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The occurrence of deleterious or even fatal drug-drug interactions (DDIs) in the perioperative period is no longer a theoretical concern but a harrowing reality. A Case Approach to Perioperative Drug-Drug Interactions addresses the complex realm of pharmacokinetic drug interactions in an easy-to-read volume that functions as both a comprehensive clinical reference and a casebook. The book presents a summary of the core concepts of drug interactions; an organized, annotated presentation of the drug interactions most relevant to the perioperative clinician; and approximately 200 case scenarios that highlight specific drug interactions. This book fills a real void in the clinical literature and is invaluable to anesthesiologists and surgeons, and PharmDs, as well as trainees in those specialties; intensive care staff, including physicians, physician assistants, and nurses; and nurse practitioners who staff preoperative evaluation clinics.
Part I. Introduction to Drug-Drug Interactions
1. Let’s Start at the Very Beginning: Overcoming Fear and Gaining Mastery of Drug-Drug Interactions
F. Jacob Seagull, PhD, Catherine Marcucci, MD
2. Pharmacodynamic Interactions: Core Concepts
Erica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc
3. Pharmacokinetic Interactions: Core Concepts
Erica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc
4. A Brief Treatise On The Area Under The Curve
Michael J. Sikora, MD, Barbara Jericho, MD
Part II. Introduction to Drug-Drug Interactions: Brief Review of CYP450 Enzymes, UGTs, and Transporters
5. CYP2D6: Where It All Began
John C. Sanders, MBBS, FRCA, Rachel Koll, MD, Randal O. Dull, MD, PhD
6. CYP2E1: The Anesthesia Enzyme
Benjamin S. Gmelch, MD, Randal O. Dull, MD, PhD
7. CYP3A4: The Workhorse
Jennifer DeCou, MD, Nathaniel Birgenheier, MD, Randal O. Dull, MD, PhD
8. CYP1A2: The Switch-hitter
Danielle Roussel, MD, Emily Hagn, MD, Randal O. Dull, MD, PhD
9. CYP2B: 2B or Not 2B?
Dustin Coyle, MD, Randal O. Dull, MD, PhD
10. CYP2C9: The Support Crew I
Byron Douglas Fergerson, MD, Crystal B. Wallentine, MD, Randal O. Dull, MD, PhD
11. CYP2C19: The Support Crew II
Barbara Jericho, MD, Alfredo Aguiar, MD, Randal O. Dull, MD, PhD
12. UGTs: Conjugating Cousins
Neil B. Sandson, MD
13. The Cytochrome P450 System In Disease States—A Brief Review
Catherine Marcucci, MD
PART III. Drug-Drug Interactions: Paradigms and Core Concepts
14. P-glycoprotein and OATP Transporters
Dustin Coyle MD, Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD
15. The “Fatal” Forty
Neil B. Sandson MD, Michael Hutchens MD, F. Jacob Seagull, PhD, Catherine Marcucci, MD
16. The Six Patterns of Pharmacokinetic Drug-Drug Interactions
Neil B. Sandson, MD, Catherine Marcucci, MD
17. The Problem with the Drug-Drug Interaction Software: A Procrustean Dilemma
Neil B. Sandson, MD, F. Jacob Seagull, PhD, Wayne T. Nicholson, MD, PharmD, MSc, Catherine Marcucci, MD
18. Pharmacogenomics
Chad D. Moore, PhD, William Hartman, MD, PhD, Michael Hutchens, MD, Randal O. Dull, MD, PhD
19. The Pharmacoepidemiology of Drug Interactions: Why and How They Are Important
Joseph A. Lovely, PharmD, BCPS, Stephen Esper, MD, MBA, Michael Hutchens, MD, Wayne T. Nicholson, MD, PharmD, MSc, Catherine Marcucci, MD
20. The Lawyers Can Read, Too: Case Presentations from the Courtroom
Jessica Voge, MD, David K. Miller, JD
Part IV. Drug-Drug Interactions Involving Inhalational Anesthetic Agents
21. Introduction
Catherine Marcucci, MD
22. That Sums It Up
Volatile anesthetics, additive MACs
James A. Jernigan, MD, James W. Ibinson, MD, PhD
23. 1+1+1+1=?
Variable effects of combined substances
Anthony T. Silipo, DO, Raymond M. Planinsic, MD, Erica D. Wittwer, MD, PhD, Juraj Sprung MD,PhD, Wayne T. Nicholson, MD, PharmD, MSc
