Real Life Pharmacology - Pharmacology Education for Health Care Professionals
324 episodes - English - Latest episode: 10 days ago - ★★★★★ - 643 ratingsA Meded101.com Production
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Episodes
Insulin Glargine Pharmacology
June 03, 2021 15:56 - 17 minutes - 24.6 MBOn this episode, I discuss insulin glargine pharmacology. Insulin glargine is a long-acting insulin that has the common brand names Lantus, Basaglar, and Toujeo. Due to the pharmacology of insulin glargine, it provides a baseline coverage of insulin. It cannot manage acute elevations in blood glucose like target-specific meals. Instead, insulin glargine is used to decrease blood sugar throughout the day. It is normally dosed once a day, and sometimes a patient will have another type of insu...
Primidone Pharmacology
May 27, 2021 16:21 - 12 minutes - 17.4 MBOn this episode, I discuss primidone pharmacology, adverse effects, and drug interactions. Primidone, or Mysoline, is an anticonvulsant most commonly used for essential tremors. The primary pharmacological mechanism of action of primidone is similar to other anticonvulsants, like phenobarbital. It causes a reduction in the activity of neurons. Both primidone and its metabolites are potent anticonvulsants. Primidone alters the transmembrane Na/Cl transport channel to reduce the frequency of ...
Melatonin Pharmacology
May 20, 2021 16:00 - 14 minutes - 19.6 MBI cover melatonin pharmacology on this episode of the Real Life Pharmacology Podcast. Melatonin, commonly taken by patients for insomnia, is an endogenous hormone produced by the pineal gland. It is an over-the-counter supplement available in dosage forms such as liquid drops, gummies, and tablets. The pharmacology of melatonin is primarily through the activation of melatonin receptors in the suprachiasmatic nucleus; it is also a derivative of L-tryptophan. The production and secretion of m...
Furosemide Pharmacology
May 13, 2021 15:52 - 16 minutes - 22.2 MBFurosemide is a loop diuretic most commonly recognized by its brand name, Lasix. Pharmacologically, it acts by inhibiting the reabsorption of Na/Cl in the thick ascending limb of the loop of Henle. The inhibition of electrolyte reabsorption results in a loss of fluids causing diuresis. Since it has a diuretic effect, it is commonly used to treat congestive heart failure, general edema, ascites due to cirrhosis, and to aid in fluid elimination. If a patient has a new prescription of furosemi...
Hydroxyzine Pharmacology
May 06, 2021 15:01 - 13 minutes - 18.5 MBBackground: - Hydroxyzine Pharmacology Hydroxyzine, common brands Atarax, and Vistaril, is a first-generation antihistamine. It is a part of the piperazine drug class[1], sharing structural similarities to other antihistamines like Cetirizine, but also drugs of other classes like ranolazine, buspirone, clozapine. Being an H1 blocker, hydroxyzine is commonly used for itching, anxiety, analgesia, urticaria, and insomnia. The main adverse drug reactions associated with hydroxyzine are the antich...
Vitamin B12 Pharmacology
April 29, 2021 15:42 - 14 minutes - 19.9 MBOn this episode, I cover clinical tips and practice pearls surrounding vitamin B12 pharmacology. Vitamin B12 deficiency plays a critical role in the development of macrocytic anemia. There are medications that you have to be aware that can deplete vitamin B12. Metformin, colchicine, and PPIs are some common examples. A lack of intrinsic factor can lead to B12 deficiency. Intrinsic factor is necessary for adequate GI absorption of vitamin B12.
Ketamine Pharmacology
April 22, 2021 15:50 - 12 minutes - 16.5 MBOn this episode, I discuss ketamine pharmacology. Ketamine is primarily broken down by CYP2B6 which fortunately does not have a lot of common medications that can interfere with its action. Ketamine can cause psychiatric type adverse effects such as hallucinations, nightmares, and vivid dreams. At lower to moderate dosages, ketamine does have some mild sympathetic activity which can raise blood pressure and heart rate.
