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Drug Interactions (Spring 2015) > Drug Interactions Exam #01 > Flashcards

Drug Interactions Exam #01 Flashcards

1
Q

Acidophilus

A

Transplant patients on immunosuppressants should avoid probiotics b/c introducing live bacteria into an immunocompromised system.

If taking ABO, probiotic effects will be negated (if susceptible). Recommend starting probiotics at tail end of ABO therapy

Lactobacillus acidophilus is a gram(+) anaerobic rod

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2
Q

Chasteberry (Agnus castus)

A

Uses:
Menstrual disorders and fertility

MOA:
DA agonist and estrogenic effects

DDI:
Enhances other DA agonist drugs for PD like bromocriptine, pergolide (Permax®), pramipexole (Mirapex®), and ropinirole (Requip®) resulting in too much DA which can cause change in mental status and signs of schizophrenia

Counters other DA antagonist drugs for schizophrenia like olanzapine (Zyprexa®), risperidone (Risperdal®), clozapine (Clozaril®)

Additive with estrogen

Opposes tamoxifen

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3
Q

Alfalfa

A

Uses: nutrients and vitamins

MOA:
Possible immunostimulation

DDI:
Case report of transplant rejection from immunostimulation

Warfarin - alfalfa is rich in Vit K

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4
Q

Aloe vera

A

Uses (for oral formulation only):
DM

DDI:
Additive hypoglycemic effect with drugs that lower glucose

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5
Q

Aristolochia (Birthwort)

A

Uses:
Childbirth panacea, pain and inflammation, snake bites

MOA:
KNOWN NEPHROTOXIN

DDI:
Combined nephrotoxic effects with drugs known to cause harm or that affect renal hemodynamics (NSAIDs, ACE-I, ARB)

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6
Q

Ashwagandha (winter cherry)

A

Uses:
Sedative, possibly DM

MOA:
Possible BG lowering, thyroid properties

DDI:
Additive effect with levothyroxine

Counter effect with anti-thyroid drugs like propylthiouracil, methimazole (Tapazole®)

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7
Q

Betacarotene (precursor to Vit A)

A

Uses:
Age-related eye disorders, antioxidant

DDI:
Orlistat (Xenical®) indicated for obesity reduces fat absorption - leads to reduced absorption of fat-soluble vitamins (including betacarotene)

Heavy alcohol use - interferes with conversion of betacarotene to vitamin A via CYP2E1 (competition of induction)

Diminishes effects of increasing HDL in patients on simvastatin + niacin

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8
Q

Bilberry

A

Uses:
Diarrhea, hemorrhoids, venous insufficiency, GI disorders

MOA: possible anti-platelet activity

DDI:
PD interaction with other antiplatelet or anticoagulant drugs

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9
Q

Ephedra (ma huang)

Banned by the FDA

A

Uses:
weight loss, stimulant, increased concentration, enhanced athletic performance

MOA: CNS and cardiac stimulant, stimulates uterine contractions, peripheral vasoconstriction

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10
Q

Bitter orange

A

This was manufacturers response to ephedra ban

Uses:
same as ephedra

MOA:
sympathetic alpha-adrenergic agonist

DDI:
inhibits CY3A4

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11
Q

Black cohosh

A

Use:
Peri- and post- menopausal Sx. Recent studies show no real benefit.

MOA:
Estrogenic properties

DDI:
Additive estrogenic drugs
Counters anti-estrogenic drugs

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12
Q

Caffeine

A

Sources of caffeine:
Seeds of guarana, tea leaves, nuts of cola

Metabolized by CYP1A2

DDI:
Inhibitors of 1A2 like 
Fluvoxamine (Luvox®)
Cimetidine (Tagamet®)
Disulfuram (Antabuse®)
Cipro®
Norfloxacin
Clozapine

ASA - Caffeine increases the AUC, Cmax and rate of absorption of ASA
Adenosine (vasodilator) - caffeine is an adenosine antagonist (vasoconstrictor)
Bitter Orange - increased risk of severe cardiac AE

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13
Q

Cat’s Claw

A

Use:
dyspepsia, antispasmodic, arthritis, herpes, HIV, and contraceptive

MOA: antiplatelet and antihypertensive effects

DDI:
Potent 3A4 inhibitor

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14
Q

Chamomile

A

Use:
dyspepsia, travel sickness

MOA:
contains a natural coumarin

DDI:
warfarin - additive effect

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15
Q

Chondrointin

A

Use:
OA

Structurally similar to heparin so may have additive anticoagulant properties

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16
Q

Coenzyme Q10

A

Use:
cardiac health, prevent statin-induced myopathy, antioxidant

DDI:
NO clinically significant interaction with warfarin

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17
Q

Cranberry

A

Use:
urinary antiseptic

DDI:
does NOT affect PK of drugs like cyclosporine or warfarin

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18
Q

Echinacea

A

Use:
immune system booster

AVOID in patients on immunosuppressive therapy and patients with autoimmune disease

19
Q

Evening Primrose Oil

A

Use:
arthritis, chronic fatigue syndrome, menopausal Sx, ADHD, asthma/cough

DDI:
Can inhibit platelet aggregation and increase bleeding time. No data supporting interactions with other antiplatelets

20
Q

Feverfew

A

Use:
prophylaxis and tx of HA and migraines

MOA:
Structurally related to NSAID and has anti-inflammatory properties. Inhibits platelet aggregation in vitro and has potential interactions with anticoags and antiplatelets such as ASA, clopidogrel (Plavix®), prasugrel Effient®, Ticagrelor (Brilinta®)

