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Pre-Registration Revision > Drug Interactions > Flashcards

Drug Interactions Flashcards

1
Q

What are some common drug interactions with ACE inhibitors and ARBs?

A

K+ increasing drugs- increased risk hyperkalaemia, hypotension and renal impairment

Alcohol- enhanced hypotensive effect

Diuretics- enhanced hypotensive effect

Lithium- reduces lithium excretion= toxicity

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2
Q

What are some common drug interactions with beta-blockers?

A

ACE inhibitors- enhanced hypotensive effect

Anti-arrhythmic drugs- ventricular arrhythmias

Antidepressants (citalopram, escitalopram and venlafaxine)- risk of ventricular arrhythmia

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3
Q

What are some common drug interactions with CCBs?

A

Alcohol- increased hypotension risk

Simvastatin- max 20mg dose when used alongisde verapamil, amlodipine and diltiazem

Carbamazepine- may reduce CCB levels

Grapefruit juice- increase in plasma conc. of CCB

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4
Q

What are some drugs that tend to be contraindicated or need dose adjustements in CKD and AKI?

A

NSAIDs (avoid)
Diabetes medications (adjust)
PPIs (adjust)
Statins (adjust)
ACE inhibitors (adjust)

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5
Q

Why is the use of digoxin alongside quinidine contraindicated?

A

Can lead to a significant increase in digoxin plasma concentration

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6
Q

Why should sildenafil and isosorbide mononitrate not be used together?

A

Sildenafil can hugely increase the hypotensive effects of iso.

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7
Q

What are some common drugs that should not be used alongside warfarin/need to be monitored?

A

-Aspirin and clopidogrel- bleed risk (all anticoagulants and antiplatelets)
-Azathiprine- decreases warfarin effect
-Budesonide- inreases effects of warfarin
-NSAIDs’
-Antidepressants: citalopram, paroxetine
-Antibiotics: doxycycline, amoxicillin, ciprofloxacin, clarithromycin, metronidazole
-Ketoconazole and fluconazole

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8
Q

What are some drug examples of enzyme inducers?

A

Sulphonylureas
Carbamazepine
Alcohol
Rifampicin
Phenobarbital
Cigarette smoke
Griseofulvin
Phenytoin
St John’s Wort

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9
Q

What are some examples of enzyme inhibitor drugs?

A

Ciprofloxacin
Isoniazid
Cimetidine
Sulfonamides
Alcohol binge drinking
Metronidazole
Chloramphenicol
Grapefruit juice
Omeprazole
Fluconazole
Ketoconazole
Erythromycin
Sodium valproate

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10
Q

What drugs are contraindicated or cautioned in heart failure?

A

NSAIDs- CI
Pioglitazone- CI
Beta blockers- CI
Saxogliptan- Cautioned

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11
Q

What drugs are contraindicated and cautioned in asthma?

A

Beta-blockers: CI
Aspirin- caution
NSAIDs- caution

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12
Q

What drugs are contraindicated and cautioned in epilepsy?

A

Tramadol- CI
SSRIs- CI
Quinolones- Caution
Burpropion- CI
Antihistamines- Caution

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13
Q

Drugs in Children

-Aspirin- avoid in under 16s
-Codeine- avoid in under 12s due to increased risk of _ side-effects
-Tetracycline- avoid in under 12s
-Bonjela- avoid in under 16s

A

Respiratory

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14
Q

Antibiotics in Pregnancy

Carrying Mothers Cannot Take Antibiotics

Clarithromycin
Metronidazole
Chloramphenicol
Tetracyclines
Aminoglycosides

A
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15
Q

What drugs can interact witb SSRIs?

A

-NSAIDs- increased bleeding risk
-Grapefruit juice- can increase SSRI levels
-St John’s Wort- serotonin syndrome risk
-Tamoxifen- may reduce levels
-Lithium- Increased QT prolongation risk

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16
Q

What are four drugs that can cause vitamin B deficiency?

A

Metformin
PPI
H2-receptor antagonists
Colchicine

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17
Q

Methotrexate Interactions

Increases toxicity risk:
- Aspirin
-Amoxicillin
-NSAIDs
-Ciprofloxacin
-PPI’s (decreases clearance of methotrexate)
-Flucloxacillin
-Herpes vaccine/Flu vaccine (live)/MMR vaccine (live)- increased generalised infection risk
-Indometacin
-Levetiracetam
-Phenoxymethylpenicillin
-Trimethoprim

A

.

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18
Q

What are some medications that interact with oral antifungals?

