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65 Cards in this Set
- Front
- Back
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Severity of drug interaction: Rating 1
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Major
Established, probable or suspectied |
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Rating 2
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Moderate
Established, probable or suspectied |
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Rating 3
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Minor
Established, probable or suspectied |
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Rating 4
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Major or Moderate
Possible |
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Rating 5
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Minor all classes
Possible or unlikely |
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Bacteriocidal
and bacteriostatic anti-biotics |
bacteriocidal drugs require active cells so bacteriostatic drugs are antagonistic
Rating 2 |
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tetracycline and
divalent or trivalent cations |
tetracycline chelates impairing antibiotic absorption - Serum teracycline reduced from 20-
100% with antacids |
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Metronidazole and alcohol
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metronidazole inhibits acetaldehyde dehydrogenase resulting
in acetaldehyde accumulation - flushing, headache, palp, naus |
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Metronidazole and lithium
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metro inhibits renal excretion of Li - Li toxicity - confusion,
ataxia and kidney damage |
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tetracyline and lithium
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a single case report elevated lithium blood concentration and lithium toxicity with concomitant tetracyline administration
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Erythromycin/tetracycline
and digoxin |
antiB reduce gut flora - especially Eubacterium lentum -
metabolises oral digoxin in 10% of people - elevated [digoxin] manifests as salivation, visual disturbances and arrhythmias |
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Broad Spectrum antibiotics or Tetracycline
with warfarin (or anisindione) |
antiB reduce gut flora that synthesize vit K - increased risk of
bleeding in patients with poor vitamin K intake (Warfarin: antagonise vitamin K-dependant clotting factors |
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Erythromycin, clarithromycin
or metronidazole w/ warfarin |
antiB decreases metabolism of warfarin increasing the INR-
haematuria, bruising, risk of serious bleeding and haematona formation |
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Erythromycin
clarithromycin ketoconazole itraconazole w/ drugs metabolized by CYP3A4/1A2 (example: following 10 drugs) |
these antiB block metabolism of CYP3A4/1A2 increasing blood levels of drugs
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CYP3A4/1A2:
Astemizole(H1 receptor antagonist) terfenadine cisapride (used to treat nightime heartburn) |
ventricular arrhythmias -torsades de pointes - prolonged QT
(METRONIDAZOLE also increase cisapride blood levels) |
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CYP3A4/1A2:
Alfentanil (opioid analgesic) |
enhanced and/or prolonged respiratory depression
(KETOCONAZOLE not implicated) |
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CYP3A4/1A2:
Bromocriptine |
risk of adverse CNS effects, dyskinesias and hypotension
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CYP3A4/1A2:
Carbamazepine (anticonvulsant & analgesics: for treating epilepsy & trigeminal neuralgia) |
risk of ataxia, vertigo, drowsiness and confusion
(Cardiac arrest reported in one child taking erythromycin) |
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CYP3A4/1A2:
Cyclosporine |
increased immunosupression and nephrotoxicity
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CYP3A4/1A2:
Felodipine & calcium channel blocker |
risk hypotension, tachycardia, cardiac arrthmias & edema
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CYP3A4/1A2:
Prednisone or Methylprednisolone |
risk cushing syndrome and immunosuppression
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CYP3A4/1A2:
Theophylline |
risk tachycardia, cardiac arrhythmias, tremors & seizure (except ketoconazole)
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CYP3A4/1A2:
Lovastatin & possibly other statin |
muscle pain and rhabdomyolysis
(skeletal muscle lysis) pharmacokinetic intereaction demonstrated for azole antifungal drugs |
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CYP3A4/1A2:
Triazolam or oral midazolam |
inc in blood levels of both benzodiazepines leading to inc in
sedative depth and duration |
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CYP3A4/1A2:
Dysopyramide |
arrhythmias or heart block
(clinical report with erythromycin) |
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Penicillins, cephalosporins,
erythromycin, tetracyclines, metronidazole w/ combined Estrogen and progestin OCP |
interfere w/ enterohepatic recycling of the E - leading to decreased
blood levels - unwanted pregnancy |
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Analgesics: presribed for < 5 Days
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NSAID and
anti-hyperT ACEi, diuretic and B-blockers (NOT calcium channel blockers |
an NSAID may be co-prescribed if required for 4 days or less
avoid in patients w/ severe congestive heart disease extra caution in elderly or black patients |
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NSAID and Li
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toxicity -
avoid combination OR NSAIDS should be prescribed for a very short term use w/ elderly should be avoided |
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NSAID and anticoagulants
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GI bleeds - high dosage aspirin is severity 1
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NSAID and methotrexate
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toxicity-
high dose should be avoided low dosage methotrexate (for arthritis) little concern |
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NSAID and alcohol
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GI bleeding
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NSAID and digoxin
