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Rx Prep Book General Studies > Drug interactions > Flashcards

Drug interactions Flashcards

1
Q

Which drugs are strong CYP inhibitors?

A

G PACMAN

Grapefruit
Protease inhibitors (ritonavir)
Azales
Cyclosporine, Cobicistat
Macrolides
Amiodarone
Non DHP CCP

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2
Q

Which drugs are strong CYP inducers?

A

Phenytoin
Phenobarbital
Carbamazepine/Oxcarbamazepine
St. John’s Wart
Rifampin
Smoking

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3
Q

How do CYP inducers affect prodrugs?

A

They increase their action because of more conversion to active drug

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4
Q

How do CYP inducers affect CYP substrates?

A

They decrease the efficacy

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5
Q

Warfarin is a substrate for which CYP enzymes?

A

1A2
2C9
3A4

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6
Q

A 56 year old patient has a prescription of Vfend to treat his infection. His other medications include Zocor, Hydrochlorothiazide, and Kerlone eye drops. What changes would you make?

A

Voriconazole is and CYP inhibitor

Simvastatin is a CYP substrate

Their conmittent use is contraindicated

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7
Q

What are some common substrates of P-gp?

A

DOACs
Digoxin, Diltiazem (Cardizem), Verapamil (Calan)
Cyclosporine, Tacrolimus
HCV drugs
Colchicine (Colcrys) for gout

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8
Q

What are some common INDUCERS of P-gp?

A

Carbamazepine
Phenobarbital
Phenytoin
Rifampin
St. John’s Wart

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9
Q

What are some common INHIBITORS of P-gp?

A

Cobicistat, Ritonavir
Amiodarone, Diltiazem, Verapamil
Clarithromycin
Itraconazole
Posaconazole

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10
Q

A patient is on warfarin for mitral valve. Before the patient is started on Pacerone, what drug interactions might their be?

A

Amiodarone is a strong 2C9 inhibitor, increase INR and warfarin effect

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11
Q

A patient is started on Digox and Pacerone. What interaction might you expect from this combination?

A

Amiodarone is a P-gp inhibitor and Digoxin is a substrate. Starting dose of digoxin should be at 50% lower

**monitor for bradycardia

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12
Q

What might you expect with Lanoxin and Bumex use together?

A

Digoxin toxicity of hypokalemia is worsened with bumetanide (loop)

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13
Q

Which statins are CYP3A4 substrate?

A

Lovastatin (Altoprev)
SImvastin (Zocor)
Atorvastatin (Lipitor)

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14
Q

Which statins are CONTRAINDICATED with strong CYP3A4 inhibitors?

A

Lovastatin (Altoprev)
Simvastatin (Zocor)

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15
Q

Which opioids are CYP3A4 substrates?

A

Hydrocodone
Fentanyl
Oxycodone
Methadone

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16
Q

A patient was started on Duragesic in the hospital for pain. Other medications include: Cardiazem, Pacerone, and Crestor. Which medications cause a drug interaction with Duragesic?

A

-Cardiazem
-Pacerone

Both are strong CYP inhibitors and should NOT be used with opioids with that are CYP3A4 substrate
- Hydrocodone
- Oxycodone
- Methadone (Dolophine)
- Fentanyl

17
Q

What two AED drugs need to be dose adjusted because of the drug interaction between them?

A

Valproate + Lamotrigine

***Decrease Lamotrigine dose!!!!!

18
Q

What drugs are CONTRAINDICATED with MAO inhibitor use?

A

Drugs/food that increase Epi, DA, or NE
- SNRI
- TCAs
- Bupropion
- Levodopa
- Stimulants (methylphenidate, Lisdexamfetamine)
- tyramine right foods

Drugs that increase Serotonin:
-SSRI/SNRI
- TCAs
- Mirtazapine (Remeron)
- Trazadone (Desyrel)
- Opioids

Others: Lithium, St. John’s wort, dextromethorphan (Delsym)

19
Q

Which drugs should be avoided with CYP2D6 inhibitor?

A

Tamoxifen (prodrug)
Codeine (prodrug)
Meperidine (Demerol)
Tramadol (prodrug)

20
Q

What drugs are metabolized by cyp enzymes?

A

Oral contraceptives
AEDs (carbamazepine is auto-inducer)

21
Q

What CYP enzyme does smoking have an effect on and how?

A

CYP1A2 inducer!

22
Q

What drugs may need to be increased while patient is smoking?

A

Caffeine
Theophylline
Warfarin
Antipsychotics
Antidepressants
Hypnotics
Anxiolytics

23
Q

A warfarin patient decides he would like to quit smoking. What might happen to the INR when the patient stops smoking?

A

increase INR because increase effect for warfarin

24
Q

What should you do to the Theophylline dose if a patient stops smoking?

A

Decrease the dose! will have a greater effect!

25
Q

Do Nicotine Replacement therapy also induce CYP1A2 like smoking does?

A

NOPE

26
Q

Which drugs may NOT be used in PVC bag?

A

Lorazepam
Amiodarone
Taxanes
Tacrolimus
Infliximab
Nitroglycerin

27
Q

Drugs that NEED filters

A

GAL PLAT
Golimumab (Simponi)
Amiodarone
Lorazepam

Phenytoin
Lipids
Amphocerin B
Taxanes

28
Q

Drugs that cannot be mixed with Dextrose (only saline)

A

BOAS needs saline or salt

Bactrim
Oxilaplatin
Amp B
Synercid

29
Q

Drugs that cannot be mixed with saline (only dextrose?

A

PACE DIAbetes patients

Phenytoin
Ampicillin
Caspofungin
Ertepenam

Daptomycin
Infliximab (Remicade)
Ampicillin/sulbactam (Unisym)

Rx Prep Book General Studies (7 decks)

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