08-18-2007, 06:09 PM
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#1 (permalink) |
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Eager!
 Join Date: Jul 2005
Location: ARKANSAS
Posts: 52
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Somebody answer please!
Do we have to remember the drug dosage numbers for FPGEE?
I'm talking about the dosage numbers on pharmacology sections of CPR? I also asked one more question before and never got an answer.Here it is again: Do we have to remember the hole drugs name wich has been listed on page 420 of CPR 6TH eddition?It,s all about Drug,Herb and food actions with CYP450. Does anybody have an idea how we can remember them? There is something similar on page 396 Table 17-1 . I would appreciate it .  |
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08-18-2007, 07:02 PM
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#2 (permalink) |
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Within my grasp!
 Join Date: Dec 2006
Posts: 136
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Hi pega
You do not need to remember dosage for Fpgee. You should know the common side effects of particular class of drugs, containdications. And major side effect of a particular drug like phenytoin causes gingival hyperplasia, and hirsutism. Visit In Vitro Technologies and print out that page. Chekout substrates of CYP1A , CYP2D6, CYP3A. Memorise rifampin, phenytoin, barbiturates amiodarone,cimetidine alcohol , smoking. As majority of these are inducers or inhibitors of each class. if you will see again and again, you will memorise it easily. |
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08-18-2007, 07:03 PM
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#3 (permalink) |
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Within my grasp!
Join Date: Dec 2006
Posts: 136
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Its In Vitro Technologies not invitro.com
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08-19-2007, 01:13 PM
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#6 (permalink) |
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Eager!
Join Date: Jul 2005
Location: ARKANSAS
Posts: 52
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Hi Yamiini
When you say contraindication, do you mean drug-drug interaction?In pharmacology chapters of CPR after each section we,ll see significant interactions wich is lots of drug's name and their interaction .Also I've notied about contraindication with disease wich is alot easier to remmeber .Could you make it more clear ? I appreciate your time. Last edited by knok : 08-19-2007 at 06:36 PM. Reason: i |
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08-20-2007, 02:29 PM
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#7 (permalink) | |
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Albert Einstein
Join Date: Jul 2007
Posts: 147
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Quote:
Concerning the drugs that induce or inhibit P45 enzymes, Drugs that induce P450 are rare. Try to memorize them as groups. Usually Anti-epileptic drugs induce P450 enzymes . They include Barbiturates, Phenytoin and Carbamazepine and Primidone . Another very important drug is Rifampicin. These four drugs are the most important . They affect CYP3A4 which is the most important enzyme. Cigarette smoking is important for only few drugs namely TCA , warfarin and Theophylline metabolism of which relies on CYP1A2. Alcohol is important for only few drugs too , Acetaminophen , halothane and Enflurane , metabolism of which relies on CYP2E1. St John's wort , is important for drugs being metabolised by CYP3A4 or CYP2C9. Try to memorize all CYP3A4 substrates . Important substrates include Ciclosporin , corticosteroids oral contraceptive and Amiodarone. Also try to pick up the most important drugs. For example, it's very important to know which enzyme metabolises Oral contraceptives and which drugs affect this enzyme because a therapeutic failure due to enzyme induction would result in pregnancy which is a disaster. Ciclosporin is also an important example because therapeutic failure results in transplant rejection which is disastrous too. On the other hand you can ignore other drugs which has wide theraoeutic index for example or drugs where interaction wouldn't result in calamitous results. Most drugs are usually metabolised by more than one enzyme of the P450 isoenzymes, so inhibition or induction of a single enzyme wouldn't have a potential effect. So Try to look at the list and pick up drugs that are metabolised by a single enzyme and memorize them. In such drugs interactions usually have sever results because there are no ways for the liver to compensate. That's why such drugs are the most important . That's all you need to know about enzyme induction. For enzyme inhibition , it's more difficult since there are many more. Try to memorize them as groups . Anti-fungal drugs, antivirals, anti depressants ( SSRI ) ,antibacterials ( ciprofloxacin, iso niazid and metronidazole ) , GI drugs ( cimitidine and omeprazole ) , anti rheumatic drugs and cardio vascular drugs ( amiodarone , verpamil quinidine and diltiazem ) that's most of what you need to know. It didn't take me long to memorize them . just try to repeat and repeat . don't try to memorize them all on the same day because you won't . Just repeat . Classify them and read them every day . hope this hepls Cheers, Last edited by Pharmacist771 : 08-20-2007 at 08:22 PM. |
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08-20-2007, 07:23 PM
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#8 (permalink) |
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Eager!
Join Date: Jul 2007
Location: Vancouver
Posts: 62
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Hi Pharmacist!
Thank you for you post, that is a good one. In my experience I made index carts for inhibitors, inducers and substrates and consult them all the time. For me it's easy to remember this way. Also I want to mention warfarin which is a substrate of 3A4. It has lots of interactions and we have to be careful with it - monitor INR is a usual response for interaction with this drug. ps Amiodarone is an inhibitor not a substrate. Last edited by LadyJane : 08-20-2007 at 08:45 PM. |
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08-20-2007, 08:34 PM
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#9 (permalink) | |
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Albert Einstein
Join Date: Jul 2007
Posts: 147
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Quote:
Also I'd like to share another information which really surprised me. As you know , CYP2D6 is no less important than CYP3A4. It metabolises so many drugs including TCA 's and some cardiovascular drugs. CYP2D6 is inactive in 6 % of white people which puts millions under the risk of adverse reactions . Genotyping of CYP2D6 is becoming increasingly important to determine the appropriate dose of TCA to be administered. Important inhibitors of CYP2D6 include SSRI's and Cimitidine and others that I can't remember now. |
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