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32 Cards in this Set

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  • Back
What are 4 significant drug-food interactions to know
Ziprasidone: absorption increases 2x with food

Lurasidone: drug exposure increases 2x with food

Asenapine: exposure decreases 10-20% with food/water after dose

MAOIs with tyramine rich foods (basically anything aged or fermented)
How does St Johns wart possibly effect SSRIs
increases risk of serotonin syndrome
Which psychiatric medications have significant interactions regarding epilepsy
clozapine, chlorpromazine, loxapine, clomipramine, bupropion
Which psychiatric medications have significant interactions regarding arrythmias
TCAs
Which psychiatric medications have significant interactions regarding parkinsons disease
1st gen APs
Which psychiatric medications have significant interactions regarding dementia
anticholinergic agents
Which psychiatric medications have significant interactions regarding insomnia
CNS stimulants
What is meant by a pharmacodynamics drug interaction
synergy or antagonism of drug effects at target receptor
What are common pharmacodynamics (PD) interactions in psychotropics
Sedation, orthostasis, cardiotoxicity, serotonin syndrome
Describe MAOIs PD interactions with serotonergic antidepressants, bupropion, and CNS stimulants
Increase risk Serotonin syndrome
Increase risk bupropion toxicity
Increase risk hypertensive crisis
SSRIs plus Nsaids
increased risk GI bleeding
clozapine plus carbamazepine
increased risk blood dyscrasias
IM olanzapine plus IM lorazepam
Increased sedation plus cardiorespiratory depression
Which psychotropics can cause arrythmias
TCAs, ziprasidone, thioridazine, IV haldol
What are common causes of clinically significant pharmacokinetic interactions
effects on CYP450 enzymes, alteration renal elimination, protein binding affecting distribution
What meds can cause some alterations of psychotropic drug absorption
antacids, PPIs, anticholinergics, metoclopramide; not usually clinically significant
When are protein binding interactions significant
only for highly protein bound drugs with narrow TI
Examples of 2 protein binding drug interactions
Valproate plus phenytoin = more free phenytoin

Valproate plus ASA (greater than 325/day) = more free VPA
Describe lithium interactions with NSAIDS, ACEIs/ARBs, thiazides>loops
increase lithium level, increase lithium level, increase lithium level
what is phase I metabolism
Most common enzymes involved
Conversion to more polar molecules thru reduction, oxidation, hydrolysis

Cytochrome P450
What is phase II metabolism
Conjugation with other molecule to make more water soluble, usually UDP glucuronosyltransferase
What is mechanism of cyp450 induction

what about inhibition
increased gene expression or decreased degredation of enzymes

competitive, noncompetitive binding, irreversible
clinically significant CYP1A2 interactions
fluvox + CLZ = increase CLZ level x3-4

Fluox + CLZ = increase CLZ level 50%

Fluvox + OLZ/ASEN = increased levels

OLZ/CLZ + cig smoke = decreased levels

OLZ/CLZ + CBZ = decreased levels
clinically significant CYP2B6 interactions
bupropion + CBZ/phenytoin = decreased bupriopion level
clinically significant CYP2C9 interactions
fluvox/fluox + phenytoin = increased phenytoin levels

fluvox/fluox + TCA = increased TCA levels
clinically significant CYP2D6 interactions
fluoxetine/paroxetine + thioridazone = risk thioridazine toxicity

fluoxetine/paroxetine + ris/ari/ilo/hal = increased antipsychotic level

fluoxetine/paroxetine + TCA = increased TCA levels
clinically significant CYP3A4 interactions
QTP + phen = 5 fold increase QTP clearance

antipsychotic plus CBZ = decreased CBZ levels

CBZ + nefazodone = increased CBZ level and decreased nef level (contraindicated)

CBZ plus erythro/clarithromycin = increased risk cbz toxicity
sertraline + lamotrigine = ...
moderately increased lamotrigine levels
valproate + lamotrigine = ...
doubles elimination half life lamotrigine
lamotrigine titration with valproate
25 mg QOD x2 wks, 25 mg qday x 2 wks, 50 mg/d x 1 wk
lamotrigine titration with CBZ, phenytoin, phenobarb, primidone, or rifampin
50 mg/d x 2 wks, 100 mg/d x 2 wks, 200 mg d/1 wk
normal lamotrigine titration
25 mg/d x 2 wks, 50 mg/d x 2 wks, 100 mg/d x 1 wk