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CE Drug Interactions Pharmacokinetics
The course teaches pharmacists and prescribers to identify, prevent, and manage clinically significant drug interactions using CYP450 knowledge, transporter dynamics, pharmacogenomics, and therapeutic drug monitoring.
Who Should Take This
It is intended for practicing pharmacists, clinical pharmacists, and prescribers such as physicians or nurse practitioners who have foundational pharmacology training and regularly prescribe or dispense medications. They seek to enhance their ability to apply pharmacokinetic principles, interpret pharmacogenomic data, and implement therapeutic drug monitoring to improve patient safety.
What's Included in AccelaStudy® AI
Adaptive Knowledge Graph
Practice Questions
Lesson Modules
Console Simulator Labs
Exam Tips & Strategy
20 Activity Formats
Course Outline
60 learning goals
1
CYP450 Enzyme System
3 topics
Major CYP isoforms and substrates
- Identify the major CYP450 isoforms including CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4 and their relative contribution to drug metabolism.
- List common substrate drugs for each major CYP450 isoform and explain how concurrent use of substrates for the same enzyme can lead to competitive inhibition.
- Explain the mechanism of CYP450 enzyme induction including time course, reversibility, and the clinical significance of enzyme induction on drug efficacy.
CYP inhibition and clinical impact
- Differentiate between reversible and irreversible CYP450 inhibition and explain how mechanism-based inhibition affects the duration and severity of drug interactions.
- Analyze common CYP3A4 drug interactions involving azole antifungals, macrolide antibiotics, and calcium channel blockers to predict clinical outcomes.
- Evaluate the clinical significance of CYP2D6 inhibition by SSRIs on the efficacy of codeine, tamoxifen, and other prodrugs requiring CYP2D6 activation.
CYP induction management
- Identify potent CYP enzyme inducers including rifampin, carbamazepine, phenytoin, and St. John's Wort and the isoforms they predominantly induce.
- Design a medication management plan for a patient starting a potent CYP inducer that addresses dosage adjustments, alternative agents, and monitoring parameters.
- Analyze the interaction between rifampin and oral contraceptives to determine appropriate contraceptive counseling and alternative birth control recommendations.
2
P-glycoprotein and Drug Transporters
2 topics
P-gp function and substrates
- Identify P-glycoprotein as an efflux transporter and describe its role in limiting drug absorption, facilitating drug elimination, and protecting the blood-brain barrier.
- List common P-glycoprotein substrates including digoxin, dabigatran, and cyclosporine and explain how P-gp inhibitors and inducers alter their pharmacokinetics.
- Explain the overlap between CYP3A4 and P-glycoprotein substrates and inhibitors and the clinical implications of dual CYP3A4/P-gp inhibition on drug exposure.
P-gp clinical interactions
- Analyze the digoxin-amiodarone interaction through the lens of P-glycoprotein inhibition and determine appropriate dose reduction and monitoring strategies.
- Evaluate the impact of P-glycoprotein inhibition on direct oral anticoagulant levels and the dose adjustment requirements for dabigatran with concurrent P-gp inhibitors.
- Design a monitoring plan for patients on multiple P-glycoprotein substrates who require concurrent P-gp inhibitor therapy addressing drug levels, adverse effects, and alternatives.
3
Drug-Drug Interaction Categories
2 topics
Pharmacokinetic interactions
- Identify drug interactions affecting absorption including chelation with divalent cations, pH-dependent absorption changes, and gastric motility effects on drug bioavailability.
- Explain protein binding displacement interactions and why they rarely produce clinically significant effects for most drugs despite changes in free drug fraction.
- Describe drug interactions affecting renal elimination including competition for tubular secretion, alterations in urine pH, and changes in renal blood flow.
Pharmacodynamic interactions
- Identify pharmacodynamic drug interactions including additive CNS depression, serotonin syndrome, QT prolongation, and bleeding risk with concurrent anticoagulant-antiplatelet use.
- Explain the mechanisms and clinical presentation of serotonin syndrome including precipitating drug combinations and differentiation from neuroleptic malignant syndrome.
