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Medications that interact with warfarin "ACADEMIC FACS" Amiodarone Ciprofloxacin/levofloxacin Aspirin Dicloxacillin Erythromycin (Macrolides) Metronidazole (Azoles) Indomethacin Clofibrates Fibrates Allopurinol CYP 2C9 Inducers/inhibitors Statins
Amiodarone- drug interactions -Digoxin -Warfain =decrease dose of digoxin or warfarin by 30-50% when starting amiodarone
Digoxin- drug interactions -increase in levels: likely due to decreased renal function -toxicity more likely if potassium low -P-gp substrate, narrow therapeutic range -caution with drugs that lower INR: beta blockers, non-dhp CCBs, amiodarone, dexmedetonidine (Precidex), clonidine, opioids
Grapefruit juice- interactions inhibits CYP3A4 -simvastatin -lovastatin -nifedepine -tacrolimus
Lamotrigine and Valproate- drug interaction severe rash
MAOIS, Opioids- interactions -avoid with serotonergic drugs- serotonin syndrome -parkinson's drugs -washout period for MAOIs: 14 days -tyramine metabolism decreased with MAOIs: selegiline, rasagiline -Serotonergic drugs: ephedrine, lithium, meperidine, levodopa, Dextromethorphan, cyclobenzaprine, triptans etc.
Tramadol- drug interactions -2D6 metabolized to active form -diministed effect on 2D6 inhibitors (fluoxetine, paroxetine, or poor metabolizers of 2D6)
Codeine- drug interactions partial prodrug metabolized by 2D6 -ultrametabolizers, extensive metabolizers- OD risk -2D6 inhibitors, poor metabolizers = diminished effect
CYP450 enzyme inhibitors "BIGFACES.COM" "BIGFACES.COM" Bupropion Itraconazole/ketoconazole/fluoxetine Gemfibrozil Fluoxetine/fluvoxamine Amiodarone Ciprofloxacin Erythromycin/Clarithromycin Sulfamethoxazole-trimethoprim Clopidogrel Omeprazole/Esomeprazole Metronidazole
CYP450 enzyme inducers "PS PORCS" Phenytoin Smoking Phenobarbitol Oxcarbazepine Rifampin Carbamazepine St. John's Work
CYP450 enzyme inhibitors "G PACMAN" "G PACMAN" Grapefruit Protease Inhibitors (ritonavir) Azole antifungals Cyclosporine, Cimetedine, Cobicistat Macrolides (except azithromycin) Amiodarone Non-DHP CCBs
Calcineurin Inhibiots- drug interactions CYP substrates: Systemic azoles macrolides rifampin -nephrotoxic- avoid with aminoglycosides
Fentanyl, Hydrocodone, Oxycodone, Methadone- drug interactions CYP3A4 inhibitors = fatal respiratory depression
PDE-5 Inhibitors- drug interactions C/I with nitrates = severe hypotension -decrease doses of alpha blockers with PDE5 inhibitors -caution with CYP3A4 inhbitors- PDE5 inhibitors are substrates
Quinolones, tetracyclines- drug interactions Chelation risk, seperate from vitamins, electrolytes
Statins- drug interactions increased levels = increased muscle toxicity -most are CYP3A4 metabolites: atorvastatin, simvastatin, lovastatin
1 gallon 4 quarts 3840 mL (approx) 3785 mL (exact)
1 fluid oz 30 mL (approx) 29.57 mL (exact)
1 quart 2 pints 960 mL (approx) 946 mL (exact)
1 pint 16 oz 480 mL (approx) 473 mL (exact)
1 cup 8 oz 240 mL (approx) 236.56 mL (exact)
Use IBW for these drugs -aminophylline -theophylline -acyclovir
Use AdjBw (if obese) for these drugs aminoglycosides
Use TBW (if obese) for these drugs -LMWHs -UFH -Vancomycin
When calculating CrCl- which body weight to use? Underweight: TBW Normal: IBW Overweight/obese: AdjBW
Calcium+ Phosphate total should not exceed 45 MEQ/L (precipitates)
Hazard Ratio Hazard rate in treatment group/ hazard rate in control group
Sensitivity 1- type II error(false negative)
Specificity 1- type I error (false positive)
Relative risk reduction 1- RR or (%risk in control- % risk in treatment)/ % risk in control
