Interactions / P450

Question 1

What classes of medications interact with Triptans?

Answer 1

Other Triptans
Ergotamine
SSRIs
MAOIs
QT Prolonging Medications

Question 2

Ergotamines are associated with life threatening ischemia when administered with what?

Answer 2

CYP3A4 Inhibitors (ie: Macrolides)

Question 3

Other than 3A4 inhibitors what drugs interact with Ergotamines?

Answer 3

Other Ergotamines
Vasoconstrictors
Serotonin Drugs

Question 4

Should Levodopa be used with MAOIs?

Answer 4

No

Question 5

Would Rasagiline and Selegiline interact with each other?

Answer 5

Yes

Question 6

What Opioids do MAOIs interact with?

Answer 6

Dextromethorphan
Meperidine
Tramadol
Methadone
Propoxyphene

Question 7

What Abx with interact with MAOIs?

Answer 7

Ciprofloxacin

Question 8

T/F: St. John’s Wart interactions with MAOIs

Answer 8

True

Question 9

What P450 enzyme metabolizes Rasagiline?

Answer 9

CYP1A2

Extensively metabolized in the liver

Question 10

When would Entacapone be considered a P450 inhibitor?

Answer 10

At higher doses than recommended for treatment

Question 11

What medications interact with Safinamide?

Answer 11

Dextromethorhan
MAOIs
SNRIs
St. John's Wart
SSRis
TCAs
Cyclobenzaprine

Question 12

T/F: Donepezil is metabolized by CYP 3A4 and 2D6

Answer 12

True

Question 13

Is Rivastigmine metabolized by P450?

Answer 13

No

Question 14

Are drug interactions commonly seen with Galantamine?

Answer 14

No

Question 15

In what cardiac conditions should Galantamine be avoided?

Answer 15

Heart Block

Sick Sinus Syndrome

Question 16

Tetrabenazine should be avoided with what class of medications?

Answer 16

MAOIs

Question 17

Does acetaminophen interact with P450 2E1 inhibitors or inducers?

Answer 17

Inducers

Question 18

Should NSAIDs be given to patients taking blood thinners?

Answer 18

No

Question 19

Should patients with G6PD Deficiency take ASA?

Answer 19

No, this can trigger hemolysis

Question 20

What may happen if NSAIDs (Particularly Ibuprofen) is given with ASA?

Answer 20

It may block the antiplatalet effects of ASA.

Question 21

Other than ASA, what medication classes may interact with NSAIDs?

Answer 21

Anti-coagulants
Anti-hypertensives
Diuretics
Hypoglycemics

Question 22

Codeine is a CYP 2D6 ________ (Inducer/Inhibitor/Substrate)

What medications would inhibit this?

Answer 22

Substrate

Inhibited by…..

Bupropion, Cimetidine, Celecoxib, Cocaine

Question 23

Oxycodone is metabolized by CYP 2D6 to __________.

Answer 23

Oxymorphine

Question 24

Hydrocodone is metabolized by CYP 2D6 to __________.

Answer 24

Hydromorphone

Question 25

Does Oxymorphone have P450 interactions?

Answer 25

No

Question 26

What P450 isoenzyme is fentanyl metabolized by?

Answer 26

CYP 3A4

Question 27

What class of medications will Meperidine interact with?

Answer 27

MAOIs (Respiratory Depression)

Question 28

Propoxyphene is a CYP 3A4 _________ (substrate/inhibitor/inducer).

Answer 28

Inhibitor

Question 29

What P450 isoenzymes is methadone metabolized by?

Answer 29

CYP 3A4 and 2D6

Question 30

What P450 isoenzymes is Bupenorphine metabolized by?

Answer 30

3A4

Question 31

Tramadol used in combination with a MAOI or SSRI may result in an increased risk of what?

Answer 31

Seizures

Question 32

Should Tramadol be given with CYP 2D6 and 3A4 inhibitors?

Answer 32

No

Question 33

Can tramadol be used in combination with carbamazepine?

Answer 33

No

Question 34

Does Tapentadol have P450 Interactions?

Answer 34

No

Question 35

What may happen if Tapentadol is taken with EtOH?

Answer 35

Death

Question 36

What would happened to the levels of TCAs if given with morphine or methadone?

Answer 36

Decrease the metabolism of TCAs leading to toxicity

Question 37

How would quinidine effect codeine levels?

Answer 37

It would slow the conversion of codeine to morphine leading to decreased efficacy

Question 38

If metoclopramide was given in combination with an opioid, what would you expect to see in the plasma levels of the opioid?

Answer 38

Earlier peak plasma levels

Question 39

Would propoxyphene ___________ (increase/decrease) levels of carbamazepine, Metoprolol, and propanolol

Answer 39

Increase

Question 40

Why should propoxyphene be avoided in benzodiazepines?

Answer 40

It decreases the excretion of benzodiazepines leading to increased accumulation

Question 41

Does erythromycin increase or decrease the effect of opioids?

Answer 41

Increase

Question 42

Rifampin, Phenytoin, and Carbamazepine all __________ (increase/decrease) levels of methadone

Answer 42

Decrease

Question 43

CYP2D6 Inhibitors __________ (increase/decrease) tramadol levels

Answer 43

Increase

Question 44

CYP2D6 Inhibitors __________ (increase/decrease) efficacy of hydrocodone and codeine

Answer 44

Decrease

Question 45

CYP2D6 Substrates __________ (increase/decrease) tramadol levels

Answer 45

Increase

Question 46

CY3A4 inhibitors __________ (increase/decrease) methadone levels

Answer 46

Increase

Question 47

CY3A4 inducers __________ (increase/decrease) methadone levels

Answer 47

Decrease

Question 48

What P450 isoenzymes is cyclobenzaprine metabolize by?

Answer 48

CYP 3A4, 1A2, 2D6

Question 49

What are patients taking tramadol and cyclobenzaprine more at risk for?

Answer 49

Seizures

Question 50

What should MAOIs be avoided with cyclobenzaprine?

Answer 50

It can be a potentially fatal interaction

Question 51

When should you avoid using BenGay (Methyl Salicylate)?

Answer 51

Sulfa Allergies

ASA Allergies