Pharm - Toxicities and Side Effects (P-450 Interactions & Sulfa Drugs)

Question 1

Name 9 drugs that are inducers (+) of P-450.

Answer 1

(1) Chronic alcohol use (2) Modafinil (3) St. John’s wort (4) Phenytoin (5) Phenobarbital (6) Nevirapine (7) Rifampin (8) Griseofulvin (9) Carbamazepine; Think: “CHRONIC ALCHOLic MOna STeals PHEN-PHEN and NEver Refuses GReasy CARBs”

Question 2

Name 12 drugs/substances that are inhibitors (-) of P450.

Answer 2

(1) Acute alcohol use (2) Gemfibrozil (3) Ciprofloxacin (4) Isoniazid (5) Grapefruit juice (6) Quinidine (7) Amiodarone (8) Ketoconazole (9) Macrolides (10) Sulfonamides (11) Cimetidine (12) Ritonavir; Think: “A CUTE GEntleman ‘CIPped’ Iced GRAPEFRUIT JUICE QUickly And KEpt Munching on Soft Cinnamon Rolls”

Question 3

What are 8 examples of Sulfa drugs?

Answer 3

(1) Probenecid (2) Furosemide (3) Acetazolamide (4) Celecoxib (5) Thiazides (6) Sulfonamide antibiotics (7) Sulfasalazine (8) Sulfonylureas; Think: “Popular FACTSSS”

Question 4

What are 7 toxicities/symptoms due to sulfa allergies? What is the range of such symptoms?

Answer 4

Patients with sulfa allergies may develop (1) Fever, (2) UTIs, (3) Stevens-Johnson syndrome, (4) hemolytic anemia, (5) thrombocytopenia, (6) agranulocytosis, & (7) urticaria (hives); Symptoms range from mild to life-threatening

Question 5

Of Antipsychotics, Macrolides, Modafinil, which is the P-450 inducer, inhibitor, or substrate?

Answer 5

Inducer - Modafinil; Inhibitor - Macrolides; Substrate - Antipsychotics

Question 6

Of Amiodarone and Antidepressants, which is the P-450 inhibitor versus substrate?

Answer 6

Inhibitor - Amiodarone; Substrate - Antidepressants

Question 7

Of Grapefruit juice and St. John’s wort, which is the P-450 inducer versus inhibitor?

Answer 7

Inducer - St. John’s wort; Inhibitor - Grapefruit juice

Question 8

Of Isoniazid, OCPs, and Phenytoin, which is the P-450 inducer, inhibitor, or substrate?

Answer 8

Inducer - Phenytoin; Inhibitor - Isoniazid; Substrate - OCPs

Question 9

Of Cimetidine and Rifampin, which is the P-450 inducer versus inhibitor?

Answer 9

Inducer - Rifampin; Inhibitor - Cimetidine

Question 10

Of Griseofulvin and Ritonavir, which is the P-450 inducer versus inhibitor?

Answer 10

Inducer - Griseofulvin; Inhibitor - Ritonavir

Question 11

Of Acute alcohol abuse and Carbamazepine, which is the P-450 inducer versus inhibitor?

Answer 11

Inducer - Carbamazepine; Inhibitor - Acute alcohol abuse

Question 12

Of Chronic alcohol abuse and Ciprofloxacin, which is the P-450 inducer versus inhibitor?

Answer 12

Inducer - Chronic alcohol abuse; Inhibitor - Ciprofloxacin

Question 13

Of Anesthetics and Ketoconazole, which is the P-450 inhibitor versus substrate?

Answer 13

Inhibitor - Ketoconazole; Substrate - Anesthetics

Question 14

Of Statins and Sulfonamides, which is the P-450 inhibitor versus substrate?

Answer 14

Inhibitor - Sulfonamides; Substrate - Statins

Question 15

Of Gemfibrozil and Theophylline, which is the P-450 inhibitor versus substrate?

Answer 15

Inhibitor - Gemfibrozil; Substrate - Theophylline

Question 16

Of Carbamazepine and Quinidine, which is the P-450 inducer versus inhibitor?

Answer 16

Inducer - Carbamazepine; Inhibitor - Quinidine

Question 17

Name 8 drugs/substances that are substrates of P450.

Answer 17

(1) Anti-epileptics (2) Antidepressants (3) Antipsychotics (4) Anesthetics (5) Theophylline (6) Warfarin (7) Statins (8) OCPs; Think: “Always, Always, Always Think When Starting Others”

Question 18

Of Anti-epileptics and Phenobarbital, which is the P-450 inducer versus substrate?

Answer 18

Inducer - Phenobarbital; Substrate - Anti-epileptics

Question 19

Of Acute Alcohol abuse, Nevirapine, and Warfarin which is the P-450 inducer, inhibitor, or substrate?

Answer 19

Inducer - Nevirapine; Inhibitor - Acute alcohol abuse; Substrate - Warfarin