Pharm Flashcards
drugs that cause drug-drug interactions
macrolides (erythromycin, clarithromycin)
antifungals (ketoconazole, fluconazole)
cimetidine (Tagamet)
citalopram (celexa)
what drugs do grapefruit juice affect?
statins
erythromycin
CCB (nifedipine, isolipdine)
antivirals (indinavir, saquinavir)
amiodarone
benzodiazepines (diazepam, traizolam)
cisapride
carbazempine
buspirone
narrow therapeutic index drugs
warfarin (Coumadin): monitor INR
Digoxin (Lanoxin): monitor dig level, EKG, e- (Ca, Mg, K)
levothyroxine: monitor TSH
lithium: monitor blood lvls, TSH, (hypothy risk)
Proton pump inhibitors safety issues
increase risk of fractures (post menopausal women, pneumonia, C diff, hypOmg, B12, iron malabsorption, atrophic gastritis, kidney disease)
Omeprazole (Prilosec) safety issues
interacts with warfarin, diazepam, carbamazepine, phenytoin, ketoconazole
Vitamin K antagonist: Warfarin (Coumadin) Safety issues
interacts with “G” herbs: garlic, ginger, ginkgo, ginseng
fish oil, green tea
STOP 1 week before surgery
TZDs: Pioglitazone (Actos) safety issues
BBW: cause/worsen congestive heart failure; NO use in HF 3 or 4
stop if causes dyspnea, weight gain, cough (heart failure)
atypical antipsychotics:
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
safety
high risk: weight gain, metabolic syndrome, DM 2
monitor weight q 3 months
BBW: higher mortality in elderly pts
monitor: TSH, lipids, weight/BMI
bisphosphonates:
Alendronate (Fosamax)
Risedronate (Actonel)
STOP if?
how to take?
erosive esophagitis, abd pain
STOP if sx’s of esophagitis (chest pain, difficulty swallowing, burning mid back) or jaw pain
take with 8 oz WATER before breakfast, 1st thing in morning
do not lie down 30 mins after
statins
atorvastatin (Lipitor)
lovastatin (Mevacor)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
NO grapefruit juice
drug induced hepatitis or rhabdomyolysis higher if mixed with azole antifungals
high dose simvastatin 80 mg have highest risk of rhabdomylosis
Cr kinase goes up
clindamycin has a higher risk of what?
c diff associated diarrhea
cardiac glycosides: Digoxin (Lanoxin)
treats:
s/sx OD:
SVT and HF due to LV systolic
s/sx of OD: GI (anorexia, n/v, abd pain), arrythmias, confusion, yellow/green color vision changes
What laboratory tests should be ordered if digoxin toxicity is suspected?
treatment?
Order a digoxin level, electrolytes (potassium, magnesium, calcium), creatinine, and
serial EKGs
tx: Digoxin-specific antibodies are immunoglobulin G (IgG) antidigoxin
antibodies that bind free digoxin in blood (Digibind, DigiFab)
warfarin (Coumadin) indications
Prophylaxis and treatment thromboembolic events a/s with atrial
fibrillation or heart valve replacement (pulmonary embolism, DVT, stroke, thromboemboli)
warfarin in pregnancy
category X
in warfarin for atrial fib, what is the target INR?
2-3 (ideal INR 2.5)
takes 2-5 days for duration of action for single dose
warfarin initial dose:
2-5 mg QD
check baseline PT, APTT, creatinine, LFT, INR
ACE inhibitors (Enalapril, Captopril) contraindications
no K supplements
careful with K sparing diuretics
new onset dry cough, switch to ARB
ARBs (valsartan, losartan) contraindications
No K supplements
don’t combine with ACEi
K sparing diuretics (triameterene, HCTZ, amiloride, spironolactone (Aldactone) contraindications
higher risk of hyperkalemia if taken with ACEI or ARBS and with severe renal dz
worsen urinary incontinence
NO with ACE, ARB, high K supps, salt subs, chronic NSAIDs
beta blocks (propranolol (Inderal), atenolol, metoprolol, pindolol) contraindications
pt with chronic lung disease (asthma, COPD, emphysema, chronic bronchitis)
don’t stop abruptly = severe rebound = hypertensive crisis
phosphodiesterase 5 inhibitors (sildenafil Viagra, tadalafil (Cialis), vardenafil Levitra) contraindications
NO nitrates (nitroglycerine, isosorbide), some alpha blockers
if erection > 4 hours = go ED!
do not give w/in 3-6 months of MI or stroke
SSRI (citalopram (Celexa))
avoid doses > 40 mg, can cause QT prolongation
if pt > 60 yrs old, max dose is 20 mg qd
do not combine __ with thiazides due to increase risk of __ toxicity
lithium , lithium toxicity
thiazide (HCTZ, chlorthalidone, indapamide) contraindications
*& loop diuretics
sulfa allergy
Thiazide adverse effects
elevates plasma glucose/hyperglycemia
elevates LDL
elevates uric acid (gout)
hypokalemia
