CYP450 Enzymes, Major Inhibitors of

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The CYP450 enzymes are essential for the production of numerous agents including cholesterol and steroids. Additionally, these enzymes are necessary for the detoxification of foreign chemicals and the metabolism of drugs.⁠ ⁠ Drugs that are CYP450 inhibitors block the metabolic activity of one or more of the CYP450 enzymes. The extent to which an inhibitor affects the metabolism of a drug depends upon factors such as the dose and the ability of the inhibitor to bind to the enzyme.⁠

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Drug Allergies

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Drug Allergies2
Drug Allergies3
Drug Allergies4

While any drug can cause an allergic reaction, let’s focus on the top 3 most common drug allergies:⁠⠀
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💊 Penicillin allergies⁠⠀
💊 Sulfa allergies⁠⠀
💊 Opioid allergies⁠⠀
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When you realize a patient has an allergy to a medication you are about to prescribe, verify, or administer, always assess to see if the patient is TRULY allergic to the medication by:⁠⠀
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✏️ Asking what reaction they had to it⁠⠀
✏️ Determine if the reaction is a considered side effect/intolerance vs. a true allergy that is IgE mediated (anaphylaxis or angioedema) ⁠⠀
✏️ If it is a true allergy, replace the medication with an alternative drug⁠⠀
✏️ If using another agent that could potentially cross-react be sure to monitor the patient closely ⁠⠀
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Most often patients who report they have an allergy to one of these medications are truly not allergic to it but are often just intolerant to its side effects which can lead to costlier and less effective medications being used in its place. ⁠It’s important to assess the nature of the allergy and weigh the risks and benefits of using other alternatives.

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Drug Antidotes⁠ #1⠀

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🚦 Antidotes are substances used to reverse the effects of poisoning. The word “antidote” itself derives from the Greek word, antidoton, meaning “administered as a remedy’.⁠⠀
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Some antidotes are used to treat one specific drug while other antidotes (ex: charcoal) can reverse the effects of many different toxins. ⁠⠀

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Drug Names #1

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There are a plethora of drug facts to memorize for school, but it is definitely helpful when their names hint at what they are used for, their mechanism of action, frequency, or duration. ⁠ 💊 Lasix: short for ‘last six hours’ because of the 6-hour duration of action. Try not to administer this diuretic to patients after 4 pm to decrease nighttime awakenings.⁠ ⁠ 💊 Macrobid: this formulation of Macrodantin is given BID (twice a day). Macrodantin is recommended to be given 4 times a day. Ensure you are using the right formulation for the right frequency. ⁠ ⁠ 💊 Protonix: Protonix belongs to a class of proton pump inhibitors. Its brand name, Protonix, tells you that it is used to ‘nix protons’ or acid and is used to treat GERD and acid-reflux disorders. ⁠ ⁠ 💊 Lopressor: brand name for metoprolol, a beta-blocker that is used for high blood pressure. The brand name, lo-pressor, tells you that it is used to help ‘lower pressures’. ⁠ ⁠ 💊 Flonase: brand name for fluticasone nasal spray. Its name, Flonase, sounds an awful lot like ‘flow nasal’ which tells you that it is used to treat allergies that commonly cause nasal congestion. ⁠ 💊 Ambien: AM is the sig for morning and Bien means good in Spanish. It is a sleeping aid medication that translates into ‘good morning’. ⁠

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Drug Names #2

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Part 2 of It’s all in the name! Hope these mnemonics make it easier for you to memorize these medications. ⁠ 💊 Flomax: brand name for tamsulosin, a medication used to treat urinary retention or benign prostatic hyperplasia (BPH). Its name tells you that it is used to ‘maximize flow’. ⁠ ⁠ 💊 Lunesta: a sleep aid medication whose root word Luna means moon in Latin. ⁠ ⁠ 💊 Xarelto: brand name for rivaroxaban, an oral anticoagulant. Its name hints at its mechanism of action, inhibiting factor Xa in the clotting cascade. ⁠ ⁠ 💊 Fosamax: brand name for alendronic acid, it is a medication used to treat osteoporosis or bone weakening. Its name means os = bone, and max = great in Latin. ⁠ ⁠ 💊 Prevacid: brand name for lansoprazole, it belongs to a class of proton pump inhibitors. Its name tells you that it ‘prevents acid’ and is used to treat GERD and acid-reflux disorders. ⁠ ⁠ 💊 Glucophage: brand name for metformin. It is a medication used to treat type 2 diabetes. Its name derives from the Greek words gluco= glucose and phage = eat or consume. ⁠This helps you remember metformin’s mechanism of action is to increase uptake of glucose by cells in the body to be used as energy (or in other words increase insulin sensitivity). ⁠