21
Q

Garlic

A

Use:
respiratory infections, CV disorders

Benefits from garlic come from eating raw chopped garlic. Crushing garlic releases and destroys Alliin (the active ingredient) which makes gelcap and capsule formulations useles

DDI:
May have interaction with antiplatelet drugs and warfarin, but interaction is over-hyped

22
Q

Ginger

A

Use:
N/V

DDI:
Does NOT increase anticoagulant effect of warfarin and no evidence of antiplatelet interactions

23
Q

Ginkgo

A

Use:
improve memory and cognitive function

MOA:
Has antiplatelet effects and may affect CYP enzymes

DDI:
VPA and phenytoin - risk of seizure - Ginkgo seeds contain a neurotoxin which inhibits activity of glutamate which results in seizure induction by lowering GABA levels OR induction of 2C19

Anti platelet drugs - many case reports of increased bleeding

Omeprazole - Ginkgo induces 2C19

24
Q

Ginseng

A

Use:
improve mental and physical performance, energy booster

DDI:
Warfarin - possible decrease effect

Estrogen - may contain estrogenic properties so additive or antagonistic with estrogens and anti-estrogens, respectively; plus case reports of vaginal bleeding

25
Q

Hawthorne

A

Use:

“Cardiotonic” for weak heart. Morons try to treat HF with this

26
Q

Horse Chestnut

A

Use:
Tx of varicose veins as both topical and oral products

MOA:
has antiplatelet activity

DDI:
antiplatelet drugs

27
Q

Licorice (dried licorice root and extracts, not candy)

A

Use:
expectorant, antispasmodic, anti-inflammatory

MOA:
Has mineralocorticoid effects including Na and H2O retention and K+ excretion leading to HTN and hypokalemia

DDI:
PD interactions with digoxin, laxatives, and diuretics

28
Q

Milk Thistle

A

Use:
“liver tonic,” used by nursing mothers for milk production

Active constituent = silymarin

DDI:
Silymarin inhibits 3A4 - caution w/ NTI 3A4 substrates

29
Q

St. John’s Wort

A

Use:
mild to moderate depression

DDI:
Potent 3A4 inducer (and many others)

Cyclosporine/Tacrolimus - risk of organ rejection
Protease Inhibitors - reduction in serum PI levels

Oral contraceptives - treatment failure
Warfarin - decreased INR
Methadone - tx failure and withdrawal Sx
Voriconazole - reduced efficacy

PD interactions:
Serotonin syndrome
Photosensitivity

30
Q

Green Tea

A

Potential interaction w/ warfarin b/c contains small amount of vitamin K, but brewing tea destroys some of the vitamin K

31
Q

Valerian

A

Use:
Sedative/hypnotic

DDI:
enhanced sedative effects with alcohol, BZD, barbiturates

32
Q

White Willow Bark

A

Major component is salicin which is metabolized to salacylic acid (caution in ASA allergy)

DDI:
other antiplatelet and anticoagulant medications

33
Q

Herbal meds to D/C prior to surgery

A
  1. Ephedra (ma huang) - 24 hr
  2. Kava - 24 hr
  3. Ginkgo - 36 hr
  4. St. John’s Wort - 5 days
  5. Garlic - 7 days
  6. Ginseng - 7 days
34
Q

Digoxin

A

Goes by many names; from foxglove plant. Earliest sign of digoxin toxicity is bradycardia

35
Q

Which herbals/dietary supplements interact w/ warfarin and can increase INR and bleeding risk?

A 
Alfalfa
Chamomile
Feverfew
Ginseng
Horse chestnut
Willow 
Over-hyped Interactions:
Chondroitin*
Garlic*
Ginger*
Ginkgo*
36
Q

Which herbals/dietary supplements interact w/ warfarin and can decrease INR reducing effects of warfarin?

A

St. John’s Wort

Green tea

37
Q

Which herbs that contain tannin can counter effects of iron supplementation and lead to anemia?

A 
Chamomile
Black Cohosh
Saw Palmetto
Feverfew
St. John's Wort
Valerian
38
Q

Which of the following can potentially adulterate herbal medications and dietary supplements?

A. Botanicals
B. Toxic metals
C. Drugs
D. A & C
E. All of the above
A

E. all of the above + microorganisms and pesticides have also been found to be contaminants in herbals/dietary supplements

39
Q

Federal Food, Drug, and Cosmetic Act of 1938

A

Drugs must be tested for safety and efficacy before being marketed. Drugs being used before 1938 were grandfathered in and didn’t have to prove safety/efficacy

40
Q

Shirley Amendment of 1912

A

No false labeling claims

41
Q

Food and Drug Act of 1906

A

Prohibited shipment of adulterated or misbranded drugs across state lines

42
Q

T/F - the majority of botanicals are classified as OTC?

A

True - even though they have pharmacologic activity

43
Q

OTC categories

A

Cat I - safe and effective
Cat II - not recognized as safe and effective
Cat III - insufficient data

Most herbals are Cat II

44
Q

DSHEA (dietary supplement health and education act)

A

Established first legal definition of dietary supplement - product intended to supplement the diet and contains a vitamin, mineral, amino acid, herb or other botanical as capsule, powder, soft gel or gel cap (NOT injection)

“This product is not intended to Dx, Tx, cure or prevent any disease”

Drug Interactions (Spring 2015) (2 decks)

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