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toxicity - combo avoided if elderly or renal disease
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NSAID and cyclosporine
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toxicity
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NSAID & other NSAID/acetaminophen
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renal damage - if given long term
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Aspirin & oral hypoglycemics
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hypoglycemic effect can be increased
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Aspirin and anticonvulsants
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toxicity w/ valproic acid
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Aspirin & carbonic anhydrase
inhibitors |
toxicity
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Acetaminophen & alcohol -
acute ingestion |
can be used if normal liver - in alcoholics or liver disease lower
max dosage (<4g/day) |
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Acetaminophen & alcohol
cessation after chronic use |
liver damage - do not tell alcoholic to quit if on acetaminophen
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Opioids and alcohol
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additive sedation
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Anaesthetics w/ opioid sedatn (mepivacaine with meperidine)
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risk of local anaesthetic toxicity partic w/ children -reduce dose of local anesthetic
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Meperidine and MAOIs
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toxicity - aviod if taken MAOI in past 14 days
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Summatn w/ CNS depressants:
diazepam and alcohol - antihistamines and barbiturates |
CNS depression is additive for sedatives and anxiolytics; LOC,
resp depression & death are possible complications |
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Chloral hydrate and alcohol
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each limits metabolism of other - depressn is > additive
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Chloral hydrate and warfarin
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compete for plasma protein binding of anticoagulant causes
hypoprothrombinemia |
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Chloral hydrate & furosemide
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rare diaphoresis, tachycardia, hypertension
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Phenobarbital & valproic acid
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elim of barbiturate is decreased; sedation prolonged and enhanced
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Benzodiazepines & rifampicin
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bioavailability of triazolam and oral midazolam is significantly reduced
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Benzodiazepn & Carbamazepn
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bioavailability of triazolam and oral midazolam is significantly reduced
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Benziodiazepn&verapamil &
diltiazem & cimetidine(sev 3) |
level of sedation is increased and prolonged
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Benzodiazepin & erythromycin
& azole antimycotics |
bioavailability of triazolam and oral midazolam is significantly INCREASED
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Benzodiazepines & protease
inhibitors-indinavir, nelfinavir |
bioavailability of triazolam and oral midazolam is significantly INCREASED
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Summatn w/ local anaesthetics
: licocaine with bupivacaine |
toxicity is additive - total dose should not exceed MRD
Total dose should not exceed combined maximum recommended doses or MRDS |
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Ester local w/ sulphonamide
antibiotics- procaine w/ sulfamethoxazole |
procaine metabolite para-amino Procaine metabolite : para-amino benzoic acid may transiently
reduce sulphonamide antibiotic efficacy |
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Amide local w/ inhibitors of
metabolism - lidocaine w/ cimetidine or w/ propranolol |
Inhibition of local anaesthetic metabolism - will have little effect on peak plasma levels as a single injection
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Local anaesthetic induced methaemoglobinaemia -
Prilocaine with dapsone |
methaemoglobinemia usually results from prilocaine dosing in excess of MRD: increased risk may be possible when similar oxidising durgs are administered
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Vasoconstrictor w/ TCA (levonordefrin with imipramine)
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sympathomimetic effect may be enhanced - E cautiously
use of levonordefrin should be avoided |
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Vasoconstrictor w/ nonselectv
B - adrenoceptor antagonist (epinephrine with propranolol) |
hypertensive and/or cardiac reactions, vasoconstrictors should be used cautiously;
BP & HR should be monitored E w/ propranolol |
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Vasoconstrictors w/ general anaesthetic
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poss cardiac arrythmias w/ some GA
(Halothane); consult anaesthesiologist |
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VasoC w/ antipsych or other
α-adrenoceptor blocker (epinephrine and chlorpromazine) |
hypotension from OD of antipsych may be worsened
E and chlorpromazine |
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VasoC w/ adrnergc neuronal
blocker |
sympathomimetic effect may be enhancd-vasoC used cautiously
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VasoC w/ local
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systemic toxicity - self limiting
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VasoC w/ thyriod hormone
cautiously if signs of hyperthy |
summative when thyroid hormones are used in excess - vasoC used cautiously if signs of hyperthyroidsm are present
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VasoC w/ monoamine oxidase inhibitor - (epinephrine and phenelzine)
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No substantial evidence of an interaction
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