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Which CYP3A system in inhibitted by grapefruit juice?
What does this mean for cardiac drugs?
drugs metabolized by the INTESTINAL (not hepatic CYP3A are inhibited): dihydropyridine CCBs, lovastatin, simvastatin, cyclosporine, tacrolimus, sildenafil
Which beta blockers are lipophilic?
Metoprolol, labetalol, propranolol
How does the volume of distribution change for elderly?
Small volume of distribution due to less muscle mass and less water content (both)
What interaction does potassium have with digoxin?
Hypokalemia leads to digoxin toxicity
What is the treatment for beta blocker overdose?
glucagon, beta agonists, pacing
Calcium, inotropes, vasopressors
What is the treatment for digoxin toxicity?
How are anthracyclines and cardiomyopathy related?
Cumulative dose (about 500 mg/m2)
What does anthracycline cardiomyopathy show on biopsy?
Hos is biologic chemo agent different from anthracyclines?
What pathology is known with Xeloda?
Coronary vasospasm (5FU based chemo)
What effect does St. John's Wort have on cardiac medications?
Inducer of CYP3A4 and CYP2D9 --> reduced bioavailability of amiodarone, CCBs, beta blockers, statins, warfarin
What herbals increase bleeding risk?
Garlic, ginger, gingko, saw palmetto
What effect does Hawthorn have?
increases dig effect; increases vasodilator effect of CCBs and nitrates
What is the effect of licorice?
Increases spironolactone effect
Why are elderly at risk for adverse drug reactions?
decreased muscle mass (decreased volume of distribution), decreased renal function, cognitive decline, comorbid diseases, polypharmacy
What is the risk of drug-drug interaction with 8 meds or more?
What percent of clopidogrel taken in is actually activated?
Which Cytochrome enzyme accounts for activation?