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Pharm 3 > Drug interaction > Flashcards

Drug interaction Flashcards

1
Q

Name 3 categories of drug interactions

A

Incompatibility, Pk interaction, Pd interaction

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2
Q

Two types of incompatibilities

A

Physical and chemical

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3
Q

Three types of chemical incompat

A

Precipitation, chelation, binding

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4
Q

Effects of incompatibilities (4)

A

Damage from toxic compound, particle emboli, change pH leading to tissue irritation, therapeutic failure

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5
Q

Name the 6 drugs incompatible with any others

A

ADDPNT- aminoglycosides, diazepam, digitalis, pentobarbital, NaHCO3, theophylline

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6
Q

Effect of ket and valium

A

Precipitate

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7
Q

Effect of doxy and calcium gluconate

A

Chelation from pH difference

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8
Q

Doxy + anything with a metal ion

A

Precipitate- poop it out, less efficacy

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9
Q

Name two drugs that interact with IV tubing

A

Plastic binding- insulin and diazepam

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10
Q

4 changes due to Pk interaction

A

Change absorption, distribution, metabolism, elimination

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11
Q

What is the most common type of drug interaction

A

Pk

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12
Q

Omperazole and ketoconazole

A

Omep increases pH = decreased keto absorption by 50%

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13
Q

Effect of antacids on absorption

A

Increased pH = decreased abs of weak acids and increased abs of weak bases

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14
Q

Effect of infection or any decrease in pH

A

Increased abs of weak acids and decreased abs of weak bases

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15
Q

Metaclopramide + digoxin

A

Increased gastric emptying = dec abs of delayed release Rx

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16
Q

Epinephrine and lidocaine

A

Increased vasoconstriction leads to prolonged local effect

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17
Q

Insulin and NaCl

A

Decreased absorption due to pH change leads to hyperglycemia

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18
Q

When two drugs compete for protein binding- what happens

A

The more potent drug will become even more potent bc it loses the competition for protein binding- increased toxicity risk

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19
Q

Phenobarb and kepra

A

Phenobarb increases enzymes to speed metabolism- leads to need for 30% more levetiracetam for efficacy

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20
Q

Phenobarb + ammonium chloride

A

Increased elimination

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21
Q

Phenobarb + NaHCO3

A

Decreased elimination

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22
Q

Pharmacodynamic effects of interaction

A

Synergistic or antagonistic

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23
Q

Methods of Pd interaction

A

Same receptor, common process (diff recep), same final pathway

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24
Q

B blockers and Ca blockers

A

Bradycardia

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25
Q

NSAIDs and steroids

A

Ulcers

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26
Q

Aminoglycosides and amphoteracin B

A

synergistic

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27
Q

Digoxin + furosemide

A

Antagonistic

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28
Q

Digoxin and hypokalemia

A

Digoxin inhibits NaK pump, increasing intracell Ca- when K low, increased binding occurs- toxicity

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29
Q

Digoxin and hyperkalemia-

A

Decreased binding and decreased efficacy

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30
Q

Digoxin and quinidine

A

Compete for receptors- leads to decreased renal clearance of digoxin

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31
Q

Digoxin and diuretics-

A

Digoxin leads to hypokalemia - increaed binding- toxicity

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32
Q

Hypercalcemia and digoxin

A

Increased effects

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33
Q

Hypomagnesemia and digoxin

A

Arrhythmias

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34
Q

Steroids - effect on lab tests

A

Increased ALP

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35
Q

KBr- - effect on lab tests

A

Artifact increase in Cl

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36
Q

Phenobard- effect on lab tests

A

Increased liver enzymes, neutropenia

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37
Q

Methimazole, acetominophe- effect on lab tests

A

Methemoglobinemia

38
Q

NSAIDs- effect on lab tests

A

Platelet dysfunction

39
Q

Chemo, estrogen, griveofulvin, phenylbutazone- effect on lab tests

A

Bone marrow suppression

40
Q

Levetiracetam- cautions

A

Decreaed efficacy with phenobarb

41
Q

Diazepam- cautions

A

Precipitate with ketamine, not compatible with anything

42
Q

Sucralfate- cautions

A

Binds with many drugs (tetracyclines, FQs, cimetidine, phenytoin, phenobarb, griseofulvin, milk)