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Drug Names #3

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💊 Vicodin is the brand name for hydrocodone/acetaminophen. Its component hydrocodone is approximately 6 times (VI) times as potent as codeine (codin). ⁠ ⁠ 💊 Levitra is the brand name for vardenafil, a medication used to treat erectile dysfunction. The article ‘Le’ is used to describe masculine nouns in French (‘La’ is used with feminine nouns) and vitra is similar to the word vitality. So together, the name masculine vitality will help you remember the indication for Levitra. ⁠ ⁠ 💊 Actigall is the brand name for ursodiol, a medication used to dissolve certain types of gallstones. It sounds a lot like “ACTS ON THE GAL-bladder” to help you remember what it is used for. ⁠

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Drug Names #5

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💊 Cisplatin is a chemotherapy medication used to treat a number of different cancers. Its name tells you that it is an isomer of a platinum-containing compound. ⁠ ⁠ 💊 Maalox is used to treat heartburn, acid indigestion, sour stomach, and upset stomach. The name is an acronym that refers to the solution’s compositional elements: MAgnesium and ALuminum Oxide.⁠ ⁠ 💊 Sonata is the brand name of Zaleplon, a sedative used to treat insomnia. The prefix Sona means ‘sleepy’ in Portuguese to help you remember its indication. ⁠

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Drug Names #4

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💊 Bactroban is the brand name of mupirocin, an antibiotic ointment that works to inhibit the growth of bacteria, hence the name ‘ban bacteria’ or Bactroban. ⁠ ⁠ 💊 Emend is the brand name of aprepitant, an anti-nausea medication indicated to prevent nausea and vomiting caused by chemotherapy. The name emend has the components of ‘end emesis’ in it. ⁠ ⁠ 💊 Morphine is an opioid pain medication. The drug was named after Morpheus, the Greek god of dreams because in addition to its long-lasting analgesic effects, it would also induce sleep. ⁠

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Drug Names #6

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💊 Premarin is an estrogen-replacement drug prescribed for the treatment of menopause. It is made from horse urine noted by the drug’s name Premarin which is short for ‘PREgnant MARes’ urINe’. ⁠ ⁠ 💊 Ursodiol‘s active chemical, ursodeoxycholic acid, is one of the acids found in bear bile that has been shown to be effective in treating gallstones. Since the 1950s, the drug has been produced synthetically.⁠ ⁠ 💊 Forfivo is the brand name of the once-daily bupropion 450 mg formulation. It is indicated for the treatment of major depressive disorder (MDD). The brand name hints at its dosing ‘four-five-O’ for 450 mg. ⁠ ⁠

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Entresto® (Sacubitril/Valsartan)

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📖 Angiotensin receptor-neprilysin inhibitors (ARNI) is a new class of heart failure medications. ⁠
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☝🏻 The first drug in this class is Entresto® (sacubitril/valsartan). It is a combination medication comprised of a neprilysin inhibitor (sacubitril) and an angiotensin II receptor blocker (valsartan). ⁠
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💊 Sacubitril is a prodrug that inhibits neprilysin thus preventing it from breaking down natriuretic peptides. This mechanism leads to an increase in vasodilation and diuresis as levels of natriuretic peptides rise. ⁠
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💊 Valsartan directly blocks angiotensin II receptors inhibiting angiotensin II from binding onto the receptors and causing vasoconstriction and aldosterone release.⁠
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Calcium Channel Blockers

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Calcium channel blockers (CCBs) are used in the treatment of many cardiovascular conditions. They are divided into subclasses, non-dihydropyridines and dihydropyridines. The non-dihydropyridine CCBs cause less vasodilation and more cardiac depression than dihydropyridine CCBs (hence why they are not recommended in decompensated heart failure). They cause reductions in heart rate and contractility. Dihydropyridine CCBs have more vascular selectivity and fewer cardiac effects. They are indicated in the treatment of hypertension and angina. They do not suppress AV conduction or the SA node automaticity.

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