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Final NAPLEX > Learning Drug Interactions > Flashcards

Learning Drug Interactions Flashcards

1
Q

List five groups of P-gp inhibitors

A
  1. ABX (Clarithromycin, itraconazole, posaconazole)
  2. CV (amiodarone, carvedilol, dronedarone, conivaptan, diltiazem, quinidine, verapamil)
  3. HIV (Cobicistat, ritonavir)
  4. HCV (daclatasvir, ledipasvir, paritaprevir, simeprevir)
  5. Others (cyclosporine, flibanserin, ticagrelor)
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2
Q

List seven Inducers of P-gp

A
  1. Carbamazepine
  2. dexamethasone
  3. phenobarbital
  4. phenytoin
  5. rifampin
  6. St. John’s wort
  7. tipranavir
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3
Q

List five groups of P-gp inducers

A
  1. anticoagulant (apixaban, edoxaban, rivaroxaban, dabigatran)
  2. CV (carvedilol, digoxin, ranolazine)
  3. Immuno (cyclosporine, sirolimus, tacrolimus)
  4. HCV (dasabuvir, paritaprevir, ombitasvir, simeprevir, sofosbuvir)
  5. Others (atazanavir, colchicine, dolutegravir, posaconazole, raltegravir, saxagliptin)
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4
Q

How to manage interaction between amiodarone and warfarin?

A
  1. If using amiodarone first: start warfarin at less than 5 mg.
  2. If using warfarin first: empirically reduce warfarin dose by 30-50%
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5
Q

How to manage interaction between amiodarone and digoxin?

A
  1. If using amiodarone first: start digoxin at low dose, such as 0.125 mg daily.
  2. If using digoxin first: empirically reduce digoxin dose by 50% (consider every other day if already at 0.125 daily)
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6
Q

List three statins not metabolized through CYP

A
  1. Pravastatin
  2. Rosuvastatin
  3. Pitavastatin
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7
Q

List five monoamine oxidase inhibitors

A
  1. Phenelzine
  2. Isocarboxazid
  3. Tranylcypromine
  4. Linezolid
  5. Methylene blue
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8
Q

How long is washout for MAOI if before using serotonergic drug (plus exception for fluoxetine)

A
  1. 2 week washout

2. Fluoxetine requires 5 week washout

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9
Q

List three calcineurin inhibitors and the most common drug interaction

A
  1. CNI: Tacrolimus, cyclosporine, sirolimus

2. Interact with CP3A4 inhibitors and P-GP inhibitors

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10
Q

Tobacco smoke primarily has what effect on CYP?

A

CYP1A2 inducer

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11
Q

List five drugs with ototoxicity

A
  1. aminoglycosides
  2. cisplatin
  3. loop diuretics (especially IV)
  4. salicylates (aspirin, salsalate, megnsium salicylate)
  5. vancomycin
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12
Q

List twelve drugs/drug classes that can have additive serotonergic toxicity

A
  1. Antidepressants (SSRI, SNRI, TCA, Mirtazapine, Trazodone)
  2. MAOI (tranylcypormine, isocarboxazid, phenelzine)
  3. selective MAOI (selegiline, rasagiline)
  4. other MAOI (linezolid, metaxalone, methylene blue)
  5. buspirone
  6. dextromethorphan (taken in excess as drug of abuse)
  7. dihydroergotamine
  8. Lithium
  9. Opioid (meperidine, methadone, tramadol, tapentadol, fentanyl)
  10. metoclopramide
  11. triptans
  12. Natural products (St. John’s wort, l-Tryptophan)
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13
Q

List four drugs/drug classes that can have additive bleeding risk

A
  1. anticoagulants (warfarin, dabigatran, apixaban, betrixaban, edoxaban, rivaroxaban, heparin, enoxaparin, dalteparin, fondaparinux, argatroban, bivalirudin)
  2. antiplatelets (salicyltes, aspirin, dipyridamole, clopidogrel, prasugrel, ticagrelor)
  3. NSAID, SSRI, SNRI
  4. Natural products (Five Gs): (ginkgo biloba, garlic, ginger, glucosamine, ginseng, vitamin E, willow bark, fish oils in high dose)
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14
Q

List nine drugs with additive hyperkalemia risk

A
  1. spironolactone, eplerenone
  2. RAAS: ace, arb, aliskiren, sacubitril/valsartan
  3. amiloride, triamterene
  4. salt substitutes (KCl)
  5. calcineurin inhibitors (tacrolimus, cyclosporine)
  6. canagliflozin
  7. pentamidine
  8. Bactrim
  9. drospirenone-containing oral contraceptives
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15
Q

List five drug/drug classes with additive nephrotoxicity

A
  1. ABX: aminoglycosides, amphotericin B, vancomycin
  2. CHEMO: cisplatin, methotrexate with high chemo doses
  3. IMMUNO: calcineurin inhibitors (cyclosporine, tacrolimus)
  4. Loop diuretics (especially IV)
  5. NSAIDs (avoid use in renal impairment)
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16
Q

