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Naplex
DDI
| Question | Answer |
|---|---|
| Q1. In D ucers? - PS PORCS | • D ecreased levels/effects of substrate, unless it is a prodrug PS PORCS • Phenytoin • Smoking • Phenobarbital and primidone • Oxcarbazepine • Rifampin, rifabutin, rifapentine • Carbamazepine • St. John's wort |
| Q2. IN hibitors? G PACMAN | IN creased effects/levels/ADR/toxicities of substrates, unless it is a prodrug • Grapefruit • PIs - ritonavir & others • Azole • C: cyclosporine, cobicistat, cimetidine • Macrolides: clari, ery • Amiodarone, dronedarone • Non-DHP CCB |
| Q3. Inducer vs Inhibitor in term of duration of effects | • InHibitor: Fast onset (within days) and fast offset after the inhibitor is stopped. • InDucer: Slow onset (up to 4 weeks) and slow offset (2-4 weeks) after the inducer is stopped. |
| Q4. P-glycoprotein (P-gp) efflux pump | • Transporter that pumps drugs out of cells, reducing drug absorption and increasing drug elimination. |
| Q5. Enterohepatic recycling | • Occurs when a drug is excreted into bile, reabsorbed from the intestine, and returned to the liver, prolonging its effect. |
| Q6. CII CYP 3A4 substrates | • Fentanyl, hydrocodone, oxycodone, methadone, hydrocodone, hydromorphone (major) |
| Q7. Valproate + Lamotrigine | • Valproate is an inhibitor of lamotrigine metabolism • Reduce Lamotrigine dose |
| Q8. MAOi | • Phenelzine, isocarboxazid, tranylcypromine and linezolid, methylene blue |
| Q9. MAOi + Drugs that increases epinephrine (Epi), norepinephrine (NE), dopamine (DA) | Pseudoephedrine, phenylephrine, epinephrine, norepinephrine, dobutamine, SNRIs, bupropion and stimulants, incl amphetamines for ADHD (methylphenidate, lisdexamfetamine, dextroamphetamine, others) |
| Q10. MAOi + Drugs that increase serotonin (5HT) | • Antidepressants: SSRIs, SNRIs, TCAs, MAO inhibitors, mirtazapine, trazodone • Opioids: fentanyl, methadone, tramadol • Others: buspirone, dextromethorphan (high doses taken as drug of abuse), lithium, St John's wort |
| Q11. MAOi | Phenelzine, isocarboxazid, tranylcypromine, linezolid, methylene blue) and the selective MAO-B inhibitors selegiline, rasagiline |
| Q12. CYP 3A4, P-GP inhibitors | Calcineurin Inhibitors (CNIs) tacrolimus, cyclosporine, sirolimus |
| Q13. PDE-5 inhibitor - CYP 3A4 Inhibitors | • PDE-5 inhibitor: 3A4 substrate • Sildenafil, vardenafil, tadalafil, avanafil • Cut half dose |
| Q14. Alpha-Blockers - CYP 3A4 Inhibitors | • Lower dose to avoid: cause orthostatic hypotension, which consequently causes dizziness, fall down |
| Q15. Drugs prolong QT interval - As | • Antiarrhythmics • Antibiotics/Antifungals: Quinolones, macrolides, Azole (except isavuconazonium Cresemba) • Antidepressants: TCA, SSRIs, mirtazapine, trazodone, venlafaxine • Antipsychotics • Antiemetic agents • Donepezil, fingolimod, methadone |
| Q16. Antiarrhythmics cause QT prolongation “Amio DRONES S-I-D” | Class Ia, Ic, III antiarrhythmics • Quinidine, Procainamide, Disopyramide • Ic: --- • Amiodarone, dronedarone • Sotalol, ibutilide, dofetilide |
| Q17. Azole without QT prolongation | • Isavuconazonium (Cresemba) |
| Q18. Antidepressants w highest risk of QT prolongation | • Citalopram, escitalopram |
| Q19. Antipsychotics cause QT prolongation | • Most • Phenothiazines (end in -azine, such as thioridazine) • Haloperidol • Ziprasidone |
| Q20. Antiemetic agents cause QT prolongation | • 5-HT3 receptor antagonists, including ondansetron • Droperidol • Metoclopramide, promethazine |
| Q21. 5-HT3 receptor antagonists has lowest risk of QT prolongation | • Palonosetron |
| Q22. Gilenya - QT prolongation | • Fingolimod • PO immunomodulating medication prescribed to treat relapsing forms of multiple sclerosis (MS) |
| Q23. Aricept - QT prolongation | • Donepezil • Alzheimer's |
| Q24. What need to be seperated from Quinolones, Tetracyclines administration | • Antacids, sucralfate, bile acid resins, magnesium, aluminum, calcium, iron, zinc, multivitamins, phosphate binders |
| Q25. List of CNS Depression | • Opioids, skeletal muscle relaxants, antiepileptic drugs, benzodiazepines, barbiturates, hypnotics, mirtazapine, trazodone, dronabinol, nabilone, propranolol, clonidine, sedating antihistamines, cough syrups w antihistamine or opioid, NSAIDs |
| Q26. Additive: CNS Depression Opioids + Benzodiazepines or CNS depressants | • Highest risk for fatality when used in combination • Do NOT use together (esp for exams) |
