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Paeds, MEP, OTC & Misc. > Common drug interactions & SE's & important facts! > Flashcards

Common drug interactions & SE's & important facts! Flashcards

1
Q

What are the CYP450 enzyme substrates?

A
  1. Warfarin
  2. Oral contraceptives
  3. TCAs
  4. Statins
  5. Methadone
  6. Amlodipine
  7. LTRA
  8. Theophylline
  9. ?Corticosteroids
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2
Q

What are the CYP450 inducers? (BTS CRAP GPSS)

A

B - Barbiturates
T - topiramate
S - St John’s Wort

C - Carbamazepine or oxcarbazepine
R - Rifampicin or Rifabutin
A - Alcohol (chronic)
P - Phenytoin

G - Griseofulvin
P - Phenobarbital
S - Sulphonylureus - gliclazide
S - Smoking!

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3
Q

What are the CYP450 inhibitors? (SICKFACES.COM GAVID)

A

S - Sodium valproate
I - Isoniazid
C - Cimetidine
K - Ketoconazole
F - Fluconazole
A - Alcohol (binge)
C - Chloramphenicol
E - Erythromycin or Clarithromycin
S - Sulfonamides - Trimethoprim
.
C - Ciprofloxacin
O - Omeprazole
M - Metronidazole

G - Grapefruit
A - Amiodarone
V - Verapamil
I - Itraconazole
D - Diltiazem

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4
Q

What does grapefruit juice do to some drugs?

A

It’s an enzyme inhibitor => increase plasma concentration!

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5
Q

Which CVS drugs do grapefruit juice increase their plasma concentrations?

A
  • amiodarone
  • statins
  • dihydropyridine CCBs - amlodipine
  • verapamil
  • dronedarone
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6
Q

Which CNS drugs do grapefruit juice increase their plasma concentrations?

A
  • Sertraline
  • quetiapine
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7
Q

Which immunosuppressants do grapefruit juice increase their plasma concentrations?

A
  • tacrolimus
  • ciclosporin
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8
Q

Which OTHER DRUGS do grapefruit juice increase their plasma concentrations?

A
  • phosphodiesterase type-5 inhibitors = sildenafil
  • colchicine
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9
Q

Which common drugs are hepatotoxic?

A
  • antipsychotics
  • amiodarone
  • carbamazepine
  • co-amoxiclav
  • fluconazole
  • fluclox
  • isoniazid
  • ketoconazole
  • labetalol
  • methotrexate
  • paracetamol
  • phenothiazine
  • pioglitazone
  • rifampicin
  • statins
  • tetracycline
  • valproate
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10
Q

Which common drugs are nephrotoxic?

A
  • ACEi
  • aminoglycosides
  • aciclovir
  • ciclosporin
  • cephalosporins
  • Li
  • methotrexate
  • NSAIDs
  • quinolones
  • tacrolimus
  • tetracyclines
  • vancomycin
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11
Q

Which “sick day rules” meds need to be stopped temporarily due to a risk of an AKI. This is because it can result in dehydration, V, diarrhoea, fever or sweats?

A
  • ACEi/ARB - nephrotoxic and reduces eGFr
  • diuretics - exacerbates dehydration and electrolyte disturbance
  • Metformin - increased risk of lactic acidosis in renal impairment
  • NSAIDs - nephrotoxic and reduces eGFR, Na, and water retention
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12
Q

Regarding oral SE’s of drugs, which drugs can cause ORAL ULCERS?

A

1st: ACEi
1st: NSAID
1st: Cytotoxic = methotrexate
Nicorandil
Pancreatin

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13
Q

Regarding oral SE’s of drugs, which drugs can cause ORAL CANDIDIASIS?

A

corticosteroid inhalers

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14
Q

Regarding oral SE’s of drugs, which drugs can cause STAINING OF TEETH

A

Chlorhexidine = brown
Liquid iron = black
1st: Tetracyclines = yellow-grey

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15
Q

Regarding oral SE’s of drugs, which drugs can cause OSTEONECROSIS OF THE JAW?

A

bisphosphonates - esp IV route for treatment of cancer

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16
Q

Regarding oral SE’s of drugs, which drugs can cause GINGIVAL HYPERTROPHY?

A

Phenytoin

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17
Q

Regarding oral SE’s of drugs, which drugs can cause XEROSTOMIA (DRY MOUTH)?

A

1st: antimuscarinics
antipsychotics
1st: opioids
1st: antihistamines
1st: antidepressants

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18
Q

Regarding oral SE’s of drugs, which drugs can cause TASTE DISTURBANCE?

A

1st: ACEi
1st: amiodarone
1st: clarithromycin
1st: metformin
1st: metronidazole
1st: zopiclone
carbimazole
Li

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19
Q

Which type of drugs cause MYELOSUPPRESSION?

