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NAPLEX > Pharm Foundations: CYP and Therapeutic Levels > Flashcards

Pharm Foundations: CYP and Therapeutic Levels Flashcards

1
Q

Carbamazepine TL

A

4-12 mcg/mL

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2
Q

Digoxin TL

A
  1. 8-2 ng/mL (Afib)

0. 5-0.9 ng/mL (HF)

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3
Q

Gentamicin/Tobramycin (Traditional) TL

A

Peak: 5-10 mcg/mL
Trough: <2 mcg/mL

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4
Q

Lithium TL

A

0.6-1.2 mEq/L (up to 1.5 for acute symptoms)

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5
Q

Phenytoin/Fosphenytoin TL

A

10-20 mcg/mL; correct if albumin is low

Free phenytoin: 1-2.5 mcg/mL

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6
Q

Procainamide TL

A

4-10 mcg/mL

  • NAPA: 15-25 mcg/mL
  • Combined: 10-30 mcg/mL
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7
Q

Theophylline TL

A

5-15 mcg/mL

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8
Q

Valproic Acid TL

A

50-100 mcg/mL (up to 150 for some pts)

-Correct if albumin is low

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9
Q

Vancomycin TL

A
  • AUC can be used to monitor
  • Trough: 15-20 mcg/mL for serious infections (pneumonia, endocarditis, osteomyelitis, etc.)
  • Trough: 10-15 mcg/mL for others
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10
Q

Warfarin TL

A
  • Goal INR: 2-3 for most indications

- Can be higher (2.5-3.5) for high risk indications like mechanical mitral valves

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11
Q

CYP3A4 Substrates

A
  • Analgesics: fentanyl, hydrocodone, methadone, oxycodone
  • Anticoagulants: apixaban, rivaroxaban, R-warfarin
  • CV Drugs: amiodarone, amlodipine, diltiazem, verapamil
  • Immunosuppressants: cyclosporine, tacrolimus, sirolimus
  • Statins: atorvastatin, lovastatin, simvastatin
  • PDE-5i: ___-fil
  • Other: ethinyl-estradiol
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12
Q

CYP3A4 Inducers

A
  • Carbamazepine
  • Oxcarbamazepine
  • Phenobarbital
  • Phenytoin
  • Rifampin
  • Smoking
  • St. John’s Wort
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13
Q

CYP3A4 Inhibitors

A
  • Anti-infectives: clarithromycin, erythromycin, azole antifungals
  • CV Drugs: amiodarone, diltiazem, verapamil
  • Key HIV Drugs: cobicistat, ritonavir, protease inhibitors
  • Other: cyclosporine, grapefruit juice
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14
Q

CYP1A2 Substrates

A
  • Theophylline

- R-warfarin

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15
Q

CYP1A2 Inducers

A
  • Carbamazepine
  • Phenobarbital
  • Phenytoin
  • Rifampin
  • Smoking
  • St. John’s Wort
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16
Q

CYP1A2 Inhibitors

A
  • Ciprofloxacin

- Fluvoxamine

17
Q

CYP2C9 Substrates

A

-S-warfarin

18
Q

CYP2C9 Inducers

A
  • Carbamazepine
  • Phenobarbital
  • Phenytoin
  • Rifampin
  • Smoking
  • St. John’s Wort
19
Q

CYP2C9 Inhibitors

A
  • Amiodarone
  • Fluconazole
  • Metronidazole
  • SMP/TMZ
20
Q

CYP2C19 Substate

A

Clopidogrel

21
Q

CYP2C19 Inhibitors

A

-PPIs (esomeprazole, omeprazole)

22
Q

CYP2D6 Substrates

A
  • Analgesics: codeine, meperidine, and tramadol
  • Antipsychotic/Antidepressants
  • Other: tamoxifen
23
Q

CYP2D6 Inhibitors

A
  • Amiodarone
  • Duloxetine
  • Fluoxetine
  • Paroxetine

NAPLEX (59 decks)

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