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Adverse Drug Rxns test 2
CBZ
58
Pharmacology
Graduate
10/07/2012

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Cards

Term
Carbamazepine
Definition
Fluoxetine, Fluvoxamine, Nefazodone
Antimicrobials
CCB
Inhibitors
Term
Monitoring for CBZ toxicity...
Definition
N/V, dizziness, drowsiness, HA, diplopia (double vision), confusion
Term
Central Alpha adren agonists (clonidine, guanabenz, guanfacine)
Definition
TCA
Term
Cephalosporins
Definition
Gastric Alkalinizers
Term
Cephalosporin + Mylanta or Zantac?
Definition
give cephalo 2 hours before antacid... (unless it's a PPI). MONITOR for reduced antibiotic effect!
Term
1A2 antipsychotic (asenapine, olanzapine, clozapine)
Definition
Inhibitors (Oral contraceptives, CIPRO cimetadine, HIV)
FLUVOXAMINE
Term
Asenapine + Cipro or Enoxacin???
Definition
Try gemifloxacin, levofloxacin, lomefloxacin, moxifloxacin, ofloxacin; monitor for altered response
Term
What if you have a resistant schizophrenic patient who's on Olanzapine and Fluvoxamine?
Definition
Leave them on it. Monitor. This concentration increase of 5-10x is useful for resistance.
Term
Codeine Derivatives
Definition
2D6 antidepressants
Inhibitors
Term
Oxycodone + Bupropion ??
Definition
use morphine instead (hydromorphone... morphine)
Term
Colchicine
Definition
Antimicrobials
PGP/3A4 inhibitors
Term
What do you expect to see in colchicine toxicity?
Definition
diarrhea, fever, ab pain, muscle pain/weakness
Term
Birth Control
Definition
inducers
antibiotics
Term
birth control + amoxicillin?
Definition
add another form of contraceptive during antibiotic therapy and at least one cycle after D/C
Term
Corticosteroids (budesonide, dexamethasone, fluticasone, methylprednisolone, mometasone)
Definition
antimicrobials
3A4 antidepressants
enzyme inhibitors
Inducers
Term
what does the corticosteroid + inhibitors interaction do?
Definition
Increase plasma concentrations of steroids!

Results in CUSHING'S and Adrenal suppression!
Term
Steroid Toxicity?
Definition
Hypertension, edema, poor wound healing, diabetes, ocular toxicity, cushing's, (moon face, central obesity, hirsutism, acne, bruising)
Term
Dabigatran
Definition
CCB (+ bepridil)
PGP inhibitors
PGP Inducer
Term
Digoxin
Definition
PGP inhibitors
CCB
Term
What to do with Digox + azithromycin (PGP i) ??
Definition
inhibitors reduce renal elimination of digox.... MONITOR serum levels... takes up to 10 days to achieve new steady state. Consider conservative doses of Digox.
Term
diuretics
Definition
Binding Resins (cholestyramine, colestipol)

[decrease absorption and diuretic effect]
Term
Furosemide + colestipol?
Definition
Change the colestipol to Zetia.

OR Give Lasix 2 hours before or 6 hours after colestipol. Monitor.
Term
Dofetilide
Definition
Cationic Tubular Secretion inhibitor (cimet, ketoconazole, triamterene, trimethoprim)

[increases conc = prolong QTc]

MONITOR for increased QTc interval
Term
DA agonist (bromocriptine... levodopa)
Definition
DA antagonist
Term
If a patient is on Levodopa and is given Metoclopramide (reglan) for sluggish bowel or gastroparesis... what do you do?
Definition
Instead of Reglan, give patient Erythromycin which helps move bowel along
Term
A patient is given pramipexole (Mirapex) for RLS and Haldol for schizophrenia. What do you do?
Definition
Worsens parkinsonism. Change the Haldol to Clozapine, Olanzapine, Quetiapine or Risperidone (less EP SE)
Term
Eplerenone
(mineralocorticoid rec antag - for HTN)
Definition
Antimicrobials
3A4 antidepressants (fluvox, nefazodone)
3A4 inhibitors
Term
What would you see with Eplerenone toxicity?
Definition
Hypotension
Hyperkalemia
Term
Ergot Alkaloids
Definition
inhibitors
antidepressants (3A4i)
Antimicrobials
Triptans
Term
What would you monitor for Ergot interaction?
Definition
Monitor for Ergotism such as ischemia of extremities (pain, tenderness, cyanosis, low skin temperature), HTN, tongue ischemia
Term
What happens with Ergot Alkaloid + Imitrex (sumatriptan)?
Definition
CLASS I interaction! Causes excessive vasoconstriction! AVOID within 24 hours of ergots
Term
A patient is taking Ergotamine for migraines and was given Cipro.. what do you do?
Definition
Use Azithromycin instead of Cipro.
Term
A patient was taking dihydroergotamine or migraines and was given fluvoxamine for depression. What do you do?
Definition
Change the fluvoxamine to citalopram.
Term
HMG CoA Reductase inhibitor
Definition
Antimicrobial
Fibrates
CCB
3A4 i/antidepressants
Inducer
OATPi
Term
What are signs/sxs of myopathy from statin toxicity?
Definition
Dark urine
Muscle Pain
Muscle weakness
Increase serum CK concentration
Term
A patient is on simvastatin for cholesterol and comes in with a Rx for Itraconazole. What do you do?
Definition
(1) use pravastatin instead of simvastatin
(2) change Itraconazole to fluconazole.

