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Flashcards in Drug Interactions Deck (28):
1

name two PGP substrates?

dabigatran (pradaxa)
Rivaroxaban (xarelto)

2

name inhibitors of PGP

cyclosporine
ketokonazole
itraconzole,
LPV/r
IDVr
erythormycin
verapamil
St John's wort

3

Pneumonic for BIG CYP450 inducers

PS PORCS
pheytoin
Smoking
Phenobarbital
Oxcarbazepine
Rifampin
Carbamazepine
St. John's wort

4

Pneumonic for BIG CYP450 inhibitors

G <3 PACMAN
Grapefruit
P rotease inhibotrs
Azole antifungals
Cimetidine
Macrolides except azithromycin
Amiodarone
Non-dihydropyridines: verapamil/ diltiazem

5

DDIs amiodarone

Avoid w/ agents that prolong the QT
avoid w/ neg chrnotropes: BB, diltiazem, verap
correct electrolyte abnormailities before starting
avoid GFJ
decrease the doses of these by 30-50% when using w/ amiodarone: warfarine, digoxin
use lower doses of simva, lova and atorvastatin

6

all azoles inhibit which enzyme?

cyp3a4

7

which of the azoles requires an acidic environment to be absorbed

itraconazole
ketoconazole

8

name contraindicated voriconazole agents

barbiturates
carbamzzepine
rifampin
rifabutin
ritonavir
st johns wort

9

digoxin DDIs

BB, CCB can dec HR
cyp 3a4 and pgp substate
hypokalemia, hypercalcemia anc dec digxoicn levels

10

GFJ DDIs

statins : lova, simva, atorva
cyp 3a4 inhibitors and inducer

11

where is lithium primarily cleared?

renally ! just like sodium

12

which agents increase lithium levels?

less salt intake, NSAIDS, ACEI, ARBS, dehydration

13

which agents will decrease lithium levels

salt intake ,
cafene
theophylline

14

which have additive DDI w/ lithium

SSRIS,
SNRIs
Triptans,
linezolid
RISK OF SEROTONIN SYNDROME

15

what is the consequence of using non sleective MAOIs that have ddis?

Serotonin sydnrome
hypertensive crisis
death

16

MAOI DDIS

SSRIS, SNRIS, TCAS
buporpion
buispirone
lithium
linezolid
destromethorphan, triptans
tyramine rich foods etc

17

NSAIDS DDIS

w/ agents that cuase bleeding
agents that raise blood pressure
agents that causer renal toxiicty
lithium (inc lithium toxicity)
CV toxicity

18

oral contraceptives DDI

antibiotics: amp, smx/ doxy, rif (use backup while on antibiotic for rif for 1.5 months afterwards too.
-anticonfvulsants
-st johns wort (do not use concurrentlyO
-ATV, LPV, r, NFV, NVP
-mycophenylate reduces efficacy
-smoking

19

Oxycontin and other oxycodone products

increased levels if cyp 3a4 inhibitors

20

phosphodiesterace inhibitors DDIs

nitrates- severy hypotension
alpha blockers esp non selective agents
CYP3A4 substrates

21

which of the FQ is mostly renally cleared

levofloxacin

22

which of the FQ is mostly hepatically cleared?

moxifloxacin

23

DDIs of FQ

Polyvalent actions, MVs, bile acids, sucralfate : chelation leading to decreased absorption
They increase Warfarin, SUs and QT prolonging drugs
-NSAIDS and probenacid increase FQ levels

24

what is Rifampin a strong inducer of?

cyp 3A4
CYP 2C9
CYP 2c19

25

which of the statins undergo extensive first pass metabolism by cyp 3a4

simvastatin
lovastatin
atorvastatin (but more minimal)

26

max regimen of rosuvastatin on patients with ritonavir

10mg/day

27

max rosuvastati w/ cyclosporine?

5mg/day

28

DDI w/ tetracycliens

Diaveltn cations
can increase inr in warfarin
can decrease OC effectiness
avoid wi/ retinoic acid derrivatieves due to risk of pseudotumor cerebri