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Quiz #01 Flashcards

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1
Q

Which are the only (3) CYP enzymes that exhibit polymorphisms?

A

2C9
2C19 (more common in Asians)
2D6 (more common in Caucasians)

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2
Q

Which of the following would have a rapid onset typically within 24 hrs?

A. Enzyme induction
B. Enzyme inhibition

A

B. Onset of enzyme inhibition is more rapid than enzyme induction.

Enzyme inhibition is faster b/c it involves the drug binding with the enzyme, thereby preventing its function, whereas enzyme induction requires increased synthesis of the enzyme (a slower process).

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3
Q

Carbamazepine

give the brand name, state whether it’s an inducer, inhibitor and/or substrate of any CYP enzyme

A

Tegretol®

3A4 inducer
2C9 inducer
1A2 inducer

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4
Q

Phenytoin

A

Dilantin®

3A4 inducer
2C9 inducer
2C9 substrate
2C19 substrate
1A2 inducer
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5
Q

Phenobarbital

A

Luminal®

3A4 inducer
2C9 inducer
1A2 inducer

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6
Q

Rifampin

A

Rifadin®

3A4 inducer
2C9 inducer
1A2 inducer

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7
Q

Nafcillin

A

3A4 inducer

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8
Q

Dexamethasone

A

3A4 inducer

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9
Q

St. John’s wort

A

3A4 inducer

1A2 inducer

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10
Q

Itraconazole

A

Sporanox®

3A4 inhibitor

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11
Q

Ketoconazole

A

Nizoral®

3A4 inhibitor
2C19 inhibitor

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12
Q

Voriconazole

A

Vfend®

3A4 inhibitor
2C9 inhibitor
2C19 inhibitor

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13
Q

Fluconazole

A

Diflucan®

3A4 inhibitor (only at high doses)
2C9 inhibitor
2C19 inhibitor

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14
Q

HIV Protease Inhibitors

Atazanavir
Nelfinavir
Ritonavir
Saquinavir

A

Atazanavir - Reyataz®
Nelfinavir - Viracept®
Ritonavir - Norvir®
Saquinavir - Invirase®, Fortovase®

3A4 inhibitors
2C9 inhibitor (ritonavir)
2D6 inhibitor (ritonavir)
1A2 inducer (ritonavir)
1A2 inhibitor (atazanavir)
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15
Q

