Contraindications

Question 1

Contraindications & Drug Interactions

Answer 1

Drug Name

Question 2

Do not use concurrently with sildenafil

Answer 2

Isosorbide dinitrate

Question 3

Hyperkalemia if used concurrently with spironolactone

contraindicated in 2nd/3rd trimesters of pregnancy

Answer 3

ARBs:

Valsartan

Question 4

macrolide antibiotics (e.g., erythromycin) that ↓Eubacterium activity → ↑ toxicological potentials

Answer 4

Digoxin

Question 5

Oral K+ or concurrent use of ACE inhibitor or ARB → ↓Hypokalemia

Patients with allergy to sulfonamide-based drugs

Answer 5

Furosemide

Question 6

Patients with hyperkalemia or at risk of developing hyperkal;emia (e.g., patient with renal insufficiency)

Answer 6

Spironolactone

Question 7

Patients with predisposition to asthma or severe bradycardia

Answer 7

Carvedilol

Metoprolol

Question 8

spironolactone → Hyperkalemia

Aspirin or NSAIDs → ↓Antihypertensive effects of ACEIs

contraindicated in 2nd/3rd trimesters of pregnancy

Answer 8

ACE Inhibitors:

Captopril, Enalapril, Lisinopril

Question 9

β-Blockers can attenuate effect

Answer 9

Dobutamine

Question 10

– With P450 inhibitors
– With grapefruit juice

Liver disease; pregnancy & lactation

Answer 10

Statins

Question 11

1. Cell wall synthesis inhibitors + aminoglycosides —> synergistic
2. Anesthetics and neuromuscular blockers

Answer 11

Aminoglycosides: Gentamicin

Question 12

1. Cephalosporins + aminoglycosides —> synergistic
2. Cephalosporins + bacteriostatic agents (e.g., TCN) —> antagonistic

Patients exhibiting a hypersensitivity reaction to penicillins

Answer 12

Cephalosporins: Ceftriaxone

Question 13

1. Patients with liver disease
2. Pregnancy except in extraneous conditions,
   e.g., severe hyper‐triglyceridemia (>2000 mg/dL),
   or pancreatitis

Answer 13

Fibrates

Question 14

1. • aminoglycosides —> synergistic
2. • β-lactamase inhibitors —> synergistic
3. • bacteriostatic agents (e.g., TCN) —> antagonistic

Answer 14

Ampicillin
Nafcillin
Penicillin G
Penicillins
Amoxicillin + clavulanate
Penicillin G and V
Piperacillin + tazobactam

Question 15

a. Cell wall synthesis inhibitors + aminoglycosides : synergistic
b. Anesthetics and neuromuscular blockers

Answer 15

Aminoglycosides - Gentamicin

Question 16

a. + aminoglycosides : synergistic
b. + bacteriostatic agents (e.g., TCN) : antagonistic

Patients exhibiting a hypersensitivity reaction to penicillins

Answer 16

Ceftriaxone

Question 17

a. Surgery within 10 days
b. Serious gastrointestinal bleeding within 3 months
c. History of hypertension (diastolic pressure >110 mm Hg)
d. Active bleeding or hemorrhagic disorder
e. Previous cerebrovascular accident or active intracranial process
f. Aortic dissection
g. Acute pericarditis

Answer 17

tPA; alteplase

Question 18

CNS effects of are potentiated by concurrent ingestion

of alcohol or other CNS depressants

Answer 18

Chlorpheniramine

Diphenhydramine

Question 19

Combination of β‐Blockers with organic nitrates → ↑Exercise tolerance

Answer 19

Metoprolol, atenolol (cardio-selective)

Propranolol

Question 20

CONTRAINDICATED in neonates and last month of pregnancy

Concurrent use of azathioprine, 6-mercaptopurine, methotrexate may increase risk of bone marrow suppression

Answer 20

Trimethoprim-sulfamethoxazole

Question 21

Contraindicated in patients with active pathological bleeding and
presence or history of intracranial hemorrhage

