Drug Interactions Flashcards
what are three types of drugs that are most commonly involved in DDIs?
NSAIDs
anticoagulants
cardiovascular drugs
in this type of DI, one drug has a pharmacologic action that increases, decreases, or somehow alters the pharmacologic action of another drug
pharmacodynamic
this type of DI is related to the drug’s effect in the body
one drug modulates the pharmacologic effect of another (addictive, synergistic, or antagonist)
CANNOT be remedied by adjusting the dose of the interacting drugs
pharmacodynamic
in this type of DI, one drug alters the concentration of another drug in the body and usually can be remedied by adjusting the dose of the altered drug
pharmacokinetic
this is a group of enzymes in the liver that are highly involved in drug metabolism
CYP450 enzymes
this type of medication increases the rate of metabolic activity of a specific CYP450 enzyme
inducer
this type of medication decreases the rate of metabolic activity of a specific CYP450 enzyme
inhibitor
this type of medication uses CYP450 enzymes to be metabolized in the liver
substrate
these protein are transporters found in the gut and pump drugs out of the blood stream and into the gut
p-glycoproteins
are these p-glycoprotein inhibitors or substrates?
azole antifungals
ritonavir
verapamil
St. John’s Wort
inhibitor
are these p-glycoprotein inhibitors or substrates?
rivaroxaban
dabigatran- novel oral anticoagulants
substrates
2C9 inhibitors
bactrim
metronidazole
2D6 inhibitors
TCAs
fluoxetine
paroxetine
34A inhibitors
haloperidol
azoles
protease inhibitors
NNRTIs
diltiazem
verapamil
erythromycin
are these inducers or inhibitors?
rifampin
carbamazepine
phenobarbital
phenytoin
ritonavir
efavirenz
St. John’s Wort
Nafcillin
inducers
inducer timeline
2-3 weeks
inhibitor timeline
2-3 days
in what diseases should chronic NSAID use be avoided?
chronic renal insufficiency
heart failure
previous peptic ulcer
what drug should those with heart failure avoid?
diltiazem/ verapamil
what diseases should avoid metformin?
chronic renal insufficiency
heart failure
what diseases should avoid thiazide diuretics?
gout
renal insufficiency (GFR less than 30)
clinical presentations of DI
serious ADR
poor tolerability
decreased efficacy
worsening of disease state
withdrawal symptoms
with prodrugs, will inhibiting CYP450 enzymes increase or decrease active level of drug in the body?
decrease
with prodrugs, will inducing CYP450 enzymes increase or decrease active level of drug in the body?
increase
this drug is an inhibitor of 2C9, 2D6, 34A and P-glycoprotein
amiodarone
what drug should avoid the consumption of grapefruit juice
amiodarone
amiodarone decreases the dose of these medications by 30-50%
digoxin
warfarin
what type of drug are these
ketoconazole
itraconazole
voriconazole
poasconazole
azole antifungals
what 2 antifungals require low pH for effective absorption and must be avoided with drugs that increase pH (antacids, H2 blockers, proton pump inhibitors)
itraconazole
ketoconazole
this azole antifungal is an inhibitor of 2C9, 2C19, and 3A4 and many drugs are contradicted
voriconazole
this drug has a very narrow TI and is a substrate of p-glycoprotein
digoxin
this drug has an inverse relationship with serum potassium levels
digoxin
how is most of digoxin cleared?
renal excretion
true or false- there is more risk of digoxin toxicity with hypokalemia
true
this type of drug is a substrate of 3A4
statins
what are the 3 most prevalent DI statin?
lovastatin
simvastatin
atorvastatin
this drug is 100% renally cleared
lithium
these conditions lead to increased lithium levels
NSAIDs
ACEI
ARBs
dehydration
diuretics
what type of drugs are these
isocarboxazid
phenelzine
selegiliine
tranylcypromine
MAOIs
these decrease MAOI metabolism
tyramine (aged, fermented, pickled, or smoked foods)
serotonin
NE and epi
these drugs raise levels of monoamines
antidepressants
triptans
dextromethorphan
this type of drug inhibits COX1 and COX2 enzymes and decrease the synthesis of PGs
NSAIDs
NSAIDs carry risks of…
GI bleeding
kidney injury
cardiovascular toxicity
CYP450 enzyme _____ decreases effectiveness of BC
inducers
what 5 factors contradict BC
anticoagulants
St. Johns Wort
Abx
anti-retrovirals
smoking
this drug is the gold standard inducer and is used to treat TB and leprosy
rifampin
this drug is a strong inducer of CYP 2C9 2C19, and 3A4 and will decrease the concentration of any drug that is a substrate
rifampin
this drug induces CYP 2C8, 9 and 19, 3A4, and p-glycoprotein
phenytoin
this drug is highly protein bound and must have caution if pt on other CNS depressants (addictive effects)
phenytoin
this drug is a strong 3A4 inducer and induces its own metabolism which decreases the level of 3A4 substrate drugs
carbamazepine
3A4 inhibitors will ______ carbamazepine levels
increase
3A4 inducers will _______ carbamazepine levels
decrease
these must not be consumed within 2 hours of tetracycline and quinolone abx
vitamins
iron supplements
antacids
dairy
sucralfate
coated aspirin
these types of drugs leads to decreased absorption of abx and chelates with aluminum, magnesium, calcium, iron, and zinc
tetracycline and quinolone abx
what class of medication are these
ciprofloxacin
levofloxacin
moxifloxacin
tetracycline and quinolone abx
this drug is a substrate of 2C9 (major) and 1A2 and 3A4 (minor)
warfarin
induction of 2C9, 1A2, or 3A4 will _______ effectiveness of warfarin
decrease
inhibition of 2C9, 1A2, or 3A4 will ______ effectiveness of warfarin
increase
what drugs/ supplements lead to increased bleeding risk on warfarin?
NSAIDs and antiplatelets
garlic, ginseng, and gingko
foods/ supplements high in vitamin K
this health condition may lead to cardiac arrhythmias and sudden cardiac death
hyperkalemia
these medication classes may lead to hyperkalemia
ACEIs
ARBs
K+- sparing diuretics
trimethoprim
aldosterone antagonists
NSAIDs
digoxin
cyclosporine or tacrolimus
these are drug classes that are red flags for QTc
warfarin
HAART meds
amiodarone
some antidepressants
quiolones
antipsychotics w/ abx
antiarrhythmics w/ abx
anti-epileptic meds
statins
