BIUH1H2• List1. NumQuoteTableImage

Drug-Drug Interactions in Anaesthesia 1. WARFARIN + AZOLES (e.g. Fluconazole) Mechanism: Fluconazole inhibits CYP2C9 → reduced warfarin metabolism → ↑ plasma warfarin → ↑ INR Clinical significance: MAJOR Management: Monitor INR daily; reduce warfarin dose by 25–50% 2. PROPOFOL + FENTANYL (Synergistic) Mechanism: Additive CNS and respiratory depression via independent pathways Clinical significance: MODERATE — beneficial synergism used clinically Management: Reduce propofol induction dose by 30% when fentanyl premedication given 3. ROCURONIUM + AMINOGLYCOSIDES Mechanism: Aminoglycosides enhance NMJ blockade (pre-synaptic + post-synaptic effects) Clinical significance: HIGH in ICU patients on aminoglycosides Management: Use lower rocuronium doses; monitor TOF ratio; have sugammadex ready

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