24. A Delayed Surgeon Is A “Dismayed” Surgeon?
Nitrous oxide, dexmedetomidine, somatosensory evoked potentials
Jonathan Anson, MD
25. Relax, It’s Only Gentamicin
Volatile anesthetics, aminoglycoside antibiotics, neuromuscular junction
Brian Gierl, MD, Ferenc E. Gyulai, MD
26. Jaundice After Surgery
Halothane hepatitis, CYP2E1
Jonathon E. Kivela, MD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD
27. Everybody Clear?
Halothane, epinephrine arrhythmia
Nikhli Patel, MD, Barbara Jericho MD, Randal O. Dull, MD, PhD
28. The Hemodynamic Hole
general anesthetics, ACE-I, ARBs
Arun L. Jayaraman, MD, PhD, Theresa A. Gelzinis, MD
29. Alpha-2 To The Rescue But Beware Bradycardia
volatile anesthetics, alpha-2 agents
Phillip Adams, DO, Nashaant N. Rizk, MD
30. Hot Stuff!
triggering drugs, ryanodine receptor, malignant hyperthermia
Cornelius B. Groenewald, MD, ChB, Juraj Sprung, MD, PhD
Part V. Drug-Drug Interactions Involving Intravenous Anesthetic Agents
31. Introduction
Catherine Marcucci, MD
32. How to Successfully Occlude an Intravenous Line
thiopental, succinylcholine, line precipitation
Helga Komen, MD, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD
33. A Curious Cause of Seizures
ketamine, theophylline
Charles Galaviz, MD, Randal O. Dull, MD, PhD
34. Magnesium Mama And The Mad Dad
magnesium sulfate, propofol, remifentanil, vecuronium
Ana Maria Manrique MD, Catherine Marcucci, MD, Kathirvel Subramaniam, MD
35. Dexy’s Midnight Spinal
dexmedetomidine, bupivaine spinal, multiple mechanisms, CYP3A4, CYP2D6
Michael Hutchens, MD, Edward A. Kahl, MD, Matthias J. Merkel, MD, PhD
Part VI. Drug-Drug Interactions Involving Local Anesthetics
36. Introduction
Catherine Marcucci, MD
37. Comfortably Numb
local anesthetics
Joseph J. Yurigan, DO, Todd M. Oravitz, MD
38. Naturally Occurring And Nasty
cocaine, propranolol
Lauren Partyka, MD, Li Meng, MD, MPH
39. LOL-LOL: Little Old Lady—Lots of Lido
lidocaine, bupivacaine
Kitling M. Lum, RN, BSN, CCRN-CSC, Kelly N. Stafford, BSN, CCRN, CSC
40. The Spinal Countdown
general anesthesia after spinal anesthesia
Audra M. Webber, MD, Franklyn P. Cladis, MD, FAAP
41. Are Drug-Drug Interactions The Smoking Guns of Local Anesthetic Toxicity? Smoking Gun I
Fatal Forty DDI: ropivacaine, fluoxetine, CYP1A2, CYP3A4
L. Michele Noles, MD
42. Are Drug-Drug Interactions The Smoking Guns of Local Anesthetic Toxicity? Smoking Gun II
Fatal Forty DDI: bupivacaine, methocarbamol
L. Michele Noles, MD
43. A Perfect Storm?
Fatal Forty DDI: omeprazole, nicardipine, diltiazem, bupivacaine, CYP3A4, CYP2C19, CYP2D6
J. Andrew Dziewit, MD, Nabil M. Elkassabany, MD
44. Shake Rattle and Roll
Fatal Forty DDI: lidocaine, cimetidine, CYP3A4
Hans P. Sviggum, MD, Juraj Sprung, MD, PhD
45. Hello, We Have A Patient With Acute Delirium and We Need An Urgent Psych Consult
lidocaine, metoprolol
Katarina Bojanić, MD, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD
46. Fatal Pain Relief
local anesthetics, intrathecal morphine
Matthew M. Kumar, MD, Richard Levi Boortz-Marx, MD, MS
47. Lipid Lifesaver
local anesthetic, lipid emulsion
Adrian Pichurko, MD, Guy Weinberg, MD
Part VII. Drug-Drug Interactions Involving Opioids
48. Introduction
Toby N. Weingarten, MD
49. No ‘Subs’titute for Sobriety
buprenorphine, mu agonist opioids
James Hilliard, MSN, CRNA, Kirk Lalwani, MD, FRCA, MCR
50. A Needle And The Damage Done
Fatal Forty DDI: buprenorphine, ritonavir, CYP3A4
James Hilliard, MSN, CRNA, Kirk Lalwani, MD, FRCA, MCR
51. Dad’s Not Having Much Pain
Fatal Forty DDI: methadone, ciprofloxacin, CYP3A4
Rani Chovatiya, MD, Mehmet S. Ozcan, MD, FCCP, Randal O. Dull, MD, PhD
52. Royal Flush
Fatal Forty DDI: methadone, nortriptyline, CYP2D6, CYP3A4
Kimberly Mauer, MD, Catherine Marcucci, MD, Neil B. Sandson, MD
53. The Worry That’s Always With Us: Afternoon Nap
oxycodone, diazepam
Syed M. Quadri, DO, Randal O. Dull, MD, PhD
54. The Bawling Baby
Fatal Forty DDI: rifampin, methadone , CYP3A4, CYP2B6
Angela Kendrick, MD
55. Sleeping Beauty
Fatal Forty DDI: fentanyl, ritonavir, CYP3A4
Hans P. Sviggum, MD, Juraj Sprung, MD, PhD
56. Codeine Can’t Do It
Fatal Forty DDI: codeine, fluoxetine, CYP2D6
Katarina Bojanić, MD, Wayne T. Nicholson MD PharmD, MSc, Erica D. Wittwer MD, PhD, Toby N. Weingarten MD, Juraj Sprung, MD, PhD
57. A Shuddering Interaction
meperidine, phenelzine, serotonin toxicity
Christine A. Kenyon Laundre, MD, Randall Flick, MD, Juraj Sprung, MD, PhD
58. Double Indemnity
Fatal Forty DDI: morphine, rifampin, P-glycoprotein
Lisa Chan, MD, Catherine Marcucci, MD, Neil B. Sandson, MD, Kirk Lalwani, MD, FRCA, MCR