Clarithromycin

A

Biaxin®

3A4 inhibitor
1A2 inhibitor

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16
Q

Erythromycin

A

Erythrocin®

3A4 inhibitor
1A2 inhibitor

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17
Q

Diltiazem

A

Cardizem®

3A4 inhibitor
3A4 substrate

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18
Q

Verapamil

A

Calan®

3A4 inhibitor
3A4 substrate

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19
Q

Amiodarone

actually the active metabolite of amiodarone - desethylamiodarone

A

Cordarone®, Pacerone®

3A4 inhibitor
2C9 inhibitor
2D6 inhibitor
P-gp inhibitor

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20
Q

Alprazolam

A

Xanax®

3A4 substrate

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21
Q

Midazolam

A

Versed®

3A4 substrate

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22
Q

Felodipine

A

Plendil®

3A4 substrate

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23
Q

Nifedipine

A

Procardia®

3A4 substrate

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24
Q

Triazolam

A

Halcion®

3A4 substrate

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25
Simvastatin
Zocor® 3A4 substrate 2C9 inhibitor
26
Atorvastatin
Lipitor® 3A4 substrate
27
Lovastatin
Mevacor® 3A4 substrate 2C9 inhibitor
28
Cyclosporin
Neoral®, Sandimmune® 3A4 substrate
29
Tacrolimus
Prograf® 3A4 substrate
30
Rivaroxaban
Xarelto® 3A4 substrate
31
Apixaban
Eliquis® 3A4 substrate
32
Ticagrelor
Brilinta® 3A4 substrate
33
Which (3) statins are metabolized solely by CYP3A4?
Simvastatin, Atorvastatin, and Lovastatin
34
Which statin is not metabolized by any CYP enzymes?
Pravastatin (Pravachol®)
35
What (2) CYP enzymes metabolize Crestor®?
2C9 & 2C19
36
Which statin is metabolized by both glucuronidation and CYP2C9?
Pitavastatin (Livalo®)
37
Max dose of simvastatin is limited to 10mg while on which of the following concomitant medications? ``` A. Amiodarone B. Calan® C. Multaq® D. B & C E. All of the above ```
D. B & C (Verapamil-Calan® and dronedarone-Multaq®) are both CYP3A4 inhibitors and limit the maximum daily dose of simvastatin to 10mg. Diltiazem is the 3rd drug that limits Zocor® max dose to 10mg
38
Concomitant use of which (3) medications while on Zocor® would limit the dose to 20mg?
1. Amiodarone 2. Norvasc® 3. Ranolazine (Ranexa®)
39
True or False - Clopidogrel is a prodrug?
True - Plavix® is metabolized by several different CYP enzymes into its active metabolite Prasugrel (Effient®), another antiplatelet prodrug, is also metabolized into an active metabolite by multiple CYP enzymes
40
Which is the more active enantiomer of warfarin? A. R-warfarin B. S-warfarin
B. S-warfarin is the more active enantiomer
41
True or False - polymorphisms can exist in VKORC1 which would lead to increased warfarin effect?
True - VKORC1 or vitamin K epoxide reductase complex makes activated (reduced) vitamin K-dependent clotting factors. A polymorphism is this enzyme would decrease production of vitamin-K dependent clotting factors thereby indirectly increasing warfarin's effects which may put the patient at higher risk for bleeding.
42
Miconazole
Oravig® 2C9 inhibitor
43
Metronidazole
Flagyl® 2C9 inhibitor
44
SMZ/TMP
Bactrim® 2C9 inhibitor
45
Fluvastatin
Lescol® 2C9 inhibitor 2C9 substrate
46
Isoniazid
2C9 inhibitor
47
Gemfibrozil
Lopid® 2C9 inhibitor
48
Fenofibrate
Tricor® 2C9 inhibitor
49
NSAIDS
2C9 substrates
50
Glimepiride
Amaryl® 2C9 substrate
51
Glipizide
Glucotrol® 2C9 substrate
52
Glyburide®
Diabeta®, Micronase® 2C9 substrate
53
Warfarin
Coumadin® 2C9 substrate
54
Posaconazole
Noxafil® 3A4 inhibitor
55
Empirically, what should be done to the dose of warfarin when amiodarone is initiated? Why?
Decrease dose of warfarin by 30-50%. Amiodarone is a 2C9 inhibitor and warfarin is a 2C9 substrate. Therefore, amiodarone will inhibit the metabolism of warfarin leading to increased concentration and effect and potential risk of bleeding. If adding warfarin to a patient regimen that already includes amiodarone, initial dose of warfarin should be more conservative.