Monitor for signs of myopathy
Term
A patient is on Crestor (rosuvastatin) and Ritonavir for HIV. What do you do?
Definition
Monitor for signs of myopathy with increased serum CK levels.
Term
Lithium
Definition
ACEi/ARB
Loop/thiazide diuretics
NSAID
Term
What are signs/sxs of lithium toxicity?
Definition
N/V, anorexia, diarrhea, slurred speech, confusion, lethargy, coarse tremor, seizure, coma, death
Term
Patient comes in with Lithium and lisinopril Rx. What do you do?
Definition
(1) MONITOR for signs of Li toxicity.
OR

(2) Change the lisinopril to a CCB (amlodipine)
Term
Lamotrigine
Definition
Inducers
Valproic Acid
Term
You have a patient taking both lamotrigine and valproic acid for seizures. He needs to be on both and cannot d/c one. What do you tell him?
Definition
Stevens-Johnson syndrome or toxic cases of hyperammonemic encephalopathy have been reported in patients with this combo. We will need to adjust his lamictal dose if necessary. MONITOR for evidence of encephalopathy (lethargy, tremor, asterixis(flapping), elevated NH3 levels)
Term
A patient is on Lithium and HCTZ for HTN. How would you counsel him?
Definition
Continue the two Rxs, it may take up to several weeks for any lithium toxicity to manifest. This may cause N/V, diarrhea, slurred speech, confusion, lethargy, tremor, seizure or coma.
Term
MAOi (nonselective)
(furazolidone, Isocarboxazid, methylene blue, phenelzine, tranylcypromine)
Definition
sympathomimetics
TCA
SSRI/SNRI
Term
What would happen with a patient on tranylcypromine + Clomipramine?
Definition
Serotonin syndrome! Result in severe HTN, hyperpyrexia(fever), seizure, arrythmia, death.
Term
What should you do once you d/c a MAOi?
Definition
AVOID sympathomimetics for at LEAST 14 days after MAOi D/C.
Term
MAOi (Linezolid)
MAO-Bi (Rasa/Sele)
Definition
TCA
SSRI/SNRI
Sympathomimetics
Term
Patient is on Selegiline for parkinson's and is about to be started on Linezolid for infection. What do you do?
Definition
Depending on antibiogram, consider changing Linezolid to vancomycin or telavancin.

If used, monitor for SS signs and sxs.
Term
What are the signs and symptoms of Serotonin syndrome?
Definition
myoclonus, rigidity, tremor, hyperreflexia, fever, sweating, seizures, confusion, agitation, incoordination and coma
Term
A patient comes into the pharmacy with rasagiline for parkinson's and amphetamine... what do you do?
Definition
Monitor for HTN, fever, seizures or arrythmias. Need to discontinue!
Term
Opioid analgesics (interactions)
Definition
Inducers
antimicrobials
inhibitors
Term
fentanyl + barbiturate? Counsel.
Definition
It may take weeks to see induction affects... monitor for reduced analgesic effects or methadone withdrawal (rhinorrhea, sweating, lacrimation, restlessness, insomnia)

Increase if needed..
Term
Patient comes in with Oxycodone and cipro prescription. What do you do and how would you counsel?
Definition
Possibly change the cipro to azithromycin..

Monitor for prolonged opioid effect.. excessive sedation and respiratory depression.
Term
If patient is on methadone for pain and wants to take cimetidine for indigestion. What do you do?
Definition
Change cimetidine to Ranitidine. It will prevent excess sedation.
Term
Immunosuppressants (interactions)
cyclosporine
sirolimus
tacrolimus
Definition
Inducers
Antimicrobials
Inhibitors
Term
A patient who recently had a kidney transplant was taking sirolimus as an immunosuppressant. He was given azithromycin for a sinus infection. What do you do?
Definition
Azithromycin is a PGP inhibitor... switch to another drug class.
Term
(1) If patient on amiodarone, how would you add tacrolimus on therapy?
(2) If on tacrolimus already what do you do?
Definition
(1) start with low dose tacrolimus.

(2) monitor and then reduce dose as necesary
Term
Lamotrigine (interaction)
Definition
Inducer
Valproic acid
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