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ND Ontario Prescribing Exam > Pharma Basics > Flashcards

Pharma Basics Flashcards

1
Q

MAOI tyramine rich foods

A

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.

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2
Q

What do you need to be aware of when prescribing antibiotics?

A

Check if ABX tx taken in last 3 months and if so, switch classes

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3
Q

Red Flags by condition and drug induced conditions: Infections - Antibiotics

INT ABX & alcohol

A

Absolute CI for Metronidazole
No interaction btwn other ABCs and alcohol

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4
Q

INT ABX & Oral Contraceptives

A

Prob a MYTH that ABCs reduce efficacy of OCP
Evidence does not support this belief. Best to be safe & use add’l barrier method

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5
Q

CI of ABX Ciprofloxacin

A

CI`d Pregnancy & kids (tendons)

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6
Q

INT for ABX –Doxycycline (Tetracycline class)

A

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

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7
Q

Red Flags by condition and drug induced conditions: Infections - Antibiotics

ABX Erythromycin

A

Inhibits P450, so watch for toxicity of other drugs that are metabolised here (anticoagulants, digoxin, carbamazepine, statins, theophylline)

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8
Q

INT ABX for Erythromycin & Clarithromycin (not Azithromycin)

A

● ↑ Levels of atorvastatin, lovastatin, simvastatin, carbamazepine, digoxin, prednisone, theophylline

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9
Q

INT ABX - Fluoroquinolones (Ciprofloxacin)

A

● Concomitant antacids, metal cations, sucralfate ↓ absorption (taken with Ca)
● May ↓ clearance of theophylline or cyclosporine.
● May prolong INR if given with warfarin

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10
Q

INT ABX -Fluoroquinolones (Respiratory sx – Moxifloxacin/Levofloxacin)

A

● 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

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11
Q

What antibiotics are CI for a patient with a Penicillin allergy anaphylaxis?

A
  • Penicillin, Amoxicillin, Amox-Clavulanate, Cloxacillin
  • Cephalosporins → Are also ß-Lactams, therefore have the same allergy potential as penicillins
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12
Q

What antibiotics can you prescribe to a patient with a Penicillin allergy anaphylaxis?

A

clindamycin or azithromycin

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13
Q

INT ABX - Sulfamethozazole + Trimethoprim
(SMX-TMP)

A

● 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

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14
Q

Drug induced conditions by ABX Metronidazole

A

Causes liver failure

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15
Q

CI ABX - Sulfamethozazole + Trimethoprim
(SMX-TMP)

A

<2yo, Preg 1st & 3rd trimester, sulfa allergy

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16
Q

A/E ABX - Sulfamethozazole + Trimethoprim
(SMX-TMP)

A

A/E (severe): Steven Johnson Syndrome in 1/30k-40k pts

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17
Q

CI for ABX Metronidazole

A
  • in liver failure patients
  • not with EtOH (even tinctures)
  • during pregnancy
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18
Q

Red Flags by condition and drug induced conditions: Infections - Antibiotics

SULFA DRUGS → CI’D IN SULFUR ALLERGY

A

● 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

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19
Q

Sulfa Drugs/ABX INTERACTIONS

A

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

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20
Q

Drug induced conditions by ABX Aminoglycoside- gentamycin

A

Increased toxicity with: amphotericin B, magnesium(!!), cephalosprorins, penicillin, loop diuretics (renal failure risk), vancomycin, cisplatin, cycloprorin, indomethacin.

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21
Q

INT ABX Penicillin

A

effectiveness may be decreased with tetracycline, erythromycin.

