Real Life Pharmacology - Pharmacology Education for Health Care Professionals
324 episodes - English - Latest episode: 9 days ago - ★★★★★ - 643 ratingsA Meded101.com Production
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Episodes
Canagliflozin Pharmacology
May 26, 2022 14:15 - 13 minutes - 6.31 MBCanagliflozin is an SGLT2 inhibitor. I discuss the pharmacology, dosing, adverse effects, and drug interactions of this medication. Canagliflozin reduces blood sugar, by facilitating its exit through the urine. This can increase the risk of genitourinary infections. A diuresis type effect can happen due to canagliflozin and this effect may be exacerbated by the use of thiazide and loop diuretics. Hyperkalemia has been reported with the use of canagliflozin; the risk for this is increase...
Cabergoline Pharmacology
May 19, 2022 15:04 - 11 minutes - 10.5 MBCabergoline is a dopamine agonist. I discuss the pharmacology, adverse effects, and drug interactions in this podcast episode. Be on the lookout for drugs that could oppose the effects of cabergoline such as antipsychotics and metoclopramide. Cabergoline can be used for hyperprolactinemia management and may cause adverse effects like hypotension and GI upset. Cabergoline has a very long half-life so it is most often only dosed 1-2 times per week.
Venlafaxine Pharmacology
May 12, 2022 16:01 - 16 minutes - 15.3 MBIn this episode, I discuss venlafaxine pharmacology, adverse effect, dose conversion of IR to ER, and drug interactions. Venlafaxine is notorious for producing withdrawal symptoms when discontinued abruptly. I discuss these in detail on the podcast. How significant is the interaction of venlafaxine with antiplatelet agents? I discuss that in this episode. The onset of action is a critical education point that patients must be aware of as it takes some time for venlafaxine to work.
Chlorthalidone Pharmacology
May 05, 2022 15:23 - 15 minutes - 14.6 MBOn this episode I discuss chlorthalidone pharmacology, adverse effects, and recent literature regarding cardiovascular disease reduction. Our friends at Pyrls.com are offering a free diagram of the nephron including the mechanism of action AND a summary of diuretic effects that I discussed on the podcast - Go sign up and get these for free and support this awesome sponsor! Chlorthalidone is a thiazide diuretic that uniquely raises blood calcium levels compared to loop diuretics which lower c...
Verapamil Pharmacology Podcast
April 28, 2022 15:47 - 13 minutes - 6.26 MBOn this episode, I discuss verapamil pharmacology, adverse effects, and important drug interactions. There are numerous drug interactions to be aware of with verapamil as it inhibits the enzyme CYP3A4. Verapamil is a calcium channel blocker (non-dihydropyridine) that blocks calcium channels in the heart and vessels. In addition to hypotension and bradycardia, verapamil can cause constipation which may be more prominent in our geriatric patients.
Salmeterol (Serevent) Pharmacology
April 21, 2022 14:51 - 14 minutes - 6.76 MBIn this episode, I cover salmeterol (Serevent) pharmacology, adverse effects, drug interactions and special warnings with this medication. Salmeterol is a long acting beta agonist that can be used in combination with inhaled corticosteroids for management of asthma. Salmeterol can be used as monotherapy in COPD and should not be used as monotherapy in asthma. Elevations in pulse and blood pressure can happen with a beta agonist like salmeterol.
Esomeprazole (Nexium) Pharmacology
April 14, 2022 15:51 - 15 minutes - 14.3 MBOn this episode, I discuss esomeprazole (Nexium) pharmacology, adverse effects, tapering, kinetics, and drug interactions. I spend a good amount of time discussing the esomeprazole and clopidogrel interaction in this podcast episode. Esomeprazole inhibits CYP2C19. This can cause an increase in citalopram concentrations and raise the potential for QTc prolongation. It is critical to reassess the length of therapy and the dose of PPIs like esomeprazole.