43
Q

Ketoconazole- cautions

A

With antacid increases pH decreasing absorption by 50% or more

44
Q

Digoxin- type of interaction

A

inhibitor (Slow metabolism = increase concentration)

45
Q

Digoxin + metoclopramide

A

Increased gastric emptying = decreased absorption

46
Q

What drugs inhibit p450

A

Cimetidine, chloramphenicol, ketoconazole, omeprazole

47
Q

What drugs are inducers

A

Levetiracetam, phenobarbitol

48
Q

What drugs are inhibitors

A

Ketoconazole, cimetidine,

49
Q

Define inducer

A

Induce metabolism- Decrease the potency or duration of others

50
Q

Define inhibitor

A

Slowing metabolism to increase plasma concentration- Increase duration and potency of other drugs

51
Q

Levetiracetam- MOA

A

Anticonvulsant SVA2 binder

52
Q

Levetiracetam- type

A

Inducer

53
Q

Levetiracetam with phenobarbital

A

Need 30% more leve because of increased enzymes from phenobarb use

54
Q

Phenobarbital - MOA

A

Barbituate - EP/NE inhib, GABA mimetic

55
Q

Phenobarbital + Ammonium chloride

A

Increased elimination

56
Q

What drug increases the phenobarbital effect

A

Chloramphenicol

57
Q

Phenobarbital + NaHCO3

A

Decreased elimination

58
Q

Phenobarbital - type

A

Inducer

59
Q

Phenobarbital - drugs effected

A

Cyclosporine, levetiracetam, Bblockers, metronidazole

60
Q

Cimetidine- MOA

A

H2 inhibitor

61
Q

Cimetidine- type

A

Inhibitor

62
Q

Cimetidine- interactions

A

Decreased metabolism/increased effectiveness of diazepam, chloramphenicol, lidocaine, metronidazole

63
Q

Chloramphenicol- MOA

A

50S cidal, p450 inhibitor

64
Q

Chloramphenicol- effect on anesthesia

A

Prolongs

65
Q

Chloramphenicol + cimetidine

A

increased chlor toxicity due to decreased metabolism

66
Q

Ketoconazole- MOA

A

Antifungal azole- membranes, p450 inhibitor

67
Q

Ketoconazole- type

A

Inhibitor

68
Q

Ketoconazole- effects

A

Increases efficacy of benzos, cyclosporine, digoxin

69
Q

Ketoconazole + H2 blockers or PPI

A

decreased efficacy

70
Q

Omeprazole- MOA

A

PPI (blocks HCl), p450 inhibitor

71
Q

Omeprazole- effects

A

increased pH decreases acidic drug absorption (ex. ketoconazole); prolonged duration/increased bioavailability of diaz, cyclo, digoxin)

72
Q

Sucralfate- binds:

A

Tetracyclines, FQs, cimetidine, phenobarb

73
Q

Diazepam- MOA

A

Serotonin agonist, increased GABA

74
Q

Diazepam- Interactions

A

Cimetidine, ketoconazole, omeprazole increase levels; phenobarb decreases

75
Q

Diazepam- type

A

Metabolites formed

76
Q

KBr- additive effect

A

Increase sedation

77
Q

KBr- what effects efficacy negatively

A

Increased salt in diet

78
Q

Digoxin + diuretics

A

Decreased potassium

79
Q

What drugs decrease digoxin efficacy

A

Alluminum hydroxide, antacids, sucralfate, chloramphenicol, cimetidine, phenobarb

80
Q

What drugs increase digoxin efficacy

A

Cyclosporine, diazepam, ketoconazole, omeprazole

81
Q

Chloramphenicol- interactions

A

dec digoxin

82
Q

Cimetidine- interactions

A

dec digoxin, keto; inc chloram/diaz

83
Q

Diaz– interactions

A

Increase digoxin

84
Q

Keto- interactions

A

inc diaz/digoxin/cyclosporin

85
Q

Omeprazole- interactions

A

decrease keto; inc digoxin/diaz

86
Q

Phenobarb- interactions

A

Lower levetiracetam, diaz

87
Q

Digoxin + increased K

A

decreased binding/efficacy

88
Q

Digoxin + decreased K

A

increased binding/toxicity

89
Q

Digoxin + increased Ca

A

Inc efficacy and Ca

90
Q

Digoxin + decreased Mg

A

Arryhthmias

91
Q

Digoxin + quinidine

A

Decreased renal clearance

Pharm 3 (8 decks)

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