Topiramate Pharmacology
April 15, 2021 15:32 - 12 minutes - 16.8 MBOn this episode of the Real Life Pharmacology Podcast, I cover topiramate pharmacology. Topiramate is indicated for migraine prevention, seizures, and weight loss which are the most common uses that I see this medication used for. Topiramate has carbonic anhydrase activity, so rarely, use of this drug may induce metabolic acidosis. By far, the most common patient complaint I get with the use of topiramate is that it causes cognitive slowing or impairment.
Colchicine Pharmacology
April 08, 2021 14:06 - 12 minutes - 17.4 MBOn this episode I discuss colchicine pharmacology, adverse effects, drug interactions, and pharmacokinetics. Colchicine ultimately works by reducing the activity of neutrophils that help contribute to pain and inflammation associated with gout. Colchicine does have some drug interactions with medications and grapefruit juice via CYP3A4. The most common dose limiting side effect of colchicine is diarrhea. Colchicine can be used as a potential alternative to NSAIDs or corticosteroids in ...
Fexofenadine Pharmacology
April 01, 2021 16:20 - 14 minutes - 19.4 MBFexofenadine is a 2nd generation antihistamine that is primarily used for allergic rhinitis. I cover fexofenadine pharmacology on this podcast episode. Fruit juices can actually impair the absorption of fexofenadine and increase the risk of treatment failure. Fexofenadine is mildly anticholinergic but overall has low to no CNS penetration. Because fexofenadine has low CNS penetration, the risk for sedation and dizziness is much lower than older antihistamines like diphenhydramine.
Empagliflozin Pharmacology
March 25, 2021 17:07 - 12 minutes - 17.6 MBOn this episode I discuss empagliflozin pharmacology and how this medication lowers blood sugar. In this episode, I talk about empagliflozin pharmacology. Empagliflozin is more commonly known by the brand name Jardiance and is in the class of sodium-glucose co-transporter-2 inhibitors or SGLT2 inhibitors. Jardiance use has definitely escalated over the last few years in the management of type 2 diabetes, but this has been changing a little bit as well due to recent evidence for the cardiovas...
Rifaximin Pharmacology
March 18, 2021 17:24 - 12 minutes - 16.6 MBOn this episode, I discuss rifaximin pharmacology. Rifaximin is most commonly used in hepatic encephalopathy and C. difficile infection. Rifaximin systemic absorption is minimal so that is why it is primarily only used for GI conditions. Drug interactions with rifaximin are fairly minimal compared to its cousin rifampin which has tons of drug interactions.
Naproxen Pharmacology
March 11, 2021 18:23 - 13 minutes - 18.5 MBOn this episode of the Real Life Pharmacology Podcast, I discuss naproxen pharmacology. Naproxen can raise the concentrations of lithium and increase the risk for toxicity. Compared to most other NSAIDs, naproxen tends to have a lower cardiovascular risk. Naproxen can contribute to renal insufficiency, GI bleed risk, and CHF exacerbations.
Cyclosporine Pharmacology
March 04, 2021 16:36 - 14 minutes - 20.7 MBOn this episode, I discuss cyclosporine pharmacology. This medication is an immunosuppressant used to reduce the risk of transplant rejection. Cyclosporine has a long list of potential adverse effects such as hyperglycemia, renal impairment, GI toxicity, and hypertriglyceridemia. Important monitoring parameters for cyclosporine include drug levels, electrolytes, renal function, and blood sugars. CYP3A4 interactions are critical with cyclosporine. Inhibitors can raise concentrations and ...
Leflunomide Pharmacology
February 25, 2021 20:43 - 12 minutes - 16.6 MBOn this episode, I discuss leflunomide pharmacology. It is classified as a DMARD and is primarily used in rheumatoid arthritis. Leflunomide carries a boxed warning for hepatoxicity. LFTs must be monitored with its use. Leflunomide can inhibit CYP2C8 which plays an important role in pioglitazone metabolism. Concentrations of pioglitazone can go up on account of this interaction. TB screening should be done prior to beginning the immunosuppressant leflunomide.