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22
Q

INT ABX Ampicillin

A

increased risk rash if combo with allopurinol

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23
Q

Red Flags by condition and drug induced conditions: Infections - Antibiotics

NITROFURANTOIN

A

CI in people with renal failure, do NOT use if pyelonephritis is suspected

24
Q

Red Flags by condition and drug induced conditions: Infections - Antibiotics

Pimozide(antipsychotic) INTX WITH MACROLIDES

A

● erythromycin base and pimozide both increase QTc interval. Contraindicated
● erythromycin base increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation
erythromycin base will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Significant - Monitor Closely

25
Red Flags by condition and drug induced conditions: Infections - Antibiotics Pimozide (antipsychotic) INTX WITH AZOLES
● fluconazole and pimozide both increase QTc interval. Contraindicated ● fluconazole increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation fluconazole will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor or non-significant interaction
26
Red Flags by condition and drug induced conditions: Infections - Antibiotics QUINOLONES INTX WITH THEOPHYLLINE
ciprofloxacin will increase the level or effect of theophylline by affecting hepatic enzyme CYP1A2 metabolism. Serious - Use Alternative. Concomitant use of theophylline and ciprofloxacin has decreased theophylline clearance and increased plasma levels and symptoms of toxicity. Serious and fatal reactions have included cardiac arrest, seizure, status epilepticus, and respiratory failure. If concomitant use cannot be avoided, monitor theophylline levels and adjust dosage as needed
27
ABX that cause C. Difficile
FREQUENTLY- Fluoroquinolone, clindamycin, penicillins (broad spectrum), cephalosporins (broad spectrum)- cefprozil and cefluorixime OCCASIONALLY- Macrolides (azith, clar), trimethoprim, sulfonamides RARELY- aminoglycosides (gentamicin, tobramycin, amikacin, streptomycin, neomycin, paromomycin), tetracyclines, chloramphenicol, metronidazole and vancomycin
28
Adverse Effects of ABX Clindamycin
Higher incidence of C.Diff-associated diarrhea (15-25%)
29
Adverse Effects of ABX Erythromycin
Pro-motility agent, producing diarrhea in 40-50% of people (those that have receptor)
30
Adverse Effects of ABX Fluoroquinolones
Reports of tendon ruptures and cases of severe liver injury have been reported. May see HA and dizziness
31
Adverse Effects of ABX Nitrofurantoin
HA, nausea, flatulence and ↓ appetite, pulmonary and hepatic toxicity w/LT use, rare acute pulmonary toxicity
32
Adverse Effects of ABX Tetracyclins (Doxycycline)
Should not be used in kids or pregnant ladies d/t permanent greying of teeth
33
Adverse Effects of ABX TMP-SMX
Higher incidence of Stevens Johnson Syndrome (1/35,000)
34
Drugs with narrow therapeutic window
Gentamycin Warfarin Lithium Digoxin Theophylline Methotrexate Phenytoin Insulin Cyclosporine
35
CHOLINERGIC DRUGS
the Parasympathetic nervous system uses acetylcholine to send its messages. Cholinergic drugs produce same effect as acetylcholine. Some directly mimic the effect of acetylcholine, and others block effects of acetylcholinesterase (enzyme that destroys acetylcholine). Effects: slowing heartbeat, increases normal secretions including the digestive acids of the stomach, saliva, and tears.
36
CHOLINERGIC DRUGS CAUTIONS
Asthma Epilepsy Hyperthyroidism Issues with slow heartrate, Obstruction to urinary or digestive tract such as tumour or severe inflammation causing blockage Stomach ulcer
37
Anticholinergic Drugs
block acetylcholine in the CNS and PNS and inhibit parasympathetic nerve impulses by selectively blocking the binding of acetylcholine to its receptor in nerve cells.
38
