect-acting sympathomimetics

2. Serotonergic drugs

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2
Q

What is the only REVERSIBLE MAOI mentioned?

A

Moclobemide

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3
Q

Name some IRREVERSIBLE MAOIs

A
  1. Isocarboxazid (marplan)
  2. Phenelzine (nardil)
  3. Selegiline (eldepryl)
  4. Tranylcypromine (Parnate)
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4
Q

This MRSA antibiotic is a MAO-A & B inhibitor

A

Linezolid

increases pressor effect of sympathomimetics

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5
Q

Which 2 drugs can have a synergistic effect increasing BP?

A

Linezolide + Pseudoephedrine

[both can individually increase BP. Together they are synergistic]

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6
Q

This is the only given MAO-A inhibitor that does NOT inhibit MAO-B

A

Moclobemide

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7
Q

These are the two MAO-B inhibitors that do NOT inhibit MAO-A

A

Rasagiline, Selgiline (under 10 mg per day)

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8
Q

Avoid taking this antibiotic with Sudafed

A

Linezolid

[note: NO interaction with dextromethorphan]

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9
Q

T/F:

Serotonin Syndrome is always drug related

A

TRUE

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10
Q

Serotonin syndrome can be confused with this occurrence

A

Neuroleptic Malignant syndrome

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11
Q

These are the 5 highlighted symptoms of Serotonin syndrome

A
  1. tremor
  2. myoclonus
  3. rigidity
  4. sweating
  5. agitation
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12
Q 
What do all these drugs have in common? 
Dextromethorphan
Buspar
TCA's
SSRIs 
Tramadol 
Meperidine
Sibutramine
Trazadone 
Vilazodone
A

SEROTONERGIC drugs

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13
Q

Paroxetine is an inhibitor of what enzyme?

A

2D6

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14
Q

The [3A4/2D6] metabolite of tramadol is active?

A

2D6

(the 3A4 metabolite is INACTIVE)

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15
Q

[O/N]-desmethytramadol is processed by 2D6 and is ACTIVE

A

O-desmethyl tramadol

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16
Q

Paroxetine + tramadol can cause what SE?

A

Serotonin syndrome

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17
Q

T/F: Dextromethorphan has case reports of causing serotonin syndrome with SSRIs

A

TRUE

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18
Q

What common OTC analgesic increases BP?

A

NSAIDs

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19
Q

T/F:
ACEI are most sensitive to BP effects of NSAIDS, followed by ARBs, BB, and diuretics.
CCBs have minimal effects.

A

TRUE

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20
Q

This class of drugs will reduce the effectiveness of ACEIs

A

NSAIDS

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21
Q

ACEI + NSAID will lead to a(n) {INCREASE/DECREASE] in GFR?

A

DECREASE

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22
Q

This major HTN Class seems to have the least effect from NSAID administration

A

CCB

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23
Q

T/F:

Metabolic inhibition significantly INCREASES QTC prolongation

A

FALSE

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24
Q

Name 4 drugs most often involved in QT prolongation DDIs

A
  1. Ondansetron
  2. Amiodarone
  3. Metronidazole
  4. Haloperidol
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25
Q

What categories of drugs are expected to INCREASE QTc at therapeutic concentrations?

A 
Class I antiarrhythmic agents 
Class III antiarrhythmic agents 
Other: 
-Moxifloxacin 
-Ceritinib 
-Lumefantrine
26
Q

List 7 antiarrhythmic agents expected to increase QTc at therapeutic concentrations.?

A 
Class I antiarrhythmic agents 
-quinidine
-procainamide 
-disopyramide 
Class III antiarrythmic agents 
-amiodarone 
-sotalol
-Ibutilide 
-Dofetilide
27
Q

Which antibiotic is expected to INCREASE QTc at therapeutic concentrations?

A

Moxifloxacin

28
Q

What categories of drugs may produce extended QTc intervals, especially at elevated plasma concentrations?

A
  1. antibiotics
  2. TCAs
  3. Antipsychotics
  4. GI agents
29
Q

Name 2 antibiotics which may produce extended QTc intervals, especially at elevated plasma concentrations?

A
  1. Clarithromycin

2. Erythromycin

30
Q

Name 2 antidepressants which may produce extended QTc intervals, especially at elevated plasma concentrations?

A
  1. Imipramine

2. Desipramine

31
Q

Name 4 antipsychotics which may produce extended QTc intervals, especially at elevated plasma concentrations?

A
  1. haloperidol
  2. Pimozide
  3. Thioridazine
  4. Ziprasidone
32
Q

Name a GI agent which may produce extended QTc intervals, especially at elevated plasma concentrations?

A

Cisapride

33
Q

T/F:

Patients on multiple QTc prolonging drugs will experience an additive effect

A

FALSE

34
Q

AVOID use of 2 QTc prolonging drugs if they have BOTH PD & ______ QTc prolonging effect.

A

PK

35
Q

Cisapride + Erthromycin
and
quinidine + thioridazine are 2 examples of what type of interactions?

A

PD & PK
prolonging effect
[use together if benefit outweighs risk]

36
Q

What QT prolongation strategy should you use with two drugs:
Dofetilide + Propafenone?

