Case Approach to Perioperative Drug-Drug Interactions (eBook)

Catherine Marcucci, MDAnesthesia Services DepartmentPhiladelphia Veterans Affairs Medical Center Philadelphia, PA, USA Michael P. Hutchens, MD, MADepartment of Anesthesiology & Perioperative MedicineOregon Health & Science University                                               Portland, OR, USA Erica D. Wittwer, MD, PhDDepartment of AnesthesiologyMayo ClinicRochester, MN, USA Toby N. Weingarten, MDDepartment of AnesthesiologyMayo Clinic Rochester, MN, USA Juraj Sprung, MD, PhDDepartment of AnesthesiologyMayo Clinic Rochester, MN, USA Wayne T. Nicholson, MD, PharmD, MScDepartment of AnesthesiologyMayo ClinicRochester, MN, USA Kirk Lalwani, MD, FRCA, MCRDepartment of Anesthesiology & Perioperative MedicineOregon Health & Science UniversityPortland, OR, USA David G. Metro, MDDepartment of AnesthesiologyUniversity of Pittsburgh School of MedicinePittsburgh, PA, USA Randal O. Dull, MD, PhDDepartment of AnesthesiologyUniversity of Illinois at ChicagoChicago, IL, USA Christopher E. Swide, MDDepartment of Anesthesiology & Perioperative MedicineOregon Health & Science UniversityPortland, OR, USA F. Jacob Seagull, PhDDepartment of Medical EducationUniversity of Michigan Medical SchoolAnn Arbor, MI, USA         Jeffrey R. Kirsch, MD Department of Anesthesiology & Perioperative MedicineOregon Health & Science University Portland, OR, USA Neil B. Sandson, MDDepartment of PsychiatryUniversity of Maryland Medical SystemDepartment of PsychiatryVA Maryland Health Care SystemBaltimore, MD, USA

Part I. Introduction to Drug-Drug Interactions1. Let’s Start at the Very Beginning: Overcoming Fear and Gaining Mastery of Drug-Drug Interactions F. Jacob Seagull, PhD, Catherine Marcucci, MD2. Pharmacodynamic Interactions:  Core ConceptsErica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc3. Pharmacokinetic Interactions:  Core ConceptsErica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc 4. A Brief Treatise On The Area Under The CurveMichael J. Sikora, MD, Barbara Jericho, MDPart II. Introduction to Drug-Drug Interactions:  Brief Review of CYP450 Enzymes, UGTs, and Transporters5. CYP2D6:  Where It All BeganJohn C. Sanders, MBBS, FRCA, Rachel Koll, MD, Randal O. Dull, MD, PhD                                6. CYP2E1:  The Anesthesia EnzymeBenjamin S. Gmelch, MD, Randal O. Dull, MD, PhD7. CYP3A4:  The WorkhorseJennifer DeCou, MD, Nathaniel Birgenheier, MD, Randal O. Dull, MD, PhD8. CYP1A2:  The Switch-hitterDanielle Roussel, MD, Emily Hagn, MD, Randal O. Dull, MD, PhD9. CYP2B:   2B or Not 2B?Dustin Coyle, MD, Randal O. Dull, MD, PhD10. CYP2C9:  The Support Crew IByron Douglas Fergerson, MD, Crystal B. Wallentine, MD, Randal O. Dull, MD, PhD11. CYP2C19:   The Support Crew IIBarbara Jericho, MD, Alfredo Aguiar, MD, Randal O. Dull, MD, PhD12. UGTs:  Conjugating CousinsNeil B. Sandson, MD13. The Cytochrome P450 System In Disease States—A Brief ReviewCatherine Marcucci, MDPART III.   Drug-Drug Interactions:  Paradigms and Core Concepts14. P-glycoprotein and OATP TransportersDustin Coyle MD, Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD15. The  “Fatal” FortyNeil B. Sandson MD, Michael Hutchens MD, F. Jacob Seagull, PhD, Catherine Marcucci, MD16. The Six Patterns of Pharmacokinetic Drug-Drug InteractionsNeil B. Sandson, MD, Catherine Marcucci, MD17. The Problem with the Drug-Drug Interaction Software: A Procrustean DilemmaNeil B. Sandson, MD, F. Jacob Seagull, PhD, Wayne T. Nicholson, MD, PharmD, MSc, Catherine Marcucci, MD  18. PharmacogenomicsChad D. Moore, PhD, William Hartman, MD, PhD, Michael Hutchens, MD, Randal O. Dull, MD, PhD19. The Pharmacoepidemiology of Drug Interactions: Why and How They Are ImportantJoseph 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 CourtroomJessica Voge, MD, David K. Miller, JDPart IV. Drug-Drug Interactions Involving Inhalational Anesthetic Agents21. IntroductionCatherine Marcucci, MD22. That Sums It Up  Volatile anesthetics, additive MACs James A. Jernigan, MD, James W. Ibinson, MD, PhD23. 