Drug Interactions

Front 1

Common Drugs that inhibit P-glycoproteins (increase the substrate drug concentration):

Back 1

Cyclosporine, Ketoconazole, Erythromycin, Quinidine

Front 2

Big Inducers Acronym

Back 2

PS CROPS

Front 3

Big Inducers
P

Back 3

Phenytoin

Front 4

Big Inducers
S

Back 4

Smoking

Front 5

Big Inducers
C

Back 5

Carbamazepine
*also auto-inducer

Front 6

Big Inducers
R

Back 6

Rifampin, Rifabutin, Rifapentine

Front 7

Big Inducers
O

Back 7

Oxcarbazepine

Front 8

Big Inducers
P

Back 8

Phenobarbital

Front 9

Big Inducers
S

Back 9

St. John's Wort

Front 10

Big Inhibitors Acronym

Back 10

G Loves PACMAN

Front 11

Big Inhibitors
G

Back 11

Grapefruit

Front 12

Big Inhibitors
P

Back 12

Please Please dont miss ritonavir but check all PIs (protease inhibitors) since many are potent inhibitors

Front 13

Big Inhibitors
A

Back 13

Azole antifungals
fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole

Front 14

Big Inhibitors
C

Back 14

Cimetidine

Front 15

Big Inhibitors
M

Back 15

Macrolides
Clarithromycin & Erythromycin
Not azithromycin
Include Telithromycin

Front 16

Big Inhibitors
A

Back 16

Amiodarone & Dronedarone

Front 17

Big Inhibitors
N

Back 17

Non-DHP CCB's
Diltiazem & Verapamil

Front 18

Amiodarone

Back 18

Moderate inhibitor of 2C9, 2D6, & 3A4
Substrate of 3A4 & 2C8
P-glycoprotein inhibitor

Front 19

Drugs you must decrease dose by 30-50% when starting Amiodarone:

Back 19

Digoxin, Warfarin, Quinidine, and Procainamide

Front 20

Drugs you should also lower the doses of when starting Amiodarone:

Back 20

Simvastatin, Lovastatin, Atorvastatin

Front 21

What food should you avoid when taking Amiodarone?

Back 21

Grapefruit products

Front 22

Azole Antifungals are ____ inhibitors

Back 22

3A4

Front 23

Azole Antifungals with pH dependent absorption:

Back 23

Itraconazole & Ketoconazole

Front 24

What Azole Antifungals should you avoid using antacids, H2-blockers and PPIs?

Back 24

Itraconazole & Ketoconazole

Front 25

CYP 450 enzymes that Voriconazole is metabolized by:

Back 25

2C9, 2C19, & 3A4

Front 26

Concurrent use of Voriconazole and what drugs are CI?

Back 26

Alfuzosin, barbiturates, Carbamazapine, Cisapride, Darunavir, Dofetilide, Ergot derivatives, Lopinavir, Nilotinib, Pimozide, Quinidine, Rifampin, Rifabutin, Ritonavir, St. John's wort, etc.

Front 27

Clopidogrel is a ___ substrate.

Back 27

2C19

Front 28

Clopidogrel should not be used with:

Back 28

Cimetidine, Esomeprazole, Omeprazole, Fluoxetine, Fluvoxamine, Ketoconazle, Modafinil, Topiramate, Voriconazole, Etravirine, & Efavirinz

Front 29

Colchicine should not be used with ___ especially in pts wtih renal and hepatic impairment.

Back 29

P-glycoprotein or strong 3A4 inhibitors (G loves PACMAN)

Front 30

Digoxin is mostly ____ cleared.

Back 30

Renally (85%)

Front 31

Drugs that increase Digoxin levels:

Back 31

Amiodarone, Quinidine, Verapamil, Erythromycin, Clarithyromycin, Telithromycin, Itraconzaole, Cyclosporine, Propafenone, Spironolactone, etc.

Front 32

What abnormal lab value will increase digoxin levels?

Back 32

Hypokalemia
(K+ < 3.5)
K+ must be maintained between 3.5-5

Front 33

Drugs that decrease Digoxin levels:

Back 33

Cholestyramine, colestipol, & metoclopramide

Front 34

Grapefruit juice interactions

Back 34

Atorvastatin, Simvastatin, Lovastatin, Buspirone, Amiodarone, Carbamazepine, Cyclosporine, Tacrolimus, Diazepam, Triazolam, Verapamil, Nicardipine, Felodipine, Nisoldipine, Nifedipine, Telithromycin, Voriconazole, etc.

