Pharma Basics Flashcards
MAOI tyramine rich foods
Tyramine is naturally found in small amounts in protein-containing foods. As these foods age, the tyramine level increases. Some foods high in tyramine include:
● Aged cheeses, such as aged cheddar and Swiss; blue cheeses such as Stilton and Gorgonzola; and Camembert. Cheeses made from pasteurized milk are less likely to contain high levels of tyramine, including American cheese, cottage cheese, ricotta, farm cheese and cream cheese.
● Cured meats, which are meats treated with salt and nitrate or nitrite, such as dry-type summer sausages, pepperoni and salami.
● Fermented cabbage, such as sauerkraut and kimchee.
● Soy sauce, fish sauce and shrimp sauce.
● Yeast-extract spreads, such as Marmite.
● Improperly stored foods or spoiled foods.
● Broad bean pods, such as fava beans.
Tyramine amounts can vary among foods due to different processing, storage and preparation methods. While you’re taking an MAOI, your doctor may recommend eating only fresh foods — not leftovers or foods past their freshness dates.
What do you need to be aware of when prescribing antibiotics?
Check if ABX tx taken in last 3 months and if so, switch classes
Red Flags by condition and drug induced conditions: Infections - Antibiotics
INT ABX & alcohol
Absolute CI for Metronidazole
No interaction btwn other ABCs and alcohol
INT ABX & Oral Contraceptives
Prob a MYTH that ABCs reduce efficacy of OCP
Evidence does not support this belief. Best to be safe & use add’l barrier method
CI of ABX Ciprofloxacin
CI`d Pregnancy & kids (tendons)
INT for ABX –Doxycycline (Tetracycline class)
CI pregnancy, children <8 yrs (dt mottling of teeth)
● May ↑ warfarin effects, ↑ digoxin levels
● Aluminum, bismuth, iron and magnesium ↓ absorption (not affected by Ca)
● Alcohol, carbamazepine, phenytoin and phenobarbital may ↓ concentrations
Red Flags by condition and drug induced conditions: Infections - Antibiotics
ABX Erythromycin
Inhibits P450, so watch for toxicity of other drugs that are metabolised here (anticoagulants, digoxin, carbamazepine, statins, theophylline)
INT ABX for Erythromycin & Clarithromycin (not Azithromycin)
● ↑ Levels of atorvastatin, lovastatin, simvastatin, carbamazepine, digoxin, prednisone, theophylline
INT ABX - Fluoroquinolones (Ciprofloxacin)
● Concomitant antacids, metal cations, sucralfate ↓ absorption (taken with Ca)
● May ↓ clearance of theophylline or cyclosporine.
● May prolong INR if given with warfarin
INT ABX -Fluoroquinolones (Respiratory sx – Moxifloxacin/Levofloxacin)
● Calcium ↓ absorption (antacids, sucralfate, metal cations, dairy, pediatric powders) EXCEPT w/Moxifloxacin
● Avoid in patients on class IA (Na channel blockers) or III (K channel blockers) antiarrythmics due to QT interval prolongation
● May ↑ effects of warfarin
● NSAIDs may ↑ risk of CNS stimulations and/or seizures
What antibiotics are CI for a patient with a Penicillin allergy anaphylaxis?
- Penicillin, Amoxicillin, Amox-Clavulanate, Cloxacillin
- Cephalosporins → Are also ß-Lactams, therefore have the same allergy potential as penicillins
What antibiotics can you prescribe to a patient with a Penicillin allergy anaphylaxis?
clindamycin or azithromycin
INT ABX - Sulfamethozazole + Trimethoprim
(SMX-TMP)
● NOT with sulfa allergy
● May ↑ effects of warfarin and phenytoin
● Additive bone marrow suppression with methotrexate
● May ↑ risk of hypoglycemia when co-administered with rosiglitazone
● ↑’d nephrotoxicity with cyclosporine
Drug induced conditions by ABX Metronidazole
Causes liver failure
CI ABX - Sulfamethozazole + Trimethoprim
(SMX-TMP)
<2yo, Preg 1st & 3rd trimester, sulfa allergy
A/E ABX - Sulfamethozazole + Trimethoprim
(SMX-TMP)
A/E (severe): Steven Johnson Syndrome in 1/30k-40k pts
CI for ABX Metronidazole
- in liver failure patients
- not with EtOH (even tinctures)
- during pregnancy
Red Flags by condition and drug induced conditions: Infections - Antibiotics
SULFA DRUGS → CI’D IN SULFUR ALLERGY
● Trimethoprim-sulfamethoxazole TMP SMX
● Erythromycin-sulfisoxazole
● Sulfasalazine (for AI Dz)
● Dapsaone (leprosy, dermatitis, pneumonia)
● Watch for diuretics, sulfonylureas (Glyburide), celecoxib → may not be a huge concern but should be noted
● “Fat Sucky Surfers Can Swim Tenaciously HardCore”
○ furosamide
○ sumatriptan
○ sulfamethoxazole (and trimethoprim)
○ celecoxib
○ sulfasazaline
○ tamsulosin
○ hydrocholorothiazide
See full list (separate sheet) & effects of sulfa drugs
Sulfa Drugs/ABX INTERACTIONS
BLOOD(albumin)/LIVER/KIDNEYS →
* they all INHIBIT P450 (think warfarin)
* they are easily displaced by albumin (weakly bound), therefore anything that highly binds to albumin will knock it off → increased affect
* compete for renal transport → increase things that need to get out this way
highly allergenic
Sulfadrugs will increase:
■ WARFARIN (coumadin)
■ METHOTREXATE
Don’t give broad-spectum antibiotics to people on warfarin because they kill bacteria, which reduces vitamin K… decreasing clotting even more
Other things that inhibit platelets:
■ cephalosporins, nsaids, penicillins, salicylates, onions, garlic, ginger, ginkgo
○ decrease warfarin effect:
■ estrogen, vitamin K
Drug induced conditions by ABX Aminoglycoside- gentamycin
Increased toxicity with: amphotericin B, magnesium(!!), cephalosprorins, penicillin, loop diuretics (renal failure risk), vancomycin, cisplatin, cycloprorin, indomethacin.
INT ABX Penicillin
effectiveness may be decreased with tetracycline, erythromycin.
INT ABX Ampicillin
increased risk rash if combo with allopurinol