59. Breaking the Codeine
Fatal Forty DDI: codeine, quinidine CYP2D6
Clint Christensen, MD, Nathan G. Orgain, MD, Randal O. Dull, MD, PhD
60. The Ultimate Ultram Primer I: My Mood Is Better, But Boy Do I Hurt!
Fatal Forty DDI: tramadol, paroxetine, CYP2D6
Toby N. Weingarten MD, Juraj Sprung, MD, PhD
61. The Ultimate Ultram Primer II: I “Haight” Narcotics But I Hate Seizures Worse
Fatal Forty DDI: tramadol, buproprion, seizures, CYP2D6
Bruce T. Dumser, MD, Neil B. Sandson, MD
62. The Ultimate Ultram Primer III: Tremor-dol Trigger in Serotonin Syndrome
Fatal Forty DDI: tramadol, paroxetine, 2D6 inhibition, serotonin syndrome
Bryan C. Hoelzer, MD, Stephanie Neuman, MD
63. Too Much of A Good Thing
Fatal Forty DDI: codeine, drug-gene interaction, CYP2D6
Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson MD, PharmD, MSc
Part VIII. Drug-Drug Interactions Involving Non-opioid Pain Medications
64. Introduction
Toby N. Weingarten, MD
65. Pining For Pete In The Pain Clinic
Fatal Forty DDI: nortriptyline, paroxetine, CYP2D6
Steven S. Liu, MD, Toby N. Weingarten MD, Catherine Marcucci, MD
66. You Do Not Look Well Today, Mon Ami
Fatal Forty DDI: amitriptyline, amiodarone, QRS widening
Kimberly Mauer, MD, Catherine Marcucci, MD, Neil B. Sandson, MD
67. My Headache is Gone, But My Leg Now Hurts
Fatal Forty DDI: methysergide, erythromycin, CYP3A4
Jessica D. Lorenz, MD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc
68. Special ‘K’ase
Oral S-ketamine, ticlopidine
Lisa Chan, MD, Kirk Lalwani, MD, FRCA, MCR
69. Not Manic About NSAIDs
Fatal Forty DDI: ketorolac, lithium, toxicity
Allen N. Gustin, MD, FCCP, Michael J. Bishop, MD
70. Keep It Capped!
acetominophen, ethanol
Christine M. Formea, PharmD, BCPS, Wayne T. Nicholson MD, PharmD, MSc
71. The ACE Is Not Always High
Fatal Forty DDI: ketorolac, lisinopril
Wayne T. Nicholson, MD, PharmD, MSc
72. When The Smoke Clears, Relaxation Disappears
Fatal Forty DDI: cyclobenzaprine, smoked tobacco, CYP1A2
Avinash Ramchandani, MD, Julio A. Gonzalez-Sotomayor, MD
73. Befuddled by Aspirin
Fatal Forty DDI: aspirin, valproic acid, protein binding
Melisa N. Weingarten, RN, MS, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD
74. You Can’t Trick Us!
Fatal Forty DDI: ibuprofen, phenytoin, CYP2C9, protein binding
Catherine Marcucci, MD, Neil B. Sandson, MD
Part IX. Drug-Drug Interactions Involving Benzodiazepines and Other Sedatives
75. Introduction
Catherine Marcucci, MD
76. The Worry That’s Always With Us: Now I’m Depressed
benzodiazepines, opioids, propofol
Kelly T. Peretich, MD, Raymond M. Planinsic, MD
77. The Worry That’s Always With Us: Tragic But Not Rare alprazolam, clonazepam, and buprenorphine
Phillip Adams, DO, Ibtesam A. Hilmi, MB, CHB, FRCA
78. Lack of Sedation
Fatal Forty DDI: midazolam, carbamazepine interaction, CYP3A4
Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc
79. A Cold Isn’t Going to Slow Me Down
midazolam, goldenseal, CYP3A4, CYP3A5, CYP2D6
Leelee Thames, MD, Jessica Miller, MD, BM
80. Her Patients Never Wake Up On Time
Fatal Forty DDI: midazolam, diltiazem, alfentanil, CYP3A4, CYP3A5, CYP3A7
Toby N. Weingarten, MD, Erica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc
81. When Enough Is Now Too Much
Fatal Forty DDI: midazolam, itraconazole, CYP3A4
Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc
82. The Distressed Daughter
Fatal Forty DDI: alprazolam, carbamazepine, CYP3A4
Jennifer Egan, MD, Kirk Lalwani, MD, FRCA, MCR, Catherine Marcucci, MD
83. Check Check and Double Check
Fatal Forty DDI: diazepam, fluvoxamine, CYP3A4, CYP2C19
Catherine Marcucci, MD, Neil B. Sandson, MD
84. Doggone It—The Case is Cancelled
Fatal Forty DDI: midazolam, lopinavir/ritonavir, CYP3A4
Erica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc, Corinne Wisdo, DPM, Catherine Marcucci, MD
85. Noct’ Out
Fatal Forty DDI: chloral hydrate, phenobarbital, furosemide
Michael Wollenberg, MD, Kirk Lalwani, MD, FRCA, MCR
86. Predisposed to Doze
promethazine, CYP2D6 poor metabolizer
Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson MD PharmD, MSc
87. Synergistic Sedation
Fatal Forty DDI: midazolam, clozapine, synergism and clozapine, sertraline, CYP2D6
Michael Hutchens, MD, Paul Schipper, MD, FACS, FACCP, Catherine Marcucci, MD
Part X. Drug-Drug Interactions Involving Neuromuscular Blockade Agents
88. Introduction
David G. Metro, MD
89. Blocked Again
succinylcholine, repeated doses
Matthew Patrick Feuer, MD, Thomas M. Chalifoux, MD
90. Irreversibility Sux
succinylcholine, neostigmine
Joseph C. Shy, MD, David G. Metro, MD
91. Keep An “Ion” The Twitches
magnesium, neuromuscular blockade
Brian Gierl, MD, Ferenc E. Gyulai, MD
92. A Reversal of Misfortune
neostigmine, glycopryrolate,
Thomas N. Talamo, MD, Richard J. Kuwik, MD
93. Stop Moving
Fatal Forty DDI: vecuronium, phenytoin
Michael D. Olson, PA-C, Randall Flick, MD
94. There’s Just Not Enough Roc In The World
Fatal Forty DDI: rocuronium, carbamazepine
Tammara S. Goldschmidt, MD, Randal O. Dull, MD, PhD
95. Slow Sux I: A Lengthy Wake-Up Period After Electroconvulsive Therapy
succinylcholine, atypical plasma cholinesterase
Jennifer A. Rabbitts, MB, ChB, Juraj Sprung, MD, PhD
96. Slow Sux II: I Remember Reviewing This For The Boards
succinylcholine, atypical plasma cholinesterase
Andrew Oken, MD, Scott Richins, MD
97. Slow Sux III: Where Did the Twitches Go?
succinylcholine, donepizil, atypical pseudocholinesterase
Katarina Bojanić, MD, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD
98. Weakened All Weekend
vecuronium, amakacin
Daniel W. Johnson, MD
99. The Patient Who Could Not Raise Her Head
vecuronium, gentamicin
Nicole L. Varela, MD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD
100. An Unexpected Wait
pancuronium,mivacurium
Michael W. Best, MD, Shawn T. Beaman, MD
101. Diabolical Cough Syrup
rocuronium, pholcodine
Melisa N. Weingarten, RN, MS, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD
Part XI. Drug-Drug Interactions Involving Antibiotics and Antifungals
102. Introduction
Catherine Marcucci, MD
103. Full Stop
ceftriaxone, calcium
Norah Janosy, MD
104. Flummoxed by the FLOX
Fatal Forty DDI: ciprofloxacin, tizanidine, CYP1A2
Janice Kim, MD
105. Tales of Terror
Fatal Forty DDI: ciprofloxacin, simvastatin, CYP3A4
Arun Subramanian, MBBS, Juraj Sprung, MD, PhD
106. Too Low To Go
Fatal Forty DDI: erythromycin, nifedipine, CYP3A4
Catherine Marcucci, MD, Neil B. Sandson, MD
107. A Fungal Story
Fatal Forty DDI: fluconazole, phenytoin, CYP2C9, CYP2C19
Jerusha Taylor, PharmD, BCPS, Ansgar M. Brambrink, MD, PhD
108. Rejection Protection Turned Kidney Killer
Fatal Forty DDI: voriconazole, tacrolimus, CYP3A4, P-glycoprotein
Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Christine M. Formea, PharmD, BCPS
