pharmacy foundations 1 Flashcards by ashley wellington

muscarinic action & agonist/antagonist

ACh
SLUDD - pilocarpine
anti SLUDD - atropine, oxybutynin

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nicotinic action & agonist/antagonist

ACh
increase BP, HR - nicotine
NM blockade - NM blockers (rocuronium)

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alpha 1 action & agonist/antagonist

Epi/NE - peripheral
increase BP/ smooth muscle vasoconstriction - PE, dopamine
decrease BP/ vasodilation - doxazosin, carvedilol, phentolamine

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alpha 2 action & agonist/antagonist

Epi/NE - central
decrease BP, HR - clonidine, brimonidine
increase BP, HR - ergot alkaloids, yohimbe

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beta 1 action & agonist/antagonist

Epi/NE - heart
increase contractility, HR, CO - dobutamine, isoproterenol, dopamine
decrease CO, HR - AMEBBA, propranolol, carvedilol

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beta 2 action & agonist/antagonist

Epi - lungs
bronchodilation - albuterol, isoproterenol, terbutaline
bronchoconstriction - non selective BB

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dopamine action & agonist/antagonist

renal, cardiac, CNS - levodopa, pramiprexole
renal, cardiac, CNS - FGA, metoclopramide

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serotonin action & agonist/antagonist

platelet, GI, psych - triptans
platelet, GI, pysch - ondansetron, SGA

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AChesterase drugs

donepezil, rivastigmine, galantamine

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MAO inhibitors

phenelzine, tranylcypromine, isocarboxazid, selegiline, rasagiline, methylene blue, linezolid

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what drugs should be separated from polyvalent ions

levothyroxine, tetracyclines, quinolones, bisphosphonates

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which drugs are polyvalent cations and should be separated from certain drugs

antacids, MVI, sucralfate, bile acid resins, Al, Ca, Fe, Mg, Zn, phosphate binders

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where do most PK drug interactions occur

liver

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list of prodrugs and their active metabolites

colistimethate - colistin
cortisone - cortisol
famciclovir - penciclovir
isavuconazonium sulfate - isavuconazole
prednisone - prednisolone
primidone - phenobarbital
tramadol - active

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CYP inhibitors

G <3 PACMAN
Grapefruit juice
Protease inhibitors (-avir)
Amiodarone
Cyclosporine, cobicistat
Macrolides (not azithromycin)
Azoles
Non DHP CCB

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CYP inducers

PS PORCS
Phenytoin
Smoking
Phenobarbital/Primidone
Oxcarbazepine
Rifampin
Carbamazepine (auto inducer)
St john’s wort

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Pgp substrates

anticoagulants
digoxin
non dhp ccb
cyclosporine/tacrolimus
colchicine
HCV drugs

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Pgp inhibitors

PACMAN
Protease inhibitor (AND HCV drugs)
Azoles (itraconazole/posaconazole)
Cyclosporine/Cobicistat
Macrolides (clarithromycin)
Amiodarone
Nonn DHP CCB

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Pgp inducers

P PRCS
Phenytoin
Phenobarbital
Rifampin
Carbamazepine
St John’s wort

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common CV drug interactions

amiodarone (2C9 inhibitor) + warfarin - decrease warfarin 50%

amiodarone (Pgp inhibitor) + digoxin - decrease digoxin 50%

digoxin + loop - decreases K, Mg, Ca, Na (digoxin increases Ca)

statin (3A4 substrate) + inhibitor - use pitastatin, pravastatin, rosuvastatin

warfarin + 2C9 inhibitor/inducer - increase/decrease warfarin level AND INR

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common inhibitor/substrate drug interactions

valproate + lamotrigine - increase lamictal (use lower starter kit)

MAO + antidepressants, antipsychotics, opioids, analgesics, ADHD drugs, lithium, st john’s wort, tyramine food

3A4, pgp inhibitors + CNI or mTOR - increases drug concentration

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common inducer/substrate drug interactions

AED + contraceptives, other AEDs (use higher lamictal kit)

smoking + antipsychotics, antidepressants, hypnotics, caffeine, theophylline, warfarin

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drugs with additive serotonergic activity

antidepressants
MAO inhibitors
opioids
triptans
St. john’s wort, L tryptophan
buspirone, lithium, dextromethorphan

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drugs with additive bleeding risk

anticoagulants
antiplatelets
NSAID
5 Gs, vitamin E, dong quai, willow bark, fish oil
SSRI/SNRI

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drugs with additive hyperkalemia risk & hypokalemia

RAAS inhibitors (ACEi, ARB, ARNI, aliskiren, aldosterone antagonists) potassium sparing (triamterene, amiloride) KCl CNI SMX/TMP canagliflozin drosperinone hypokalemia - diuretics, beta2 agonists, insulin

drugs with additive QT prolongation risk

antipsychotics antidepressants antiarrhythmics anti-infectives - macrolides, quinolones, azoles, antimalarials antiemetics ADT TKI oxaliplatin methadone loperamide hydroxyzine

drugs with additive ototoxicity risk

vancomycin aminoglycosides cisplatin salicylates loops

drugs with additive nephrotoxicity

ampB vancomycin cisplatin aminoglycosides CNI loop NSAIDs contrast dye

drugs with anticholinergic toxicity

antidepressants/antipsychotics sedating antihistamines muscle relaxants - baclofen, carisoprodol, cyclobenzaprine antimuscarinics atropine, dicyclomine

drugs with additive hypotension risk

PDE5 inhibitors + 3A4 inhibitors OR nitrates OR alpha 1 blockers

CYP3A4 substrates

opioids (fentanyl, hydrocodone, oxy, methadone, tramadol) statins warfarin, Xa inhibitors amiodarone amlodipine Non DHP CCB CNI, sirolimus NNRTIs PDE5 inhibitors EE