1+1+1+1=?  Variable effects of combined substancesAnthony T. Silipo, DO, Raymond M. Planinsic, MD, Erica D. Wittwer, MD, PhD, Juraj Sprung MD,PhD, Wayne T. Nicholson, MD, PharmD, MSc24. A Delayed Surgeon Is A “Dismayed” Surgeon? Nitrous oxide, dexmedetomidine, somatosensory evoked potentialsJonathan Anson, MD25. Relax, It’s Only Gentamicin  Volatile anesthetics, aminoglycoside antibiotics, neuromuscular junctionBrian Gierl, MD, Ferenc E. Gyulai, MD26. Jaundice After Surgery  Halothane hepatitis, CYP2E1Jonathon E. Kivela, MD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD27. Everybody Clear?  Halothane, epinephrine arrhythmiaNikhli Patel, MD, Barbara Jericho MD, Randal O. Dull, MD, PhD28. The Hemodynamic Hole  general anesthetics, ACE-I, ARBsArun L. Jayaraman, MD, PhD, Theresa A. Gelzinis, MD29. Alpha-2 To The Rescue But Beware Bradycardia  volatile anesthetics, alpha-2 agentsPhillip Adams, DO, Nashaant N. Rizk, MD30. Hot Stuff!  triggering drugs, ryanodine receptor, malignant hyperthermiaCornelius B. Groenewald, MD, ChB, Juraj Sprung, MD, PhDPart V. Drug-Drug Interactions Involving Intravenous Anesthetic Agents 31. IntroductionCatherine Marcucci, MD32. How to Successfully Occlude an Intravenous Line  thiopental, succinylcholine, line precipitationHelga Komen, MD, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD       33. A Curious Cause of Seizures  ketamine, theophyllineCharles Galaviz, MD, Randal O. Dull, MD, PhD34. Magnesium Mama And The Mad Dad  magnesium sulfate, propofol, remifentanil, vecuroniumAna Maria Manrique MD, Catherine Marcucci, MD, Kathirvel Subramaniam, MD35. Dexy’s Midnight Spinal  dexmedetomidine, bupivaine spinal, multiple mechanisms, CYP3A4, CYP2D6Michael Hutchens, MD, Edward A. Kahl, MD, Matthias J. Merkel, MD, PhDPart VI. Drug-Drug Interactions Involving Local Anesthetics  36. IntroductionCatherine Marcucci, MD37. Comfortably Numb  local anestheticsJoseph J. Yurigan, DO, Todd M. Oravitz, MD38. Naturally Occurring And Nasty  cocaine, propranololLauren Partyka, MD, Li Meng, MD, MPH39. LOL-LOL:  Little Old Lady—Lots of Lido  lidocaine, bupivacaineKitling M. Lum, RN, BSN, CCRN-CSC, Kelly N. Stafford, BSN, CCRN, CSC40. The Spinal Countdown  general anesthesia after spinal anesthesiaAudra M. Webber, MD, Franklyn P. Cladis, MD, FAAP41. Are Drug-Drug Interactions The Smoking Guns of Local Anesthetic Toxicity?  Smoking Gun I  Fatal Forty DDI:  ropivacaine, fluoxetine, CYP1A2, CYP3A4L. Michele Noles, MD42. Are Drug-Drug Interactions The Smoking Guns of Local Anesthetic Toxicity?  Smoking Gun II  Fatal Forty DDI:  bupivacaine, methocarbamolL. Michele Noles, MD43. A Perfect Storm?  Fatal Forty DDI:  omeprazole, nicardipine, diltiazem, bupivacaine, CYP3A4, CYP2C19, CYP2D6J. Andrew Dziewit, MD, Nabil M. Elkassabany, MD44. Shake Rattle and Roll  Fatal Forty DDI:  lidocaine, cimetidine, CYP3A4 Hans P. Sviggum, MD, Juraj Sprung, MD, PhD45. Hello, We Have A Patient With Acute Delirium and We Need An Urgent Psych Consultlidocaine, metoprololKatarina Bojanić, MD, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD46. Fatal Pain Relief  local anesthetics, intrathecal morphineMatthew M. Kumar, MD, Richard Levi Boortz-Marx, MD, MS47. Lipid Lifesaver  local anesthetic, lipid emulsionAdrian Pichurko, MD, Guy Weinberg, MDPart VII. Drug-Drug Interactions Involving Opioids  48. IntroductionToby N. Weingarten, MD49. No ‘Subs’titute for Sobriety buprenorphine, mu agonist opioidsJames Hilliard, MSN, CRNA, Kirk