109. Can’t Get Well
Fatal Forty DDI: itraconazole, budesonide, CYP3A4
Michael J. Sikora, MD, Barbara Jericho, MD, Randal O. Dull, MD, PhD
110. Linezolid (I): Be VREy Careful
Fatal Forty DDI: linezolid, buproprion
Bruce T. Dumser, MD
111. Linezolid (II): Hyper and Hot
linezolid, meperidine, serotonin syndrome
Erica D. Wittwer, MD, PhD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD
112. Not Sweet At All
Fatal Forty DDI: trimethoprim/sulfamethoxazole, glipizide, CYP2C9
Mayumi Horibe, MD, Michael J. Bishop, MD
113. Where Did All The Sugar Go?
Fatal Forty DDI: levofloxacine, glyburide, complex interaction
Nicole L. Varela, MD, Federica Scavonetto, MD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD
114. Exposed! (Part 1)
Fatal Forty DDI: rifampin, buspirone, CYP3A4
L. Michele Noles, MD, Catherine Marcucci, MD
115. Exposed! (Part 2)
Fatal Forty DDI: rifampin, ondansetron, CYP3A4
L. Michele Noles, MD, Catherine Marcucci, MD
116. Seizures on 5 West
carbapenem, valproic acid, P-glycoprotein, UGT
Elizabeth Duggan, MD, Nabil M. Elkassabany, MD
Part XII. Drug-Drug Interactions Involving Cardiovascular Medications
117. Introduction
Michael Hutchens, MD
118. Riding The Rollercoaster
nitroglycerine, sodium nitroprusside, propofol,
Catherine Marcucci, MD, Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD
119. A Pressing Need For Vasopressin!
ACE-Is, general anesthesia
Erin B. Payne, MD, Anna Dubovoy, MD
120. Too Young To Die
Fatal Forty DDI: bupropion, pseudoephedrine, pharmacodynamic interaction
Catherine Marcucci, MD
121. A Widening Gyre
epinephrine, phosphorus, insulin
Edward A. Kahl, MD, Michael Hutchens, MD
122. Misusing Mom’s Meds
chronic amphetamine, indirect acting sympathomimetics
Pulsar Li, DO, Steven L. Orebaugh, MD
123. If the Patient Has No Renal Failure, Why is Her Potassium So High?
candesartan, spironolactone,
Jennifer A. Rabbitts, MB, ChB, Wayne T. Nicholson, MD, PharmD, MSc, Juraj Sprung, MD, PhD
124. Prazosin and the PTSD Paratrooper
prazosin, tadalafil,
Allen N. Gustin, MD, FCCP, Michael J. Bishop, MD
125. Nicardipine Notes
Fatal Forty DDI: nicardipine, tacrolimus, CYP3A4
Nenna Nwazota, MD, Randal O. Dull, MD, PhD
126. Hypotension Harry
Fatal Forty DDI: nicardipine, clarithromycin, CYP3A4
Matthew Hart, MSN, CRNA, Bryan J. Read, MSN,CRNA, Wayne T. Nicholson, MD, PharmD, MSc, Toby N. Weingarten, MD
127. Too Slow to Flow
Fatal Forty DDI: CYP2D6 ultraslow metabolism of metoprolol
Scott W. Cantwell, MD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD
128. Better Sleep But Slower Heart
metoprolol, diphenhydramine, CYP2D6
Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD
129. Extreme Blood Pressure After Ephedrine: Should We Rule Out Pheochromocytoma?
ephedrine, selegiline
Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc
130. Heart-Stopping Treatment
Fatal Forty DDI: verapamil, erythromycin, CYP3A4
Erica D. Wittwer, MD, PhD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD
131. Induction Crashes: Are There Clues In the Ashes?
Fatal Forty DDI: theophylline, smoked tobacco, CYP1A2
Dawn L. Baker, MD, MS, L. Lazarre Ogden, MD
132. The Wakeup Call: 2AM Trauma
beta blockers, cocaine
Devin C. Tang, MD, Nabil M. Elkassabany, MD
133. Falling Down
Fatal Forty DDI: nifedipine, fluoxetine, CYP3A4
Scott Kennedy, MD, Norman A. Cohen, MD
134. A Hidden Drug
Fatal Forty DDI: diltiazem, sildenafil, CYP3A4 and sildenafil, nitroglycerin
Helga Komen, MD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD
135. I’m Listening, I’m Listening
Fatal Forty DDI: diltiazem, carbamazepine, CYP3A4
Catherine Marcucci, MD, Jerusha Taylor, PharmD, BCPS, Ansgar M. Brambrink, MD, PhD, Neil B. Sandson, MD
136. Jump Start My Heart
metoprolol, amiodarone , CYP2D6, CYP1A2
Katarina Bojanić, MD, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD
137. The Statin Trilogy (I): ‘Statin’ From The Beginning
Fatal Forty DDI: simvastatin, cimetidine, diltiazem, CYP3A4
Brian Mitchell, MD
138. The Statin Trilogy (II): Tripped And Fell At The Train ‘Statin’
Fatal Forty DDI: simavastatin, itraconazole, CYP3A4
Brian Mitchell, MD
139. The Statin Trilogy (III): Welcome To The United ‘Statins’ Of America
Fatal Forty DDI: atorvastatin, phenytoin, CYP3A4
Brian Mitchell, MD
140. Be Still, My Beating Heart
Fatal Forty DDI: amiodarone, digoxin, P-glycoprotein
Branka Polić, MD, MSc, Julije Meštrović, MD, PhD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD
