We avoid giving valproic acid (depakine) for women of childbearing age because of risk of teratogenicity.

CYP450 Inhibitors:

Antibiotics/virals/fungal agents:
• Macrolides (except azithromycin)
• Ciprofloxacin
• TMP/SMX
• INH
• Azole antifungals (including metronidazole)
• HIV antivirals (especially protease-inhibitors)

Cardiovascular drugs:
• Non-dihydropyridine CCBs (verapamil, diltiazem)
• Amiodarone
• Carvedilol
• Metoprolol

Neuropsychiatric drugs:
• Fluoxetine
• Bupropion
• Duloxetine
• Sertraline
• Amitriptyline
• Codeine
• Tramadol
• Valproate

Miscellaneous:
• Cimetidine
• Cyclosporine
• Grapefruit juice

CYP450 Inducers:

Steroids:
• Dexamethasone
• Combined oral contraceptives (contain estradiol & gestodene)

Anti-epileptics:
• Phenytoin
• Phenobarbital
• Carbamazepine

Miscellaneous:
• Rifampin
• Lumacaftor (for cystic fibrosis)
• Tobacco

Interestingly, tobacco is an inducer of CYP1A2 which metabolizes caffeine

ذني مهمات لأن بيهن interactions وطيحان حظ

طبعًا السالفة بيها تفاصيل أكثر؛ أكو تقريبًا 57 إنزيم ضمن الـ cytochrome system بس عدنا منهن 6 كلش مهمات، لأنهن مسؤولات عن أيض العديد من الأدوية، وكل إنزيم من ذني الـ 6 يتأثر بعدة أدوية ومواد كيميائية، قسم منها يحفزنّه inducers، قسم يثبطنّه inhibitors، وقسم هنّ ركائز substrates يشتغل عليهن الإنزيم.

The 6 most essential CYP450 enzymes with their inducers, inhibitors, and substrates.

The coagulation cascade is intricate and cross-linked that it's better to call it the coagulation network, since it doesn't proceed like a cascade from point A to point B, rather, point A affects both points B and C which subsequently affect point A,... etc.

Cell formation in the bone marrow

This book is elegantly simplistic and integrative

When examining the patient with Broca’s aphasia, the patient often feels frustrated, while when examining the patient with Wernicke’s aphasia, the examiner may feel frustrated.

Other names are sometimes used to refer to Broca’s aphasia and Wernicke’s aphasia, respectively, including expressive and receptive aphasias, motor and sensory aphasias, anterior and posterior aphasias, and nonfluent and fluent aphasias. However, these terms each have drawbacks. For example, Broca’s aphasia is not simply an expressive deficit, since comprehension of syntactically dependent structures is impaired. Conversely, Wernicke’s aphasia is not simply a receptive deficit, since speech expression is highly paraphasic and largely uninterpretable. Similarly, although Broca’s and Wernicke’s aphasias are usually caused by anterior and posterior lesions, respectively, this is not always the case. The simple syndromic names Broca’s aphasia and Wernicke’s aphasia are preferable.

When examining patients with aphasia, recall that neurologic deficits are not all-or-none phenomena. In addition to deciding on the absence or presence of a deficit such as decreased fluency or impaired comprehension, it is important to assess the deficit’s severity. This assessment can help both to clarify the diagnosis and to track the clinical progression of the disorder. For example, consider a patient with normal fluency who can comprehend and repeat simple phrases but who has difficulty comprehending and repeating more complex phrases and has occasional paraphasic errors. Despite the fact that some comprehension is present, this patient would be considered to have Wernicke’s aphasia, but in a relatively mild form.