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