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Pharmacology · USMLE Step 1

USMLE Pharmacology: Drug Interactions and Cytochrome P450

Cytochrome P450 enzyme inducers and inhibitors and the drug interactions they cause tested on USMLE Step 1.

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Which CYP450 isoenzyme is the most abundant in the liver and metabolizes the largest number of drugs?
CYP3A4
Rifampin induces CYP450 enzymes, which can cause failure of what commonly used medication class?
Oral contraceptives
How does chronic phenytoin use (a CYP450 inducer) affect warfarin's anticoagulant effect?
It decreases warfarin's anticoagulant effect by increasing its metabolism
Carbamazepine is well known for inducing the metabolism of which drug, including itself over time?
Itself (autoinduction)
Phenobarbital, like other barbiturates, has what effect on hepatic CYP450 enzymes?
It induces them
Chronic alcohol use induces which CYP450 enzyme?
CYP2E1
St. John's Wort induces CYP3A4, which can reduce the effectiveness of which transplant immunosuppressant?
Cyclosporine
Griseofulvin, an antifungal drug, has what effect on hepatic CYP450 enzymes?
It induces them
Cigarette smoking induces CYP1A2, which lowers serum levels of which bronchodilator drug?
Theophylline
Cimetidine is known as a potent, broad inhibitor of CYP450 enzymes, potentiating the effect of which anticoagulant?
Warfarin
Azole antifungals such as ketoconazole have what effect on CYP3A4?
They inhibit it
Which two macrolide antibiotics are potent CYP3A4 inhibitors, unlike a third macrolide that is not?
Erythromycin and clarithromycin (azithromycin does not significantly inhibit CYP450)
Ritonavir is used at low doses in HIV therapy specifically to inhibit which enzyme and boost other protease inhibitor levels?
CYP3A4
Grapefruit juice inhibits intestinal CYP3A4, increasing the oral bioavailability of which two drug classes?
Statins and calcium channel blockers
Combining simvastatin with clarithromycin (a CYP3A4 inhibitor) increases the risk of what adverse effect?
Myopathy or rhabdomyolysis

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