Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NAPLEX Prep > DDI > Flashcards

DDI Flashcards

1
Q

examples of prodrugs

A

codeine – morphine
clopidogrel
prednisone – prednisolone
tramadol
valacyclovir – acyclovir
levodopa – DA
cortisone – cortisol
prmodone – phenobarbital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

codeine is activated by CYP____

A

2D6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

hypermetabolizers of 2D6 will have ________ concentrations of morphine after taking codeine

slow metabolizers of 2D6 will have ______ concentrations of morphing after codeine admin

A

HMs will have higher morphine concentrations and increased risk of toxicity

slow metabolizers will have dec concentrations of morphine and have poor analgesic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

clopidogrel is metabolized by CYP____

A

2C19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is p-gp? what happens if it induced/inhibited)

A

p-gp effluxes drugs from the bloodstream back into the gut to be excreted in stool
inhibit pgp –> inc Cp of substrate
induce pgp –> dec Cp of substrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

common p-gp substrates

A

DOACs
dig, dilt, verapamil, cervedilol
cyclosporine and tacro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

common p-gp inducers

A

carbamazepine
phenobarb
pnehytoin
rifampin
SJ Wort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

common inhbitors of pgp

A

clarithro
itraconazole, posaconazole
amiodarone
dilt
verapamil
cobicistat, ritonavir
cyclosporine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is enterohepatic recycling

A

drugs are metabolized in the liver then transported, through bile, back to the gut where drug can be reabsorbed, enter portal vein and go back to the liver
this increases duration of action of some drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what drugs undergo enterohepatic recycling

A

ABX
NSAIDs
zetia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

amiodarone and warfarin DDI? How do we adjust dose(s)

A

w is a 2C9 substrate
a inhibits 2C9 causing inc Cp warfarin

if ADDING warfarin to a, start warfarin at low dose </= 5mg
if ADDING a to warfarin, dec warfarin dose 30-50%
monitor INR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

amiodarone and digoxin DDI? How do we adjust dose(s)

A

amiodarone inhibits p-gp
dig is a p-gp substrate and amio will inc Cp when given together
if adding digoxin : start at 0.125mg daly
if adding amio: dec dig dose 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DDI between digoxin and loops
how to monitor

A

loops dec K, Na, Mg, Ca
digoxin toxicity is increased w/ dec K and Mg and inc Ca ESPECIALLY in renal imp

monitor electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

statins and 3A4-i

A

lovastatin, simvastatin and atorvastatin are 3A4 substrates
3A4-i increase statin concentration and increase risk for rhabdo, AKI and myopathy

simva and lova are CI with strong 3A4-i

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

warfarin and 2C9 DDI

A

S-warfarin is metabolized by 2C9 and can be the cause of many DDI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

which opioids are metabolized by 3A4?

A

fentanyl
oxycodone
hydrocodone
methadone

all CI with strong 3A4-i

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

VPA and lamictal DDI? How do we adjust dose(s)

A

VPA inhibits lamictal metabolism and increases Cp of lamictal which increases risk of toxicity including SJS/TEN

titrate lamictal very slowly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what does MAO metabolize

A

NE
DA
5-HT
tyramine
EN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

inhibiting MAO will increase its substrates NE, EN, DA and tyramine leading to _____

A

hypertensive crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MAO-i examples

A

linezolid
selegeline
rasageline
methylene blue
isocarboxazid
tranylcypromine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MAO-is are of concern with which types of medications/substances

A

serotinergics
tyramine foods
sympathomimetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the major 2D6 substrates

A

codeine
meperidine
tramadol
tamoxifen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how does rifampin usually contribute to DDI