Carvedilol (Coreg) Pharmacology
April 07, 2022 15:17 - 15 minutes - 14 MBOn this episode of the Real Life Pharmacology podcast, I discuss carvedilol pharmacology, drug interactions, and adverse effects. Carvedilol is one of the few beta-blockers that has alpha-blocking activity. Carvedilol is almost exclusively metabolized by various CYP enzymes so renal function changes typically don't change drug concentrations to a significant extent. Beta-blockers like carvedilol are well known to cause the adverse effects of fatigue and sexual dysfunction.
Umeclidinium Pharmacology
March 31, 2022 15:23 - 12 minutes - 11.1 MBOn this episode, I discuss umeclidinium pharmacology, adverse effects, patient education pearls, and drug interactions. Umeclidinium is used in the management of COPD. Below is an excellent quick overview of the COPD guidelines from pyrls.com - You can get the full PDF by signing up for a free account at pryls.com/rlp Umeclidinium is a long-acting anticholinergic (anti-muscarinic) LAMA and as you can see from the figure above drugs from this class are frequently used in COPD management. ...
Denosumab (Prolia) Pharmacology
March 24, 2022 14:39 - 14 minutes - 6.43 MBOn this episode, I discuss denosumab pharmacology, adverse effects, clinical pearls, and drug interactions. Whenever I see an osteoporosis medication like denosumab used, I review the medications to ensure that we avoid medications that can cause osteoporosis. Denosumab is often used as a potential alternative in osteoporosis management for those that cannot tolerate bisphosphonates. We need to monitor calcium levels when using denosumab as levels can be dangerously low, especially when ...
Roflumilast (Daliresp) Pharmacology
March 17, 2022 15:26 - 10 minutes - 4.84 MBOn this episode I discuss roflumilast (Daliresp) pharmacology, adverse effects, and important drug interactions. Roflumilast is indicated to reduce the incidence of COPD exacerbations. Roflumilast is significantly broken down by CYP3A4 so there are numerous drug interactions that we have to take into account. Psychiatric issues, GI upset, and weight loss are all potential adverse effects due to roflumilast.
Trihexyphenidyl (Artane) Pharmacology
March 10, 2022 17:18 - 9 minutes - 4.35 MBOn this episode, I breakdown trihexyphenidyl (Artane) pharmacology, adverse effects, and drug interactions. Trihexyphenidyl is highly anticholinergic and can cause constipation, dry eyes, dry mouth, and urinary retention. Dementia medications like donepezil can have their effects blunted by the use of trihexyphenidyl. Trihexyphenidyl is an older anticholinergic that is rarely used for the management of EPS caused by antipsychotics.
Liraglutide Pharmacology
March 03, 2022 17:20 - 12 minutes - 5.93 MBOn this episode, I discuss liraglutide pharmacology, drug interactions, and adverse effects. Liraglutide is well known to cause nausea. It is important to assess the severity of nausea as it may subside in some patients as they gain tolerability to the medication. We mentioned the 2022 Diabetes Guideline Cheat Sheet in the podcast - you can get that for free at pyrls.com/rlp Liraglutide has a fairly low risk of hypoglycemia when used alone, but this risk increases when it is used with in...
Losartan Pharmacology
February 24, 2022 16:40 - 14 minutes - 13.3 MBOn this episode, I discuss losartan pharmacology, adverse effects, drug interactions, and appropriate monitoring. Losartan is an ARB and can increase potassium levels. Keep an eye out for medications like spironolactone and trimethoprim which can increase this risk further. Losartan has been shown to lower uric acid levels which could potentially be helpful in patients with gout. Monitoring renal function is very important with losartan. The risk of ARF goes significantly higher when use...
Pravastatin Pharmacology
February 17, 2022 18:24 - 11 minutes - 5.04 MBOn this episode, I breakdown pravastatin pharmacology, adverse effects, drug interactions and when you might see this drug used in practice. Pravastatin is a statin and will lower LDL. Its use is a little limited in the fact that it is not as potent as other agents in its LDL lowering effects. Pravastatin is hydrophilic which differentiates it from simvastatin, atorvastatin, and lovastatin. I describe rhabdomyolysis in this podcast as it is a potential rare adverse effect of pravastatin.