| Q27. Additive: Nephrotoxicity | • Aminoglycosides, Amphotericin B, Vancomycin • Cisplatin, methotrexate w high chemo doses • Cyclosporine, tacrolimus (calcineurin inhibitors) • Loop diuretics (especially IV) • NSAIDs: avoid use with renal impairment |
| Q28. Additive: Ototoxicity | • Aminoglycosides, Vancomycin • Cisplatin • Loop diuretics (especially IV) • Salicylates (including aspirin, salsalate, magnesium salicylate) |
| Q29. Additive: Anticholinergic Effects (List 1) | • Paroxetine, TCA, 1st antipsychotics • Sedating antihistamines (diphenhydramine, brompheniramine, chlorpheniramine, doxylamine, hydroxyzine, cyproheptadine) • Atropine, belladonna, dicyclomine, meclizine |
| Q30. Additive: Anticholinergic Effects (List 2) | • Benztropine, trihexyphenidyl • Muscle relaxants (carisoprodol, cyclobenzaprine, baclofen) • Overactive bladder antimuscarinics (tolterodine, oxybutynin, darifenacin) |
| Q31. CYP 2C19 inhibitors | • Omeprazole (Prilosec) • Esomeprazole (Nexium) |
| Q32. Plavix | • Clopidogrel • ProDrug, metabolized by CYP2C19 inhibitors |
| Q33. DDI if (AMIODARONE + Warfarin) | • Cut warfarin dose 30-50% |
| Q34. DDI if (AMIODARONE + Digoxin) | • Cut Digoxin dose 50% |
| Q35. CYP3A4 substrate ABCDEFGHIS | • Anticoagulants • Antiplatelet • Aripirazole • AmIODAron / Dronedaron • BZD (except LOT) • CCB, Carbamazepine, Colchicine • "-done", Daliresp (Roflumilast) • Estrogen • Fentanyl • HIV-PI • Immuno: Tacrolimus, cycloporin • Statin: SAL |
| Q36. Daliresp | • Roflumilast • Phosphodiesterase-4 (PDE-4) inhibitor, server COPD |
| Q37. Codein is substrate of CYP3A4 | • NO • ProDrug • Metabolized via 2D6 to morphine • Cl in pediatric patients <12 years and in pediatric patients <18 years after tonsillectomy +/or adenoidectomy |
| Q38. 1A2 substrate | • Clozapine • Olanzapine • Theophylline • Warfarin R-isomer |
| Q39. 1A2 inhibitor | • Ciprofloxacin • Fluvoxamine • |
| Q40. 1A2 inducer | • Smoking (strongest) • Rifampin (more for 3A4) • Carbamazepine • Phenytoin • Phenobarbital |
| Q41. P-gp substrate | • Digoxin • Dabigatran • Apixaban • ... |
| Q42. Morphine metabolized via 3A4 | • NO • Metabolized via UGT2B7 |
| Q43 Lamotrigine metabolized by glucuronidation (UGT enzymes) | • Main enzyme: UGT1A4, Minor contribution: UGT2B7 • Inducers (carbamazepine, phenytoin) decrease lamotrigine levels • Valproic inhibits UGT → increase lamotrigine levels (toxicity risk) |
| Q44. SGA has highest risk QT prolongation | • Ziprasidone • Use alternate SGA in patients with risk factors |
| Q45. Leuprolide (Androgen deprivation therapy) safety concern | • QT prolongation |
| Q46. Additive vasodilatory effects w PDE-5 inhibitors | • Nitrates, Riociguat: CI • Alpha-1 adrenergic agonists (doxazosin, tamsulosin): low dose • PI, Azole: start 50% dose |
| Q47. Digoxin is not metabolized by CYP450 enzymes | • Digoxin is not metabolized by CYP450 enzymes • Primarily eliminated unchanged by the kidneys. P-glycoprotein: Pumps digoxin out of cells • Intestine: reduce absorption • Kidney tubules → increase renal excretion • BBB: limits CNS penetration |
| Q48. Willow bark + anticoagulants | • Bleeding risk Others: • High-dose fish oil • Garlic, ginger, ginkgo biloba, ginseng, glucosamine (the "5Gs") • Vitamin E |
| Q49. Anti-infectives increase risk of QT prolongation | • Antimalarials (eg, hydroxychloroquine) • Azole (except isavuconazonium) • FQ • Macrolides • Lefamulin (Xenleta): treat CABP |
| Q50. Potassium-sparing diuretics | • Amiloride • Triamterene • Aldosterone receptor antagonists (eg, spironolactone) |
| Q51. Other meds cause hyPERkalemia | • Calcineurin inhibitors (eg, tacrolimus, cyclosporine) • Bactrim • Canagliflozin • Drospirenone-containing oral contraceptives • Potassium chloride supplements or salt substitutes |
| Q52. Wash out time for MAOi | • 14 days (vice versa) Should be stopped for"--" prior initiate MAOi: • Vortioxetine: 21 days • Fluoxetine: 5 weeks |
| Q53. Salicylates (Aspirin, magnesium salicylate) can cause ototoxicity at regular dose | • NO • ONLY If high or toxic doses. |
| Q54. Lamotrigine starter kits | • Green kit: Higher dose if w inducer (eg, carbamazepine, phenobarbital, phenytoin, primidone) • Orange kit • Blue kit: lower dose if w valproate / divalproex |
| Q55. Calcineurin inhibitors (eg, cyclosporine, tacrolimus) cause ototoxicity | • NO • Nephrotoxicity |
| Q56. P450 2C9 inhibitor | • Amiodarone, |
| Q56. P450 2C9 substrate | • S-warfarin |
Created by:
dao.vo11017