W13_04 drug interactions Flashcards Preview

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Flashcards in W13_04 drug interactions Deck (18)
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1
Q

whichP450 enzyme metabolizes sulfonylurea?

A

2C9

2
Q

SMX/TMP (septra) inhibits which P450?

A

2C9

3
Q

which P450 metabolizes codeine?

A

2D6. puts codeine into morphine

4
Q

paroxetine inhibits which P450?

A

2D6

5
Q

2D6 is absent in how much of the population?

A

7-10% are poor metabolizers

6
Q

how does grapefruit juice affect statins?

A

GFJ inhibits 3A4 in the gut, and really upregulates the amount of statin that gets absorbed, which would usually be metabolized by 3A4

7
Q

which classes of drugs are affected by grapefruit juice

A

some statins;
all CCBs;
some benzos;
randoms, including sildenafil

8
Q

which macrolide is not an inhibitor of 3A4?

A

azithromycin

9
Q

what are some inducers of 3A4?

A

anticonvulsants;
dexamethasone;
tamoxifen;
st john’s wort

10
Q

how do digoxin and clarithromycin interact?

A

clarithromycin turns of P-glycoprotein exporter, and digoxin is more absorbed into the blood

11
Q

verapamil and dabigitran are often given together. How do they interact?

A

verapamil an hour before dabigitran causes 80% increase in dabigitran concentration. Due to P-glycoprotein inhibition

12
Q

how does refamipin alter P-GP levels?

A

upregulates expression, causing more efflux of drug

13
Q

how does acetaminophen interact with warfarin?

A

NAPQI (toxic metabolite of acetaminophen) inhibits an enzyme that activates the clotting factors 2, 7, 9, 10

14
Q

which drugs have interactions with warfarin?

A

amiodarone;
antibiotics;
antidepressants (depletes serotonin in platelets to reduce their stickiness;
analgesics;
antiplatelets

15
Q

what are some usual causes of hyperkalemia?

A

renal disease;
ace inhibitors;
ARBs;
K supplements;
spironolactone, amiloride, triamterene

16
Q

what are some unusual causes of hyperkalemia?

A

diabetes;
NSAIDs;
septra;
b-blocker;
salt substitute

17
Q

what’s tramadol?

A

“dual mechanism of analgesia”

18
Q

how is tramadol metabolized?

A

2D6 (prodrug to active metabolite);
notice 2D6 has variability within the population

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