[LADME] Metabolism - Enzyme Inducers vs Inhibitors

Proverbs 16:3

● Smoking

● Carbamazepine

● Rifampicin

● Alcohol (CHRONIC)

● Phenytoin

● Griseofulvin

● Phenobarbital

● St. John's Wort

→Mnemonic: “SCRAP” “GPS”

Enzyme induces include ____ [8]

● Clarithromycin

● Amiodarone

● Cimetidine

● Azole antifungals

● Alcohol (ACUTE/BINGE)

● Metronidazole

● Omeprazole

● Verapamil

● Isoniazid

● Erythromycin

Enzyme inhibitors include _____ [10]

Inducer

[CLASSIFY]

Smoking

Inducer

[CLASSIFY]

Carbamazepine

Inducer

[CLASSIFY]

Rifampicin

Inducer

[CLASSIFY]

CHRONIC alcoholism

Inducer

[CLASSIFY]

Phenytoin

Inducer

[CLASSIFY]

Griseofulvin

Inducer

[CLASSIFY]

Phenobarbital

Inducer

[CLASSIFY]

St. John's Wort

Inhibitor

[CLASSIFY]

Clarithromycin

Inhibitor

[CLASSIFY]

Amiodarone

Inhibitor

[CLASSIFY]

Cimetidine

Inhibitor

[CLASSIFY]

Azole antifungals (ketoconazole, fluconazole)

Inhibitor

[CLASSIFY]

ACUTE / BINGE alcoholism

Inhibitor

[CLASSIFY]

Metronidazole

Inhibitor

[CLASSIFY]

Omeprazole

Inhibitor

[CLASSIFY]

Verapamil

Inhibitor

[CLASSIFY]

Isoniazid

Inhibitor

[CLASSIFY]

Erythromycin

Reduced contraceptive effectiveness → Risk of pregnancy

[SAMPLE SITUATION]

OCP + Rifampicin

Decreased anticoagulant effect → Risk of thrombosis

[SAMPLE SITUATION]

Warfarin + Phenytoin

Increased digoxin levels → Risk of digoxin toxicity

[SAMPLE SITUATION]

Digoxin + Quinidine

Increased theophylline metabolism → Reduced therapeutic effect

[SAMPLE SITUATION]

Theophylline + Smoking

Decreased metabolism of alprazolam → Excessive sedation

[SAMPLE SITUATION]

Alprazolam + Itraconazole

Decreased diazepam plasma levels → less sedation, increased anxiety

[SAMPLE SITUATION]

Diazepam + smoking

Increased diazepam plasma levels → Increased sedation

[SAMPLE SITUATION]

Diazepam + alcohol (BINGE)

TRUE

[SPECIAL CONSIDERATION - NEONATES]

TRUE OR FALSE:

Neonates have REDUCED enzyme capacity, leading to DECREASED drug clearance and INCREASED half-life (TOXICITY).