CYP1A2 substrates

theophylline R-warfarin

CYP1A2 inhibitors

ciprofloxacin fluvoxamine

CYP2C9 subtrate

S-warfarin

CYP2C9 inhibitors

amiodarone fluconazole metronidazole SMX/TMP

CYP2D6 substrates

codeine, meperidine, tramadol tamoxifen

CYP2D6 inhibitors

amiodarone duloxetine fluoxetine paroxetine

drugs that affect Ca

increase - thiazide, vit D, digoxin decrease - loop, heparin, bisphosphonate, cinacalcet, steroids

drugs that affect Mg

decrease - PPI, diuretics, ampB

drugs that affect Na

increase - tolvaptan, saline decrease - diuretics, SSRI, tegretol, trileptal

what drug decreases bicarbonate

topiramate

drugs that increase SCr

aminoglycosides, ampB, vancomycin, CNI, loops, colistin, NSAIDs, cisplatin

drugs that decrease folate

phenytoin, phenobarbital, methotrexate, SMX/TMP

drugs that cause hemolytic anemia

penicillins/cephalosporins, dapsone, isoniazid, levodopa, methyldopa, methylene blue, nitrofurantoin, pegloticase, primaquine, quinidine, quinine, rasburicase, rifampin, sulfonamides, fava beans

what drugs can lead to a false PT/INR and aPPT reading

daptomycin, oritavancin, televancin

drugs that cause pancreatitis (increased amylase, lipase)

GLP1 agonists, DPP4 inhibitors, didanosine, valproic acid

drugs that increase CPK

statins, INSTI, TDF/TAF, daptomycin

drugs that increase uric acid

diuretics, CNI, aspirin, niacin, pyrazinamide, pancreatic enzymes

drugs that cause DILE

hydralazine anti TNF isoniazid methimazole/PTU methyldopa minocycline procainamide quinidine terbinafine

drugs that increase lactic acid

NRTI, metformin

therapeutic level for carbamazepine

4-12

therapeutic level for digoxin

0.5-0.9 for HF 0.8-2 for AF

therapeutic level for aminoglycosides

peak 5-10 trough <2

therapeutic level for lithium

0.6-1.2

therapeutic level for phenytoin

10-20

therapeutic level for procainamide

4-10 15-25 for NAPA 10-30 for combined

therapeutic level for theophylline

5-15

therapeutic level for valproic acid

50-100

therapeutic level for vancomycin

15-20 for serious infection 10-15 for others

therapeutic level for warfarin

2-3 2.5-3.5 for mechanical valve

references for ADR

ASHP FDAble MedWatch

references for compounding

Allens ASHP Excipients SDS Merck Index Remington Trissels USP

references for drug interactions

Hansten and Horns

reference for drug pricing

red book

references for drug shortages

ASHP FDA

references for immunizations

ACIP MMWR pink book immunization action coalition

references for international drug information

index nominum martindale USAN

references for IV drug compatability and stability

ASHP handbook on injectable drugs king guide trissels

references for drug safety

MedWatch ISMP NIOSH

references for pediatrics

NeoFax red book harriet lane AAP

references for pharmacology

goodman and gilman

references for pregnancy and lactation

briggs micromedex lactmed hales CDC

references for regulatory and business development

CDER pink sheet

references for therapeutics and disease management

DiPiro handbook of nonprescription drugs koda kimble merck manual up to date

which injectable medications are NOT refrigerated

methotrexate lovenox fondaparinux imitrex

which patches should be applied twice weekly

alora, vivelle-dot oxytrol

which patch should be applied twice daily

diclofenac

which patches should be applied weekly

butrans catapress climara xulane

which patches should be removed during an MRI

catapres neupro transderm andoderm

what drugs have sorption or leaching issues with PVC containers

Leach Absorbs To Take In Nutrients Lorazepam Amiodarone Tacrolimus Taxanes Insulin Nitroglycerin

what drugs must be diluted in SALINE ONLY

A DIAbetic Can't Eat Pie Ampicillin Daptomycin Infliximab Ampicillin/sulbactam Caspofungin Ertapenem Phenytoin

what drugs must be diluted in DEXTROSE ONLY

Outrageous Bakers Avoid Salt Oxaliplatin Bactrim AmpB Synercid

what IV drugs require filtration

GAL PLAT Golimumab Amiodarone Lorazepam Phenytoin Lipids - 1.2 micron AmpB - 5 micron Taxanes, except docetaxel

what IV drugs should NOT be refrigerated

Dear Sweet Pharmacist, Freezing Makes Me Edgy Dexmedetomidine SMX/TMP Phenytoin Furosemide Metronidazole Moxifloxacin Enoxaparin

what IV drugs should be protected from the light

Protect Every Necessary Med from Daylight Phytonadione Epoprostenol Nitroprusside Micafungin Doxycycline