141. The Nice Niece
digoxin, St. John’s wort, CYP3A4, P-glycoprotein
Michael Hutchens, MD, Catherine Marcucci, MD
142. Cyclo Killer: Qu’est-ce que c’est?
carvedilol, cyclosporine, P-glycoprotein
Jeff Chen, MD, Michael Hutchens, MD, Wayne T. Nicholson MD, PharmD, MSc
143. Blurry-Eyed With Rapid Heart Beats
Fatal Forty DDI: digoxin, hydrochlorothiazide,
William A. Shakespeare, MD, Juraj Sprung, MD, PhD
Part XIII. Drug-Drug Interactions Involving Coagulation Modifiers
144. Introduction
Catherine Marcucci, MD
145. Seize the Day
Fatal Forty DDI: tranexamic acid, furosemide, ibuprofen
Roman M. Sniecinski, MD, Erica D. Wittwer, MD, PhD, Kenichi Tanaka, MD, MSc, James Zaidan, MD
146. The Third and Final Complication
Fatal Forty DDI: warfarin, nafcillin
Daniel W. Johnson, MD
147. An Interaction With the Furniture
Fatal Forty DDI: warfarin, metronidazole, ciprofloxacin, CYP2C9, CYP1A2
Heather Norvelle, PharmD, BCPS, Ines P. Koerner, MD, PhD
148. Macrolide Mishap for Little Miss Muffett
Fatal Forty DDI: warfarin, clarithromycin, CYP2C9
Elizabeth Pedigo, MD
149. From Asymptomatic to Symptomatic: a Cause of Nosebleed
Fatal Forty DDI: warfarin, amiodarone, CYP2C9
Joško Markić, MD, MSc, Julije Meštrović, MD, PhD, Juraj Sprung, MD, PhD
150. The Consequences of Not Following A Cardiac Diet
Fatal Forty DDI: clopidogrel, omeprazole, CYP2C19
Kristen B. McCullough, PharmD, BCPS, BCOP, Wayne T. Nicholson, MD, PharmD, MSc
151. Clopidogrel (I): Bagel Brunch
Fatal Forty DDI: clopidogrel, omeprazole, CYP2C19
Ann Marie Canelas, MD, Randal O. Dull, MD, PhD
152. Clopidogrel (II): Conferring Over The Kung Pao
clopidogrel, proton pump inhibitors, calcium channel blockers, CYP2C19, CYP3A4
Catherine Marcucci, MD, Neil B. Sandson, MD
Part XIV. Drug-Drug Interactions Involving Immunosuppressants, Antiemetics, and Chemotherapy
153. Introduction
Catherine Marcucci, MD
154. Beaned
Fatal Forty DDI: diltiazem, tacrolimus, CYP3A4, P-glycoprotein
Matthew Hart, MSN, CRNA, Michael Hutchens, MD
155. Addisonian Adjustment
Fatal Forty DDI: prednisone, fluconazole, CYP3A4
Catherine Marcucci, MD, Neil B. Sandson, MD
156. Tea Time
Fatal Forty DDI: St. John’s Wort, tacrolimus, cyclosporine, CYP3A4, P-glycoprotein
Nikki Jaworski, MD
157. No Fits at Uffizi
Fatal Forty DDI: phenytoin, cyclosporine, CYP3A4
Michael Hutchens, MD, Christine M. Formea, PharmD, BCPS
158. Quit Steroids Quit Kidneys
steroid, tacrolimus, CYP3A, P-glycoprotein
Toby N. Weingarten, MD, Wayne T. Nicholson, MD, PharmD, MSc, Christine M. Formea, PharmD, BCPS
159. The Fall Guy (I)
Fatal Forty DDI: tamoxifen, metoclopramide, CYP2D6
Catherine Marcucci, MD, Neil B. Sandson, MD
160. The Fall Guy (2)
Fatal Forty DDI: tamoxifen, diphenhydramine, CYP2D6
Catherine Marcucci, MD, Neil B. Sandson, MD
161. The Topic of the Day
Fatal Forty DDI: cimetidine, lidocaine, CYP1A2, CYP3A4
Catherine Marcucci, MD
162. Bounce Back
ondansetron, CYP2D6 ultrarapid metabolism
Erica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc, Juraj Sprung, MD, PhD
163. Call The Cath Lab!
Fatal Forty DDI: omeprazole, clopidogrel, CYP2C19
Anna Dubovoy, MD, Erin B. Payne, MD
164. The Imatinib Inquiry: A Theoretical Case (For Now)
imatinib, metoprolol, midazolam, fentanyl, CYP3A4
Stephen J. Gleich, MD, Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Nicole Henwood, MD
