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84 Cards in this Set

  • Front
  • Back
carbamazepine
strong CYP inducer
adriamycin
P-glycoprotein – substrate
amiodarone
2D6 – moderate inhibitor
use sotalol

2C9 – moderate inhibitor
use sotalol

P-glycoprotein – inhibitor
amphetamines
2D6 – major substrate
atypical antipsychotics
2D6 – major substrate
benzodiazepines (alprazolam, triazolam, diazepam, midazolam)
3A4 – major substrate

use lorazepam or oxazepam for triazolam esp.
caffeine
1A2 – major substrate
carvedilol
2C9 – major substrate
CCB (amlodipine, felodipine, diltiazem, verapamil)
3A4 – major substrate
celecoxib
2C9 – major substrate
charcoal-broiled foods
1A2 – moderate inhibitor
cigarette smoke
1A2 – moderate inhibitor
cimetidine
1A2 – moderate inhibitor
use famotidine

2C19 – moderate inhibitor
use famotidine

2D6 – moderate inhibitor
use famotidine

3A4 – moderate inhibitor
ciprofloxacin
1A2 – strong inhibitor

use another FQ
citalopram
2C19 – major substrate
clarithromycin
1A2 – moderate inhibitor
use azithromycin

3A4 – strong inhibitor

P-glycoprotein – substrate

P-glycoprotein – inhibitor
clozapine
1A2 – major substrate
codeine --> morphine
2D6 – major substrate
daunorubicin
P-glycoprotein – substrate
diazepam
2C19 – major substrate

use lora-/oxa-/tema-zepam
digoxin
P-glycoprotein – substrate
erythromycin
1A2 – moderate inhibitor
use azithromycin

3A4 – moderate inhibitor

P-glycoprotein – substrate

P-glycoprotein – inhibitor
fluconazole
2C19 – strong inhibitor
use voriconazole

3A4 – moderate inhibitor

2C9 – strong inhibitor
use voriconazole
fluoxetine
2C19 – moderate inhibitor

2C9 – major substrate

2D6 – strong inhibitor
use escitalopram
fluvastatin
2C9 – major substrate

2C9 – moderate inhibitor
fluvoxamine
1A2 – major substrate

1A2 – strong inhibitor
use escitalopram

2C19 – strong inhibitor
garlic (allicin)
strong CYP inducer
gemfibrozil
2C19 – strong inhibitor
use fenofibrate

2C9 – strong inhibitor
glimepiride
2C9 – major substrate
glipizide
2C9 – major substrate
grapefruit juice
3A4 – strong inhibitor
haloperidol
2D6 – major substrate
hydro-/oxy-codone
2D6 – major substrate
hypericum (St. John’s Wort)
strong CYP inducer
ibuprofen
2C9 – strong inhibitor

use APAP
isoniazid
2C19 – strong inhibitor

3A4 – strong inhibitor
itraconazole
3A4 – strong inhibitor
ketoconazole
1A2 – strong inhibitor
use fluconazole

2D6 – moderate inhibitor
use fluconazole

3A4 – strong inhibitor

2C9 – strong inhibitor

P-glycoprotein – inhibitor
losartan
2C9 – major substrate
methadone
2D6 – major substrate
metoprolol
2D6 – major substrate
metronidazole
3A4 – moderate inhibitor
mirtazapine
1A2 – major substrate
omeprazole
2C9 – moderate inhibitor

use lansoprazole or famotidine
oral contraceptive
1A2 – major substrate

3A4 – major substrate
paclitaxel
P-glycoprotein – substrate
paroxetine
2D6 – strong inhibitor

use escitalopram
PDE5-I (sildenafil, tadalafil, & vardenafil)
3A4 – major substrate
phenobarbital
strong CYP inducer

2C19 – major substrate
phenytoin
strong CYP inducer

2C19 – major substrate

2C9 – major substrate

P-glycoprotein – substrate

P-glycoprotein – inducer
primidone
strong CYP inducer
propranolol
1A2 – major substrate

2D6 – major substrate
protease inhibitors
3A4 – major substrate

P-glycoprotein – substrate
quinidine
2D6 – strong inhibitor

3A4 – strong inhibitor

P-glycoprotein – inhibitor
rifampin
strong CYP inducer

P-glycoprotein – inducer
ritonavir
2D6 – strong inhibitor

3A4 – strong inhibitor
sertraline
2C19 – major substrate

2D6 – moderate inhibitor
SSRIs
2D6 – major substrate
St. John’s Wort
P-glycoprotein – inducer
statins (atorvastatin, lovastatin, simvastatin)
3A4 – major substrate

use pravastatin or rosuvastatin
TCA
2D6 – major substrate
telithromycin
3A4 – strong inhibitor
theophylline
1A2 – major substrate
TMP/SMX
2C9 – major substrate

2C9 – strong inhibitor
tramadol
2D6 – major substrate
verapamil
P-glycoprotein – inhibitor
vinca alkaloids
P-glycoprotein – substrate
voriconazole
3A4 – moderate inhibitor

2C9 – major substrate
warfarin
2C9 – major substrate
zileuton
1A2 – moderate inhibitor

use montelukast

cyclosporine and tacrolimus are substrates of

3A4 and P-gp

mycophenolate

decrease levels of hormonal contraception




decreased by antacids, multivit, cyclosporine, metronidazole, PPIs, fluoroquinolones, sevelamer, bile acid resins, rifampin.




increased by acyclovir, valganciclovir, ganciclovir.




avoid grapefruit

triptan product comparisons

sumatriptan (Imitrex): PO, nasal, SQ, transdermal patch




rizatriptan (Maxalt): PO, ODT




zolmitriptan (Zomig): PO nasal, ODT




frovatriptan (Frova): long t1/2




eletriptan (Relpax): more effective than sumatriptan

Fiorinal vs Fioricet

Fiorinal: ASA, butalbital, caffeine




Fioricet: APAP, butalbital, caffeine +/- codeine

migraine prophylaxis

acute medication use more than 2 times per week

propranolol, timolol, metoprolol, valproate, topiramate

gout prophylaxis

more than 2 acute attacks per year, goal uric acid: 5-6 mg/dL

Loop dose equivalency

furosemide 40 mg


bumetanide 1 mg


torsemide 20 mg


ethacrynic acid 50 mg

beta blocker use in HF

recommend: carvedilol, metoprolol succinate, bisoprolol




start: class II-IV




improves ventricular systolic function, decrease morbidity/mortality

aldosterone antagonist in HF

reduce morbidity and mortality




start: class III-IV

hydralazine+nitrate in HF

black patients




start: class III-IV with symptoms despite therapy




no effect on outcomes alone.

digoxin in HF

Positive ionotropic effect (increase CO), negative chronotropic effect (decrease HR)




no change in survival but reduced hospitalizations and improved symptoms

ADHF

congestion: jugular vein distension, edema, rales, ascites




hypoperfusion: cool extremities, hypotension, decreased renal function, impaired mental function -- DC beta blocker

factor Xa inhibitor

SQ: fondaparinux




PO: rivaroxaban, apixaban

direct thrombin inhibitors

SQ/IV: argatroban, bivalirudin, desirudin




PO: dabigatran