A

CYP3A4 inducers (carbamazepine, phenobarbital, phenyotin etc)

Anticoagulants/antiplatelets, such as warfarin, clopidogerel and aspirin

Some antibiotics such as ciprofloxacin and erythromycin

Some antipsychotics

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19
Q

Beta-Blocker Contraindications

  • Asthma/COPD (cardioselective beta-blocker can be used if no alternative)
    -Sick sinus syndrome
    -Sinus bradycardia (HR less than 60BPM at start of treatment)
    -Severe hypotension (systolic less than 100mmHg)
    -Uncontrolled HF

Cautioned in:
-Diabetes
-Psoriasis
-Myasthaneia gravis

A

.

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20
Q

Key Beta-Blocker Drug Interactions

-ACEi and ARBs- enhanced hypotensive effect

-Parkinsons medication, Baclofen, ANxiolytics, Diuretics, MAOIs- enhanced hypotensive effect

-TCAs/mirtazapine/trazadone- increased postural hypotension risk

-Antidiabetic drugs- can mask hypoglycaemia

-CCBs- verapamil+BB can cause bradycardia and HF. Diltiazam can cause bradycardia and AV block. Nifedipine can cause HF and severe hypotension. Other CCBs can cause an enhanced antihypertensive effect.

-Amiodarone, flecainide and Quinidine- bradycardia and myocardia depression

-Clonidine- risk of withdrawal hypertension

-Corticosteroids, oestrogrens- hypotensive effect antagonised

-Digoxin-Reduce HR and prolong AV conduction time, increasing AV block and bradycardia risk. Monitor pulse carefully.

-NSAIDs- hypotensive effect antagonised

A

.

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21
Q

At what heart rate at the start of treatment would beta-blocker use be contraindicated?

A

Below 60 BPM

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22
Q

What are some drugs that interact with beta-blockers?

A

ACEis and ARBs
NSAIDs
Clonidine
Amiodarone/Flecainide/Quinidine
Corticosteroids
Oestrogens
Digoxin
Parkinsons medication
Baclofen
CCBs
Antidiabetic drugs
TCAs/mirtazapine/trazodone

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23
Q

What are some foods that can interact with anticoagulants?

A

Cranberry juice
Garlic
Ginger
Certain vegetables (asparagus, broccoli, cauliflower etc)

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24
Q

What can happen if you combine trimethoprim with methotrexate?

A

Bone marrow suppression- AVOID

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25
Q

Commonly Assessed Drug Interactions

-Aspirin/NSAIDs with Warfarin- increased bleeding risk

-Diuretic combinations

-Digoxin and quinidine- increased digoxin levels, may need to reduce by half.

-Digoxin and broad-spectrum antibiotics- can double serum digoxin levels

-Sildenafil and isosorbide mononitrate- Increased hypotensive effects

-Amiodarone and clarithromycin- prolonged QTc interval, avoid if possible

-Clarithromycin and simvastatin- increased myopathy risk, withhold simvastatin if clarithromycin taken.

A

.

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26
Q

What can happen if clarithromycin and simvastatin are taken together?

A

Increased myopathy risk

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27
Q

What can happen if digoxin is taken alongside quinidine?

A

Significantly increased digoxin levels, may need to reduce dose by up to a half

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28
Q

Alcohol-Drug Interactions

-Metronidazole- AVOID for up to 7 days after course finishes
-Warfarin- may affect INR and anticoagulation effect
-MAOI- can cause hypertensive crisis
-Mirtazapine or TCAs- increased sedative effect

A

.

29
Q

Enzyme (P450) Inducers- Increases specific drug metabolism

Rachael’s Black Car Goes Putt Putt and Smokes

Rifampicin
Barbiturates
Carbamazepine
Griseofulvin
Phenytoin
Phenobarbitone
Smoking cigarettes

A

.

30
Q

Enzyme (P450) Inhibitors- Decreases specific drug metabolism

Isoniazid
Cimetidine
Grapefruit
Disulfiram
Quinolones
Fluconazole
Sodium valproate

A

.

31
Q

Remember: Lithium + thiazide diuretics can cause hyponatraemia.

A
32
Q

What are some drugs that can cause fluid retention?

A

NSAIDs
Corticosteroids

33
Q

Liver Disease and Drugs that May Cause Issues

-Amlodipine: may need a dose reduction

-Antacids- avoid in patients with fluid retention

-Anticoagulants- avoid if prothrombin time increased

-Carbamazepine- metabolism impaired, increased conc.

-Chloramphenicol- AVOID

-Clarithromycin/Co-amoxiclav/flucloxacillin- cholestatic jaundice, need to monitor

-Metformin- advised to avoid

-Metronidazole- reduce total daily dose to 1/3 if severe

-NSAIDs- AVOID

-Opioids- avoid or reduce dose

-Phenytoin- reduce dose

-Paracetamol- avoid large doses

A

.

34
Q

Drug Induced Blood Dyscrasia and Agrunulocytosis

-Dyscrasia- a pathological condition of the blood, usually involving cellular elements.