There are three categories of anticholinergics
Antimuscarinic agents Ganglionic blockers Neuromuscular blockers
39
Anticholinergic drugs are typically used to treat
GI disorders( gastritis, diarrhea, diverticulitis, UC, nausea, vomiting), GU disorders (cystitis, urethritis, prostatitis), Resp Disorder (Asthma, chronic bronchitis, COPD), Insomnia, Dizziness
40
Cholinergic Effects
Bradycardia (muscarinic) or tachycardia (nicotinic), vasodilation, hypotension or irregular heartbeat Bronchospasm/bronchoconstriction (difficulty breathing)/wheezing Convulsions Cramps Diarrhea Dizziness Headache/browache Increased stomach acid and saliva Lacrimation/watery eyes Lethargy Mimics acetylcholine effects: Miosis (pinpoint pupils) Muscle weakness/muscle cramps Nausea and vomiting Polyuria Salivation Sweating Tremor
41
Anti-cholinergic Effects
Aggravation of glaucoma Confusion and memory impairment (especially in elderly) Constipation Dementia Dry mouth Dry nose Easily startled Euphoria/dysphoria Increased body temperature Mydriasis (blurred vision)- pupil dilation, photophobia, double vision Orthostatic hypotension Poor coordination Reduced sweating, Sedation Tachycardia Trouble breathing/resp depression Urinary retention
42
COMMON MNEMONIC for Anticholinergic syndrome
Blind as a Bat (dilated pupils) Red as a beet (vasodilation/flushing) Hot as a Hare (hyperthermia) Dry as a Bone (dry skin) Mad as a Hatter (hallucinations/agitation) Bloated as a Toad (ileus, urinary retention) And the Heart Runs Alone (tachycardia)
43
Cholinergic Drugs
Bethanechol Carbachol (stimulates muscarinic receptors) Pilocarpine (stimulates muscarinic receptors)
44
Anti-cholinergic Drugs
Aclidinium Benztropine Darifenacin Ethopropazine Fesoterodine Glycopyrronium Ipratropium Oxybutynin Procyclidine Scopolamine Solifenacin Tolterodine Trihexyphenidyl Trospium *See anticholnergics reference list in RxFiles
45
Anti- histaminergic Side Effects
weight gain and sedation
46
What causes anti-histaminergic side effects?
Caused by TCA, antipsychotics and anti-histamines
47
Anti- Alpha Adrenergic Side effects
postural hypotension, sexual dysfuntion
48
What causes Anti- Alpha Adrenergic side effects?
Caused by TCA, anti psychotics
49
Anti- dopaminergic Side effects
extra pyramidal effects, drug-induced movement disorders that include acute and tardive symptoms. These symptoms include dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness), parkinsonism (characteristic symptoms such as rigidity), bradykinesia (slowness of movement), and tremor, and tardive dyskinesia (irregular, jerky movements); Also cause hyperprolactinemia- galactorrhea, oligomenorrhea, infertility, neuroleptic syndrome and oculogyric crisis
50
What causes Anti- dopaminergic side effects?
Caused by metoclopramide and anti psychotics
51
P450 INDUCERS
*Barbiturates *Carbamazepine Dexamethasone Efavirenz *Glucocorticoids Modafinil Nevirapine Phenobarbital Phenylbutazone *Phenytoin Pioglitazone Primidone Rifabutin Rifampin *St. John's Wort Sulfinpyrazone Troglitazone
52
P450 INHIBITORS
Amiodarone Anastrozole Chloramphenicol Cimetidine *Ciprofloxacin *Clarithromycin Clotrimazole Danazol Delavirdine Diltiazem *Erythromycin *Fluconazole *Fluoxetine Fluvoxamine *Grapefruit juice Indinavir *Itraconazole *Ketoconazole *Metronidazole Mibefradil *Miconazole Nefazodone Nelfinavir Nevirapine Norfloxacin Norfluoxetine Omeprazole *Paroxetine Propoxyphene Quinidine *Ranitidine
53
Examples of Calcium containing drugs, food, supplements
antacids, sucralfate, metal cations, dairy, pediatric powders
54
What kind of drugs are class IA antiarrythmics?
Na channel blockers
55
What kind of drugs are class III antiarrythmics?
K channel blockers

ND Ontario Prescribing Exam (21 decks)

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