- Analyze complex polypharmacy regimens to identify overlapping pharmacodynamic risks and prioritize interventions based on severity and probability of adverse outcomes.
- Evaluate QT prolongation risk in patients receiving multiple QT-prolonging medications and determine appropriate monitoring, dose modifications, or therapeutic substitutions.
- Design a systematic approach for managing a patient on concurrent warfarin, aspirin, and NSAID therapy that balances cardiovascular benefit against bleeding risk.
4
Drug-Food Interactions
2 topics
Common drug-food pairs
- Identify clinically significant drug-food interactions including grapefruit juice with CYP3A4 substrates, vitamin K-rich foods with warfarin, and tyramine-containing foods with MAOIs.
- Explain the mechanism by which grapefruit juice irreversibly inhibits intestinal CYP3A4 and increases systemic exposure of susceptible drugs including statins and calcium channel blockers.
- Describe the effect of high-fat meals on the absorption of lipophilic drugs and the clinical significance of food-effect bioequivalence studies for dosing instructions.
Counseling and management
- Analyze the interaction between dietary calcium, iron, or antacids and fluoroquinolone or tetracycline antibiotics to determine optimal dosing intervals.
- Evaluate warfarin-vitamin K dietary interactions and develop consistent dietary counseling strategies that maintain stable INR without unnecessary food restrictions.
- Analyze alcohol-drug interactions including disulfiram-like reactions, enhanced CNS depression, and hepatotoxicity risk with concurrent acetaminophen use.
- Design patient education materials for drug-food interactions that are health-literacy appropriate and include specific food examples, timing recommendations, and warning signs.
5
Pharmacogenomics Basics
2 topics
Key pharmacogenes
- Identify the major pharmacogenes with clinical guidelines including CYP2D6, CYP2C19, CYP2C9, VKORC1, HLA-B, DPYD, TPMT, and UGT1A1.
- Explain CYP2D6 metabolizer phenotypes from poor to ultrarapid and their impact on drug response for codeine, tramadol, and tamoxifen.
- Describe CYP2C19 polymorphisms and their effect on clopidogrel antiplatelet efficacy and proton pump inhibitor metabolism.
- Explain the clinical significance of HLA-B*5701 testing before abacavir initiation and HLA-B*1502 testing before carbamazepine use in at-risk populations.
Clinical application of pharmacogenomics
- Analyze pharmacogenomic test results to recommend appropriate drug and dose selections according to CPIC guidelines for actionable gene-drug pairs.
- Evaluate the cost-effectiveness and clinical utility of preemptive pharmacogenomic panel testing versus reactive single-gene testing in clinical practice.
- Identify barriers to pharmacogenomic implementation in clinical practice including reimbursement challenges, clinician education gaps, and electronic health record integration.
- Design a pharmacist-led pharmacogenomics service including test ordering protocols, result interpretation workflows, prescriber communication templates, and patient counseling approaches.
6
Therapeutic Drug Monitoring
2 topics
TDM fundamentals
- Identify drugs that require therapeutic drug monitoring including vancomycin, aminoglycosides, phenytoin, lithium, digoxin, theophylline, and immunosuppressants.
- Explain the pharmacokinetic principles underlying TDM including steady-state timing, trough versus peak levels, area-under-the-curve monitoring, and sample collection protocols.
- Describe vancomycin AUC-guided dosing as recommended by current consensus guidelines and its advantages over traditional trough-only monitoring.
TDM clinical application
- Analyze patient-specific factors affecting drug levels including renal function, hepatic function, protein binding, body composition, and concurrent interacting medications.
- Evaluate phenytoin levels in hypoalbuminemic patients using corrected phenytoin equations and determine appropriate dose adjustments.
- Analyze aminoglycoside dosing strategies including extended-interval dosing with Hartford nomogram and traditional dosing with peak and trough monitoring.
- Identify factors that cause falsely elevated or decreased drug levels including sample timing errors, hemolysis, drug assay cross-reactivity, and non-steady-state sampling.
- Design a pharmacist-managed TDM protocol for an antimicrobial stewardship program including dosing algorithms, monitoring schedules, and dose adjustment criteria.