Lalwani, MD, FRCA, MCR50. A Needle And The Damage Done  Fatal Forty DDI:  buprenorphine, ritonavir, CYP3A4James Hilliard, MSN, CRNA, Kirk Lalwani, MD, FRCA, MCR51. Dad’s Not Having Much Pain Fatal Forty DDI:  methadone, ciprofloxacin, CYP3A4Rani Chovatiya, MD,  Mehmet S. Ozcan, MD, FCCP, Randal O. Dull, MD, PhD52. Royal Flush  Fatal Forty DDI:  methadone, nortriptyline, CYP2D6, CYP3A4Kimberly Mauer, MD, Catherine Marcucci, MD, Neil B. Sandson, MD53. The Worry That’s Always With Us:  Afternoon Nap  oxycodone, diazepamSyed M. Quadri, DO, Randal O. Dull, MD, PhD54. The Bawling Baby Fatal Forty DDI:  rifampin, methadone , CYP3A4, CYP2B6 Angela Kendrick, MD55. Sleeping Beauty  Fatal Forty DDI:  fentanyl, ritonavir, CYP3A4Hans P. Sviggum, MD, Juraj Sprung, MD, PhD56. Codeine Can’t Do It  Fatal Forty DDI:  codeine, fluoxetine, CYP2D6Katarina 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 toxicityChristine A. Kenyon Laundre, MD, Randall Flick, MD, Juraj Sprung, MD, PhD58. Double Indemnity Fatal Forty DDI:  morphine, rifampin, P-glycoproteinLisa Chan, MD, Catherine Marcucci, MD, Neil B. Sandson, MD, Kirk Lalwani, MD, FRCA, MCR59. Breaking the Codeine  Fatal Forty DDI:  codeine, quinidine CYP2D6Clint Christensen, MD, Nathan G. Orgain, MD, Randal O. Dull, MD, PhD60. The Ultimate Ultram Primer I:  My Mood Is Better, But Boy Do I Hurt!Fatal Forty DDI:  tramadol, paroxetine, CYP2D6Toby N. Weingarten MD, Juraj Sprung, MD, PhD61. The Ultimate Ultram Primer II: I “Haight” Narcotics But I Hate Seizures Worse Fatal Forty DDI:  tramadol, buproprion, seizures, CYP2D6Bruce T. Dumser, MD, Neil B. Sandson, MD62. The Ultimate Ultram Primer III:  Tremor-dol Trigger in Serotonin Syndrome Fatal Forty DDI:  tramadol, paroxetine, 2D6 inhibition, serotonin syndromeBryan C. Hoelzer, MD, Stephanie Neuman, MD63. Too Much of A Good Thing  Fatal Forty DDI:  codeine, drug-gene interaction, CYP2D6Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson MD, PharmD, MScPart VIII. Drug-Drug Interactions Involving Non-opioid Pain Medications64. IntroductionToby N. Weingarten, MD65. Pining For Pete In The Pain Clinic  Fatal Forty DDI:  nortriptyline, paroxetine, CYP2D6Steven S. Liu, MD, Toby N. Weingarten MD, Catherine Marcucci, MD66. You Do Not Look Well Today, Mon Ami  Fatal Forty DDI:  amitriptyline, amiodarone, QRS wideningKimberly Mauer, MD, Catherine Marcucci, MD, Neil B. Sandson, MD67. My Headache is Gone, But My Leg Now Hurts  Fatal Forty DDI:  methysergide, erythromycin, CYP3A4Jessica D. Lorenz, MD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc68. Special ‘K’ase  Oral S-ketamine, ticlopidineLisa Chan, MD, Kirk Lalwani, MD, FRCA, MCR69. Not Manic About NSAIDs  Fatal Forty DDI:  ketorolac, lithium, toxicityAllen N. Gustin, MD, FCCP, Michael J. Bishop, MD70. Keep It Capped!  acetominophen, ethanolChristine M. Formea, PharmD, BCPS, Wayne T. Nicholson MD, PharmD, MSc71. The ACE Is Not Always High Fatal Forty DDI:  ketorolac, lisinoprilWayne T. Nicholson, MD, PharmD, MSc72. When The Smoke Clears, Relaxation Disappears  Fatal Forty DDI:  cyclobenzaprine, smoked tobacco, CYP1A2Avinash Ramchandani, MD, Julio A. Gonzalez-Sotomayor, MD73. Befuddled by Aspirin  Fatal Forty DDI:  aspirin, valproic acid, protein bindingMelisa N. Weingarten, RN, MS, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD74. You Can’t Trick Us!  