Pharm Foundations: CYP and Therapeutic Levels Flashcards
1
Q
Carbamazepine TL
A
4-12 mcg/mL
2
Q
Digoxin TL
A
- 8-2 ng/mL (Afib)
0. 5-0.9 ng/mL (HF)
3
Q
Gentamicin/Tobramycin (Traditional) TL
A
Peak: 5-10 mcg/mL
Trough: <2 mcg/mL
4
Q
Lithium TL
A
0.6-1.2 mEq/L (up to 1.5 for acute symptoms)
5
Q
Phenytoin/Fosphenytoin TL
A
10-20 mcg/mL; correct if albumin is low
Free phenytoin: 1-2.5 mcg/mL
6
Q
Procainamide TL
A
4-10 mcg/mL
- NAPA: 15-25 mcg/mL
- Combined: 10-30 mcg/mL
7
Q
Theophylline TL
A
5-15 mcg/mL
8
Q
Valproic Acid TL
A
50-100 mcg/mL (up to 150 for some pts)
-Correct if albumin is low
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
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
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
12
Q
CYP3A4 Inducers
A
- Carbamazepine
- Oxcarbamazepine
- Phenobarbital
- Phenytoin
- Rifampin
- Smoking
- St. John’s Wort
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
14
Q
CYP1A2 Substrates
A
- Theophylline
- R-warfarin
15
Q
CYP1A2 Inducers
A
- Carbamazepine
- Phenobarbital
- Phenytoin
- Rifampin
- Smoking
- St. John’s Wort
