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Palliative Exam > Drug Interactions > Flashcards

Drug Interactions Flashcards

1
Q

Name the 4 strong inducers of CYP 3A4. (PPFC)

A

Phenytoin, Fosphenytoin, Carbamezapine, phenobarbital

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2
Q

How does dexamethasone affect methadone?

A

Decrease efficacy of methadone.

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3
Q

Cipro affect on methadone/fentanyl? Preferred floxacin abx?

A

Cipro inhibits CYP3A4 causing increased levels of methadone/fentanyl. Preferred Levaquin.

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4
Q

Effects of Erythro and clarithromycin? Alt mycin abx?

A

Inhibit CYP3A4, causing increase drug levels and potency. Consider Azithromycin.

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5
Q

Name the -Azoles with sig drug interactions? What is effect on CYP3A4?

A

Fluconazole, voriconazole, posaconazole. Inhibit CYP3A4.

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6
Q

Adverse effect to watch out for Buproprion?

A

Can lower seizure threshold

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7
Q

St. Johns Wort indication? Effect on CYP? Important AE?

A

Tx for depression, Inducer, can cause serotonin syndrome.

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8
Q

Grapefruit effect on CYP? What meds does it affect?

A

Inhibit, increase doses of statins

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9
Q

What is 1st line tx for opioid induced itching?

A

Diphenhydramine (Benadryl)

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10
Q

What age should pts taking TCA be screened with EKG?

A

40 years or older

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11
Q

True/false. Respiratory acidosis increases effect of opioids?

A

False, Resp Alkalosis can increase transmission to cross BBB.

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12
Q

What is Rifampin effect on CYP?

A

Inducer, increase breakdown of meds making less effective.

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13
Q

Effect of TCA on methadone?

A

Increase methadone’s effect

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14
Q

What to worry about when starting Meperidine?

A

It can cause seizures due to its metabolite.

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15
Q

What is one advantage of clonidine?

A

It can decrease postoperative oxygen consumption.

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16
Q

Which class of meds should be used cautiously if pt also taking L-tryptophan?

A

SSRI can cause serotonin syndrome.

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17
Q

What meds should be avoided with buprenorphine?

A

Antiarrhythmics

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18
Q

Weird SE of glucocorticoids?

A

Hiccups.

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19
Q

What herbal medicine has some effect in helping chemotherapy induced fatigue? What meds should be used cautiously with this herb?

A

American Ginseng, interacts with anticoagulation meds

20
Q

What is indication for Kava-Kava?

A

Anxiety, possible benefit.

21
Q

What is indication for Ginkgo biloba?

A

Dementia, but not shown to be beneficial.

22
Q

What are some important SE of megace? 3

A

VTE, adrenal insufficiency, male androgen deficiency

23
Q

What 3 chemo drugs are highest emetogenic?

A

Cisplatin, cyclophosphamide, dacarbazine.

24
Q

Of the 3 which meds can cause sexual dysfunction and decreased libido? Buspar, Buproprion, opioids?

A

Opioids.

25
Q

What are the 4 “A’s” when initiating chronic opioids?

A

Analgesia, Adverse effects, Aberrant behaviors and Activity.

26
Q

True/False.

Methylnaltrexone crosses the blood brain barrier?

A

False, it is quaternary structure so it doesn’t.

27
Q

Which NSAID has greatest risk of CV risk?

A

Diclofenac.

28
Q

Olanzapine blocks what receptors for nausea?

A

serotonin, histamine, dopamine, and acetylcholine.

29
Q

What drug is 6-MAM a metabolite of?

A

Specific to heroin.

30
Q

Which opioid is least likely to cause bradycardia?

A

Meperidine, it can cause tachycardia.

31
Q

Which TCA has the least SE?

A

Nortriptyline.

32
Q

What drug metabolizes into meprobamate?

A

Carisoprodol (soma), used as antispasmodic

33
Q

In neonates, how are opioids different compared to adults?

A

Neonates have decreased clearance leading to prolong half life of opioids.

34
Q

Which NSAIDs are available parenterally?

A

Meloxicam, ibuprofen, ketorolac, diclofenac

35
Q

True/False about lidocaine patch?

  1. Caution in use with antiarrhythmics/local anesthetic?
  2. Needs dose escalation and tolerance builds quickly?
  3. Safe to use in severe hepatic disease and works quickly?
A
  1. True
  2. False
  3. False
36
Q

Nortryptiline and desipramine are what class of of TCA?

A

Secondary amine and have more favorable SE profile/ less anticholinergic effects.

37
Q

Linezolid has odd MOA, what is MOA and can lead to what condition?

A

MOA-inhibitor, leads to serotonin syndrome with other serotonin agents.

38
Q

Drugs/classes that can cause serotonin syndrome?

15 drugs

A

SSRI, MAOi, meperidine, fentanyl, TCA, triptans, carbamazepine, valproic acid, tramadol, lithium, St. Johns wort, ritonavir, metaclopramide, zofran.

39
Q

What is oral to intrathecal ratio conversion of morphine?

A

1 intrathecal : 10 epidural.
1 epidural : 10 IV
1 IV : 3 mg Oral

40
Q

What SE should you be worried about when starting baclofen?

A

lower seizure threshold

41
Q

What is most common SE of modafinil (provigil)?

A

Headaches

42
Q

What is MOA of cyclobenzaprine? What other drug class is it similar to?

A

Inhibits norepinephrine reuptake and serotonergic reuptake. Similar to 1st gen TCA.

43
Q

Which SSRI can be stopped abruptly due to it’s long half life?

A

Fluoxetine.

44
Q

True/false.
Meperidine is not affected by renal insufficiency?
Meperidine has an active metabolite?

A

False. AKI increases bioavailability

True, it can lead to seizures/serotonin syndrome

45
Q

True/False.

  1. Methylnaltrexone induces opioid withdrawal?
  2. What is absolute contraindication to starting methylnaltrexone?
A
  1. False

2. Bowel obstruction, it can cause bowel perf.

46
Q

What common SE can be seen in Tramadol?

A

Hypoglycemia

Palliative Exam (4 decks)

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