7
Narrow Therapeutic Index Drugs
2 topics
NTI drug identification and monitoring
- Identify narrow therapeutic index drugs including warfarin, digoxin, lithium, phenytoin, theophylline, cyclosporine, and levothyroxine and their clinical monitoring parameters.
- Explain the regulatory and clinical implications of generic substitution for NTI drugs including FDA bioequivalence standards and state substitution restrictions.
- Describe the signs and symptoms of toxicity for major NTI drugs and the corresponding monitoring parameters and antidotes when available.
NTI management strategies
- Analyze the impact of drug interactions, dietary changes, and physiological alterations on NTI drug levels and determine when dose adjustments are warranted.
- Evaluate warfarin management scenarios including INR interpretation, dose titration algorithms, bridging therapy decisions, and reversal strategies for supratherapeutic INR.
- Analyze lithium toxicity risk factors including dehydration, NSAID use, ACE inhibitor initiation, and sodium intake changes to prevent adverse outcomes.
- Design a comprehensive monitoring protocol for a patient on multiple NTI drugs that integrates laboratory schedules, drug interaction screening, and patient self-monitoring education.
8
Drug Interaction Resources and Clinical Communication
2 topics
Interaction databases and evidence
- Identify major drug interaction databases and resources including Lexicomp, Micromedex, Clinical Pharmacology, and the FDA drug interaction table for CYP substrates.
- Explain interaction severity rating systems used by drug information databases and the criteria distinguishing major, moderate, and minor interaction classifications.
- Analyze discrepancies between drug interaction databases for the same drug pair and determine the most clinically relevant assessment using primary literature evidence.
Clinical communication
- Describe effective pharmacist-prescriber communication strategies for drug interaction alerts including prioritization, clinical significance framing, and alternative recommendations.
- Analyze alert fatigue in clinical decision support systems and evaluate strategies to improve the signal-to-noise ratio of drug interaction alerts in electronic health records.
- Evaluate patient counseling approaches for drug interactions including appropriate health literacy level, actionable instructions, and when to seek emergency medical attention.
- Design a pharmacy drug interaction management protocol that integrates database screening, clinical significance assessment, prescriber notification, and patient education workflows.
Scope
Included Topics
- CYP450 enzyme system including major isoforms (1A2, 2C9, 2C19, 2D6, 3A4), substrates, inhibitors, inducers, and their clinical significance in drug metabolism.
- P-glycoprotein transporter function, substrates, inhibitors, and inducers and their role in drug absorption, distribution, and elimination at the blood-brain barrier and intestinal epithelium.
- Drug-drug interactions including pharmacokinetic interactions affecting absorption, distribution, metabolism, and excretion, and pharmacodynamic interactions involving additive, synergistic, and antagonistic effects.
- Drug-food interactions including grapefruit juice effects on CYP3A4, vitamin K and warfarin, tyramine and MAOIs, calcium and tetracyclines, and high-fat meal effects on drug absorption.
- Pharmacogenomics basics including CYP2D6 poor and ultrarapid metabolizer phenotypes, CYP2C19 polymorphisms affecting clopidogrel, HLA-B*5701 screening for abacavir, and DPYD testing for fluoropyrimidines.
- Therapeutic drug monitoring including drugs requiring TDM (vancomycin, aminoglycosides, phenytoin, lithium, digoxin), sampling times, target ranges, and dosage adjustment strategies.
- Narrow therapeutic index drugs including warfarin, digoxin, lithium, phenytoin, theophylline, and cyclosporine with emphasis on monitoring parameters and factors affecting drug levels.
Not Covered
- Advanced medicinal chemistry or drug design principles beyond clinician-level understanding of drug interaction mechanisms.
- Laboratory techniques for drug level measurement or genotyping procedures beyond interpretation of results.
- Regulatory aspects of drug interaction labeling or FDA guidance documents beyond clinical application.
- Veterinary pharmacokinetics or drug interactions in non-human species.
CE Drug Interactions Pharmacokinetics is coming soon
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