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Pre Reg > Interactions > Flashcards

Interactions Flashcards

1
Q

What do MAOIs interact with?

A

Tyramine: the cheese effect - hypertensive crisis

Sympathomimetics: pseudoephedrine, epherdrine - hypertensive crisis

Sumatriptan: increases exposure to sumatriptan - avoid for 14 days after stopping MAOI

Other antidepressants: washout period

Lithium: increased risk of serotonin syndrome

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1
Q

What are the interactions of methotrexate?

A

Can cause blood disorders, photosensitivity, respiratory effects

Trimethoprim: both anti-folate drugs - increased risk of haematological side effects + risk of nephrotoxicity

NSAIDs: increased risk of toxicity + nephrotoxicity

Penicillins: increased risk of toxicity

Aspirin: increased risk of toxicity + nephrotoxicity

Co-trimoxazole: sulfamethoxazole increases exposure to methotrexate and trimethoprim increases haematological side effects

Omeprazole: decreases clearance of methotrexate (lansoprazole is a better option)

Quinolones: increases toxicity

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2
Q

What are the interactions of statins?

A

Macrolides

Grapefruit jucie

Fusidic acid (oral only) - wait for 7 days before going back to statins

Colchicine

Fluconazole

Amlodipine with simvastatin over 20mg

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3
Q

What are the interactions for warfarin?

A

Amiodarone

Cranberry and pomegranate juice

Azoles (topical + oral)

Omeprazole

Alcohol

NSAIDs

Ciprolfoxacin

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4
Q

What are common interactions of theophyline?

A

Serum conc target: 10-20mg/L
Toxicity - activated charcoal

Tobacco (potent enzyme inducer)

Diuretics

Rifampicin

Erythromycin

Cimetidine

Phenytoin

Ciprofloxacin

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5
Q

What are the interactions of omeprazole?

A

Only PPI that can be taken in pregnancy
PPIs can mask gastric cancer symptoms
Increase risk of lupus
Cause gastric infections e.g. C.diff
Hypomagnesaemia
Osteoporosis

Warfarin

Methotrexate

Escitalopram

Clopidogrel: omeprazole reduces anti-platelet effect of clopidogrel

Citalopram

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6
Q

What are the interactions of sildenafil?

A

Do not supply to patient who had stroke in last 6 months

Alpha blockers

Erythromycin

Nitrates

Diltiazem

Ritonavir

Nicorandil

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7
Q

What are the interactions of amiodarone?

A

Can cause corneal micro-deposits

Digoxin

Verapamil

Diltiazem

Grapefruit juice

Flecanide

Warfarin

Phenytoin

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8
Q

What are the interactions of St John’s Wort?

A

Aminophyline

Phenytoin

Contraceptives

Vinca alkaloids

Warfarin

Theophyline

Statins

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9
Q

What is the interaction between allopurinol and azathioprine?

A

Allopurinol increases risk of haematological toxicity - adjust azathioprine dose to just one quarter of regular dose

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10
Q

What should be avoided with MR and gastro-resistant mesalazine?

A

Lactulose - lowers stool pH in intestine = prevents sufficient release

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11
Q

What should be avoided with co-danthramer?

A

Bulk-forming laxatives - causes painful colic and obstruction

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12
Q

What is the interaction between theophylline and beta2-agonists?

A

Potentially serious hypokalaemia - particular caution in severe asthma

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13
Q

What decreases theophylline concentration?

A

Smoking
Alcohol
Enzyme inducers

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14
Q

Which drugs increase the risk of hypokalaemia with theophylline?

A

Corticosteroids
Loop and thiazide diuretics
Beta-2 agonists

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15
Q

What drug increases the risk of convulsions with theophylline?

A

Ciprofloxacin (quinolones) - an enzyme inhibitor and lowers seizure threshold

A side effect of theophylline is also convulsions

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16
Q

What drugs increase the plasma concentration of theophylline?

A

CCB
Cimetidine
Fluconazole
Macrolides

17
Q

What drugs reduce the plasma concentrations of theophylline?

A

St Johns Wort
Rifampicin
Phenytoin
Carbamazepine
Phenobarbital

18
Q

What is the interaction between methotrexate and aminophylline?

A

Methotrexate decreases clearance of aminophylline

19
Q

Which anti-epileptics reduce clearance of methotrexate?

A

Levetiracetam, phenytoin and sodium valproate

They also increase the risk of liver toxicity

20
Q

What is the interaction between methotrexate and NSAIDs

A

Increased risk of renal toxicity = risk of methotrexate toxicity

21
Q

What is the interaction between methotrexate and fluconazole?

A

Increases risk of liver toxicity

22
Q

What is the interaction between methotrexate and isotretinoin?

A

Increased risk of liver toxicity

23
Q

What is the interaction between methotrexate and penicillins?

A

Reduced clearance of methotrexate (if short course up to 10 days - consider using and monitor for signs of methotrexate toxicity)

24
Q

What is the interaction between methotrexate and PPIs?

A

Reduced methotrexate clearance - consider H2-receptor antagonists as alternative

25
Q

What is the interaction between methotrexate and statins?

A

Increased risk of liver toxicity

26
Q

What is the interaction between methotrexate and tamoxifen?

A

Increased risk of liver toxicity

27
Q

What is the interaction between methotrexate and terbinafine?

A

Increased risk of liver toxicity

28
Q

What juice decreases ciclosporin concentration?

A

Purple grape juice

29
Q

What is the interaction between an SSRI and NSAIDs

A

GI bleed

30
Q

What is the interaction between Ibuprofen and ramipril

A

Nephrotoxicity

31
Q

What is the interaction between simvastatin and amlodipine

A

myopathy

32
Q

What is the interaction between ramipril and spironolactone

A

Hyperkalaemia

33
Q

What is the interaction between bisoprolol and donepezil?

A

Bradycardia

34
Q

What would cause a pharmacodyamic interaction with donepezil?

A

Oxybutynin - anticholinergic drugs counteract what this does because donepezil prevents the breakdown of acetylcholinterase in the brain whereas anticholingeric drugs does the opposite

35
Q

What is the interaction between sodium valproate and doxycycline?

A

Risk of hepatotoxicity

36
Q

Do SSRIs impact epilepsy?

A

SSRIs lower seizure threshold

37
Q

What is the interaction between sildenafil and nitrates?

A

CONTRAINDICATED - risk of hypotension

38
Q

What is the interaction between alpha blockers and sildenafil?

A

Risk of hypotension

39
Q

What is the interaction between ACEi and insulin or other oral antidiabetics?

A

Hypoglycaemia

40
Q

What is the interaction between lithium and candesartan?

A

Candesartan increases concentration of lithium

Pre Reg (14 decks)

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