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JKC Pharm- Spring '24 > Drug Interactions- Exam 2 > Flashcards

Drug Interactions- Exam 2 Flashcards

1
Q

Drug Interactions: Category A

A

Unknown, no known interaction

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2
Q

Drug Interactions: Category B

A

Category B: Minor, No action needed. Minimal effect.

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3
Q

Drug Interactions: Category C

A

Category C: Moderate, monitor, may require adjustments

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4
Q

Drug Interactions: Category D

A

Category D: Major, consider alternative, may be life-threatening

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5
Q

Drug Interactions: Category X

A

Category X: Contraindicated, avoid combination, no concurrent use allowed.

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6
Q

What are the common risk factors associated with drug interactions?

A

Polypharmacy
Multiple prescribers
Multiple pharmacies
Genetic makeup
Special populations
Drug makeup

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7
Q

What is the definition of a drug interaction?

A

Modification of the effect of one drug by the prior concomitant administration of another drug.

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8
Q

What are the drug - dietary supplement interactions?

A

Can occur with Rx, OTC, illicit substances
St. John’s Wort
Cocaine & antiHTNs

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9
Q

What are the drug - food or drink interactions?

A

May cause interaction or prevent appropriate absorption
Doxycycline & milk
Metronidazole and alcohol

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10
Q

What are the drug - disease interactions?

A

Some drugs are helpful in one disease but harmful in others
Beta blockers & asthma
NSAIDs & heart failure

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11
Q

What are the pharmacodynamic drug interactions?

A

Additive effects on same receptor or additive effects on different receptors.

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12
Q

Define and give an example of an synergistic effect pharmacodynamic drug interaction?

A

Effect of two drugs magnified beyond what would be expected

Synergistic effects (aminoglycosides + penicillin)

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13
Q

Define and give an example of an Antagonist blocking agonist effect pharmacodynamic drug interaction?

A

Antagonist blocks and prevents further activation of receptor

Naloxone for opioids

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14
Q

What are some of the additive interactions pharmacodynamically?

A

Increased bleeding risk

Anticholinergic toxicity

Nephrotoxicity

QT Prolongation

Serotonergic Agents

Hyperkalemia (increased potassium)

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15
Q

What drugs can cause increased bleed risk additively?

A

Anticoagulants: warfarin, DOACs
Antiplatelets: Clopidogrel, NSAIDs, SSRIs
Natural products: garlic, gingko, ginger, ginseng, glucosamine

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16
Q

Give some examples of Direct Oral Anticoagulants

A

rivaroxaban/Xarelto or apixaban/Eliquis or dabigatran/Pradaxa

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17
Q

Rivaroxaban

A

Xarelto

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18
Q

Apixaban

A

Eliquis

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19
Q

Dabigatran

A

Pradaxa

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20
Q

Clopidogrel

A

Plavix

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21
Q

Ticagrelor

A

Brilinta

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22
Q

Prasugrel

A

Effient

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23
Q

Duloxetine

A

Cymbalta

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24
Q

Venlafaxine

A

Effexor

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25
Q

Name the five natural products that increase bleeding risk

A

Garlic, Gingko, Ginger, Ginseng, Glucosamine

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26
Q

Give some examples of SSRIs

A

Prozac, Lexapro, Zoloft

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27
Q

Give some examples of SNRIs

A

Duloxetine, Venlafaxine

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28
Q

Name two Pharmacodynamic receptor Interactions:

A

Additive effects on same receptor-> Multiple agonist working on the similar receptor

Additive effects on different receptors-> Different agonists work on different receptors with similiar adverse effects

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29
Q

What drugs can cause anticholinergic toxicity additively? 6

A

Antihistamines

SSRIs

antipsychotics

TCAs

Muscle relaxants

Overactive bladder antimuscarinics

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30
Q

Fluoxetine

A

Prozac

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31
Q

Escitalopram

A

Lexapro

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32
Q

Sertraline

A

Zoloft

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33
Q

Risperidone

A

Risperdal

34
Q

Olanzapine

A

Zyprexa

35
Q

Aripiprazole

A

Abilify

36
Q

Amitriptyline

A

Elavil

37
Q

What drugs can cause nephrotoxicity additively?