A

strong p-gp and CYP inhibitor

24
Q

how does smoking contribute to DI

A

induces 1A2 and 2C9

25
which drugs can contribute to serotonin toxicity
SSRI SNRI SRI MAO-i methadone, fentanyl, meperidine, tramadol SJ wort triptans buspirone lithium linezolid methylene blue
26
drugs that contribute to bleed risk
anticoags NSAIDs SSRI/SNRI antiplatelets teh 5G's! ginseng ginger ginko balboa glucosamine garlic
27
medications/conditions that contribute to hyperkalemia
KCl RAAS-i SMX/TMP CN-i (tacro) K-sparing diuretics (amiloride, triamterene, spironolactone) canagliflozin drosperinone in OCs renal impairment!!!
28
medications that contribute to QT prolongation
5 A's! Antiarrhythmics Anti-infectives: macrolides, FQs, azoles, antimalarials ADs: trazodone, mirt, SSRI (escit, cit), venlafaxine, TCAs APs: ziprasidone>>, 1st genes Antiemetics: 5HT3 RAs, metoclopramide, promethazine, droperidol others: loperamide, methadone
29
methadone places patients at risk of
serotonin syndrome and QT prolongation
30
CNS depressants
opioids benzos sk m relaxants barbiturates hypnotics antihistamines alcohol cough syrups cannabinoids (dronabinol) mirtazepine trazodone
31
ototoxins
vancomycin AGs cisplatin loops salicylates
32
nephrotoxins
NSAIDs vanco AGs loops radiographic contrast dye Amph B polymixins CN-i (tacro, siro) cisplatin
33
how do we prevent cisplatin-induced nephrotoxicity
use amifostine and fluids
34
orthostasis risk medications
PDE-5 -i alpha blockers (flomax, doxazosin, terazosin) nitrates
35
3A4 substrates
opioids fentanyl, oxycodone, hydrocodone, methadone, bup, tramadol DOACs, warfarin amiodarone, amlodipine, dilt, verap atorv, simva, lova - statin NNRTIs PDE5-i ethanyl estradiol
36
3A4 inducers
carbamazepine phenobarbital phenytoin SJW rifampin
37
3A4 inhibitors
clarithro, erythro isoniazid azoles amodarone diltiazem verapamil cobicistat ritonavir protease-i (-navir) grapefruit cyclosporine
38
CYP2C8 substrates
amiodarone pioglitazone repaglinide
39
CYP2C8 inducers
phenytoin rifampin
40
CYP2C8 inhibitors
amiodarone clopidogrel ketoconazole SMX/TMP
41
CYP2D6 substrates
codeine, meperidine, tramadol APs doxepin trazodone TCAs ADs tamoxifen carvedilol metoprolol propranolol
42
CYP2D6 inducers
none
43
CYP2D6 inhibitors
amiodarone duloxetine fluoxetine paroxetine bupropion cobicistat
44
CYP2C9 substrates
S-warfarin!!!!! carvedilol diazepam SUs phenytoin tamoxifen zolpidem
45
CYP2C9 inducers
smoking carbamazepine phenobarbital phenytoin rifampin SJW
46
CYP2C9 inhibitors
amiodarone fluuconazole metronidazole ketoconazole voriconazole VPA TMP/SMX
47
tramadol therapy concerns
prodrug 2D6 and 3A4 substrate serotinergic
48
trazodone therapy concerns
QTp CNS depressant 2D6 substrate
49
azoles cause DDI by_________________
3A4 and 2C9 inhibition
50
CYP2C19 substrates
clopidogrel!!! phenytoin
51
CYP2C19 inducers
phenobarbital phenytoin rifampin carbamazepine
52
CYP2C19 inhibitors
esomeprazole omeprazole
53
CYP1A2 substrates
R-warfarin theophylline some APs hypnotics anxiolytics ADs
54
CYP1A2 inducers
smoking phenobarbital phenytoin rifampin carbamazepine
55
CYP1A2 inhibitors
fluvoxamine ciprofloxacin
56
what are the common inducers and what CYPs do they induce
phenobarbital phenytoin rifampin carbamazepine 3A4, 2C9, 2C19, 1A2 phenytoin and rifampin induce 2C8

NAPLEX Prep (57 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions