Naplex Interactions

Front 1

Top 3A4 inducers

Back 1

CS PROPS

Hint 1

carbamazepine
smoking
phenytoin
rifampin
oxcarbazepine
phenobarbital
st johns wort

Front 2

Top 3A4 inhibitors

Back 2

GI PAC MAN:

Hint 2

grape fruit
inh
protease inhibitors
azole
cimetidine
macrolides ( not azith)
amiodarone
non-DHP's

Front 3

amiodarone significant interactions
(inhibitors and substrates)

Back 3

inhibitor of:
2C9
2D6
3A4
P-gp

Hint 3

Substrate of:
3A4
2C8

Front 4

amiodarone significant interactions continued (lower does of the following)

Back 4

digoxin (increase QT prolongation)
warfarin (increase bleeding)
quinidine (increase QT prolongation)
procainamide (increase QT prolongation)
simvastation (increase myalgia risk)
lovastatin (increase myalgia risk)
atorvastin (increase myalgia risk)

Hint 4

amiodarone has a grapefruit interaction
because amidarone is a not only a substrate but also a 3A4 inhibitor

Front 5

Azole interactions

Back 5

intraconazole pH dependent for absorption.

Hint 5

Give with food to increase absorption and avoid H2 blockers, PPIs, antacids

Front 6

clopidogrel interactions

Back 6

avoid:
2C19 inhibitors
esomeprazole
omeprazole

Front 7

colchine interactions (dont use)

Back 7

in renal or hepatic patients
3A4 inhibitors
P-gp inhibitors

Front 8

Digoxin interactions

Back 8

concerned with renal and hepatic clearance (because cleared by kidneys and partially metabolized by liver)

Hint 8

Digoxin levels increased with:
PAC MANS
propafenone
amiodarone
macrolides
azoles
non-DHPs
Spironolactone

Front 9

Lamotrigine and valproate interactions

Back 9

increase risk of severe rash
titrate slowly

Front 10

lithium interactions
(increase levels and decrease levels)

Back 10

decreased salt
dehydration (diuretics)
NSAIDS
ACE I's/ ARBS

Hint 10

increase salt
caffeine
theophylline

Front 11

Lithium contiuned

Back 11

increased risk of 5HT syndrome with:
SSRI, SNRIS, triptans, linezolid

Hint 11

increase risk of neurotoxicity:
non-DHPS
phenytoin
carbamazepine

Front 12

MAO inhibitor interactions increae of ?

Back 12

serotonin syndrome with:
Antidepressants
SSRIs, SNRIs, TCA, tramadolm, triptans, st johns wort etc.

Front 13

NSAIDs can:

Back 13

raise blood pressure and have cardiovascular toxicity (M.I.) except ASA

Front 14

birth control interactions

Back 14

ABX, anticonvulsants, st johns wort, protease inhibitors, nevirapoine

Hint 14

Smoking increase of stroke, MI

Front 15

OPIODS

Back 15

substrate of 3A4

Front 16

Rifampin interactions

Back 16

warfarin (decreases INR)
birth control
2C9, 2C19, 3A4 substrates (rifampin inducer)

Front 17

Statin interactions

Back 17

Telithromycin with lovastitin, simvastatin, atorvastatin, may increase risk of muscle damage therefore hold these meds

Hint 17

dont use pitivastatin with cyclosporine

Front 18

tamoxifen interactions

Back 18

interaction with 2D6 inhibitors, (SSRIs)
because prevents conversion of active form of tamoxifen

Front 19

tetracyline and FQ inteactions

Back 19

Chelating drugs/foods:
antacids, Mg, Al, Zn, Ca2+, Fe, sucralfatem buffered aspirin
(space at least 2 before and 2 after)

Front 20

theophylline interactions

Back 20

it follows First order kinetics followed by Zero order ( like phenytion, voriconizole).

metabolized by 3A4 and 1A2 therefore interacts with:
BC, GI PAC MAN, CS PROPS,

Front 21

Warfarin interactions

Back 21

S-isomer 3 to 5 times stronger than R.

2C9 substrate

Hint 21

2C9 inducers: P.R.'s
phenobarbital
phenytoin
primidone
rifampin
St Johns wort

2C9 inhibitors:
amiodarone
Bactrim
Azoles
Tamoxifen (C/I)
metronidazole

Front 22

Warfarin Pharmacodynamics

Back 22

NSAIDS (not selective agents), ASA, Plavix,, DEFFGGGG (Dong Quai, vitamin E, fever few, fish oil, ginko, ginger, garlic, ginseng, ST johns wort, SSRIs,

INCREASES BLEEDING RISK BUT NOT INR

Hint 22

Warfarin and ASA unnecessary in STENT PATIENTS there dont pick in NAPLEX pick PLAVIX and ASA

Front 23

Hyperkalemia RISK

Back 23

ACE I's, ARB's, sparing diuretics, YAZ. YASMIN, NATAZIA

Front 24

CNS DEPRESSION

Back 24

OH, PN meds, mirtazipine, trazodone, proprandolol, clonidine

Front 25

QT prolongation

Back 25

Time it take the heart to re-polarize after each beat. may lead to torsafe de pointes

Hint 25

CLASS 1 and 3 antiarrhythmics (amidarone, disopyramide, procainamide, qunidine, sotalol), FQ, Macorlides, Azoles, TCA's, Antipsychotics, methadone,

Front 26

narrow therapeutic drugs

Back 26

Carbamazepine, Levothyroxine, lithium, phenytion, theophylline, digoxin, procainamde, Valproic acid, warfarin

Front 27

2C9 inhibs

Back 27

FAMIS
fluconazole
amiodarone
metronidazole
INH
sulfamethoxazole/TMP