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RC Pearls > CYP interactions > Flashcards

CYP interactions Flashcards

1
Q

Fluvoxamine

A

Strong inhibitor *1A2 /2C19
Mod inhibitor 2C9/ *3A4

Substrate: 2D6, 1A2

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2
Q

Fluoxetine
Norfluoxetine

A

FLUOXETINE:
Strong inhibitor 2D6
substrate: 2D6

NORFLUOXETINE (active metabolite)
Mod inhibitor 3A4

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3
Q

Paroxetine

A

Strong inhibitor *2D6
Weak inhibitor *2C9 and 2C19
Substrate: 2D6

note* carbamazepine reduces paroxetine levels by 28%

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4
Q

Sertraline

A

Mod inhibitor 2D6
Substrate: 3A4, 2D6, 2C19, 2C9

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5
Q

Citalopram, Escitalopram

A

Substrate: 2C19

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6
Q

Venlafaxine
Desvenlafaxine

A

Venlafaxine:
Mild inhibitor 2D6
Substrate: 3A4, 2D6

Desvenlafaxine: active metabolite, not metabolized by 2D6

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7
Q

Duloxetine

A

moderate inhibitor 2D6
Substrate: 2D6

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8
Q

Buproprion

A

Mod inhibitor 2D6

Substrate: 2B6 (not D)

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9
Q

Mirtazapine

A

Substrate: 2D6, 3A4, and (lesser extent) 1A2

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10
Q

Meds that decrease epival levels

A

Carbamazepine (tegretol)
+ Phenytoin (dilantin)

Phenobarbital
Rifampin
Lamotrigine decreases VPA by 25%

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11
Q

Meds that increase epival

A

ASA + Ibuprofen
Chlopromazine
Luvox + Prozac + Amitryptyline
Topiramate
Erythromycin

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12
Q

Epival increases levels of:

A

Lamotrigine x2
Dilantin
Diazepam
No interaction with OCP

Clomipramine & TCAs
Phenobarbital

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13
Q

Clomipramine Luvox interaction

A

Luvox inhibits metabolism clomipramine via CYPA 1 A2

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14
Q

Epival & Phenobarbital interaction

A

Phenobarbital decreases epival levels

Epival increases phenobarbital levels via CYP2C9

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15
Q

Epival in pregnancy - % neural tube defects, spinal bifida

A

Neural tube defects = 5%

Spina bifida = 1-2 %

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16
Q

What to prescribe if VPA must be used in pregnancy

A

Folic acid 5mg DIE x14 weeks then 0.4–1mg DIE

Vitamin K x last 6 weeks pregnancy (reduce bleeding risk)

17
Q

Lamotrigine MoA

A

Sodium channel blockade
Inhibition glutamate release

18
Q
A

RC Pearls (4 decks)

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