drug interactions Flashcards
statins with least DI
pravast, rosuv
fibrates DI
fenofibrate has least, gemfibrozil has most (never with statin)
what do DOACs interact with
3a4 and pgp
what can cause fentanyl accumulation
3a4 inhibitors
antidepressants with least DI
escit, cit, venla
which antidepressants are 2d6? 2c19?
2d6=buprop, duloxetine, fluox, parox, 2c19= fluox, fluvox (also1a2)
anticonvulsant potent cyp inducers
carbamaz, phenytoin, primidone, phenobarb
most interactive ppis and what they inhibit
omeprazole and esomep; 2c9 and 2c19
avoid preemptively adjusting warfarin when adding interacting med- list these meds. how do you manage
check inr in 4-6 days and adjust accordingly. Interacting; acet, antibiotics (esp septra, macrolides, fluoroquinolones, metronidazole), anti epileptic (phenobarb, carbamaz, pheny), antifungal (clotrimazole), alternative remedies, amiodarone, antidepressants (SSRIs), antithyroid (PTU)
name common inducers
carbamaz, pheny, phenobarb, rifampin, st johns wort, ritonavir, dexamethasone
name common inhibitors
macrolides (eryth and clarith only), ciprofloxacin, amiodarone, dronedarone, azole antifungals, bupropion, non DHP CCB, septra, SSRIs (esp fluox, fluvox, parox), gemfibrozil,
when should you avoid qtc drugs
greater than 60msec over baseline or equal to/over 500msec. Caution if at 450msec
top 3 torsades prolonged qt drugs
citalopram, digoxin, sotalol. Other common ones include most antiarrhytmics, atomoxetine, the “azines” (antipsychotics), quetiapine, lithium, mirtazepine, aripip, TCAs, FQs, macrolides (not azith), fluconazole, methadone etc……
common culprits in SS
SSRIs, SNRIs (esp venlafax- others questionable), TCAs, triptans, lithium, methadone, tramadol. Usually happens within hours. MAOI use concurrently with any of these is CI bc too high risk
which ssri is the most anticholinergic
parox
