Term
|
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
|
|
Term
|
Definition
|
|
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
|
Definition
2D6 antidepressants
Inhibitors |
|
|
Term
|
Definition
| use morphine instead (hydromorphone... morphine) |
|
|
Term
|
Definition
Antimicrobials
PGP/3A4 inhibitors |
|
|
Term
| What do you expect to see in colchicine toxicity? |
|
Definition
| diarrhea, fever, ab pain, muscle pain/weakness |
|
|
Term
|
Definition
|
|
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
|
Definition
| Hypertension, edema, poor wound healing, diabetes, ocular toxicity, cushing's, (moon face, central obesity, hirsutism, acne, bruising) |
|
|
Term
|
Definition
CCB (+ bepridil)
PGP inhibitors
PGP Inducer |
|
|
Term
|
Definition
|
|
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
|
Definition
Binding Resins (cholestyramine, colestipol)
[decrease absorption and diuretic effect] |
|
|
Term
|
Definition
Change the colestipol to Zetia.
OR Give Lasix 2 hours before or 6 hours after colestipol. Monitor. |
|
|
Term
|
Definition
Cationic Tubular Secretion inhibitor (cimet, ketoconazole, triamterene, trimethoprim)
[increases conc = prolong QTc]
MONITOR for increased QTc interval |
|
|
Term
| DA agonist (bromocriptine... levodopa) |
|
Definition
|
|
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
|
|
Term
|
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
|
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
|
Definition
|
|
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
|
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