Fatal Forty DDI:  ibuprofen, phenytoin, CYP2C9, protein bindingCatherine Marcucci, MD, Neil B. Sandson, MDPart IX. Drug-Drug Interactions Involving Benzodiazepines and Other Sedatives75. IntroductionCatherine Marcucci, MD76. The Worry That’s Always With Us:  Now I’m Depressedbenzodiazepines, opioids, propofolKelly T. Peretich, MD, Raymond M. Planinsic, MD77. The Worry That’s Always With Us: Tragic But Not Rare                                             alprazolam, clonazepam, and buprenorphinePhillip Adams, DO, Ibtesam A. Hilmi, MB, CHB, FRCA78. Lack of SedationFatal Forty DDI:  midazolam, carbamazepine interaction, CYP3A4Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc79. A Cold Isn’t Going to Slow Me Downmidazolam, goldenseal, CYP3A4, CYP3A5, CYP2D6Leelee Thames, MD, Jessica Miller, MD, BM80. Her Patients Never Wake Up On TimeFatal Forty DDI:  midazolam, diltiazem, alfentanil, CYP3A4, CYP3A5, CYP3A7Toby N. Weingarten, MD, Erica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc81. When Enough Is Now Too MuchFatal Forty DDI:  midazolam, itraconazole, CYP3A4Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc82. The Distressed DaughterFatal Forty DDI:  alprazolam, carbamazepine, CYP3A4Jennifer Egan, MD, Kirk Lalwani, MD, FRCA, MCR, Catherine Marcucci, MD83. Check Check and Double CheckFatal Forty DDI:  diazepam, fluvoxamine, CYP3A4, CYP2C19Catherine Marcucci, MD, Neil B. Sandson, MD84. Doggone It—The Case is Cancelled Fatal Forty DDI:  midazolam, lopinavir/ritonavir, CYP3A4Erica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc, Corinne Wisdo, DPM, Catherine Marcucci, MD85. Noct’ OutFatal Forty DDI:  chloral hydrate, phenobarbital, furosemideMichael Wollenberg, MD, Kirk Lalwani, MD, FRCA, MCR86. Predisposed to Dozepromethazine, CYP2D6 poor metabolizerErica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson MD PharmD, MSc87. Synergistic SedationFatal Forty DDI:  midazolam, clozapine, synergism and clozapine, sertraline, CYP2D6Michael Hutchens, MD, Paul Schipper, MD, FACS, FACCP, Catherine Marcucci, MDPart X. Drug-Drug Interactions Involving Neuromuscular Blockade Agents88. IntroductionDavid G. Metro, MD89. Blocked Againsuccinylcholine, repeated dosesMatthew Patrick Feuer, MD, Thomas M. Chalifoux, MD90. Irreversibility Suxsuccinylcholine, neostigmineJoseph C. Shy, MD, David G. Metro, MD91. Keep An “Ion” The Twitchesmagnesium, neuromuscular blockadeBrian Gierl, MD, Ferenc E. Gyulai, MD92. A Reversal of Misfortuneneostigmine, glycopryrolate, Thomas N. Talamo, MD, Richard J. Kuwik, MD93. Stop MovingFatal Forty DDI:  vecuronium, phenytoin               Michael D. Olson, PA-C, Randall Flick, MD   94. There’s Just Not Enough Roc In The WorldFatal Forty DDI:  rocuronium, carbamazepineTammara S. Goldschmidt, MD, Randal O. Dull, MD, PhD95. Slow Sux I:  A Lengthy Wake-Up Period After Electroconvulsive Therapysuccinylcholine, atypical plasma cholinesteraseJennifer A. Rabbitts, MB, ChB, Juraj Sprung, MD, PhD96. Slow Sux II:  I Remember Reviewing This For The Boardssuccinylcholine, atypical plasma cholinesteraseAndrew Oken, MD, Scott Richins, MD97. Slow Sux III:  Where Did the Twitches Go? succinylcholine, donepizil, atypical pseudocholinesteraseKatarina Bojanić, MD, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD   98. Weakened All Weekendvecuronium, amakacinDaniel W. Johnson, MD99. The Patient Who Could Not Raise Her Headvecuronium, gentamicin Nicole L. Varela, MD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD100. An Unexpected Waitpancuronium,mivacurium Michael W. Best, MD, Shawn T. Beaman, MD101. Diabolical Cough Syruprocuronium, pholcodine Melisa N. Weingarten, RN, MS, Juraj Sprung, MD, PhD, Toby N. Weingarten, MDPart XI. Drug-Drug Interactions Involving Antibiotics and Antifungals102. IntroductionCatherine Marcucci, MD103. Full Stopceftriaxone, calciumNorah Janosy, MD104. Flummoxed by the FLOXFatal Forty DDI:  ciprofloxacin, tizanidine, CYP1A2Janice Kim, MD105. Tales of TerrorFatal Forty DDI:  ciprofloxacin, simvastatin, CYP3A4Arun Subramanian, MBBS, Juraj Sprung, MD, PhD106. Too Low To GoFatal Forty DDI:  erythromycin, nifedipine, CYP3A4Catherine Marcucci, MD, Neil B. Sandson, MD107. A Fungal StoryFatal