A

Aminoglycosides, vancomycin, amphotericin B

NSAIDs

IV Loop Diuretics

Chemotherapy

Cyclosporine/Tacrolimus

All of these drugs require renal clearance or act on the kidney

38
Q

Furosemide

A

Lasix

39
Q

Bumetanide

A

Bumex

40
Q

Torsemide

A

Demadex

41
Q

What drugs can cause QT prolongation additively? Anti

A

Antiarrhythmics

Antimicrobials

Antipsychotics

Antidepressants

Methadone, Sumatriptan, Ondansetron

42
Q

Haloperidol

A

Haldol

43
Q

Quetiapine

A

Seroquel

44
Q

Ondansetron

A

Zofran

45
Q

What drugs can boost serotonin additively?

A

Mood-altering meds (SSRIs, SNRIs, mirtazapine, Trazadone, Buspirone, TCAs, MAOj, Lithium)

Linezolid

Tramadol, Methadone, Meperidine

Dextromethorphan

Antimetics (Ondansetron)

Triptans (Sumatriptan)

46
Q

MAOi

A

Monoamine Oxidase Inhibitor

47
Q

What drugs can cause hyperkalemia additively?

A

ACE inhibitors, ARBs, Entresto

K-sparing diuretics

Aldosterone antagonists

Sulfamethoxazole/trimethoprim

Tacrolimus/cyclosporine

48
Q

What are the four ways to affect absorption via drug interactions?

A

Chelation/complex formation

Change in pH

Increased motility time

p-gp efflux pumps

49
Q

What are the two ways to affect distribution via drug interactions?

A

Binding to alpha-1 acid glycoproteins

Binding to albumin

50
Q

What are the two ways to affect elimination via drug interactions?

A

Competition for transport

Change in urinary pH

51
Q

What are the CYP Inducers?

A

SCRAP GPS’S

Sulfonylureas (T2DM drugs)
Carbamazepine (antiseizure)
Rifampin/rifabutin (Abx for TB)
Alcohol use (chronic)
Phenobarbital (antiseizure)
Griseofulvin (antifungal)
Phenytoin (antiseizure)
Smoking
St. John’s Wort

52
Q

What are the CYP inhibitors?

A

PACMAN’S GM

Protease inhibitors (Anti HIV)
Amiodarone (antiarrhythmic)
Cyclosporine (immunosuppressant), chlorophenol (pesticide), cimetidine (GERD)
Macrolides (except azithromycin, Abx)
Azoles (antifungals)
Non-DHP CCBs (antiarrhythmics)
Sodium Valproate (antiseizure)
Grapefruit Juice
Metronidazole (Abx)

53
Q

What drugs are 3A4 substrates?

A

Analgesics, anticoagulants (ACs), Antiplatelets, Antidiabetics, CV drugs, Immunosuppressants, Statins, HIV drugs, PDE-5 Inhibitors, Others

54
Q

What drugs are 2D6 substrates?

A

Analgesics, Antidepressants/antipsychotics, and other

55
Q

How much of the top 200 drugs are NOT metabolized by CYP enzymes?

A

33%, mostly via phase II metabolism.

Note:
Non-CYP metabolism usually has less drug interactions.
Most common are via UDP, NAT, and MAO.

56
Q

What toxicity can occur via Non-CYP enzyme metabolism?

A

Isoniazid toxicity

57
Q

What are some p-gp substrates?

A

Anticoagulants (apixaban, rivaroxaban, and dabigatran)
Antineoplastics (Docetaxel, vincristine)
Immunosuppressants (cyclosporine, tacrolimus)
Macrolides (clarithromycin)
HIV drugs (dolutegravir)
Digoxin

58
Q

What are some p-gp Inhibitors?

A

Antibiotics (clarithromycin, itraconazole, posaconazole)
HIV drugs (cobicistat, ritonavir)
Cardio drugs (verapamil, amiodarone, dronedarone, diltiazem)
Cyclosporine
Ticagrelor (Brilinta)

ABCCH

59
Q

Why do we use prodrugs?

A

We can use the CYP enzyme to convert it to the active metabolite, saving us money.
Reduces drug abuse, increases bioavailability
Risk lack of activity or potential toxicity

60
Q

What are the common prodrugs?

