American Association of Nurse Anesthetists 222 South Prospect Avenue Park Ridge, IL 60068-4001

Copyright ©2016 American Association of Nurse Anesthetists

All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission of the publisher.

Printed in the United States of America.

Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1

The authors and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation.

Library of Congress Cataloging-in-Publication Data

Names: Welliver, Mark, editor. | Bruton-Maree, Nancy, editor. | Welliver, Dawn Dalpé, editor. | American Association of Nurse Anesthetists, issuing body.

Title: Drug/Drug interactions / edited by Mark Welliver, Nancy Bruton-Maree, Dawn Dalpé Welliver.

Other titles: Drug/Drug interactions (Welliver)

Description: Park Ridge, IL : American Association of Nurse Anesthetists, [2016] | Includes bibliographical references.

Identifiers: LCCN 2016018800 | ISBN 9780982991244

Subjects: | MESH: Drug Interactions | Pharmacokinetics | Nurses’ Instruction

Classification: LCC RM302 | NLM QV 37.5 | DDC 615.7/045--dc23 LC record available at https://lccn.loc.gov/2016018800

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PrefaceThis book is targeted toward practicing Certified Registered Nurse Anesthetists and student nurses in anesthesia training. We, the editors, want this to be as thorough a treatment as necessary to enable anesthesia professionals to deliver the best possible, most efficacious care to their patients.

Being cognizant of interactions and potential interactions among drugs of various classifications is of paramount importance to each of us. At times, we anesthetists seem like the alchemists of olden days in search of turning lead into gold. We administer multiple medications in rapid succession, so we need to be aware of the potential interactions among them. It might seem we are nearly like chemists giving these numerous medications. Medications are chemicals; chemicals react and interact with one another. At times these interactions are beneficial, but interactions may well become detrimental, if we aren’t careful in our approach to their administration. We, the editors of this book, wish—to the extent feasible and possible—to include in the various chapters in vivo and in vitro interactions for the various drugs.

In vitro drug interactions are related to drug characteristics and formulary preparations:

1. Weak acids

2. Weak bases

3. pH of solvents and pKa of drugs

4. Ionization and aqueous solubility

5. Ionized (hydrophilic) vs unionized (lipophilic) incompatibility

In vivo drug interactions fall into 2 main categories:

1. Alterations of metabolism (ADME)

2. Opposition or enhancement of effect:AntagonismAgonism

Each category is related to induction or inhibition of hepatic enzymes and/or poten-tiation or attenuation of effects due to agonism or antagonism of relevant receptors.

We are excited about working with you on this endeavor to enhance and improve our delivery of anesthesia care.

Mark Welliver, DNP, CRNA, ARNP

Nancy Bruton-Maree, MS, CRNA

Dawn Dalpé Welliver, DNP, CRNA, ARNP

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AuthorsGreg Bozimowski, DNP, CRNA

Nancy Bruton-Maree, MS, CRNA

Reamer L. Bushardt, PharmD, PA-C, DFAAPA

Dennis J. Cheek, RN, PhD, FAHA

Sass Elisha, EdD, CRNA

Lynn Fitzgerald Macksey, RN, MSN, CRNA

Mark Gabot, MSN, CRNA

Sarah E. Giron, PhD, CRNA

Mary Karlet, PhD, CRNA

Ryann Lavenia, MS, CRNA

Kiran Macha, MBBS, MPH

Nina McLain-Calkins, PhD, CRNA

Zulay H. Ritrosky, DNP, CRNA

Kay K. Sanders, DNP, CRNA

Allan Schwartz, DDS, CRNA

Ryan Shores, DNP, CRNA

Dawn Dalpé Welliver, DNP, CRNA, ARNP

Mark Welliver, DNP, CRNA, ARNP

Kelly L. Wiltse Nicely, PhD, CRNA

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ContentsPreface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Chapter 1 Introduction to the Biochemistry of Drug Interactions . . . . . . . . . . . 1

Chapter 2 Chemistry Review of Drug Incompatibilities. . . . . . . . . . . . . . . . . . 15

Chapter 3 Inhalational Anesthetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Chapter 4 Local Anesthetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Chapter 5 Benzodiazepines and Drug Interactions. . . . . . . . . . . . . . . . . . . . . . 75

Chapter 6 Common Induction Agents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Chapter 7 Opioids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Chapter 8 Pure Opioid Antagonists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Chapter 9 Neuromuscular Blocking Agents . . . . . . . . . . . . . . . . . . . . . . . . . . 159

Chapter 10 Neuromuscular Blocking Agent Reversal Drugs . . . . . . . . . . . . . . . 173

Chapter 11 Anticholinergic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193

Chapter 12 Sympathomimetic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

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Chapter 13 Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229

Chapter 14 Anticoagulant Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

Chapter 15 Beta Adrenergic Receptor Antagonists . . . . . . . . . . . . . . . . . . . . . . 253

Chapter 16 Calcium Channel Blocking Drugs . . . . . . . . . . . . . . . . . . . . . . . . . 263

Chapter 17 Antiepileptic Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279

Chapter 18 Steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

Chapter 19 Nonsteroidal Anti-inflammatory Drugs . . . . . . . . . . . . . . . . . . . . 305

Chapter 20 Antacids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327

Chapter 21 Herbal Dietary Supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337

About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377