drug interactions Flashcards
acetaminophen
● Increased effect with caffeine.
● Decreased effect with antacids, anticholinergics, carbamazepine, and phenytoin.
● Alcohol may increase hepatotoxicity risk
activated charcoal
● Moderate interactions with acetylcysteine, citalopram, digoxin, dyphylline, methotrexate, and theophylline
adenosine
● Methylxanthines (stimulants) block actions of adenosine.
● Actions are potentiated with dipyridamole, carbamazepine, and nicotine
albuterol
● May potentiate hypokalemia caused by diuretics
amiodorone
● May increase the effects of digoxin, disopyramide, fentanyl, lidocaine,
procainamide, quinide, or warfarin.
● Cimetidine may increase amiodarone levels.
● Beta blockers or calcium channel blockers may potentiate bradycardia, sinus
arrest and AV blocks.
● Amiodarone will precipitate with sodium bicarbonate and heparin. Use a
different IV if coadministering.
● Do not combine with other drugs that prolong the QT interval (ondansetron,
procainamide)
aspirin
● Increased risk of bleeding with concurrent anticoagulant/NSAID use.
● Diminishes effects of ACE inhibitors and loop diuretics.
● Decreased effectiveness and absorption with antacids and corticosteroids.
● Increased risk of hypoglycemia when administered with oral hypoglycemic
drugs.
atropine
● Potential adverse effects with administered with digitalis, cholinergics, and
physostigmine.
● Effects enhanced by antihistamines, procainamide, quinidine, antipsychotics,
benzodiazepines and antidepressants.
calcium chloride
● May increase ventricular irritability and precipitate digitalis toxicity when taken
with digoxin.
● Potentiated by thiazide diuretics
● Incompatible with most medications
calcium gluconate
● Severe bradycardia with concurrent digitalis use.
● Incompatible with most medications
dexamethasone
● Simultaneous use with ASA/NSAIDs may increase risk of GI bleed and ulcers.
● Concurrent use with diuretics can result in hypokalemia
dextrose
Sodium Bicarbonate, Warfarin
diazepam
● Incompatible with most drugs and fluids
diltiazem
● Use with caution in patients taking medications that affect cardiac contractility
diphenhydramine hydrochloride
● Potentiates effects of CNS depressants.
● MAOIs prolong and intensify anticholinergic effects.
dopamine hydrochloride
● Deactivated by alkaline solutions.
● MAOIs and TCAs prolong and potentiate effects.
● Beta blockers antagonize cardiac effects.
● Simultaneous use of vasopressors may result in severe hypertension.
● Simultaneous administration of phenytoin may cause hypotension, bradycardia
and seizures
epinephrine
none
etomidate
● Potentiated by other CNS depressants
fentanyl citrate
none
flumazenil
● Toxic effects when combined with TCAs
furosemide
● May potentiate lithium toxicity and digitalis toxicity because of sodium depletion and potassium depletion, respectively
glucagon
● Incompatible in solution with most substances
glucose, oral
none
haloperidol
● Potentiates antihypertensive medications.
● Antagonizes amphetamines and epinephrine.
hydromorphone
● MAOIs and SSRIs
hydroxocobalamin
● Do not administer in the same IV line with diazepam, dobutamine, dopamine, fentanyl, NTG, propofol, sodium nitrate or sodium thiosulfate
ibuprofen
● Additive risk for bleeding if given in combination with other agents that affect
hemostasis
● May diminish the antihypertensive effects of hydralazine
● May diminish the diuretic effect of loop, thiazide, and thiazide-like diuretics
● TCAs may enhance NSAID antiplatelet effects
ipratropium bromide
none
ketamine
● Ketamine may enhance effects of CNS depressants and nondepolarizing
neuromuscular blockers
ketorolac tromethamine
● TCAs may enhance antiplatelet effects
labetolol
none
lidocaine hydrochloride
● High doses of lidocaine may prolong apneic period with succinylcholine
● Cardiac depression may occur in conjunction with IV phenytoin
● Procainamide may exacerbate CNS effects
lorazepam
none
magnesium sulfate
● Serious changes in overall cardiac function may occur with cardiac glycosides
mannitol
● May precipitate digitalis toxicity when given concurrently
● Avoid use with NSAIDs, salicylates, nitrates and diuretics
methylprednisolone sodium succinate
● Response to insulin and hypoglycemic agents may be blunted
midazolam hydrochloride
none
morphine sulfate
● MAOIs may cause paradoxical excitation
naloxone hydrochloride
● Incompatible with bisulfate and alkaline solutions
nitroglycerin
● Incompatible with other drugs given IV
● Increased hypotensive effect with alcohol and phenothiazines
norephinephrine bitartrate
● Inactivated by alkaline solutions
● Alpha-adrenergic effects can be blocked with concurrent administration of
phenothiazines.
● TCAs can markedly increase response to pressors
ondansetron hydrochloride
● Serotonin syndrome can occur with simultaneous use of several SSRIs or
serotonin receptor-blocking drugs.
● Avoid administration with other drugs that prolong the QT interval.
oxygen
none
oxytocin
● Can cause severe, persistent hypertension if administered with vasopressors
phenylephrine
● Exaggerated adrenergic effects if given with, or up to 21 days after, MAOI use.
● Hypertensive effects may be potentiated by PCAs, guanethidine, methyldopa,
and atropine-like drugs.
pralidoxime
● Avoid concurrent use with succinylcholine and respiratory depressants
procainamide hydrochloride
none
promethazine hydrochloride
● Increased extrapyramidal effects with MAOIs
rocuronium bromide
● Additive effects if administered with, or following, an opioid, sedative or anesthetic agent
sodium bicarbonate
● Additive effects if administered with, or following, an opioid, sedative or anesthetic agent.
succinylcholine chloride
● Diazepam may reduce the duration of action.
● Oxytocin, beta blockers and organophosphates may potentiate effects.
terbutaline sulfate
● MAOIs may potentiate dysrhythmias
thiamine hydrochloride
● Unstable in alkaline solutions
tranexamic acid
● Hormonal contraceptives and clotting factor complexes increase the risk of thromboembolic disorders.
vecuronium bromide
● Additive effects if administered with, or following, an opioid, sedative, or anesthetic.
verapamil hydrochloride
● Increases the serum concentration of digoxin
● May potentiate the action of neuromuscular blocking agents
● Increased risk of sudden death when given concurrently with erythromycin