Front 35

Lamotrigine & ____ can increase the risk of a severe rash so should be used with caution and titrated slowly.

Back 35

Valproate

Front 36

Lamotrigine can increase the concentration of ___ up to 2X's and can be life threatening.

Back 36

Valproate

Front 37

Drugs that will increase lithium concentrations:

Back 37

NSAIDs, ACEis, ARBs, dehydration, use with caution with diuretics

Front 38

Drugs that will decrease lithium concentrations

Back 38

caffeine & theophylline

Front 39

How does decreased salt intake affect lithium?

Back 39

Increase the litihium levels

Front 40

MAOis DDIs:

Back 40

SSRIs, SNRIs, TCAs, tramadol, mirtazapine, dextromethorphan, ephedrine and its analogs, buspirone, linezolid, lithium, meperidine, tramadol, mirtazapine, dextromethorphan, cyclobenzaprine, triptans, and St. John's wort

Front 41

Rasagaline is non-selective and should not be used with what type of foods:

Back 41

tyramine containing

Front 42

What is the washout period before starting a MAOi? How is it different with prozac?

Back 42

2 wks
5 wks with prozac

Front 43

NSAIDs have what general effect on BP?

Back 43

Raise it

Front 44

How do non-selective agents affect bleeding? Is this different with selective agents?

Back 44

Non-selective: increase bleeding risk
Selective: decrease bleeding risk

Front 45

NSAIDs should be avoided with renal disease (true/false)

Back 45

True

Front 46

What are the black box warnings for all NSAIDs? Are these true for ASA?

Back 46

CV toxicity and GI Bleeding
CV toxicity not true for ASA

Front 47

What classes of medications decrease the effectiveness of Oral Contraceptives (OCs)?

Back 47

Antibiotics, Anticonvulsants, St. John's Wort, Smoking and some anti-retrovirals

Front 48

What is an important counseling point for a patient on an oral contraceptive and rifampin?

Back 48

Need to use alternative method for 1 1/2 month afterwards

Front 49

What anti-retrovirals increase OC metabolism?

Back 49

Atazanavir, Lopinavir, Nelfinavir, Nevirapine, Ritonavir

Front 50

CYP enzyme involved in oxycodone and other products DDIs?

Back 50

CYP 3A4
Increased levels with CYP 3A4 inhibitors

Front 51

What is a major DDI with PD5 inhibitors such as sidenafil, tadalafil, and vardenafil?

Back 51

Nitrates can cause severe hypotension

Front 52

What other agents should PD5 inhibitors be used cautiously with?

Back 52

alpha blockers especially the non-selective agents such as doxazosin

Front 53

What enzyme metabolizes PD5 inhibitors?

Back 53

CYP3A4
Increased levels with CYP 3A4 inhibitors

Front 54

What enzymes metabolize Rifampin???

Back 54

CYP 2C9, 2C19, & 3A4

Front 55

Is Rifampin a strong inhibitor or inducer?

Back 55

Strong inducer

Front 56

What are two major interactions with rifampin?

Back 56

Oral contraceptives and Warfarin (will decrease INR)

Front 57

What statins are metabolized mostly by CYP 3A4?

Back 57

Lovastatin, Simvastatin, & Atorvastatin

Front 58

What drugs should Lovastatin, Simvastatin, & Atorvastatin be used with caution?

Back 58

Amiodarone, Dronedarone, Cyclosporine, Protease inhibitors, Ketoconazole, Grapefruit juice, Diltiazem, Verapamil, etc.

Front 59

What drug cannot be used with pitavastatin?

Back 59

Cyclosporine

Front 60

Cyclosporine can ___ pravastatin levels

Back 60

Increase

Front 61

What other lipid lower medications should be chosen to give with statins?

Back 61

fenofibrates
gemfibrozil has an increased risk of muscle toxicity

Front 62

Niacin and statins DDI:

Back 62

Increased risk of muscle and liver toxicity

Front 63

Telithromycin use with Lovastatin, Simvastatin, & Atorvastatin:

Back 63

hold these statins due to increase risk of muscle toxicity

Front 64

Tamoxifen is CI with what common heart medication?

Back 64

WARFARIN

Front 65

Tamoxifen should not be used with what type of CYP inhibitor?

Back 65

2D6 which includes SSRIs like paroxetine, fluoxetine, and sertraline

Front 66

Tetracycline and Quinolone antibiotics interact with what elements?

