drug interactions

Question 1

acetaminophen

Answer 1

● Increased effect with caffeine.
● Decreased effect with antacids, anticholinergics, carbamazepine, and phenytoin.
● Alcohol may increase hepatotoxicity risk

Question 2

activated charcoal

Answer 2

● Moderate interactions with acetylcysteine, citalopram, digoxin, dyphylline, methotrexate, and theophylline

Question 3

adenosine

Answer 3

● Methylxanthines (stimulants) block actions of adenosine.
● Actions are potentiated with dipyridamole, carbamazepine, and nicotine

Question 4

albuterol

Answer 4

● May potentiate hypokalemia caused by diuretics

Question 5

amiodorone

Answer 5

● May increase the effects of digoxin, disopyramide, fentanyl, lidocaine,
procainamide, quinide, or warfarin.
● Cimetidine may increase amiodarone levels.
● Beta blockers or calcium channel blockers may potentiate bradycardia, sinus
arrest and AV blocks.
● Amiodarone will precipitate with sodium bicarbonate and heparin. Use a
different IV if coadministering.
● Do not combine with other drugs that prolong the QT interval (ondansetron,
procainamide)

Question 6

aspirin

Answer 6

● Increased risk of bleeding with concurrent anticoagulant/NSAID use.
● Diminishes effects of ACE inhibitors and loop diuretics.
● Decreased effectiveness and absorption with antacids and corticosteroids.
● Increased risk of hypoglycemia when administered with oral hypoglycemic
drugs.

Question 7

atropine

Answer 7

● Potential adverse effects with administered with digitalis, cholinergics, and
physostigmine.
● Effects enhanced by antihistamines, procainamide, quinidine, antipsychotics,
benzodiazepines and antidepressants.

Question 8

calcium chloride

Answer 8

● May increase ventricular irritability and precipitate digitalis toxicity when taken
with digoxin.
● Potentiated by thiazide diuretics
● Incompatible with most medications

Question 9

calcium gluconate

Answer 9

● Severe bradycardia with concurrent digitalis use.
● Incompatible with most medications

Question 10

dexamethasone

Answer 10

● Simultaneous use with ASA/NSAIDs may increase risk of GI bleed and ulcers.
● Concurrent use with diuretics can result in hypokalemia

Question 11

dextrose

Answer 11

Sodium Bicarbonate, Warfarin

Question 12

diazepam

Answer 12

● Incompatible with most drugs and fluids

Question 13

diltiazem

Answer 13

● Use with caution in patients taking medications that affect cardiac contractility

Question 14

diphenhydramine hydrochloride

Answer 14

● Potentiates effects of CNS depressants.
● MAOIs prolong and intensify anticholinergic effects.

Question 15

dopamine hydrochloride

Answer 15

● Deactivated by alkaline solutions.
● MAOIs and TCAs prolong and potentiate effects.
● Beta blockers antagonize cardiac effects.
● Simultaneous use of vasopressors may result in severe hypertension.
● Simultaneous administration of phenytoin may cause hypotension, bradycardia
and seizures

Question 16

epinephrine

Answer 16

none

Question 17

etomidate

Answer 17

● Potentiated by other CNS depressants

Question 18

fentanyl citrate

Answer 18

none

Question 19

flumazenil

Answer 19

● Toxic effects when combined with TCAs

Question 20

furosemide

Answer 20

● May potentiate lithium toxicity and digitalis toxicity because of sodium depletion and potassium depletion, respectively

Question 21

glucagon

Answer 21

● Incompatible in solution with most substances

Question 22

glucose, oral

Answer 22

none

Question 23

haloperidol

Answer 23

● Potentiates antihypertensive medications.
● Antagonizes amphetamines and epinephrine.