A

Codeine => morphine
Clopidogrel => active form
Lisdexamphetamine=> dexamphetamine
Fosphenytoin => phenytoin
Enalapril => enalaprilat
Valacyclovir => acyclovir
Cortisone => cortisol
Prednisone => Prednisolone
Primidone => Phenobarbital
Tramadol => active
Levodopa => dopamine
Diazepam = Oxazepam

61
Q

What are the common narrow therapeutic index drugs?

A

Aminoglycosides (G- ABx)
Vancomycin (ABx)
Digoxin (antiarrhythmic)
Warfarin (AC)
Tacrolimus (immunosuppressant)
Mycophenolate (immunosuppressant)
Cyclosporine (immunosuppressant)
Phenytoin (antiseizure)
Valproic acid/Sodium valproate (antiseizure)
Carbamazepine (antiseizure)
Theophylline (Bronchodilator)
Lithium (antimania)
Levothyroxine (HYPOthyrodism)

62
Q

What are the four ways we can affect warfarin via drug interactions?

A

Increased bleed risk via other ACs, NSAIDs, or SSRIs
Metabolism Interference via ABCDEF/Rifampin
Reduced Vit K production by gut flora via ABx
Interrupting the Vit K cycle via acetaminophen (1.5-2g chronically)

63
Q

What is the ABCDEF R of warfarin and its effects?

A

Increased INR = increased bleeding
Amiodarine
Bactrim
Cipro + other fluoroquinolones
Diflucan + other azoles
Erythromycin + other macrolides
Flagyl (Metronidazole)

Decreased INR = decreased bleeding
Rifampin

64
Q

If I want to start a patient on amiodarone but they are on warfarin already, how should I adjust the warfin dosage?

A

I would expect a REDUCTION in my warfarin dosage by up to 50%, because amiodarone INCREASES INR.
(AKA bleeding more bc takes longer to clot)

65
Q

When Lamotrigine is given in combination with carbamazepine, will I need more or less lamotrigine? Why?

A

Carbamazepine is an inducer, will need MORE lamotrigine

Lamotrigine + carbamazepine = drug gets metabolized faster

66
Q

What is the effect of a PDE-5 inhibitor and nitrate together?

A

They have additive effects of major vasodilation and consequently severe hypotension.

PDE-5 inhibitors = sildenafil/viagra or tadalafil
Nitrates = Nitroglycerins, isosorbides
Category X interactions.

67
Q

When Lamotrigine is given in combination with valproic acid, will I need more or less Lamotrigine? Why?

A

Valproic acid is an inhibitor, so will need LESS lamotrigine

Lamotrigine + Valproic acid = drug barely gets metabolized, so I need LESS lamotrigine.

68
Q

Sacubitril/Valsartan

A

Entresto

69
Q

Pharmaco(dynamic/kinetics) involves process or change of drug, interaction at the receptor level

A

Dynamic

70
Q

Pharmaco(dynamic/kinetics) involves motion of drug through body, interactions drug moving through body

A

Kinetics

71
Q

CYP450 enzymes are metabolized in (Phase I/II) ?

A

Phase I

72
Q

Where are CYP450 enzymes located?

A

in the liver

73
Q

CYP Inducers (increase/decrease) enzyme activity and (increase/decrease) the amount of active drug available

A

Increase enzyme activity (Increase metabolism of drugs that are substrates of P450)

decrease amount of active drug available

74
Q

The CYP inducer washout period is very (long/short)

A

long

75
Q

CYP Inhibitor (increase/decrease) enzyme activity metabolism and (increase/decrease) the amount of active drug available

A

decrease enzyme activity

Increase amount of drug available

76
Q

Warfarin and Amiodarone:

If starting Warfarin, how would you prescribe medication?

A

Reduce starting dose by 30-50%

77
Q

Warfarin and Amiodarone:

If starting Amiodarone, how would you prescribe this medication?

A

Expect reduction in warfarin dose by 50%

78
Q

Amiodarone and Digoxin:

If Amiodarone used first, what do you do to Digoxin?

A

start Digoxin at a lower dose

79
Q

Amiodarone and Digoxin

If Digoxin used first, what do you do to Amiodarone?

A

Decrease digoxin dose by 50%

80
Q
A

JKC Pharm- Spring '24 (18 decks)

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