165. A HAART-Breaking Tale
metformin, tenofovir
Dean Laochamroonvorapongse, MD, Kirk Lalwani, MD, FRCA, MCR
Part XV. Drug-Drug Interactions Involving Neuropsychiatric Drugs
166. Introduction
Neil B. Sandson, MD
167. Phenytoin (I): Going Crazy!
Fatal Forty DDI: phenytoin, quetiapine, CYP3A4
Sara M. Skrlin, MD, Ansgar M. Brambrink, MD, PhD
168. Phenytoin (II): The Wrong Drug for the Schizophrenic
Fatal Forty DDI: phenytoin, quetiapine, CYP3A4
Melisa N. Weingarten, RN, MS, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD
169. Dizzy and Depressed
Fatal Forty DDI: nefazodone, carbamazepine, CYP3A4
William A. Shakespeare, MD, Juraj Sprung, MD, PhD
170. The Funeral Is On Monday
Fatal Forty DDI: phenytoin, valproic acid, CYP2C9
Elizabeth Macri, MD, Ansgar M. Brambrink, MD, PhD, Neil B. Sandson, MD
171. This Antacid Is Making Me Sick!
Fatal Forty DDI: phenytoin, cimetidine, CYP2C9, CYP2C19
Arun Subramanian, MBBS, Toby N. Weingarten MD, Juraj Sprung, MD, PhD
172. Young at Heart
Fatal Forty DDI: pimozide, nefazodone, CYP3A4
Catherine Marcucci, MD
173. Shiver Yes, Die No –
selegiline patch, meperidine, serotonin syndrome
Ahmed F. Zaky, MD, MPH, Michael J. Bishop, MD
174. Clip and Dip
Fatal Forty DDI: carbamazepine, felodipine, CYP3A4
David W. Barbara, MD, Randall Flick, MD, Juraj Sprung, MD, PhD
175. Blue Fog
citalopram, methylene blue, serotonin syndrome
Toby N. Weingarten, MD, Wayne T. Nicholson, MD, PharmD, MSc, Juraj Sprung, MD, PhD
176. Confiscated Contraceptives
Fatal Forty DDI: lamotrigene, ethinylestradiol, UGT1A4
Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD PharmD, MSc
177. Gotta Love Derm
Fatal Forty DDI: lamotrigine, valproic acid, UGT1A4
Jonathan Anson, MD, Richard C. Month, MD
178. Desperate for A Drink
Fatal Forty DDI: amitriptyline, CYP2D6 poor metabolizer
Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc
Part XVI. Drug-Drug Interactions Involving QT Prolonging DDIs
179. Introduction
Matthew DeCaro, MD, FACC, FACP
180. Delusion At Heart
Fatal Forty DDI: thioridazine, ondanestron, QT-prolongation
Arun Subramanian, MBBS, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD
181. At Long Last
Fatal Forty DDI: ziprasidone, moxifloxacin, CYP3A4, CYP2D6, QT-prolongation,
Kristen B. McCullough, PharmD, BCPS, BCOP, Wayne T. Nicholson, MD, PharmD, MSc
182. Metha-don’t!
Fatal Forty DDI: methadone, amitriptyline, levofloxacin, CYP2D6 , QT-prolongation