Question 24

hydromorphone

Answer 24

● MAOIs and SSRIs

Question 25

hydroxocobalamin

Answer 25

● Do not administer in the same IV line with diazepam, dobutamine, dopamine, fentanyl, NTG, propofol, sodium nitrate or sodium thiosulfate

Question 26

ibuprofen

Answer 26

● Additive risk for bleeding if given in combination with other agents that affect hemostasis ● May diminish the antihypertensive effects of hydralazine ● May diminish the diuretic effect of loop, thiazide, and thiazide-like diuretics ● TCAs may enhance NSAID antiplatelet effects

Question 27

ipratropium bromide

Answer 27

none

Question 28

ketamine

Answer 28

● Ketamine may enhance effects of CNS depressants and nondepolarizing neuromuscular blockers

Question 29

ketorolac tromethamine

Answer 29

● TCAs may enhance antiplatelet effects

Question 30

labetolol

Answer 30

none

Question 31

lidocaine hydrochloride

Answer 31

● High doses of lidocaine may prolong apneic period with succinylcholine ● Cardiac depression may occur in conjunction with IV phenytoin ● Procainamide may exacerbate CNS effects

Question 32

lorazepam

Answer 32

none

Question 33

magnesium sulfate

Answer 33

● Serious changes in overall cardiac function may occur with cardiac glycosides

Question 34

mannitol

Answer 34

● May precipitate digitalis toxicity when given concurrently ● Avoid use with NSAIDs, salicylates, nitrates and diuretics

Question 35

methylprednisolone sodium succinate

Answer 35

● Response to insulin and hypoglycemic agents may be blunted

Question 36

midazolam hydrochloride

Answer 36

none

Question 37

morphine sulfate

Answer 37

● MAOIs may cause paradoxical excitation

Question 38

naloxone hydrochloride

Answer 38

● Incompatible with bisulfate and alkaline solutions

Question 39

nitroglycerin

Answer 39

● Incompatible with other drugs given IV ● Increased hypotensive effect with alcohol and phenothiazines

Question 40

norephinephrine bitartrate

Answer 40

● Inactivated by alkaline solutions ● Alpha-adrenergic effects can be blocked with concurrent administration of phenothiazines. ● TCAs can markedly increase response to pressors

Question 41

ondansetron hydrochloride

Answer 41

● Serotonin syndrome can occur with simultaneous use of several SSRIs or serotonin receptor-blocking drugs. ● Avoid administration with other drugs that prolong the QT interval.

Question 42

oxygen

Answer 42

none

Question 43

oxytocin

Answer 43

● Can cause severe, persistent hypertension if administered with vasopressors

Question 44

phenylephrine

Answer 44

● Exaggerated adrenergic effects if given with, or up to 21 days after, MAOI use. ● Hypertensive effects may be potentiated by PCAs, guanethidine, methyldopa, and atropine-like drugs.

Question 45

pralidoxime

Answer 45

● Avoid concurrent use with succinylcholine and respiratory depressants

Question 46

procainamide hydrochloride

Answer 46

none

Question 47

promethazine hydrochloride

Answer 47

● Increased extrapyramidal effects with MAOIs

Question 48

rocuronium bromide

Answer 48

● Additive effects if administered with, or following, an opioid, sedative or anesthetic agent

Question 49

sodium bicarbonate

Answer 49

● Additive effects if administered with, or following, an opioid, sedative or anesthetic agent.

Question 50

succinylcholine chloride

Answer 50

● Diazepam may reduce the duration of action. ● Oxytocin, beta blockers and organophosphates may potentiate effects.

Question 51

terbutaline sulfate

Answer 51

● MAOIs may potentiate dysrhythmias

Question 52

thiamine hydrochloride

Answer 52

● Unstable in alkaline solutions

Question 53

tranexamic acid

Answer 53

● Hormonal contraceptives and clotting factor complexes increase the risk of thromboembolic disorders.

Question 54

vecuronium bromide

Answer 54

● Additive effects if administered with, or following, an opioid, sedative, or anesthetic.

Question 55

verapamil hydrochloride

Answer 55

● Increases the serum concentration of digoxin ● May potentiate the action of neuromuscular blocking agents ● Increased risk of sudden death when given concurrently with erythromycin