Drugs that pose a risk:
-Aminosalicylates, such as sulfasalazine
-Carbimazole
-Methotrexate
-Clozapine
-Carbamazepine
-Captopril

-If a drug is given to a patient and the drug poses a risk, patient should be advised to monitor for unexplained bleeding, bruising, a sore throat, infections, fever and malaise.

A

.

35
Q

What happens if you combine simvastatin and amlodipine?

A

Significantly increases simvastatin levels; 20mg is the max dose of simvastatin that should be used alongside amlodipine

36
Q

Which juice should be avoided whilst taking warfarin?

A

Cranberry juice

37
Q

What happens if a patient takes carbamazepine and apixaban?

A

Severe interaction; significantly decreases apixaban exposure, so increases blood clot risk

38
Q

What can happen if you take digoxin and diuretics together?

A

Can cause hypokalaemia, which is an example of digoxin toxicity.

39
Q

Why should the use of tetracycline antibiotics be avoided alongside lithium?

A

Risk of lithium toxicity.

40
Q

What happens if you combine allopurinol and azathioprine?

A

Significantly increases azathioprine expoure, may need to reduce dose to 1/4 of usual dose.

41
Q

What can happen if you combine colchicine with simvastatin?

A

Increased risk of rhabdomyolysis

42
Q

What are they key interactions with amiodarone?

A

Decreased warfarin metabolism- bleed risk
-Increased digoxin levels

43
Q

Amiodarone interacts with drugs that are commonly used alongside it, such as p450 inhibitors. For example, it decreases the metabolism of warfarin.

True or false?

A

True

44
Q

What is the interaction between clarithromycin and simvastatin?

A

Increases simvastatin exposure= myopathy

45
Q

What effect does baclofen have on antihypertensive drugs?

A

Enhances the hypotensive effect

46
Q

Why are quinolone antibiotics cautioned in epilepsy?

A

They lower the seizure threshold

47
Q

What can occur if you combine lithium and ACEi?

A

Increased chance of lithium toxicity

48
Q

Why should lactulose and mesalazine not be taken together?

A

Latulose lowers stool pH and can prevent mesalazine from being released/working properly

49
Q

At what CrCl would the use of bisphosphonates be contraindicated?

A

Below 30 ml/min

50
Q

Colestyramine is contraindicated in complete biliary obstruction.

A

.

51
Q

Amiodarone is contraindicated in complete AV block.

A

.

52
Q

Ursodeoxycholic acid is contraindicated in patients with acute inflammation of the gall bladder.

A
53
Q

What is the interaction between omeprazole/esomeprazole and clopidogrel?

A

Reduces the antiplatelet activity of clopidogrel

54
Q

What is the interaction between theophylline and quinolones?

A

Can cause theophylline toxicity

55
Q

REMEMBER: Do not take warfarin with _ juice

A

Cranberry

56
Q

Digoxin + Quinine =??

A

Increased plasma concentration of digoxin

57
Q

What can happen if a patient has glandular fever and is given amoxicillin?

A

They can develop a rash

58
Q

Quinolone antibiotics can induce seizures, even in people without a history of seizures. This risk is increased y administration alongside which type of drug?

A

NSAIDs

59
Q

What is the interaction between sumatriptan and tramadol/SSRIs?

A

Increases serotonin syndrome risk

60
Q

What is the interaction between lithium and NSAIDs?

A

Decreases the excretion of lithium= toxicity

61
Q

Which five drugs can reduce the effectiveness of tamoxifen?

A

Terbinafine
Paroxetine
Fluoxetine
Bupropion
Cincalcet

62
Q

Which five drugs are key interactions with quinolone antibiotic?

A

-Drugs which prolong QT interval
-Corticosteroids- increase tendon damage risk
-NSAIDS- increased seizure risk
-Theophylline- can increase theophylline levels
-Methotrexate- can increase methotrexate levels

63
Q

Amoxicillin can interact with methotrexate, by _ the clearance of methotrexate. Amoxicillin can also react with allopurinol and cause a _

A

Reducing
Rash

64
Q

What is the interaction between fluoxetine and phenelzine?

A

Serotonin syndrome

65
Q

What is the interaction between clonidine and propranolol?

A

Causes hypertension

66
Q

What is the interaction between theophylline and ciprofloxacin?

A

Toxic levels of theophylline

67
Q

What is the interaction between methotrexate and probenecid?

A

Significantly increase methotrexate levels

68
Q

DAMN Drugs- These are drugs to be stopped in an AKI. What are these drugs?

A

Diuretics
ACEi/ARB
Metformin
NSAIDs

69
Q

Which vitamin should not be taken alongside spironolactone?

A

Vitamin K

Pre-Registration Revision (24 decks)

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