Back 66

Al, Mg, Ca, Iron, an Zinc by chelating

Front 67

How should tetracycline and quinolone antibiotics be given with chelating agents?

Back 67

Separate by 2 hrs before or 2 hrs after administration

Front 68

What CYP enzymes metabolize Theophylline?

Back 68

1A2 & 3A4

Front 69

Drugs that increase theophylline concentrations due to 1A2 inhibition?

Back 69

Oral contraceptives, Zafirlukast, Zileuton, Acyclovir, Cimetidine, Ciprofloxacin, Ehtinyl estradiol, Fluvoxamine, Isoniazid

Front 70

Drugs that increase theophylline concentrations due to 3A4 inhibition?

Back 70

Amiodarone, Azole Antifungals, Clarithromycin, Cyclosporine, Erythromycin, Diltiazem, Lovastatin, Verapamil, Simvastatin, Atorvastatin, PIs

Front 71

Drugs that increase theophylline concentrations by other mechanisms?

Back 71

allopurinol, erythromycin, propanolol, epherine, and possibly other systemic bronchodilators

Front 72

Drugs that decrease theophylline concentrations by other mechanisms?

Back 72

Carbamazepine, Phenobarbital, Phenythoin, Primione, Rifampin, Ritonavir, Tobacco/Marijuana smoking, St. John's wort, Tipranavir/Ritonavir, High protein diet, thyroid hormones

Front 73

Theophylline will have what effect on librium?

Back 73

Decrease it because it increases the renal excretion of librium

Front 74

How much does Amiodarone decrease Warfarins concentration?

Back 74

30-50%

Front 75

Which isomer of warfarin is more potent and by how much?

Back 75

S is 3-5 times more potent

Front 76

The more potent isomer of warfarin is metabolized by what CYP enzyme?

Back 76

S isomer metabolize by 2C9

Front 77

What are some examples of 2C9 inducers which will decrease INR when given with warfarin?

Back 77

Phenobarbital, Phenytoin, Primidone, Rifampin and St. John's wort

Front 78

What are some examples of 2C9 inhibitors which will decrease INR when given with warfarin?

Back 78

Amiodarone, Bactrim, Azole Antifunglas, Tamoxifen, and Metronidazole

Front 79

What drugs will increase bleeding risk when given with warfarin?

Back 79

NSAIDs such as ASA and ibuprofen, Clopidogrel, & Prasugrel

Front 80

What common herbal supplement increases bleeding risk when given with warfarin?

Back 80

Ginkgo bilboa

Front 81

What other herbal supplements increases bleeding risk when given with warfarin?

Back 81

High doses of fish oil, garlic, dong quai, ginseng, and vit E

Front 82

What effects do PPIs have on INR when given with warfarin?

Back 82

Increases it

Front 83

Warfarin drug interactions acronym...

Back 83

FAMES
F- fluconazole (Azoles)
A- amioarone (Decrease warfarin starting 30-50%)
M- metronidazole
E- erythromycin (Macrolides)
S- sulfamethoxazole/trimethoprim

Front 84

Warfarin herbal interactions acronym...

Back 84

DEFG
D- dong quai
E- vit E
F-feverfew, fish oils (>3g/d)
G- gingko, garlic, ginger, ginseng

Front 85

Drugs when given pose an increased bleeding risk?

Back 85

NSAIDs, antiplatelets (ASA, clopidogrel, ticlopidine, prasugrel, dipyridamole), ginkgo bilboa, high doses of fish oil, garlic, dong quai, ginseng, and vit E

Front 86

Drugs when given pose a risk of hyperkalemia?

Back 86

ACEis, ARBs, other K+ sparing agents including amiloride, triamterene, eplernon, spironolactone, salt substitutes, and Yasmin/Yaz

Front 87

Drugs when given pose additive CNS effects?

Back 87

Alcohol, most pain medications (opiods, NSAIDs), skeletal muscle relaxants, BZDs, hypnotics, mirtazapine, trazodone, dronabinol, nabilone, propanolol, clonidine, etc.

Front 88

Drugs when given can cause QT prolongation?

Back 88

Class I & II antiarryhytmics (Amiodarone, disopyramide, procainamide, quinidine, and sotalol), Quinolone antibiotics, Marcrolide antibiotics, Azole antifungals, TCAs, Antipsychotics, Apomorphine, Droperidol, Foscarnet, Methadone, and Pentamidine