Forty DDI:  fluconazole, phenytoin, CYP2C9, CYP2C19Jerusha Taylor, PharmD, BCPS, Ansgar M. Brambrink, MD, PhD108. Rejection Protection Turned Kidney KillerFatal Forty DDI:  voriconazole, tacrolimus, CYP3A4, P-glycoproteinErica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Christine M. Formea, PharmD, BCPS109. Can’t Get WellFatal Forty DDI:  itraconazole, budesonide, CYP3A4Michael J. Sikora, MD, Barbara Jericho, MD, Randal O. Dull, MD, PhD110. Linezolid (I): Be VREy CarefulFatal Forty DDI:  linezolid, buproprionBruce T. Dumser, MD111. Linezolid (II):  Hyper and Hotlinezolid, meperidine, serotonin syndromeErica D. Wittwer, MD, PhD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD112. Not Sweet At AllFatal Forty DDI:  trimethoprim/sulfamethoxazole, glipizide, CYP2C9Mayumi Horibe, MD, Michael J. Bishop, MD113. Where Did All The Sugar Go?Fatal Forty DDI:  levofloxacine, glyburide, complex interactionNicole L. Varela, MD, Federica Scavonetto, MD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD114. Exposed! (Part 1)Fatal Forty DDI: rifampin, buspirone, CYP3A4 L. Michele Noles, MD, Catherine Marcucci, MD115. Exposed! (Part 2)Fatal Forty DDI: rifampin, ondansetron, CYP3A4L. Michele Noles, MD, Catherine Marcucci, MD116. Seizures on 5 Westcarbapenem, valproic acid, P-glycoprotein, UGTElizabeth Duggan, MD, Nabil M. Elkassabany, MDPart XII. Drug-Drug Interactions Involving Cardiovascular Medications117. IntroductionMichael Hutchens, MD118. Riding The Rollercoasternitroglycerine, sodium nitroprusside, propofol, Catherine Marcucci, MD, Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD119. A Pressing Need For Vasopressin!ACE-Is, general anesthesiaErin B. Payne, MD, Anna Dubovoy, MD120. Too Young To DieFatal Forty DDI: bupropion, pseudoephedrine, pharmacodynamic interactionCatherine Marcucci, MD121. A Widening Gyreepinephrine, phosphorus, insulinEdward A. Kahl, MD, Michael Hutchens, MD122. Misusing Mom’s Medschronic amphetamine, indirect acting sympathomimeticsPulsar Li, DO, Steven L. Orebaugh, MD123. 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, PhD124. Prazosin and the PTSD Paratrooperprazosin, tadalafil, Allen N. Gustin, MD, FCCP, Michael J. Bishop, MD125. Nicardipine NotesFatal Forty DDI: nicardipine, tacrolimus, CYP3A4Nenna Nwazota, MD, Randal O. Dull, MD, PhD126. Hypotension HarryFatal Forty DDI: nicardipine, clarithromycin, CYP3A4Matthew Hart, MSN, CRNA, Bryan J. Read, MSN,CRNA, Wayne T. Nicholson, MD, PharmD, MSc, Toby N. Weingarten, MD127. Too Slow to Flow Fatal Forty DDI: CYP2D6 ultraslow metabolism of metoprololScott W. Cantwell, MD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD128. Better Sleep But Slower Heartmetoprolol, diphenhydramine, CYP2D6Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD129. Extreme Blood Pressure After Ephedrine:  Should We Rule Out Pheochromocytoma?ephedrine, selegilineErica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc130. Heart-Stopping TreatmentFatal Forty DDI: verapamil, erythromycin, CYP3A4Erica D. Wittwer, MD, PhD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD131. Induction Crashes:  Are There Clues In the Ashes?Fatal Forty DDI: theophylline, smoked tobacco, CYP1A2Dawn L. Baker, MD, MS, L. Lazarre Ogden, MD132. The Wakeup Call: 2AM Traumabeta blockers, cocaineDevin C. Tang, MD, Nabil M. Elkassabany, MD133.  