List six drug/drug classes with additive anticholinergic toxicity

A
  1. Antidepressants: Paroxetine, Tricyclic antidepressants, first-generation antipsychotics
  2. Sedative antihistamines (diphenhydramine, brompheniramine, chlorpheniramine, doxylamine, hydroxyzine, cyproheptadine
  3. Atropine, belladonna, dicyclomine, meclizine
  4. Benztropine, trihexyphenidyl
  5. muscle relaxants (carisoprodol, cyclobenzaprine, baclofen)
  6. Overactive bladder (tolterodine, oxybutynin, darifenacin)
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17
Q

List five (5) drugs/drug classes that are CYP3A4 inhibitors

A
  1. ABX: clarithromycin, erythromycin, fluconazole, isoniazid, itraconazole, ketoconazole, posaconazole, voriconazole
  2. CV (amiodarone, diltiazem, dronedarone, quinidine, ranolazine, verapamil)
  3. HIV (atazanavir, cobicistat, efavirenz, darunavir, ritonavir)
  4. Other HIV (efavirenz, fosamprenavir, indinafivr, nelfinavir, nevirapine, saquinavir)
  5. Others (aprepitant, cimetidine, cyclosporine, fluvoxamine, grapefruit juice, haloperidol, nefazodone, sertraline)
18
Q

List five drugs that are CYP1A2 inhibitors

A
  1. atazanavir
  2. cimetidine
  3. ciprofloxacin
  4. fluvoxamine
  5. zileuton
19
Q

List seven CYP2C8 inhibitors

A
  1. amidoarone
  2. atazanavir
  3. clopidogrel
  4. gemfibrozil
  5. ketoconazole
  6. trimethoprim/sulfamethoxazole
  7. ritonavir
20
Q

List nineteen CYP2C9 inhibitors

A
  1. amiodarone
  2. atazanavir
  3. capecitabine
  4. cimetidine
  5. efavirenz
  6. etravirine
  7. gemfibrozil
  8. fluconazole
  9. fluvoxamine
  10. fluorouracil
  11. isoniazid
  12. ketoconazole
  13. metronidazole
  14. oritavancin
  15. tamoxifen
  16. Bactrim
  17. valproic acid
  18. voriconazole
  19. zafirlukast
21
Q

List twelve CYP2C19 inhibitors

A
  1. cimetidine
  2. esomeprazole
  3. etravirine
  4. efavirenz
  5. fluoxetine
  6. fluvoxamine
  7. isoniazid
  8. ketoconazole
  9. modafinil
  10. omeprazole
  11. topiramate
  12. voriconazole
22
Q

List fourteen CYP2D6 inhibitors

A
  1. amiodarone
  2. bupropion
  3. cimetidine
  4. cobicistat
  5. darifenacin
  6. dronedarone
  7. duloxetine
  8. fluoxetine
  9. mirabegron
  10. paroxetine
  11. propafenone
  12. quinidine
  13. ritonavir
  14. sertraline
23
Q

List ten CYP3A4 inducers

A
  1. carbamazepine
  2. oxcarbazepine
  3. phenytoin
  4. phenobarbital
  5. primidone
  6. rifabutin
  7. rifampin
  8. rifapentine
  9. smoking
  10. st john’s wort
24
Q

List eight CYP1A2 inducers

A
  1. carbamazepine
  2. phenobarbital
  3. phenytoin
  4. primidone
  5. rifampin
  6. ritonavir
  7. smoking
  8. st john’s wort
25
Q

List two CYP2C8 inducers

A
  1. phenytoin

2. rifampin

26
Q

List nine CYP2C9 inducers

A
  1. aprepitant
  2. carbamazepine
  3. phenobarbital
  4. phenytoin
  5. primidone
  6. rifampin
  7. rifapentine
  8. ritonavir
  9. st john’s wort
27
Q

List four CYP2C19 inducers

A
  1. carbamazepine
  2. phenobarbital
  3. phenytoin
  4. rifampin
28
Q

List 10 drug/drug classes that are substrates of CYP3A4

A
  1. analgesics (buprenorphine, diclofenac, fentanyl, hydrocodone, meloxicam, methadone, oxycodone, tramadol)
  2. anticoagulants (apixaban, rivaroxaban, R-warfarin)
  3. antidiabetic drugs (nateglinide, pioglitazone, repaglinide, saxagliptin, sitagliptin)
  4. antiplatelet drugs (cilostazol, prasugrel, ticagrelor)
  5. CV (amiodarone, bosentan, diltiazem, eplerenone, ivabradine, nifedipine, quinidine, ranolazine, tolvaptan, verapamil)
  6. Immuno (cyclosporine, tacrolimus, sirolimus)
  7. Statins (atorvastatin, lovastatin, simvastatin)
  8. Key HIV (atazanavir, efavirenz, ritonavir, tipranavir)
  9. PDE-5 inhibitors (avanafil, sildenafil, tadalafil, vardenafil)
  10. others (alfuzosin, aprepitant, aripiprazole, benzodiazepines, brexpiprazole, buspirone, carbamazepine, citalopram, clarithromycin, colchicine, dapsone, dutasteride, erythromycin, escitalopram, ethinyl estradiol, felbamate, haloperidol, ketoconazole, levonorgestrel, mirtazapine, modafinil, ondansetron, paritaprevir, progesterone, quetiapine, simeprevir, tamoxifen, trazodone, venlafaxine, zolpidem)
29
Q