Baclofen Pharmacology
February 18, 2021 15:23 - 14 minutes - 20 MBBaclofen is primarily used for its ability to help relieve muscle spasms. I discuss baclofen pharmacology on this podcast episode. Baclofen should not be abruptly discontinued as it can cause a significant withdrawal reaction whose symptoms may include fever, spasticity, rhabdomyolysis, and death. While baclofen generally avoids any issues with CYP enzyme interactions, it is eliminated by the kidney. Renal function changes can alter drug concentrations. Sedation, confusion, dizziness, h...
Bromocriptine Pharmacology
February 11, 2021 14:16 - 11 minutes - 15.9 MBOn this episode, I discuss bromocriptine pharmacology. It is a dopamine agonist that can be used for hyperprolactinemia and Parkinson's symptoms. One of the major side effects of bromocriptine is nausea which stems from its dopamine agonist action. Because bromocriptine is a dopamine agonist, it can counteract the action of antipsychotics. Bromocriptine is broken down by CYP3A4, so drug interactions can be common. Erythromycin, some of the azole antifungals, verapamil, grapefruit juice,...
Tacrolimus Pharmacology
February 04, 2021 16:49 - 14 minutes - 20.7 MBOn this episode, I discuss tacrolimus pharmacology. This medication is an immunosuppressant used to reduce the risk of transplant rejection. Tacrolimus has a long list of potential adverse effects such as hyperglycemia, renal impairment, GI toxicity, and hypertriglyceridemia. Important monitoring parameters for tacrolimus include drug levels, electrolytes, renal function, and blood sugars. CYP3A4 interactions are critical with tacrolimus. Inhibitors can raise concentrations and inducers...
Ibuprofen Pharmacology
January 28, 2021 20:02 - 15 minutes - 21.7 MBOn this episode of the Real Life Pharmacology Podcast, I discuss ibuprofen pharmacology. Ibuprofen can raise the concentrations of lithium and increase the risk for toxicity. Compared to most other NSAIDs, ibuprofen has a relatively short half-life. This explains why it needs to be dosed more frequently than other agents. Ibuprofen can contribute to renal insufficiency, GI bleed risk, and CHF exacerbations.
Aripiprazole Pharmacology
January 21, 2021 17:38 - 14 minutes - 20.3 MBAripiprazole is metabolized by CYP2D6 and CYP3A4. Because of this, drug interactions can happen. I discuss specific examples in this episode. Partial dopamine agonist activity and serotonergic activity make up a significant amount of aripiprazole's pharmacology. Aripiprazole is classified as an antipsychotic and can be used in schizophrenia, bipolar disorder, and depression augmentation. Aripiprazole can cause significant akathesia. I discuss this adverse effect on this episode.
Escitalopram Pharmacology
January 14, 2021 12:58 - 15 minutes - 21.4 MBOn this episode of the Real Life Pharmacology Podcast, I discuss escitalopram pharmacology. Escitalopram is an SSRI and can be used to manage depression, anxiety, OCD, PTSD, and other psychiatric disorders. If you consider fluoxetine the most activation SSRI and paroxetine the most sedating, escitalopram probably falls somewhere in the middle. Sexual dysfunction is a potential adverse effect with escitalopram. I discuss it further on this episode.
Ziprasidone Pharmacology
January 07, 2021 15:14 - 13 minutes - 18.4 MBOn this episode of the Real Life Pharmacology Podcast, I cover ziprasidone pharmacology. Ziprasidone has dopamine blocking activity and is classified as a second generation antipsychotic. Ziprasidone tends to have lower metabolic syndrome risks compared to other antipsychotics like clozapine and olanzapine. QTc prolongation is a significant risk with ziprasidone and be aware of drug interactions and electrolyte imbalances that may increase this risk.