Falling DownFatal Forty DDI: nifedipine, fluoxetine, CYP3A4Scott Kennedy, MD, Norman A. Cohen, MD134. A Hidden DrugFatal Forty DDI: diltiazem, sildenafil, CYP3A4 and sildenafil, nitroglycerinHelga Komen, MD, Toby N. Weingarten, MD, Juraj Sprung, MD, PhD       135. I’m Listening, I’m ListeningFatal Forty DDI: diltiazem, carbamazepine, CYP3A4 Catherine Marcucci, MD, Jerusha Taylor, PharmD, BCPS, Ansgar M. Brambrink, MD, PhD, Neil B. Sandson, MD136. Jump Start My Heartmetoprolol, amiodarone              , CYP2D6, CYP1A2Katarina Bojanić, MD, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD137. The Statin Trilogy (I): ‘Statin’ From The BeginningFatal Forty DDI: simvastatin, cimetidine, diltiazem, CYP3A4Brian Mitchell, MD138. The Statin Trilogy (II): Tripped And Fell At The Train ‘Statin’Fatal Forty DDI: simavastatin, itraconazole, CYP3A4Brian Mitchell, MD139. The Statin Trilogy (III): Welcome To The United ‘Statins’ Of AmericaFatal Forty DDI:  atorvastatin, phenytoin, CYP3A4Brian Mitchell, MD140. Be Still, My Beating HeartFatal Forty DDI: amiodarone, digoxin, P-glycoprotein Branka Polić, MD, MSc, Julije Meštrović, MD, PhD, Toby N. Weingarten,                MD, Juraj Sprung, MD, PhD141. The Nice Niecedigoxin, St. John’s wort, CYP3A4, P-glycoproteinMichael Hutchens, MD, Catherine Marcucci, MD142. Cyclo Killer: Qu’est-ce que c’est?carvedilol, cyclosporine, P-glycoproteinJeff Chen, MD, Michael Hutchens, MD, Wayne T. Nicholson MD, PharmD, MSc143. Blurry-Eyed With Rapid Heart BeatsFatal Forty DDI: digoxin, hydrochlorothiazide, William A. Shakespeare, MD, Juraj Sprung, MD, PhDPart XIII. Drug-Drug Interactions Involving Coagulation Modifiers144. IntroductionCatherine Marcucci, MD145. Seize the DayFatal Forty DDI: tranexamic acid, furosemide, ibuprofen   Roman M. Sniecinski, MD, Erica D. Wittwer, MD, PhD, Kenichi Tanaka, MD, MSc, James Zaidan, MD146. The Third and Final ComplicationFatal Forty DDI: warfarin, nafcillin   Daniel W. Johnson, MD147. An Interaction With the FurnitureFatal Forty DDI: warfarin, metronidazole, ciprofloxacin, CYP2C9, CYP1A2Heather Norvelle, PharmD, BCPS, Ines P. Koerner, MD, PhD148. Macrolide Mishap for Little Miss MuffettFatal Forty DDI: warfarin, clarithromycin, CYP2C9Elizabeth Pedigo, MD149. From Asymptomatic to Symptomatic:  a Cause of NosebleedFatal Forty DDI: warfarin, amiodarone, CYP2C9Joško Markić, MD, MSc, Julije Meštrović, MD, PhD, Juraj Sprung, MD, PhD150. The Consequences of Not Following A Cardiac DietFatal Forty DDI: clopidogrel, omeprazole, CYP2C19Kristen B. McCullough, PharmD, BCPS, BCOP, Wayne T. Nicholson, MD, PharmD, MSc151. Clopidogrel (I):  Bagel BrunchFatal Forty DDI: clopidogrel, omeprazole, CYP2C19Ann Marie Canelas, MD, Randal O. Dull, MD, PhD152. Clopidogrel (II):  Conferring Over The Kung Paoclopidogrel, proton pump inhibitors, calcium channel blockers, CYP2C19, CYP3A4Catherine Marcucci, MD, Neil B. Sandson, MDPart XIV. Drug-Drug Interactions Involving Immunosuppressants, Antiemetics, and Chemotherapy153. IntroductionCatherine Marcucci, MD154. BeanedFatal Forty DDI:  diltiazem, tacrolimus, CYP3A4, P-glycoproteinMatthew Hart, MSN, CRNA, Michael Hutchens, MD                                                                                         155. Addisonian AdjustmentFatal Forty DDI: prednisone, fluconazole, CYP3A4Catherine Marcucci, MD, Neil B. Sandson, MD156. Tea TimeFatal Forty DDI: St. John’s Wort, tacrolimus, cyclosporine, CYP3A4, P-glycoproteinNikki Jaworski, MD157.  No Fits at UffiziFatal Forty DDI: phenytoin, cyclosporine, CYP3A4Michael Hutchens, MD, Christine M. Formea, PharmD, BCPS158. Quit Steroids Quit Kidneyssteroid, tacrolimus, CYP3A, P-glycoproteinToby N. Weingarten, MD, Wayne T. Nicholson, MD, PharmD, MSc, Christine M. Formea, PharmD, BCPS159. The Fall Guy (I)Fatal Forty DDI: tamoxifen, metoclopramide, CYP2D6Catherine Marcucci, MD, Neil B. Sandson, MD160. The Fall Guy (2)Fatal Forty DDI: tamoxifen, diphenhydramine, CYP2D6Catherine Marcucci, MD, Neil B. Sandson, MD161. The Topic of the DayFatal Forty DDI: cimetidine, lidocaine, CYP1A2, CYP3A4Catherine Marcucci, MD162. Bounce Backondansetron, CYP2D6 ultrarapid metabolismErica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc, Juraj