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27 Cards in this Set

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Top 3A4 inducers

CS PROPS
carbamazepine
smoking
phenytoin
rifampin
oxcarbazepine
phenobarbital
st johns wort
Top 3A4 inhibitors
GI PAC MAN:
grape fruit
inh
protease inhibitors
azole
cimetidine
macrolides ( not azith)
amiodarone
non-DHP's
amiodarone significant interactions
(inhibitors and substrates)
inhibitor of:
2C9
2D6
3A4
P-gp
Substrate of:
3A4
2C8
amiodarone significant interactions continued (lower does of the following)
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)
amiodarone has a grapefruit interaction
because amidarone is a not only a substrate but also a 3A4 inhibitor
Azole interactions
intraconazole pH dependent for absorption.
Give with food to increase absorption and avoid H2 blockers, PPIs, antacids
clopidogrel interactions
avoid:
2C19 inhibitors
esomeprazole
omeprazole
colchine interactions (dont use)
in renal or hepatic patients
3A4 inhibitors
P-gp inhibitors
Digoxin interactions
concerned with renal and hepatic clearance (because cleared by kidneys and partially metabolized by liver)
Digoxin levels increased with:
PAC MANS
propafenone
amiodarone
macrolides
azoles
non-DHPs
Spironolactone
Lamotrigine and valproate interactions
increase risk of severe rash
titrate slowly
lithium interactions
(increase levels and decrease levels)
decreased salt
dehydration (diuretics)
NSAIDS
ACE I's/ ARBS
increase salt
caffeine
theophylline
Lithium contiuned
increased risk of 5HT syndrome with:
SSRI, SNRIS, triptans, linezolid
increase risk of neurotoxicity:
non-DHPS
phenytoin
carbamazepine
MAO inhibitor interactions increae of ?
serotonin syndrome with:
Antidepressants
SSRIs, SNRIs, TCA, tramadolm, triptans, st johns wort etc.
NSAIDs can:
raise blood pressure and have cardiovascular toxicity (M.I.) except ASA
birth control interactions
ABX, anticonvulsants, st johns wort, protease inhibitors, nevirapoine
Smoking increase of stroke, MI
OPIODS
substrate of 3A4
Rifampin interactions
warfarin (decreases INR)
birth control
2C9, 2C19, 3A4 substrates (rifampin inducer)
Statin interactions
Telithromycin with lovastitin, simvastatin, atorvastatin, may increase risk of muscle damage therefore hold these meds
dont use pitivastatin with cyclosporine
tamoxifen interactions
interaction with 2D6 inhibitors, (SSRIs)
because prevents conversion of active form of tamoxifen
tetracyline and FQ inteactions
Chelating drugs/foods:
antacids, Mg, Al, Zn, Ca2+, Fe, sucralfatem buffered aspirin
(space at least 2 before and 2 after)
theophylline interactions
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,
Warfarin interactions
S-isomer 3 to 5 times stronger than R.

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

2C9 inhibitors:
amiodarone
Bactrim
Azoles
Tamoxifen (C/I)
metronidazole
Warfarin Pharmacodynamics
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
Warfarin and ASA unnecessary in STENT PATIENTS there dont pick in NAPLEX pick PLAVIX and ASA
Hyperkalemia RISK
ACE I's, ARB's, sparing diuretics, YAZ. YASMIN, NATAZIA
CNS DEPRESSION
OH, PN meds, mirtazipine, trazodone, proprandolol, clonidine
QT prolongation
Time it take the heart to re-polarize after each beat. may lead to torsafe de pointes
CLASS 1 and 3 antiarrhythmics (amidarone, disopyramide, procainamide, qunidine, sotalol), FQ, Macorlides, Azoles, TCA's, Antipsychotics, methadone,
narrow therapeutic drugs
Carbamazepine, Levothyroxine, lithium, phenytion, theophylline, digoxin, procainamde, Valproic acid, warfarin
2C9 inhibs
FAMIS
fluconazole
amiodarone
metronidazole
INH
sulfamethoxazole/TMP