Tiotropium Pharmacology
December 31, 2020 13:20 - 13 minutes - 19.4 MBOn this episode, I discuss tiotropium pharmacology. In addition, I cover adverse effects, administration pearls, and drug interactions. Tiotropium blocks acetylcholine from binding the M3 receptor in the lungs. This leads to a relaxation of the bronchial smooth muscle. Because tiotropium has anticholinergic activity, there is a potential for anticholinergic adverse effects like constipation, urinary retention, and dry mouth. The tiotropium Handihaler can be confusing to patients. I disc...
Palivizumab Pharmacology
December 24, 2020 13:10 - 13 minutes - 19.3 MBOn this episode, I discuss palivizumab pharmacology and how it is used in pediatric patients. Palivizumab is a monoclonal antibody that is used to prevent RSV infections in pediatric patients. Palivizumab is an IM injection that is dosed by weight. Learn more on this podcast episode. RSV can be devastating in pediatric patients under the age of two. Palivizumab can be used in select populations to help prevent the infection. Injection and skin reactions are possible with the use of pal...
Varenicline Pharmacology
December 17, 2020 18:19 - 13 minutes - 18.7 MBVarenicline is a partial nicotine agonist that can be used to help patients quit smoking. The two most common adverse effects that I have seen in clinical practice with varenicline are GI upset and insomnia/vivid dreams. GI upset with varenicline can be reduced by giving the drug with food and a full glass of water. A dose reduction may also be considered. Patients should identify a goal stop date for smoking cessation prior to begininng the use of varenicline.
Diphenhydramine (Benadryl) Pharmacology
December 10, 2020 18:03 - 13 minutes - 19 MBDiphenhydramine is a first generation antihistamine that is highly anticholinergic. When using medications like diphenhydramine, be sure to watch for side effects like dry eyes, dry mouth, constipation, urinary retention, and CNS changes. Sedation is a primary effect of diphenhydramine. It can be advantageous in certain situations, and detrimental in others. Drugs like donepezil, memantine, laxatives, tamsulosin, and artificial tears can be indicators of anticholinergic side effects fro...
Fluconazole Pharmacology
December 03, 2020 14:50 - 13 minutes - 19.5 MBOn this episode of the RLP podcast, I discuss fluconazole pharmacology. Fluconazole prevents fungi from producing essential components for their cell membrane and thus inhibits their growth. Drug interactions are common with fluconazole. Fluconazole inhibits CYP3A4, 2C9, and 2C19 to varying degrees. I discuss an interaction between fluconazole and phenytoin in this podcast episode. Hepatitis has rarely been reported with the use of azole antifungals like fluconazole.
Levetiracetam Pharmacology
November 26, 2020 14:42 - 12 minutes - 18 MBOn this episode of the RLP podcast, I discuss levetiracetam pharmacology. Levetiracetam is indicated for numerous types of seizures and possibly works by enhancing GABA activity. Sedation and dizziness are two common adverse effects of levetiracetam. On this episode, I discuss when and if we might do levetiracetam levels. Levetiracetam tends to have much fewer drug interactions compared to older agents like phenytoin and carbamazepine.
Scopolamine Pharmacology
November 19, 2020 14:35 - 11 minutes - 16.1 MBIn this episode of the RLP podcast, I discuss scopolamine pharmacology. Scopolamine patches can be used in the management of motion sickness and surgery/anesthesia induced nausea and vomiting. Transdermal scopolamine has a slow onset of action so we need to be deliberate about the timing of placement (usually 4-6 hours prior to anticipated time of symptoms). Transdermal scopolamine is highly anticholinergic and can cause dry eyes, dry mouth, urinary retention, and confusion.
Tamsulosin Pharmacology
November 12, 2020 19:02 - 12 minutes - 17 MBOn this episode of the RLP podcast, I discuss tamsulosin pharmacology. Tamsulosin inhibits alpha receptors which helps improve urine flow in patients with BPH. As an off-label use, you may see tamsulosin used to try to aid in the passage of renal stones. Tamsulosin concentrations may be increased by CYP3A4 inhibitors and reduced by CYP3A4 inducers.