Sprung, MD, PhD163. Call The Cath Lab! Fatal Forty DDI: omeprazole, clopidogrel, CYP2C19Anna Dubovoy, MD, Erin B. Payne, MD164. The Imatinib Inquiry:  A Theoretical Case (For Now)imatinib, metoprolol, midazolam, fentanyl, CYP3A4Stephen J. Gleich, MD, Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Nicole Henwood, MD165. A HAART-Breaking Talemetformin, tenofovirDean Laochamroonvorapongse, MD, Kirk Lalwani, MD, FRCA, MCRPart XV. Drug-Drug Interactions Involving Neuropsychiatric Drugs 166. IntroductionNeil B. Sandson, MD167. Phenytoin (I): Going Crazy!Fatal Forty DDI: phenytoin, quetiapine, CYP3A4Sara M. Skrlin, MD, Ansgar M. Brambrink, MD, PhD168. Phenytoin (II):  The Wrong Drug for the SchizophrenicFatal Forty DDI: phenytoin, quetiapine, CYP3A4Melisa N. Weingarten, RN, MS, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD169. Dizzy and DepressedFatal Forty DDI: nefazodone, carbamazepine, CYP3A4William A. Shakespeare, MD, Juraj Sprung, MD, PhD170. The Funeral Is On MondayFatal Forty DDI: phenytoin, valproic acid, CYP2C9Elizabeth Macri, MD, Ansgar M. Brambrink, MD, PhD, Neil B. Sandson, MD171. This Antacid Is Making Me Sick!Fatal Forty DDI: phenytoin, cimetidine, CYP2C9, CYP2C19Arun Subramanian, MBBS, Toby N. Weingarten MD, Juraj Sprung, MD, PhD172. Young at HeartFatal Forty DDI: pimozide, nefazodone, CYP3A4Catherine Marcucci, MD173. Shiver Yes, Die No –selegiline patch, meperidine, serotonin syndromeAhmed F. Zaky, MD, MPH, Michael J. Bishop, MD174. Clip and DipFatal Forty DDI: carbamazepine, felodipine, CYP3A4David W. Barbara, MD, Randall Flick, MD, Juraj Sprung, MD, PhD175. Blue Fogcitalopram, methylene blue, serotonin syndromeToby N. Weingarten, MD, Wayne T. Nicholson, MD, PharmD, MSc, Juraj Sprung, MD, PhD176. Confiscated ContraceptivesFatal Forty DDI: lamotrigene, ethinylestradiol, UGT1A4Erica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD PharmD, MSc177. Gotta Love DermFatal Forty DDI: lamotrigine, valproic acid, UGT1A4Jonathan Anson, MD, Richard C. Month, MD178. Desperate for A DrinkFatal Forty DDI: amitriptyline, CYP2D6 poor metabolizerErica D. Wittwer, MD, PhD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MScPart XVI. Drug-Drug Interactions Involving QT Prolonging DDIs179. IntroductionMatthew DeCaro, MD, FACC, FACP180. Delusion At HeartFatal Forty DDI: thioridazine, ondanestron, QT-prolongationArun Subramanian, MBBS, Toby N. Weingarten, MD, Juraj           Sprung, MD, PhD181. At Long LastFatal Forty DDI: ziprasidone, moxifloxacin, CYP3A4, CYP2D6, QT-prolongation,Kristen B. McCullough, PharmD, BCPS, BCOP, Wayne T. Nicholson, MD, PharmD, MSc182. Metha-don’t!Fatal Forty DDI: methadone, amitriptyline, levofloxacin,  CYP2D6 , QT-prolongationBryan C. Hoelzer, MD, Juraj Sprung, MD, PhD, Wayne T. Nicholson, MD, PharmD, MSc183. Flash Fireamiodarone, haloperidol, CYP1A2, CYP3A4, CYP2D6, QT-prolongation,Michael Hutchens, MD, Catherine Marcucci, MD, Neil B. Sandson, MD 184. I Am Dizzy When I Stand UpFatal Forty DDI: thioridazine, propranolol, CYP2D6,  QT-prolongation,Tasha L. Welch, MD, Toby N. Weingarten, MD, Juraj Sprung MD, PhDPart XVII. Drug-Drug Interactions Involving Foods and Nutrition185. IntroductionKevin W. Cleveland, PharmD, David G. Metro, MD186. High Fat Diet (I): No Juice For The Ketotic Kidketosis, carbohydrates, seizuresDenise M. Hall Burton, MD, Miya Asato, MD, Charles Boucek, MD187. Protein Huffing and Puffingtheophylline, dietary protein, CYP1A2Brian C. Bane, MD, James Gordon Cain, MD, MBA, FAAP188. Salty Samhigh salt diet, nitroprussideRobert Scott Lang, MD, Li Meng, MD, MPH189. A Peak Potassium Problemsalt substitute, spironolactone, lisinoprilJustin McCray, MD, Steven L. Orebaugh, MD190. Awake?vitamin C, general anestheticsNicole Scouras, MD, David