Odds ratio (disease present, exposed to treatment)(disease absent, unexposed to treatment)/ (disease absent, exposed to treatment)(disease present, unexposed to treatment)
Number needed to treat 1/(risk in control-risk in treatment group) or 1/ARR
absolute risk reduction %risk in control - % risk in treatment group
Risk # of subjects with unfavorable events in arm/ total # of subjects in arm
Risk ratio risk in treatment group/ risk in control group
Anion gap Na- Cl- HCO3
Calcium conversions Carbonate: 40% elemental calcium Citrate: 21% elemental calcium
% ionization of weak base 100/1 + 10^(pH-pKa)
% ionization of a weak acid 100/1 + 10^(pKa-pH)
ANC WBC X (%segs + %bands/100)
Corrected calcium Calcium reported (serum) + [(4-albumin)(0.8)]
Vd Equation amount of drug in body/ concentration of drug in plasma
Cl Renal equals Cl GFR + Cl secretion- Cl reabsorption
Cl renal > Cl GFR filtration + net secretion
Cl GFR > Cl Renal filtration + net reabsoprtion
Cl renal = Cl GFR filtration only
Loading dose equation desired concentration x Vd/F
Ke equation Cl/Vd
Peak serum concentration equation LD/Vd
Clearance equation (extravascular) absolute bioavailability x dose/ AUC
steady state concentration equation DR/Cl
half-life equation 0.693/Ke
Clearance equation (IV) dose/AUC
clearance equation rate of elimination/ concentration
acute bioavailability equation 100 X [(AUC extravascular)/(AUC intravascular)]x{(dose IV)/(dose extravascular)]
Codeine- pharmacogenomics consider testing CYP450 2D6 -ultrametablizers = toxicity risk
Clopidogrel- pharmacogenomics consider testing CYP2C19 genotype -*1 allelle = fully functional *2 and *3 = loss of function of alleles
Trastuzumab- pharmacogenomics HER2 protein overexpression- required for use
Carbamazepine- pharmacogenomics HLA-*1502 -test in Asian populations- increased risk of serious skin reactions
Abacavir- pharmacogenomics HLA-B*571 -if positive, increased risk of hypersensitivity
Allopurinol- pharmacogenomics consider testing HLA-B*5801 if positive, do not use- increased risk of SJS
Phenytoin- pharmacogenomics consider testing HLA-B*1502 in all Asain populations-incrased risk of SJS and TEN
Azathioprine- pharmacogenomics TPMT- low/absent activity = increased risk of myelosuppression
Capecitabine- pharmacogenomics consider testing DPD deficiency- increased toxicity risk
Cetuximab- pharmacogenomics KRAS- if positive, drug will not work
Warfarin- pharmacogenomics Consider testing CYP450 2C9*2/*3 -VKORC1 = increased bleed risk
Thyroid function tests needed for these drugs levothyroxine, armour thyroid, amiodarone, lithium, statins
Drugs that cause severe skin reactions allopurinol, lamotrigine, penicillins, phenytoin, piroxicam, sulfamethoxazole
drugs that cause photosensitivity carbamazepine, diruetics, methotrexate, retinoids, quinolones, st. john's wort, sulfa abx, tacrolimus, tetracyclines, voriconazole
drugs that cause TTP clopidogrel, ticlopidine
avoid these drugs with peanut and soy allergies progesterone (peanut), Clevidipine, propofol (Soy and eggs)
hyperkalemia risk with these drugs -aldosterone blockers- avoid NSAIDS -ACEIs, ARBS, aliskerin, amiloride, triamterene, calcinuerin inhibitors, bactrim, cangliflozin, pentamadine
ototoxicity risk with these drugs salicylates, vancomycin, aminoglycosides, cisplatin, loop diuretics
avoid these with drugs that have increased bleed risk NSAIDs, SSRIs/SNRIs, ginko biloba, garlic, ginger, glucosamine, ginseng
Created by: Bmiller01



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