Bryan C. Hoelzer, MD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc
183. Flash Fire
amiodarone, haloperidol, CYP1A2, CYP3A4, CYP2D6, QT-prolongation,
Michael Hutchens, MD, Catherine Marcucci, MD, Neil B. Sandson, MD
184. I Am Dizzy When I Stand Up
Fatal Forty DDI: thioridazine, propranolol, CYP2D6, QT-prolongation,
Tasha L. Welch, MD, Toby N. Weingarten, MD, Juraj Sprung MD, PhD
Part XVII. Drug-Drug Interactions Involving Foods and Nutrition
185. Introduction
Kevin W. Cleveland, PharmD, David G. Metro, MD
186. High Fat Diet (I): No Juice For The Ketotic Kid
ketosis, carbohydrates, seizures
Denise M. Hall Burton, MD, Miya Asato, MD, Charles Boucek, MD
187. Protein Huffing and Puffing
theophylline, dietary protein, CYP1A2
Brian C. Bane, MD, James Gordon Cain, MD, MBA, FAAP
188. Salty Sam
high salt diet, nitroprusside
Robert Scott Lang, MD, Li Meng, MD, MPH
189. A Peak Potassium Problem
salt substitute, spironolactone, lisinopril
Justin McCray, MD, Steven L. Orebaugh, MD
190. Awake?
vitamin C, general anesthetics
Nicole Scouras, MD, David G. Metro, MD
191. Tropical Punch Packing a Real Knockout
Fatal Forty DDI: grapefruit juice, midazolam, CYP3A4
Brian Blasiole, MD, PhD, Shawn T. Beaman, MD
192. When The Fire Won’t Go Out
pomegranate juice, sildenafil, CYP3A4
Thomas P. Pontinen, MD, Randal O. Dull, MD, PhD
193. Peppermint Patty
Fatal Forty DDI: peppermint, felodipine, CYP3A4
Ryan D. Ball, MD, Karen Boretsky, MD
194. From Bleeding Gums to Green Thumbs- A True Story
Fatal Forty DDI: warfarin, green vegetables
Audra M. Webber, MD, Patricia L. Dalby, MD
195. Delicious but Malicious
licorice, spironolactone, hypokalemia
Eric Fox, BA, Kirk Lalwani, MD, FRCA, MCR
196. I Just Can’t Lick This Problem
Fatal Forty DDI: licorice, electrolytes, digoxin
Koshy M. Mathai, MD, Michael Hutchens, MD, Robert G. Krohner, MD
197. Sommelier’s Surprise
tyramine rich foods, MAO-i drugs, monoamine oxidase
Charles Lin, MD, Joseph F. Talarico, DO
198. Dairy Carefully
Fatal Forty DDI: dairy, fluoroquinolone
Kristin Ondecko Ligda, MD, Erin A. Sullivan, MD
199. Cold And Sick, Sick And Cold
fiber, thyroxine replacement, malabsorption
A. Murat Kaynar, MD, MPH, Nikhil K. Bhatnagar, MD
200. TPN (I): A Review and Two Interactions
TPN basics and complications
Lavinia Kolarcyzk, MD, Patrick J. Forte, MD
201. TPN (II): A Traumatic Case of Increased Metabolism
TPN, valproic acid
Erica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, Pharm D, MSc, Juraj Sprung, MD, PhD
202. Skin and Bones
starvation, perioperative drugs
Mariam M. El-Baghdadi, MD, Ibtesam A. Hilmi, MB, CHB, FRCA
203. Enough to Make You Sick
syrup of ipecac, general anesthesia
John Hache, MD, Thomas M. Chalifoux, MD
204. Determined and Desperate to Diet
Fatal Forty DDI: Orlistat, warfarin
Lisa Chan, MD, Kirk Lalwani, MD, FRCA, MCR
Part XVIII. Drug-Drug Interactions Involving Spices and Supplements
205. Introduction
Kirk Lalwani, MD, FRCA, MCR
206. Caffeine Crash
Fatal Forty DDI: caffeine, ethinylestradiol, ciprofloxacin, CYP1A2
Brian Gierl, MD, Ryan Romeo, MD
207. Sad Sequelae
Fatal Forty DDI: Dong quai, warfarin
Stacy L. Fairbanks, MD
208. The Scary Side of Ginkgo Biloba Is No Match For An Anesthesia Superstar: Seizures
Ginkgo biloba, phenytoin, CYP2C19
Shreya Patel, MD, Kirk Lalwani, MD, FRCA, MCR
209. The Scary Side of Ginkgo Biloba Is No Match For An Anesthesia Superstar: Sugar
Ginkgo biloba, tolbutamide, CYP2C9
Shreya Patel, MD, Kirk Lalwani, MD, FRCA, MCR
210. The Scary Side of Ginkgo Biloba Is No Match For An Anesthesia Superstar: Subdural
Ginkgo biloba
Shreya Patel, MD, Kirk Lalwani, MD, FRCA, MCR
211. “Khat” Unawares
depletion of central and peripheral endogenous catecholamines
Brian D. Tompkins, MD, Kirk Lalwani, MD, FRCA, MCR
212. Pain on the Plane
Fatal Forty DDI: ginseng, warfarin, CYP2C9
Lei Wu, MD, Kirk Lalwani, MD, FRCA, MCR
213. Ca va, c’est Kava
kava,carbidopa-levodopa, dopamine receptors
Solina Tith, MD, Kirk Lalwani, MD, FRCA, MCR
214. Summertime and the Herbals are Hot
Fatal Forty DDI: goldenseal, amitriptyline CYP2D6, CYP3A4
Jessica Miller, MD, BM, Leelee Thames, MD
215. Garlic I: More Than Just Bad Breath
Fatal Forty DDI: garlic, ritonavir, CYP3A4, P-glycoprotein
Vincent Lew, MD, Kirk Lalwani, MD, FRCA, MCR
216. Garlic II: A Girl Named Allicin
garlic, inhibition of clotting cascade
Vincent Lew, MD, Kirk Lalwani, MD, FRCA, MCR
217. “Danshen” the Night Away
Fatal Forty DDI: Salvia miltiorrhiza, warfarin, CYP2C9, CYP1A2
Tara C. Carey, BA, MD, Kirk Lalwani, MD, FRCA, MCR
218. Caught Yellow-Handed
Fatal Forty DDI: tumeric, warfarin, CYP1A2, CYP2C9
Giorgio Veneziano, MD, Michael Mangione, MD
219. St. John: Not Such A Saint
Fatal Forty DDI: St. John’s Wort, cyclosporine, CYP3A4, P-glycoprotein
Heather Norvelle, PharmD, BCPS, Ines P. Koerner, MD, PhD
220. Hearing the News
Fatal Forty DDI: St. John’s Wort, oral contraceptives, CYP3A4, P-glycoprotein
Nikki Jaworski, MD
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