Clomiphene Pharmacology
February 10, 2022 16:21 - 10 minutes - 5.01 MBOn this episode, I discuss clomiphene pharmacology, adverse effects, clinical practice pearls, and drug interactions. Clomiphene is a commonly used medication to help manage female infertility. Clomiphene is oral and relatively inexpensive compared to other agents that are used for infertility management. Clomiphene is a SERM so you can anticipate that some patients may report vasomotor symptoms like flushing and hot flashes.
Fluticasone Nasal Pharmacology
February 03, 2022 15:48 - 12 minutes - 11.3 MBFluticasone (Flonase) is a nasal corticosteroid that is used in the management of allergic rhinitis. A primary adverse effect that I have seen in practice with fluticasone is the risk for nose bleeds. Flonase can have some interactions via CYP3A4. Inhibitors of CYP3A4 like clarithromycin can increase concentrations. While the risk for systemic exposure is low with nasal fluticasone, long-term, high dose, and frequent use should be monitored appropriately.
Sucralfate Pharmacology
January 27, 2022 15:06 - 12 minutes - 5.9 MBOn this episode, I discuss (Carafate) sucralfate pharmacology, adverse effect, kinetics, and drug interactions. Sucralfate is notorious for drug binding interactions and can reduce the concentrations of many drugs which I cover in the podcast. Four times daily dosing is a big downside to sucralfate and why it isn't used terribly often for GI issues like esophagitis. The suspension formulation of sucralfate does contain some sugar so be aware of this in our diabetes patients.
Atenolol Pharmacology
January 20, 2022 14:02 - 11 minutes - 10.6 MBOn this episode, I discuss atenolol pharmacology, adverse effects, pharmacokinetics, and drug interactions. Atenolol is primarily cleared by the kidney which should tell you that we need to pay attention to dose adjustments as renal function declines. Atenolol is a beta-1 selective agent that is NOT a preferred beta-blocker in HFrEF. Pulse and blood pressure monitoring is essential with any beta-blocker like atenolol.
Hydromorphone Pharmacology
January 13, 2022 15:03 - 13 minutes - 12.7 MBOn this episode, I discuss hydromorphone pharmacology, adverse effect, and drug interactions. I discuss the pharmacokinetics of hydromorphone and also discuss the relative potency compared to other opioids. Hydromorphone drug interactions are mostly additive effects. Drugs that cause sedation or constipation can have additive effects on hydromorphone. Be extremely careful with hydromorphone dosage forms. There are numerous different concentrations and strengths. I discuss this in this e...
Duloxetine Pharmacology
January 06, 2022 14:14 - 15 minutes - 14.6 MBOn this episode, I discuss duloxetine pharmacology, adverse effects, and common drug interactions. Duloxetine is an SNRI that is used for depression, anxiety, and various pain syndromes like neuropathy and fibromyalgia. Duloxetine can inhibit CYP2D6 which can lead to higher concentrations of clozapine and propranolol and lower activity of tamoxifen. CYP1A2 inhibitors like ciprofloxacin can raise concentrations of duloxetine leading to an increased potential for adverse effects.
Lasmiditan Pharmacology
December 30, 2021 16:07 - 13 minutes - 12.8 MBLasmiditan (Reyvow) is an agent that is utilized for acute migraine treatment. It works slightly differently than triptans which I discuss on this episode. Lasmiditan is a relatively new agent and cost will often limit its use at this time. Rosuvastatin and sulfasalazine are two common medications that may have concentrations increase when lasmiditan is used. I discuss this in detail on this episode. Lasmiditan is an oral tablet that is only recommended to give once per day which differs...
Sumatriptan Pharmacology
December 23, 2021 17:02 - 14 minutes - 13.3 MBOn this episode, I discuss sumatriptan pharmacology, adverse effects, drug interactions and more. Dosage forms can provide different methods of drug delivery and I talk about many different sumatriptan dosage forms in this episode. Cardiovascular risks need to be assessed when using a drug like sumatriptan. I discuss this in greater detail in the podcast. Sumatriptan has serotonergic activity and we need to assess the risk of serotonin syndrome in our patients.
