Corticosteroids Barbiturates

Opioids, benzodiazepines, barbiturates, corticosteroids, dopamine agonists (e.g., amantadine, bromocriptine, levodopa, pergolide, pramipexole, ropinirole), H2-receptor antagonists, anticholinergics (e.g., diphenhydramine, trihexylphenidyl), P-adrenergic blockers, clonidine, methyldopa, carbamazepine, phenytoin, baclofen, cyclobenzaprine, lithium, antidepressants (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors), and interleukin-2... 

Barbiturates Corticosteroids Decreased pharmacologic effeds of the corticosteroid may be observed. 

Intracellular steroid receptors, which alter gene expression, exist for corticosteroids, oestrogens and progesterone in the brain, as in the periphery but they cannot account for the relatively rapid depression of CNS function induced by some steroids. This was explained when Harrison and Simmonds (1984) discovered that alphaxalone (the steroid anaesthetic) potentiated the duration of GABA-induced currents at the GABAa receptor in slices of rat cuneate nucleus just like the barbiturates (Fig. 13.6). Of the... 

Transamination of barbiturate derivatives with semicarbazide Hydrolysis and acyl migration of corticosteroid esters Rate enhancement by CTABr depends on substrate structure Substrate micellization inhibits hydrolysis and acyl migration Reddy and Katiyar, 1981 Anderson el ai, 1983... 

Drugs that may affect repaglinide include CYP 450 inhibitors (eg, clarithromycin, erythromycin, ketoconazole, miconazole), CYP 450 inducers (eg, barbiturates, carbamazepine, rifampin), beta blockers, calcium channel blockers, chloramphenicol, corticosteroids, coumarins, estrogens, gemfibrozil, isoniazid, itraconazole, levonorgestrel and ethinyl estradiol, MAOIs, nicotinic acid, NSAIDs, oral contraceptives, phenothiazines, phenytoin, probenecid, salicylates, simvastatin, sulfonamides, sympathomimetics, thiazides and other diuretics, and thyroid products. 

Drugs that may affect sulfonylureas include androgens, anticoagulants, azole antifungals, barbiturates, beta blockers, calcium channel blockers, charcoal, chloramphenicol, cholestyramine, ciprofloxacin, clofibrate, corticosteroids, diazoxide, estrogens, ethanol, fluconazole, gemfibrozil, histamine H2 antagonists, hydantoins,... 

Drugs that may affect barbiturates include alcohol, charcoal, chloramphenicol, MAO inhibitors, rifampin, and valproic acid. Drugs that may be affected by barbiturates include acetaminophen, anticoagulants, beta blockers, carbamazepine, chloramphenicol, clonazepam, oral contraceptives, corticosteroids, digitoxin, doxorubicin, doxycycline, felodipine, fenoprofen, griseofulvin, hydantoins, methoxyflurane, metronidazole, narcotics, phenmetrazine, phenylbutazone, quinidine, theophylline, and verapamil. 

Rifampin is known to induce the hepatic microsomal enzymes that metabolize various drugs such as acetaminophen, oral anticoagulants, barbiturates, benzodiazepines, beta blockers, chloramphenicol, clofibrate, oral contraceptives, corticosteroids, cyclosporine, disopyramide, estrogens, hydantoins, mexiletine, quinidine, sulfones, sulfonylureas, theophyllines, tocainide, verapamil, digoxin, enalapril, morphine, nifedipine, ondansetron, progestins, protease inhibitors, buspirone, delavirdine, doxycycline, fluoroquinolones, losartan, macrolides, sulfonylureas, tacrolimus, thyroid hormones, TCAs, zolpidem, zidovudine, and ketoconazole. The therapeutic effects of these drugs may be decreased. 

Prednisolone [Corticosteroid] [See Steroids and Table VI-1] Interactions T Effects W/ clarithromycin, erythromycin, estrogen, ketoconazole, OCPs, troleandomycin X effects W/ antacids, aminoglutethimide, barbiturates, cholestyramine, colestipol, phenytoin, rifampin X effects OF anticoagulants, hypoglycemics, INH, salicylates, vaccine toxoids EMS Infxns may be masked OD May cause wt gain, T hair growth, acne, HTN, peripheral edema, and sore muscles symptomatic and supportive... 

Triamcinolone Nystatin (Mycolog ) [Anti-inflammatory Antifungal/Corticosteroid] Uses Cutaneous candidiasis Action Antifungal anti-inflammatory Dose Apply lightly to area bid max 25 mg/d Caution [C, ] Contra Varicella systemic fungal Infxns Disp Cream oint SE Local irritation, hypertrichosis, pigmentation changes Interactions T Effects W/barbiturates, phenytoin, rifampin T effects OF salicylates, vaccines EMS See Triamcinolone OD See Triamcinolone... 

HA, mild pain Action Nonnarco tic analgesic w/ barbiturate Dose 1—2 tabs or caps PO q4-6h PRN i in renal/hepatic impair 4 g/24 h APAP max Caution [C, D, +] Alcoholic liver Dz Contra G6PD deficiency Disp Caps, Liq, tabs SE Drowsiness, dizziness, hangover effect Interactions T Effects OF benzodiazepines, opiate analgesics, sedatives/hypnotics, EtOH, methylphenidate hydrochloride i effects OF MAOIs, TCAs, corticosteroids, theophylline, OCPs, BBs, doxycycline EMS See Acetaminophen may impair coordination, monitor for depression concurrent EtOH use T CNS depression butalbital is habit forming... 

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