G. Metro, MD191. Tropical Punch Packing a Real KnockoutFatal Forty DDI: grapefruit juice, midazolam, CYP3A4Brian Blasiole, MD, PhD, Shawn T. Beaman, MD192. When The Fire Won’t Go Outpomegranate juice, sildenafil, CYP3A4Thomas P. Pontinen, MD, Randal O. Dull, MD, PhD193. Peppermint PattyFatal Forty DDI: peppermint, felodipine, CYP3A4Ryan D. Ball, MD, Karen Boretsky, MD194. From Bleeding Gums to Green Thumbs- A True StoryFatal Forty DDI: warfarin, green vegetables  Audra M. Webber, MD, Patricia L. Dalby, MD195. Delicious but Maliciouslicorice, spironolactone, hypokalemiaEric Fox, BA, Kirk Lalwani, MD, FRCA, MCR196. I Just Can’t Lick This ProblemFatal Forty DDI: licorice, electrolytes, digoxin  Koshy M. Mathai, MD, Michael Hutchens, MD, Robert G. Krohner, MD197. Sommelier’s Surprisetyramine rich foods, MAO-i drugs, monoamine oxidaseCharles Lin, MD, Joseph F. Talarico, DO198. Dairy CarefullyFatal Forty DDI: dairy, fluoroquinolone  Kristin Ondecko Ligda, MD, Erin A. Sullivan, MD199. Cold And Sick, Sick And Coldfiber, thyroxine replacement, malabsorptionA. Murat Kaynar, MD, MPH, Nikhil K. Bhatnagar, MD200. TPN (I):  A Review and Two InteractionsTPN basics and complicationsLavinia Kolarcyzk, MD, Patrick J. Forte, MD201. TPN (II):  A Traumatic Case of Increased MetabolismTPN, valproic acidErica D. Wittwer, MD, PhD, Wayne T. Nicholson, MD, Pharm D, MSc, Juraj Sprung, MD, PhD202. Skin and Bonesstarvation, perioperative drugsMariam M. El-Baghdadi, MD, Ibtesam A. Hilmi, MB, CHB, FRCA203. Enough to Make You Sicksyrup of ipecac, general anesthesiaJohn Hache, MD, Thomas M. Chalifoux, MD204. Determined and Desperate to DietFatal Forty DDI: Orlistat, warfarinLisa Chan, MD, Kirk Lalwani, MD, FRCA, MCRPart XVIII. Drug-Drug Interactions Involving Spices and Supplements 205. IntroductionKirk Lalwani, MD, FRCA, MCR206. Caffeine CrashFatal Forty DDI: caffeine, ethinylestradiol, ciprofloxacin, CYP1A2 Brian Gierl, MD, Ryan Romeo, MD  207. Sad SequelaeFatal Forty DDI: Dong quai, warfarinStacy L. Fairbanks, MD208. The Scary Side of Ginkgo Biloba Is No Match For An Anesthesia Superstar: SeizuresGinkgo biloba, phenytoin, CYP2C19Shreya Patel, MD, Kirk Lalwani, MD, FRCA, MCR209. The Scary Side of Ginkgo Biloba Is No Match For An Anesthesia Superstar:  SugarGinkgo biloba, tolbutamide, CYP2C9Shreya Patel, MD, Kirk Lalwani, MD, FRCA, MCR210. The Scary Side of Ginkgo Biloba Is No Match For An Anesthesia Superstar: SubduralGinkgo bilobaShreya Patel, MD, Kirk Lalwani, MD, FRCA, MCR211. “Khat” Unawaresdepletion of central and peripheral endogenous catecholaminesBrian D. Tompkins, MD, Kirk Lalwani, MD, FRCA, MCR212. Pain on the PlaneFatal Forty DDI: ginseng, warfarin, CYP2C9 Lei Wu, MD, Kirk Lalwani, MD, FRCA, MCR213. Ca va, c’est Kavakava,carbidopa-levodopa, dopamine receptorsSolina Tith, MD, Kirk Lalwani, MD, FRCA, MCR214. Summertime and the Herbals are HotFatal Forty DDI: goldenseal, amitriptyline CYP2D6, CYP3A4Jessica Miller, MD, BM, Leelee Thames, MD215. Garlic I:  More Than Just Bad BreathFatal Forty DDI: garlic, ritonavir, CYP3A4, P-glycoproteinVincent Lew, MD, Kirk Lalwani, MD, FRCA, MCR216. Garlic II:  A Girl Named Allicingarlic, inhibition of clotting cascadeVincent Lew, MD, Kirk Lalwani, MD, FRCA, MCR217. “Danshen” the Night AwayFatal Forty DDI: Salvia miltiorrhiza, warfarin, CYP2C9, CYP1A2Tara C. Carey, BA, MD, Kirk Lalwani, MD, FRCA, MCR218. Caught Yellow-HandedFatal Forty DDI: tumeric, warfarin, CYP1A2, CYP2C9Giorgio Veneziano, MD, Michael Mangione, MD219. St. John:  Not Such A SaintFatal Forty DDI: St. John’s Wort, cyclosporine, CYP3A4, P-glycoproteinHeather Norvelle, PharmD, BCPS, Ines P. Koerner, MD, PhD220. Hearing the NewsFatal Forty DDI: St. John’s Wort, oral contraceptives, CYP3A4, P-glycoproteinNikki Jaworski, MD