Bumetanide Pharmacology
December 16, 2021 15:53 - 13 minutes - 12 MBOn this episode of the Real Life Pharmacology Podcast, I discuss bumetanide pharmacology, adverse effects, and drug interactions. Bumetanide is a loop diuretic and it is critical to monitor renal function and electrolytes with this medication. Ototoxicity is a rare adverse effect that is dose-dependent and can be worsened by aminoglycosides. It is critical to look for drugs that can worsen edema when using bumetanide to ensure that we avoid the prescribing cascade.
Oxycodone Pharmacology
December 09, 2021 17:00 - 13 minutes - 11.9 MBOn this episode, I discuss oxycodone pharmacology, adverse effect, pharmacokinetics, and drug interactions. Oxycodone is broken down by CYP3A4 and CYP2D6. I discuss this further on the podcast and how interactions may alter concentrations. When a patient stops taking oxycodone after being on it for some time, you must recognize common symptoms of withdrawal. Oxycodone comes as in an extended-release and immediate-release oral formulation.
Doxycycline Pharmacology
November 25, 2021 15:32 - 14 minutes - 13.6 MBOn this episode of the Real Life Pharmacology podcast, I explore doxycycline pharmacology, adverse effects, and drug interactions. Doxycycline can be bound by numerous minerals like calcium, magnesium, and iron. Coadministration can lead to reduced concentrations. Sun sensitivity is a really important adverse effect that can be caused by doxycycline. Be sure to educate your patients. Doxycycline can be used as an alternative to beta-lactams and macrolides in the management of community-...
Tolterodine Pharmacology
November 18, 2021 16:02 - 13 minutes - 6.06 MBOn this episode, I discuss tolterodine pharmacology, adverse effects, and drug interactions. Tolterodine (Detrol) is an anticholinergic medication used to manage the symptoms of overactive bladder. Tolterodine's anticholinergic activity can lead to a significant number of adverse effects like dry mouth, dry eyes, constipation, and urinary retention. Elderly patients may be at greater risk for anticholinergic adverse effects from tolterodine compared to younger patients. Tolterodine can ...
Clarithromycin Pharmacology
November 11, 2021 14:02 - 12 minutes - 16.9 MBOn this episode, I discuss clarithromycin pharmacology, adverse effects, and drug interactions. Clarithromycin is a macrolide antibiotic that can be used for many similar indications as azithromycin. Clarithromycin has numerous drug interactions as it can inhibit CYP3A4. This limits its use in practice. Clarithromycin can be used in the treatment of H. pylori in combination with other antibiotics and a PPI.
Azathioprine Pharmacology
November 04, 2021 14:15 - 14 minutes - 20 MBOn this episode, I discuss azathioprine pharmacology, adverse effects, monitoring parameters, and drug interactions. Azathioprine is classified as an immunosuppressive agent so it is naturally going to be used for autoimmune type disorders and transplantation. Azathioprine has a boxed warning for myelosuppression. I talk more about this in the episode. Genetic testing is recommended by the AGA prior to the use of azathioprine. I discuss which tests might be helpful to reduce the risk of...
Amitriptyline Pharmacology
October 28, 2021 16:15 - 11 minutes - 16.2 MBOn this episode, I discuss amitriptyline pharmacology, adverse effects, and drug interactions.
Grapefruit Juice Interactions
October 21, 2021 16:15 - 16 minutes - 22.3 MBOn this episode of the podcast, I discuss my approach and strategies to handle grapefruit juice interactions. Grapefruit juice causes drug interactions by inhibiting the CYP enzyme system. More specifically, it inhibits CYP3A4 which is responsible for the breakdown of many medications. Quantity is always an important consideration when assessing grapefruit juice interactions. The more that is taken, typically, the more drug concentrations will be affected. It is important to assess the us...
Pantoprazole Pharmacology
October 14, 2021 13:38 - 14 minutes - 19.3 MBOn this episode, I cover pantoprazole pharmacology, adverse effects, and drug interactions.