List seventeen substrates of CYP1A2

A
  1. alosetron
  2. aprepitant
  3. clozapine
  4. cyclobenzaprine
  5. duloxetine
  6. ethinyl estradiol
  7. fluvoxamine
  8. methadone
  9. mirtazapine
  10. olanzapine
  11. ondansetron
  12. pimozide
  13. propranolol
  14. rasagiline
  15. ropinirole
  16. theophylline
  17. R-warfarin
30
Q

List five substrates of CYP2C8

A
  1. amiodarone
  2. dasabuvir
  3. pioglitazone
  4. repaglinide
  5. rosiglitazone
31
Q

List sixteen substrates of CYP2C9

A
  1. alosetron
  2. carvedilol
  3. celecoxib
  4. diazepam
  5. diclofenac
  6. fluvastatin
  7. glyburide
  8. glipizide
  9. glimepiride
  10. meloxicam
  11. nateglinide
  12. phenytoin
  13. ramelteon
  14. S-warfarin
  15. tamoxifen
  16. zolpidem
32
Q

List four substrates of CYP2C19

A
  1. clopidogrel
  2. phenytoin
  3. thioridazone
  4. voriconazole
33
Q

List 3 drugs/drug classes that are substrates of CYP2D6

A
  1. analgesics (codeine, hydrocodone, meperidine, methadone, oxycodone, tramadol)
  2. antipsychotics/antidepressants (aripiprazole, brexpiprazole, doxepin, fluoxetine, haloperidol, mirtazapine, risperidone, thioridazine, trazodone, tricyclic antidepressants, venlafaxine)
  3. others (atomoxetine, carvedilol, dextromethorphan, flecainide, methamphetamine, metoprolol, propafenone, propranolol, tamoxifen)
34
Q

List nineteen prodrugs (active)

A
  1. codeine (morphine)
  2. clopidogrel (active)
  3. lisdexamfetamine (dextroamphetamine)
  4. primidone (phenobarbital)
  5. capecitabine (fluorouracil)
  6. fosaprepitant (aprepitant)
  7. fosphenytoin (phenytoin)
  8. enalapril (enalaprilat)
  9. valacyclovir (acyclovir)
  10. valganciclovir (ganciclovir)
  11. colistimethate (colistin)
  12. calcifediol (calcitriol)
  13. isavuconazonium sulfate (isavuconazole)
  14. famciclovir (penciclovir)
  15. fosamprenavir (amprenavir)
  16. cortisone (cortisol)
  17. prednisone (prednioslone
  18. leflunomide (teriflunomide
  19. levodopa (dopamine)
35
Q

List the most common CYP inducers (hint: PS PORCS)

A
  1. Phenytoin
  2. Smoking
  3. Phenobarbital
  4. Oxcarbazepine (and eslicarbazepine)
  5. Rifampin (and rifabutin, rifapentine)
  6. Carbamazepine (and is an auto-inducer)
  7. St. John’s wort
36
Q

List most common CYP inhibitors (G-PACMAN)

A
  1. Grapefruit
  2. Protease inhibitors (ritonavir especially)
  3. Azole antifungals (fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole, isavuconazonium)
  4. Cyclosporine, cimetidine, cobicistat
  5. Macrolides (clarithromycin and erythromycin, NOT azithromycin)
  6. Amiodarone (and dronedarone)
  7. Non-DHP CCBs (diltiazem, verapamil)
37
Q

List five major P-gp substrates (Don’t Touch A Rabid Dog, DTARD)

A
  1. Digoxin
  2. Tacrolimus
  3. Apixaban
  4. Rivaroxaban
  5. Dabigatran
38
Q

List five drugs ok with MAOIs (hint: IMALE)

A
  1. Ibandronic acid
  2. Metoprolol succinate
  3. Alprazolam
  4. Latanoprost
  5. Estrogen (prempro)
39
Q

List seven drugs which increase digoxin levels (Hint: QVC Monthly Installment Payments, QVCMIPS)

A
  1. Quinidine
  2. verapamil
  3. Cyclosporine
  4. Macrolides
  5. Itraconazole
  6. Propafenone
  7. Spironolactone
40
Q

What is pharmacist’s action if Valproic Acid and Lamotrigine must be used together?

A
  1. VPA inhibits lamotrigine metabolism and increaes risk of Lamotrigine skin rash.
  2. Lamictal Starter Kit is required if used together.

Final NAPLEX (15 decks)

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