56
# Choose all of the true statements: A. Hyperthyroidism increases effects of warfarin from increased catabolism of vit K dependent clotting factors B. Hyperthyroidism decreases effects of warfarin from increased catabolism of vit K dependent clotting factors C. Hypothyroidism increases effects of warfarin from decreased catabolism of vit K dependent clotting factors D. Hypothyroidism decreases effects of warfarin from decreased catabolism of vit K dependent clotting factors
A & D are correct
57
Digoxin
Lanoxin® P-gp substrate
58
Quinidine
Quinidex® (class IA anti-arrhythmic) 2D6 inhibitor
59
Fluoxetine
Prozac® 2D6 inhibitor 2D6 substrate 2C19 inhibitor
60
Paroxetine
Paxil® 2D6 inhibitor 2D6 substrate
61
Duloxetine
Cymbalta® 2D6 inhibitor
62
Bupropion
Wellbutrin® 2D6 inhibitor
63
Flecainide
Tambocor® (class IC anti-arrhythmic) 2D6 substrate
64
Mexiletine
Mexitil® (Class IB anti-arrhythmic) 2D6 substrate
65
Metoprolol
Lopressor®, Toprol XL® 2D6 substrate
66
Carvedilol
Coreg® 2D6 substrate
67
Propranolol
Inderal® 2D6 substrate
68
Timolol
2D6 substrate
69
Amitriptyline
Elavil® 2D6 substrate 1A2 substrate
70
Imipramine
Tofranil® 2D6 substrate
71
Nortriptyline
Pamelor® 2D6 substrate 1A2 substrate
72
Venlafaxine
Effexor® 2D6 substrate
73
Thioridazine
2D6 substrate
74
Haloperidol
Haldol® 2D6 substrate
75
Risperidone
Risperdal® 2D6 substrate
76
Tamoxifen
Nolvadex® 2D6 substrate Prodrug so inhibiting its metabolism will actually DECREASE its effect (since it's not being metabolized into its active metabolite)
77
Codeine
2D6 substrate Prodrug so inhibiting its metabolism will actually DECREASE its effect (since it's not being metabolized into its active metabolite)
78
Tramadol
Ultram® 2D6 substrate Prodrug so inhibiting its metabolism will actually DECREASE its effect (since it's not being metabolized into its active metabolite)
79
Sertraline
Zoloft® 2D6 inhibitor
80
Terbinafine
Lamisil® 2D6 inhibitor
81
Omeprazole
Prilosec® 2C19 inhibitor 2C19 substrate
82
Esomeprazole
Nexium® 2C19 inhibitor 2C19 substrate
83
Lansoprazole
Prevacid® 2C19 substrate
84
Pantoprazole
Protonix® 2C19 substrate
85
Rabeprazole
Aciphex® 2C19 substrate
86
Clopidogrel
Plavix® 2C19 substrate
87
Diazepam
Valium® 2C19 substrate
88
Escitalopram
Lexapro® 2C19 substrate
89
Efavirenz
Sustiva® 2C19 inhibitor
90
Etravirine
Intelence® 2C19 inhibitor
91
Cimetidine
Tagamet® 2C19 inhibitor 1A2 inhibitor
92
Fluvoxamine
Faverin® 2C19 inhibitor 1A2 inhibitor 1A2 substrate
93
Which CYP enzyme does charbroiled foods affect? How does it affect it?
Charbroiled foods induce CYP1A2
94
Primidone
Mysoline® 1A2 inducer
95
Which CYP enzyme does smoking affect? How?
Smoking induces CYP1A2
96
Ciprofloxacin
Cipro® 1A2 inhibitor
97
Ethinyl estradiol
1A2 inhibitor
98
Caffeine
1A2 substrate
99
Theophylline
Theolair® ``` 1A2 substrate XO substrate (if used with allopurinol, a XO inhibitor, decrease dose of theophylline by 25-33%) ```
100
Clozapine
Clozaril® 1A2 substrate
101
Olanzapine
Zyprexa® 1A2 substrate
102
Zolmitriptan
Zomig® 1A2 substrate
103
Frovatriptan
Frova® 1A2 substrate
104
Mirtazapine
Remeron® 1A2 substrate
105
Tizanidine
Zanaflex® 1A2 substrate
106
Melatonin
1A2 substrate
107
Allopurinol (Zyloprim®) and febuxostat (Uloric®) inhibit which enzyme involved in the production of uric acid?
Xanthine oxidase
108
Azathioprine
Imuran® Prodrug to 6-MP XO substrate (allopurinol and febuxostat inhibit XO which would increase the active metabolite potentially leading to increased risk of myelosuppression. (if used with allopurinol, a XO inhibitor, decrease dose of Azathioprine by 25-33%)
109
Febuxostat
Uloric® XO inhibitor CI with Azathioprine (Imuran®) and 6-MP

Drug Interactions (1 decks)

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