Pharmacology Review Sheets: Drug Interactions, p.

1 Drugs and Nutrition Drug/Nutrient #1 Drug/Nutrient #2 Mechanism of Interaction Effects Penicillins Food Decreased gastric emptying Decreased absorption Captopril Food Decreased absorption Verapamil Food Prolonged absorption Propranolol Food Increased absorption Levodopa Food (protein) Delayed absorption; decreases peak levels Theophylline, Antipyrine High protein Accelerated metabolism Decreased levels Tetracyclines Dairy foods Chelation of Ca2+, Mg2+, Fe2+; chelate not absorbed Decreased absorption Ciprofloxacin Dairy foods Chelation of Ca2+, Mg2+, Fe2+; chelate not absorbed Decreased absorption Digitalis Bran fiber Decreased absorption Lovastatin Bran fiber Decreased absorption Zidovudine Fat Decreased absorption (Clinical significance undetermined) Theophylline (Theo-24) High fat Increased absorption (to a toxic level!) (Theo-Dur NOT affected by fat) Griseofulvin High fat Increased absorption Cyclosporine Grapefruit juice cytochrome p-450 metabolism in intestine Increased absorption Inhibition of P-glycoprotein (which pumps cyclosporine out of the cell)

Nitrendipine Grapefruit juice Increased plasma concentrations, HR, BP Quinidine Grapefruit juice Inhibition of quinidine metabolism Increased serum levels (for both) Antacids Increased reabsorption of quinidine (by alkalinizing the urine) Phenacetin Charcoal CYP3A4 in intestine Decreased absorption Warfarin Vitamin K ( ingestion) Increased biotransformation of warfarin Decreased activity MAO Inhibitors Tyramine Hypertensive crisis (fatal) (Note: Levels in particular foods are variable!) Fat-soluble vitamins (A,D,E,K) Cholestyramine, Colestipol Binding of resins to bile acids Decreased absorption Vitamin D Phenytoin, Pyrimidine, Anticonvulsants Vitamin D Worse risk of seizures Decreased vitamin D; risk of seizures Ethosuxamide Fat-soluble vitamins, Ca2+, Colchicine, Neomycin, Decreased absorption (all interacting drugs) phosphate, K+, B12 Mineral oil Vitamin K Antibiotics Killing intestinal flora that make Vitamin K ( production) Decreased absorption Vitamin B6 (pyridoxine) Isoniazid, Hydralazine, Penicillamine, Ethinyl estradiol Folate Phenytoin pH enzyme conversion of polyglutamic folic acid to Decreased absorption (all interacting drugs) monoglutamic folic acid (phenytoin only) Phenobarbital

Anti-folates: Methotrexate, Trimethoprim, Pyrimethamine Oral contraceptives (estrogen) Antacids Large neutral amino acids Levodopa Competes for transport system Decreased absorption Calcium Methotrexate Decreased absorption Decreased levels Furosemide Increased excretion Decreased levels Bumetanide Increased excretion Decreased levels Phenytoin Vitamin D ( metabolism of Vitamin D) Decreased levels Glucocorticoids Vitamin D Decreased levels Thiazides Increased renal reabsorption Increased levels Potassium Diuretics Increased excretion Decreased levels Magnesium Diuretics Increased excretion Decreased levels Phosphate Aluminum hydroxide Decreased absorption Iron NSAIDs Blood loss Decreased levels Pharmacology Review Sheets: Toxicology, p.1 Toxins and antidotes Drug/Treatment Dimercaprol Toxin Pharmacokinetics Admin: IM, IV Adverse Effects Hypertension Tachycardia

Mercury Lead Arsenic

Succimer hepatotoxicity Penicillamine

Lead (drug of choice)

Admin: Oral

Possible Agranulocytosis Aplastic anemia

Copper Lead Mercury Arsenic Calcium disodium edetate Lead cells in proximal tubules) (EDTA) Deferoxamine Iron Nitrites (give first) Cyanide Methylene blue (to take care of methemoglobinemia)

Admin: Oral

Admin: IV

Nephrotoxic (kills Hypotension Allergic effects

Admin: IM