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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

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

ANTIBIOTICS

A

Check if ABCtx 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

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

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

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

ABX Ciprofloxacin

A

CI`d Pregnancy & kids (tendons)

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6
Q

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

ABX –Doxycycline Tetracycline
INT

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

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

INT ABX -Erythromycin & Clarithromycin (Azithromycin less)

A

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

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9
Q

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

INT ABX - Fluoroquinolones (Cipro)

A

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

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10
Q

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

INT ABX -Fluoroquinolones (Resp – Moxiflox/Levoflox)

A

● Calcium ↓ absorption (antacids, sucralfate, metal cations, dairy, pediatric powders) EXCEPT w/Moxifloxacin
● Avoid in patients on class 1a or 3 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

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

ABX Penicillin allergy anaphylaxis

A

CI’d Penicillin, Amoxicillin, Amox-Clavulanate, Cloxacillin
Cephalosporins → Are also ß-Lactams, therefore have the same allergy potential as penicillins (use clindamycin or azithromycin)

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12
Q

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

INT ABX - Sulfamethozazole + Trimethoprim
(SMX-TMP)

A

CI: <2yo, Preg 1st & 3rd trimester, sulfa allergy
A/E (severe): Steven Johnson Syndrome in 1/30k-40k pts
● 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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13
Q

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

ABX Metronidazole

A

Causes liver failure, CI liver failure, not with EtOH (even tinctures), pregnancy

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14
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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15
Q

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

Sulfa Drugs 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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16
Q

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

Aminoglycoside- gentamycin

A

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

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17
Q

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

Penicillin

A

effectiveness may be decreased with tetracycline, erythromycin.

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18
Q

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

Ampicillin

A

increased risk rash if combo with allopurinol

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19
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

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20
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

21
Q

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

Pimozide (antipsychotic) INTX WITH AZOLES

A

● 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

22
Q

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

QUINOLONES INTX WITH THEOPHYLLINE

A

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

23
Q

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

ABX THAT CAUSE C DIFF

A

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

24
Q

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

ABX – Clindamycin

A

Higher incidence of C.Diff-associated diarrhea (15-25%)

25
Q

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

ABX – Erythromycin

A

Pro-motility agent, producing diarrhea in 40-50% of people (those that have receptor)

26
Q

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

ABX – Fluoroquinolones

A

Reports of tendon ruptures and cases of severe liver injury have been reported. May see HA and dizziness

27
Q

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

ABX – Nitrofurantoin

A

HA, nausea, flatulence and ↓ appetite, pulmonary and hepatic toxicity w/LT use, rare acute pulmonary toxicity

28
Q

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

ABX – Tetracyclins (Doxycycline)

A

Should not be used in kids or pregnant ladies d/t permanent greying of teeth

29
Q

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

ABX – TMP-SMX

A

Higher incidence of Stevens Johnson Syndrome (1/35,000)

30
Q

Drugs with narrow therapeutic window

A

Gentamycin
Warfarin
Lithium
Digoxin
Theophylline
Methotrexate
Phenytoin
Insulin
Cyclosporine

31
Q

CHOLINERGIC DRUGS

A

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.

32
Q

CHOLINERGIC DRUGS CAUTIONS

A

Asthma
Epilepsy
Hyperthyroidism
Issues with slow heartrate,
Obstruction to urinary or digestive tract such as tumour or severe inflammation causing blockage
Stomach ulcer

33
Q

Anticholinergic Drugs

A

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.

34
Q

There are three categories of anticholinergics

A

Antimuscarinic agents
Ganglionic blockers
Neuromuscular blockers

35
Q

Anticholinergic drugs are typically used to treat

A

GI disorders( gastritis, diarrhea, diverticulitis, UC, nausea, vomiting),
GU disorders (cystitis, urethritis, prostatitis),
Resp Disorder (Asthma, chronic bronchitis, COPD),
Insomnia,
Dizziness

36
Q

Cholinergic Effects

A

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

37
Q

Anti-cholinergic Effects

A

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

38
Q

COMMON MNEMONIC for Anticholinergic syndrome

A

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)

39
Q

Cholinergic Drugs

A

Bethanechol
Carbachol (stimulates muscarinic receptors)
Pilocarpine (stimulates muscarinic receptors)

40
Q

Anti-cholinergic Drugs

A

Aclidinium
Benztropine
Darifenacin
Ethopropazine
Fesoterodine
Glycopyrronium
Ipratropium
Oxybutynin
Procyclidine
Scopolamine
Solifenacin
Tolterodine
Trihexyphenidyl
Trospium

*See anticholnergics reference list in RxFiles

41
Q

Anti- histaminergic Side Effects

A

weight gain and sedation

42
Q

What causes anti-histaminergic side effects?

A

Caused by TCA, antipsychotics and anti-histamines

43
Q

Anti- Alpha Adrenergic Side effects

A

postural hypotension, sexual dysfuntion

44
Q

What causes Anti- Alpha Adrenergic side effects?

A

Caused by TCA, anti psychotics

45
Q

Anti- dopaminergic Side effects

A

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

46
Q

What causes Anti- dopaminergic side effects?

A

Caused by metoclopramide and anti psychotics

47
Q

P450 INDUCERS

A

*Barbiturates
*Carbamazepine
Dexamethasone
Efavirenz
*Glucocorticoids
Modafinil
Nevirapine
Phenobarbital
Phenylbutazone
*Phenytoin
Pioglitazone
Primidone
Rifabutin
Rifampin
*St. John’s Wort
Sulfinpyrazone
Troglitazone

48
Q

P450 INHIBITORS

A

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

ND Ontario Prescribing Exam (22 decks)

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