A

BOTH are antiarrhythmic agents that are expected to INCREASE QT at therapeutic concentrations:
AVOID

37
Q

What QT prolongation strategy should you use with these two drugs:
quindine + thioridazine

A 
Quinidine = 2D6 INHIBITOR; can cause QT prolongation at normal concentrations 
Thioridazine = 2D6 substrate; can cause QT prolongation at HIGH concentrations

ANY drug expected to INCREASE QTc + a drug that may INCREASE QTc with PK and PD interaction potential:
AVOID

38
Q

What QT prolongation strategy should you use with these two drugs:
Procainamide + Haloperidol

A 
Procainamide = antiarrhythmic @ normal concentration
Haloperidol = antipsychotic @ elevated concentration

Drug expected to INCREASE QTc at therapeutic concentrations + a drug that may INCREASE QTc w/o PK interaction:
Use only if the benefits outweighs risk

39
Q

What QT prolongation strategy should you use with these two drugs:
Cisapride + Erythromycin

A 
Cisapride = GI agent; 3A4 SUBSTRATE
Erythromcyin = antibiotic; 3A4 INHIBITOR 
DDI = PK interaction

Drug expected to INCREASE QTc at therapeutic concentrations and have a PK interaction: Use only if the benefits outweighs risk

40
Q

What QT prolongation strategy should you use with these two drugs:
Clozapine + Ziprasidone

A

Both antipsychotics

Any 2 drugs that may INCREASE QTc & do NOT have a PK interaction:
Assess risk and monitor as indicated

41
Q

T/F:

Risk of bleeding increased when anticoagulants are added together or combined with NSAIDS

A

TRUE

42
Q

Name 2 drugs which are NOT anticoagulants but significantly INCREASE risk of bleed with warfarin?

A
  1. amiodarone

2. Bactrim (2C9 INHIBITOR)

43
Q

T/F:

Warfarin & Levothyroxine have a dangerous DDI and must NOT be used together

A

FALSE

[adjust doses based on labs as usual]

44
Q

Reversible MAOI (1)

A

Moclobemide

all others are IRREVERSIBLE

45
Q

Linezolid + Sudafed DDI

A

Linezolid = IVA w/mild MAOI activity = increases BP
Sudafed = increases BP
Linezolide + Sudafed = INCREASED BP, more than what would be if purely additive

= Synergistic

46
Q

Paroxetine + tramadol DDI

A

PK: tramadol is 2D6 Substrate; paroxetine is 2D6 inhibitor
PD: both have 5HT properties

Paroxetine + tramadol = risk for serotonin syndrome via both PK & PD interactions

[magnitude of PK DDI depends on 2D6 polymorphisms]

47
Q

What happens when you use paroxetine to inhibit 2D6 metabolism of tramadol?

A

Tramadol =2D6=active analgesic metabolite
Tramadol =3A4 = inactive

More Tramadol goes down 3A4 path= LESS analgesia

48
Q

Tramadol + terbinafine DDI

A 
Terbinafine = 2D6 inhibitor; 5HT properties 
Tramadol = 2D6 minor substrate; inhibits 5HT reuptake

= INCREASED [tramadol] exposure

Both PK & PD interactions = risk of serotonin syndrome

49
Q

Tramadol + Itraconazole DDI

A

Itraconazole = 3A4 inhibitor
Tramadol’s metabolite gets cleared by 3A4

= NO change in tramadol, but INCREASED [metabolite] = risk for serotonin syndrome

50
Q

NSAIDS that INCREASE BP more (2)

A

Indomethacin

Piroxicam

51
Q

If…
Drug A = known to prolong QTc
Drug B= known to prolong QTc
Then….

A

AVOID COMBO

52
Q

If…
Drug A = known to prolong QTc
Drug B= MAYBE to prolong QTc + additional PK interaction
Then….

A

AVOID COMBO

53
Q

If…
Drug A = known to prolong QTc
Drug B= known to prolong QTc & NO PK interaction
Then….

A

Use cautiously if benefit > risk

54
Q

If…
Drug A = MAYBE prolong QTc
Drug B= MAYBE prolong QTc + PK interaction
Then….

A

Use cautiously if benefit > risk

55
Q

If…
Drug A = MAYBE prolong QTc
Drug B= MAYBE prolong QTc & NO PK interaction
Then….

A

Use and Monitor

56
Q

Dofetilide + propafenone okay?

A

Both are known to cause QT prolongation = AVOID USE

57
Q

Quinidine + thioridazine okay?

A

Quinidine = known
thioridazine = maybe + PK interaction =
AVOID

58
Q

Procainamide + haloperidol okay?

A

Procainamide = known
haloperidol = maybe NO PK interaction=
Caution, use if benefit > risk

59
Q

Cisapride + erythromycin okay?

A

Cisapride = maybe
Erythromcyin = maybe + PK interaction =
Caution, use if benefit> risk

60
Q

Clozapine + ziprasidone okay?

A

Clozapine = maybe
Ziprasidone = maybe
=
Use + Monitor

PCEUT 510 (12 decks)

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