Answer 21

Ticagrelor

Question 22

CONTRAINDICATED in patients with liver disease or elevated liver
enzymes

P450 inhibitor increases warfarin, propranolol, and theophylline concentrations

Answer 22

Zileuton

Question 23

Contraindicated in patients with severe hepatic insufficiency

Answer 23

Cholesterol absorption
inhibitors

Ezetimibe

Question 24

corticosteroids enhance response

Answer 24

Albuterol (Inhaled & oral)

Salmeterol (Inhaled)

Question 25

Drugs which increase risk of bleeding; GI ulceration, and NSAIDs

Answer 25

Acetylsalicylic acid (aspirin)

Question 26

``` Increase half-life cimetidine macrolide antibiotics hepatic cirrhosis premature infants oral contraceptives ``` Decrease half-life cigarette smokers phenytoin barbiturates Patients with hepatic or cardiac dysfunction Patients with seizure disorders Patients with peptic ulcer disease

Answer 26

Theophylline | Aminophylline

Question 27

Inducers and inhibitors of P450 have corresponding effects on metabolism

Answer 27

Montelukast

Question 28

Inhibitors of P450 enzymes inhibit the conversion of drug to the active metabolite which would diminish the platelet effects of the drug

Answer 28

Clopidogrel

Question 29

inhibits P450 enzymes

Answer 29

Isoniazid

Question 30

Interfere with absorption of: Aspirin, Digoxin, Tetracycline, Thiazide diuretics, Pravastatin, Fluvastatin, and Warfarin

Answer 30

Bile acid sequestrants (resins) Cholestyramine, Colestipol, and Colesevelam

Question 31

NOT recommended for pregnant women or children

Answer 31

Tetracyclines - Doxycycline

Question 32

Not recommended for use in patients with asthma or COPD

Answer 32

Zanamivir (inhalation)

Question 33

Other anticoagulants can increase the risk of bleeding

Answer 33

``` Bivalirudin Dabigatran Heparin low-molecular-weight heparin [enoxaparin] ```

Question 34

P450 enzyme inhibitors increase levels, inducers decrease levels

Answer 34

Ivacaftor Montelukast Roflumilast

Question 35

patients with chronic liver disease, alcoholism, and older patients, and patients taking isoniazid (increased risk of hepatotoxicity)

Answer 35

Rifampin

Question 36

Patients with coronary artery disease or hypertension | Patients with an enlarged prostate

Answer 36

Phenylephrine (intranasal) | Pseudoephedrine (oral)

Question 37

Patients with glaucoma | Patients with prostatic hypertrophy

Answer 37

Ipratropium (intranasal)

Question 38

Phosphodiesterase 5 inhibitors —> increases action of nitrates and can lead to hypotension

Answer 38

Nitroglycerin | Isosorbide dinitrate; Isosorbide mononitrate

Question 39

Reduced absorption of drug caused by binding to cholestyramine in the gastrointestinal tract Hormone replacement therapy for hypothyroid patients Pregnancy

Answer 39

Warfain

Question 40

strong inducer of CYP3A4; will necessitate higher doses of ivacaftor when used in combination

Answer 40

Lumacaftor

Question 41

substrate for P-gp and CYP3A4 Other anticoagulants can increase the risk of bleeding Anti-platelet drug can increase the risk of bleeding

Answer 41

Rivaroxaban

Question 42

TERATOGENIC AND EMBRYOTOXIC; CONTRAINDICATED in pregnancy. Pregnant women should not directly care for patients receiving aerosol. Patients exposed to the drug should not conceive children during treatment or for 6 months after stopping the drug.

Answer 42

Ribavirin

Question 43

Teratogenic-CONTRAINDICATED in pregnancy

Answer 43

Amantadine

Question 44

Teratogenic, therefore it is contraindicated in pregnancy

Answer 44

Niacin (Vit B3)

Question 45

The binding sites for macrolides, chloramphenicol, and clindamycin overlap which may inhibit their antibacterial effects if used concurrently

Answer 45

Azithromycin, clarithromycin and erythromycin (Macrolides)

Question 46

β-blockers can attenuate the response to dobutamine

Answer 46

Dobutamine