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NAPLEX Chapter 2 MUST know drug interactions Questions with 100% Actual correct answers | verified | latest update | Graded A+ | Already Passed | Complete Solution $7.99   Add to cart

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NAPLEX Chapter 2 MUST know drug interactions Questions with 100% Actual correct answers | verified | latest update | Graded A+ | Already Passed | Complete Solution

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NAPLEX Chapter 2 MUST know drug interactions Questions with 100% Actual correct answers | verified | latest update | Graded A+ | Already Passed | Complete Solution

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  • June 26, 2024
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NAPLEX Chapter 2 MUST know drug
interactions
Amiodarone + Digoxin - ✅✅-Amiodarone= P-gp inhibitor
Digoxin= P-gp substrate

Amiodarone ↓ digoxin metabolism (increased digoxin ADRs/toxicity) → both ↓HR, ↑
risk bradycardia, arrhythmia, fatality

If using Amiodarone 1st: start low dose digoxin ≤ 0.125 mg
If using Digoxin 1st: ↓ Digoxin dose 50%

Monitor
- Symptoms of digoxin toxicity (nausea, anorexia, HR)
- Check for other drugs that ↓HR
- Switch to BB or Non-DHP CCB if digoxin is being used for rate control

Amiodarone/Dronedarone + Warfarin - ✅✅-Amiodarone= 2C9 inhibitor
Warfarin= 2C9 substrate

Amiodarone ↓ warfarin metabolism (increased warfarin levels) → ↑INR levels → ↑
risk of bleeding

If using Amiodarone 1st: start low dose warfarin ≤ 5mg
If using Warfarin 1st: ↓ Warfarin dose 30-50% when starting Amiodarone depending
on INR

Monitor:
- INR (adjust as needed)
- Check for other Amiodarone DDIs

Common CV drug interactions (5) - ✅✅ -- Amiodarone/dronedarone + warfarin
- Amiodarone + digoxin
- Digoxin + loop diuretics
- Verapamil/Diltiazem + other drugs that ↓HR
- Statins + CYP 3A4 strong inhibitors

Common inhibitors that increase substrate drugs drug interactions (6) - ✅✅-- CYP
3A4 inhibitors (PS PORCS) + CYP 3A4 substrates
- Valproate + Lamotrigine
- MAO inhibitors + drugs that ↑ Epi, NE, and DA + drugs that ↑5HT
- MAO inhibitors + Tyramine rich foods

, - CYP 2D6 inhibitors + CYP 2D6 substrates
- CYP 3A4 inhibitors & P-gp inhibitors + Calcineurin inhibitors

CYP 2D6 inhibitors + CYP 2D6 substrates - ✅✅-↓ drug metabolism → ↑
ADRs/toxicity
Avoid use together or ↓ substrate dose

CYP 2D6 UMs + prodrugs codeine and tramadol - ✅✅-increased active drug conc.
→ toxicity/fatality

do not use codeine or tramadol in children < 12 yo and in children <18 yrs following
surgery

do not crush or chew ER opioids including prodrugs

CYP 3A4 and P-gp inducers + CNIs - ✅✅-↓CNI level → ↑ risk of transplant
rejection

Monitor:
- CNI trough levels

CYP 3A4 inducers + opioids that are substrates of CYP 3A4 - ✅✅-↑ metabolism →
↓ pain relief

assess pain regimen and increase as needed, use caution (avoid respiratory
depression)

CYP 3A4 inhibitors (PS PORCS) + CYP 3A4 substrates - ✅✅-↓ substrate
metabolism → ↑ADRs/toxicity

Monitor:
- drug levels
- side effects

*Do not use CYP 3A4 inhibitors with opioids metabolized by CYP 3A4 → can be
fatal*


✅✅
CYP 3A4 inhibitors & P-gp inhibitors + Calcineurin inhibitors (tacrolimus,
cyclosporine, sirolimus) - -↓ drug metabolism → ↑ ADRs/toxicity (↑BP,
nephrotoxicity, metabolic syndrome)

Avoid use together or ↓ CNI dose
Monitor transplant drug level troughs

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