Rosuvastatin Pharmacology
October 07, 2021 15:00 - 14 minutes - 20.3 MBOn this episode, I discuss rosuvastatin pharmacology, adverse effects, drug interactions and pharmacokinetics. Rosuvastatin is a hydrophilic statin which differs from some of the most commonly used statins like simvastatin and atorvastatin. Rosuvastatin is minimally affected by CYP3A4 drug interactions so that is a small potential advantage over simvastatin and atorvastatin. At dosages of 20-40 mg, rosuvastatin is considered a high intensity statin and can bring down LDL by over 50%.
Atorvastatin Pharmacology
September 30, 2021 16:28 - 15 minutes - 21.8 MBOn this episode, I discuss atorvastatin pharmacology, adverse effects, monitoring parameters, and drug interactions. Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor, the rate-limiting step in the production of cholesterol. It is used to prevent atherosclerotic cardiovascular diseases by decreasing cholesterol. Atorvastatin is more lipophilic in comparison to other statins such as rosuvastatin. If a patient does not tolerate a statin, switching from a lipophilic to a hydrophilic or...
Gemfibrozil Pharmacology
September 23, 2021 15:23 - 13 minutes - 19.1 MBOn this episode, I discuss gemfibrozil pharmacology, adverse effects, and important drug interactions.
Trospium Pharmacology
September 16, 2021 14:17 - 11 minutes - 15.6 MBOn this episode, I discuss trospium pharmacology, adverse effects, and important drug interactions you should know. Trospium chloride (Sanctura) is a bladder antimuscarinic or anticholinergic. It blocks the action of acetylcholine in bladder smooth muscle. It is used for urinary frequency and overactive bladder. The immediate-release formulation is taken twice a day. There is an extended-release version that is more expensive. As its classification suggests it is going to have anticholiner...
Propranolol Pharmacology
September 09, 2021 14:10 - 14 minutes - 19.9 MBOn this episode, I discuss propranolol pharmacology, adverse reactions, and important drug interactions you should know. Propranolol (Inderal) is a non-selective beta-blocker. There are many indications for it including hypertension, tachycardia, atrial fibrillation, post-MI, chronic stable angina, essential tremors, migraine prophylaxis, esophageal varices, performance anxiety disorder, lithium-induced tremor, psychotic induced akathisia, and thyroid storm. Propranolol blocks beta-1 recept...
Quetiapine Pharmacology
September 02, 2021 15:22 - 14 minutes - 6.47 MBOn this episode, I discuss quetiapine pharmacology, adverse effects, pharmacokinetics, and drug interactions. Quetiapine (Seroquel) is a medication seen a fair amount, particularly in the geriatric population where there is psychosis associated with dementia. It is classified as an antipsychotic. Mechanistically it's going to block dopamine receptors, specifically D2. It also has some serotonin receptor blockade antagonism. It does have other activity as well from a mechanism of action stan...
Phenazopyridine Pharmacology
August 26, 2021 14:37 - 12 minutes - 16.6 MBOn this episode, I discuss phenazopyridine pharmacology, adverse effects, and potential drug interactions.
Fluvoxamine Pharmacology
August 19, 2021 15:11 - 13 minutes - 18.3 MBOn this episode, I discuss fluvoxamine pharmacology, adverse effects, and most importantly, drug interactions.
Oxybutynin Pharmacology
August 12, 2021 14:58 - 13 minutes - 18.6 MBOn this episode, I discuss oxybutynin pharmacology, drug interactions, and adverse effects.
Glyburide Pharmacology
August 05, 2021 12:39 - 9 minutes - 12.6 MBOn this episode, I will discuss glyburide pharmacology.
Zaleplon Pharmacology
July 29, 2021 11:25 - 10 minutes - 14.6 MBOn this episode, I discuss the pharmacology of zaleplon including side effects, drug interactions, and important clinical pearls. Zaleplon is a non-benzodiazepine sleep aide commonly known as Sonata. It is commonly used for sedation and the management of insomnia. Zaleplon is a controlled medication, with a high risk for dependence, and because of that, it is best used to treat short-term insomnia. The pharmacology of zaleplon is similar to other sleep aids like Ambien, and Lunesta; they all...