A
  • DMARDS - methotrexate
  • antiepileptics - carbamazepine, lamotrigine, phenytoin
  • Abx = chloramphenicol, co-trimoxazole
  • Immunosuppressants - azathioprine, cytotoxics (except vincristine and bleomycin)
  • anti-folates = phenytoin, methotrexate, trimethoprim
  • OTHERS = aminosalicylates, carbimazole, clozapine, mirtazepine
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20
Q

Which antimicrobials cause PHOTOSENSITISATION?

A
  • antifungals = voriconazole (skin cancer)
  • tetracyclines = doxycycline, demeclocycline
  • other Abx = co-trimoxazole, quinolones
  • anti-malarials = hydroxychloroquine, chloroquine
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21
Q

Which other drugs can cause PHOTOSENSITISATION?

A
  • amiodarone
  • tacrolimus
  • vit A
  • isotretinoin
  • benzoyl peroxide
  • topical NSAID
  • phenothiazine antipsychotics = prochlorperazine, chlorpromazine
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22
Q

Which drugs can cause CONTACT SENSITISATION?

A
  • 1st: methotrexate
  • `1st: cytotoxic drugs
  • chlorpromazine
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23
Q

Which drugs cause QT PROLONGATION (increased risk of ventricular arrhythmias)?

A
  • antipsychotic drugs = pimozide
  • antidepressants = citalopram, escitalopram, TCAs, venlafaxine
  • sotalolol, amiodarone
  • Li, 5HTa agonists (sumatriptant), 5-HT3 antagonists (ondansetron), domperidone, metoclopramide, quinine
  • macrolides, chloroquine, quinolones
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24
Q

Which drugs cause HYPOKALAEMIA?

