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32 Cards in this Set
- Front
- Back
What are 4 significant drug-food interactions to know
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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) |
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How does St Johns wart possibly effect SSRIs
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increases risk of serotonin syndrome
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Which psychiatric medications have significant interactions regarding epilepsy
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clozapine, chlorpromazine, loxapine, clomipramine, bupropion
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Which psychiatric medications have significant interactions regarding arrythmias
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TCAs
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Which psychiatric medications have significant interactions regarding parkinsons disease
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1st gen APs
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Which psychiatric medications have significant interactions regarding dementia
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anticholinergic agents
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Which psychiatric medications have significant interactions regarding insomnia
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CNS stimulants
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What is meant by a pharmacodynamics drug interaction
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synergy or antagonism of drug effects at target receptor
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What are common pharmacodynamics (PD) interactions in psychotropics
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Sedation, orthostasis, cardiotoxicity, serotonin syndrome
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Describe MAOIs PD interactions with serotonergic antidepressants, bupropion, and CNS stimulants
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Increase risk Serotonin syndrome
Increase risk bupropion toxicity Increase risk hypertensive crisis |
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SSRIs plus Nsaids
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increased risk GI bleeding
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clozapine plus carbamazepine
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increased risk blood dyscrasias
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IM olanzapine plus IM lorazepam
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Increased sedation plus cardiorespiratory depression
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Which psychotropics can cause arrythmias
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TCAs, ziprasidone, thioridazine, IV haldol
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What are common causes of clinically significant pharmacokinetic interactions
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effects on CYP450 enzymes, alteration renal elimination, protein binding affecting distribution
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What meds can cause some alterations of psychotropic drug absorption
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antacids, PPIs, anticholinergics, metoclopramide; not usually clinically significant
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When are protein binding interactions significant
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only for highly protein bound drugs with narrow TI
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Examples of 2 protein binding drug interactions
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Valproate plus phenytoin = more free phenytoin
Valproate plus ASA (greater than 325/day) = more free VPA |
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Describe lithium interactions with NSAIDS, ACEIs/ARBs, thiazides>loops
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increase lithium level, increase lithium level, increase lithium level
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what is phase I metabolism
Most common enzymes involved |
Conversion to more polar molecules thru reduction, oxidation, hydrolysis
Cytochrome P450 |
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What is phase II metabolism
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Conjugation with other molecule to make more water soluble, usually UDP glucuronosyltransferase
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What is mechanism of cyp450 induction
what about inhibition |
increased gene expression or decreased degredation of enzymes
competitive, noncompetitive binding, irreversible |
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clinically significant CYP1A2 interactions
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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 |
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clinically significant CYP2B6 interactions
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bupropion + CBZ/phenytoin = decreased bupriopion level
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clinically significant CYP2C9 interactions
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fluvox/fluox + phenytoin = increased phenytoin levels
fluvox/fluox + TCA = increased TCA levels |
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clinically significant CYP2D6 interactions
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fluoxetine/paroxetine + thioridazone = risk thioridazine toxicity
fluoxetine/paroxetine + ris/ari/ilo/hal = increased antipsychotic level fluoxetine/paroxetine + TCA = increased TCA levels |
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clinically significant CYP3A4 interactions
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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 |
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sertraline + lamotrigine = ...
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moderately increased lamotrigine levels
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valproate + lamotrigine = ...
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doubles elimination half life lamotrigine
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lamotrigine titration with valproate
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25 mg QOD x2 wks, 25 mg qday x 2 wks, 50 mg/d x 1 wk
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lamotrigine titration with CBZ, phenytoin, phenobarb, primidone, or rifampin
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50 mg/d x 2 wks, 100 mg/d x 2 wks, 200 mg d/1 wk
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normal lamotrigine titration
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25 mg/d x 2 wks, 50 mg/d x 2 wks, 100 mg/d x 1 wk
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