Hydrochlorothiazide Pharmacology
July 22, 2021 11:13 - 13 minutes - 18.1 MBOn this episode, I breakdown the pharmacology of hydrochlorothiazide including adverse effects, drug interactions, and other clinical pearls. Hydrochlorothiazide has common brand names of Microzide, Hydrodiuril, and its common abbreviation is HCTZ. Extra caution should be taken with “HCTZ”; it may be mistaken for other abbreviations. Hydrochlorothiazide works pharmacologically by blocking the reabsorption of sodium in the distal tubule of the kidney. The result of the pharmacology of hydroc...
Torsemide Pharmacology
July 15, 2021 12:26 - 14 minutes - 20 MBOn this episode, I discuss torsemide pharmacology, adverse effects, drug interactions and pharmacokinetics. Torsemide is commonly known as Demadex. It is a loop diuretic, and like other loop diuretics, it acts by inhibiting the reabsorption of Na+ and Cl- in the ascending loop of Henle. What results is a decrease in the reabsorption of water, causing a loss of electrolytes as well as water. The pharmacology of torsemide makes it useful in cases of heart failure, cirrhosis, or hypertension. To...
Doxylamine Pharmacology
July 08, 2021 15:34 - 11 minutes - 15.7 MBIn the podcast this week, I talk about doxylamine pharmacology. Doxylamine is a first-generation antihistamine; it is commonly an active ingredient in night-time medications like Unisom, Nyquil, and Mucinex. The pharmacology of doxylamine is similar to other first-generation antihistamines, it competitively inhibits the binding of histamine at H1 receptors. Its main uses are as sleep aides, in cough-and-cold medications, but doxylamine has also been given with pyridoxine to treat nausea and v...
Sacubitril Valsartan Pharmacology
July 01, 2021 15:53 - 12 minutes - 17.6 MBOn this episode, I breakdown the sacubitril valsartan pharmacology. The drug for this week is the combination drug sacubitril/valsartan, also known as Entresto. Entresto has a novel dual mechanism of action to treat HFrEF. Sacubitril, currently, is the only FDA-approved medication that is a neprilysin inhibitor. For background, neprilysin is an enzyme that breaks down natriuretic peptides. The inhibition of neprilysin results in an increase in natriuretic peptides, which causes vasodilation,...
Glipizide Pharmacology
June 24, 2021 16:56 - 12 minutes - 17.5 MBGlipizide, or Glucotrol, is a sulfonylurea used for the treatment of Type 2 Diabetes. Pharmacologically, glipizide acts by stimulating beta-cells in the pancreas to release insulin. Specifically, glipizide will block the opening of ATP-sensitive potassium channels on the plasma membrane of beta-cells on the pancreas. The result of that is depolarization, which then causes stimulation of voltage-sensitive calcium channels, eventually causing the exocytosis of insulin. The increased insulin wil...
Cetirizine Pharmacology
June 17, 2021 16:29 - 10 minutes - 14.7 MBOn this episode of the Real Life Pharmacology Podcast, I discuss cetirizine pharmacology. Cetirizine, commonly known as Zyrtec, is a 2nd generation antihistamine. Compared to 1st generation antihistamines, like diphenhydramine and chlorpheniramine, 2nd generation antihistamines have fewer anticholinergic effects. Pharmacologically, cetirizine works by selectively blocking histamine from binding to the H1 receptor. The uses for cetirizine are allergic rhinitis, itching, and sometimes acute a...
Folic Acid Pharmacology
June 10, 2021 15:26 - 12 minutes - 17.2 MBFolic acid is a water-soluble vitamin; compared to fat-soluble vitamins, accumulation is not as much of an issue. It is responsible for the formation of coenzymes, DNA synthesis, erythropoiesis, and certain metabolic processes. Due to the mechanism of folic acid, if there is a deficiency present, anemia can manifest. Although the recommended dietary intake is 0.2 mg, supplementation may be necessary. Some situations where supplementation may be desired are prevention of neural tube defects in...