A
  • loop and thiazide diuretics
  • corticosteroids
  • beta2 agonists
  • stimulant laxative overuse
  • theophylline
  • amphoteracin B
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25
Which drugs can increase the RISK OF BLEEDS?
- antiplatelets - NSAIDs, SSRIs, venlafaxine, clopidogel - Anticoagulants - warfarin, heparins, NOACs
26
Which drugs can cause THROMBOEMBOLISM?
- cytotoxics - vinca alkaloids, tamoxifen - Other drugs - oestrogen, tranexamic acid, HRT, COCs
27
Which drugs can cause BRADYCARDIA?
- CVS = BB, amiodarone, digoxin, rate-limiting CCBs (diltiazem, verapamil) - CNS = antimuscarinic
28
Which drugs can cause FIRST-DOSE HYPOTENSION?
- Alpha-blockers - ACEi/ARBs - Nitrates
29
Which drugs can cause HYPOTENSION?
- BB, CCB, ACEi/ARBs, alpha blockers - alcohol, nitrates, diuretics, sildenafil, dopamine receptor agonists
30
Which drugs can cause ANTIMUSCARINIC EFFECTS?
- antimuscarinic - TCA - antihistamine - antipsychotic - clozapine
31
Which drugs can cause CNS DEPRESSANT EFFECTS?
- alcohol - antiepileptics - antihistamines - antipsychotis - benzodiazepines - opioids - Z-drugs
32
Which drugs can cause PERIPHERAL NEUROPATHY?
- amiodarone - phenytoin - isoniazid - metronidazole
33
Which drugs can cause SEROTONIN SYNDROME?
- 5HT1A agonists = sumatriptan - antidepressants = TCAs, MAOI, SSRI, MAO-Bi (selegiline) - 5HT3 antagonists = St John's Wort
34
Which drugs can cause OTOTOXICITY?
- aminoglycosides = gentamicin, cisplatin - glycopeptides = vancomycin - loop diuretics - vinca alkaloids
35
Which drugs can LOWER THE SEIZURE THRESHOLD?
- quinolones - SSRIs - antipsychotics - tramadol - theophylline - Li
36
Which drugs can INCREASE SERUM K+?
- ACEi/ARB - aldosterone antagonists - e.g. spironolactone
37
Which drugs can REDUCE K+?
- theophylline - B2 agonists - salbutamol - corticosteroids - diuretics - stimulant laxative (excessive use)
38
Which drugs can cause HYPONATRAEMIA?
- carbamazepine - diuretics - antidepressants
39
Which drugs are TERATOGENIC?
- anti-folate = methotrexate, trimethoprim - statins - tetracyclines = dental hypoplasia, teeth staining - prostaglandin analogues: misoprostol = miscarriage, induces labour - ACEi/ARBs - isotretinoin - Li - Na valproate - Warfarin = congenital malformations, foetal and neonatal haemorrhage - chloramphenicol = grey baby syndrome - Aspirin/NSAIDs = early closure of ductus arteriosus - Topiramate = cleft palate - Finasteride = feminisation of male foetus - quinolones = arthropathy - aminoglycosides = auditory and vestibular damage in 2nd and 3rd trimester
40
Which drugs can affect BREAST-FEEDING?
- ethosuximide, lamotrigine = high amounts present in breast milk - fluvastatin = high amounts present in breast milk - phenobarbital = inhibits infant's sucking-reflex - bromocriptine = inhibits lactation
41
Which BB's are water soluble?
This means they are a lot less likely to cross the BBB and cause SE's such as nightmares and insomnia: - Atenolol - Celiprolol - Nadolol - Sotalol (CANS) Water soluble BB’s
42
Which BB's are cardioselective?
These BB's are the type to predominately select the B1-adrenoceptors found in the heart, so they are good for asthmatics or a history of asthma. - Atenolol - Acebutolol - Bisoprolol - Metoprolol - Nebivolol (BAtMAN)
43
Which BB's are OD dosing?
- Atenolol - Bisoprolol - Celiprolol - Nadolol (BANC)
44
Which BB's are less likely to cause coldness of extremities, fatigue and bradycardia?
- Pindolol - Oxprenolol - Acebutaolol - Celiprolol (A POC) Intrinsic sympathomimetic
45
What is the vitamin D (colecalciferol) conversion?
400 units = 10 mcg
46
Regarding NSAIDs and GI events, which type of NSAIDs have the lower risk?
Selective COX-2 inhibitors
47
Regarding NSAIDs and GI events, which NSAIDs have the highest risk?
- Piroxicam - Ketoprofen - Ketorolac trometamol
48
Regarding NSAIDs and GI events, which NSAIDs have the intermediate risk?
- Diclofenac, - Naproxen - Indomethacin
49
Regarding NSAIDs and GI events, which NSAIDs have the lowest risk?
Ibuprofen
50
Regarding NSAIDs and CVS events, which NSAIDs have the highest risk?
Selective COX-2 inhibitors: - Diclofenac 150mg/day + ibuprofen 2.4g/day have the highest risk (HOWEVER, low-dose ibuprofen 1.2g/day has not been associated with an increased risk) - Naproxen 1g/day has a lower risk
51
What nutritional deficiencies are found in short bowel syndrome?
Vitamins A, B12, D, E and K, essential fatty acids, zinc, and selenium
52
Which drugs can induce dyspepsia?
- Bisphosphonates - NSAIDs, Aspirin - Corticosteroids - CCB - BB - Nitrates - Benzodiazepines - Antimuscarinics - Theophylline - Tricyclic AEDs
53
Neonatal drugs
- Caffeine citrate => increase breathing rate - Vitamin K => thickens blood - Labinic => probiotic - Folic acid => give to breastfeeding mothers - Sytron (sodium feredetate) => give after 28 days as they cannot absorb the iron - Sucrose 24% solution => helps decrease their pain threshold - Pseudoephedrine eye drops => dilate eyes for the drs to see if there is any form of detachment of the eye - Curosurf => surfactant for lungs - Sodium phosphate (PO/NG) => rickets
54
Drug induced DM?
- thiazides - glucocorticoids - BB - mask hypoglycaemia - atypical antipsychotics = clozapine, olanzapine, quetiapine - ciclosporin - nicotinic acid - protease inhibitors - tacrolimus
55
Corticosteroids SE's (ACHING BOSOM)
A = Adrenal suppression, increased appetite, abrupt withdrawal reactions C = Cushing's syndrome, cataracts H = Hyperglycaemia (DM), hyperlipidaemia I = Infections, insomnia N = NS: psychiatric reactions G = Glaucoma, GI ulcers B = Increase BP O = Osteoporosis S = Skin thinning O = Obesity M = Muscle wasting
56
Antipsychotics - Best to treat negative symptoms of schizophrenia?
2nd gen antipsychotics = amisulpride, aripiprazole, quetiapine
57
Antipsychotics - best to treat extrapyramidal SE's?
2nd gen antipsychotics = aripiprazole, quetiapine, olanzapine least likely to cause this
58
Antipsychotics - the least effect on the QT interval?
Aripiprazole
59
Antipsychotics - Worst effect for QT intervals?
haloperidol + pimozide
60
Antipsychotics - the drugs that have a small chance of causing QT prolongation?
risperidone prochlorperazine, olanzapine, amisulpride
61
Antipsychotics - Pts with schizophrenia are more likely to develop insulin resistance and DM. Which antipsychotics are less likely to cause this?
1st gen typically have the lowest risk with haloperidol being the best! 2nd gen - amisulpride + aripiprazole have the lowest risk in this gen class
62
Antipsychotics - Which are least likely to cause weight gain?
amisulpride, sulpride, aripiprazole, haloperidol
63
Antipsychotics - Which causes a sexual dysfunction effect?
risperidone + haloperidol commonly cause this effect!
64
Antipsychotics - Which drugs commonly cause postural hypotension during initial dosage?
quetiapine, chlorpromazine
65
Antipsychotics - which drugs cause hyperprolactinemia?
2nd gen antipsychotics = risperidone + amisulpride are most likely to cause this Increase in prolactin = decreased fertility

Paeds, MEP, OTC & Misc. (28 decks)

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