Finasteride Pharmacology
November 05, 2020 18:44 - 11 minutes - 15.9 MBOn this episode of the RLP podcast, I discuss finasteride pharmacology. Finasteride can be used in the management of BPH or male pattern baldness. By reducing overall androgen burden, finasteride can help to shrink the prostate and improve BPH symptoms. Finasteride takes a long time to work, so this is an important education point for patients.
Lamotrigine Pharmacology
October 29, 2020 13:09 - 11 minutes - 16.9 MBOn this episode of the Real Life Pharmacology podcast, I discuss the ins and outs of lamotrigine pharmacology. Lamotrigine has a very slow dose titration schedule due to the risk of drug induced rash. Sedation, GI upset, and CNS changes are the most common adverse effects associated with lamotrigine. Lamotrigine concentrations can be increased by valproic acid, so we tend to use lower starting doses. Phenytoin and carbamazepine can lower concentrations of lamotrigine.
Propofol Pharmacology
October 22, 2020 14:43 - 12 minutes - 18.3 MBOn this episode of the Real Life Pharmacology podcast, I breakdown propofol pharmacology. Propofol is a CNS depressant that is used for general anesthesia. I discuss propofol infusion syndrome in this episode and what to look out for clinically. Adding a benzodiazepine or opioid to propofol may have a synergistic effect and the propofol dose may need to be reduced.
Glucagon Pharmacology
October 15, 2020 14:26 - 13 minutes - 18.7 MBOn this episode of the RLP podcast, I discuss glucagon pharmacology. It is important to remember with glucagon that patients will still require glucose following administration to improve their blood sugar numbers. Glucagon is typically reserved for moderate to severe episodes of hypoglycemia when patients have altered consciousness. The major adverse effect with glucagon is nausea and vomiting which often may prevent oral intake of glucose for some time after administration.
Dulaglutide Pharmacology
October 08, 2020 15:43 - 13 minutes - 18.7 MBDulaglutide is a GLP-1 agonist used in the management of diabetes. Dulaglutide has 4 different dosages that can be used to help lower A1C. As the dose goes up, so does the potential for adverse effects however. Like most of the GLP-1 agonists, dulaglutide is only available as an injection. Semaglutide is an exception to this. Nausea is the primary adverse effect of dulaglutide which some patients may get used to over time.
Dapagliflozin Pharmacology
October 01, 2020 15:32 - 12 minutes - 17.5 MBDapagliflozin is an SGLT-2 Inhibitor that reduces blood sugar by increasing the excretion of sugar through the urine. Genital and urinary infections is a potential risk with the use of SGLT2 Inhibitors like dapagliflozin. Dapagliflozin has received FDA approval for use in heart failure (in patients even without diabetes). Be aware of agents that may enhance the risk for hypoglycemia such an insulin and sulfonylureas.
Omeprazole Pharmacology
September 24, 2020 15:17 - 14 minutes - 20.5 MBOmeprazole is a proton pump inhibitor that can be commonly used for GERD, PUD, and GI prophylaxis. Omeprazole can inhibit CYP2C19 which can cause concentrations of drugs like escitalopram and citalopram to rise. Hypomagnesemia, low B12, osteoporosis, and an increase in C. Diff risk are potential complications with longer term PPI use. PPI's like omeprazole are best given 30-60 minutes before meals. This is something that patients often forget.
Conjugated Estrogens Pharmacology
September 17, 2020 20:05 - 13 minutes - 18.5 MBConjugated estrogens (Premarin) are most often used in the management of menopausal symptoms. Estrogen therapy can increase the risk for breast cancer and the risk should be assessed before beginning therapy. Blood clots are a potential consequence from the use of Premarin. Premarin can oppose the benefit of anticoagulation. Conjugated estrogens are broken down by CYP3A4. Inhibitors may increase concentrations while inducers may reduce concentrations.
Paroxetine Pharmacology
September 10, 2020 14:45 - 12 minutes - 18.3 MBParoxetine (Paxil) is an SSRI that can be used in the management of depression. I discuss more on paroxetine pharmacology in this episode. Because paroxetine has some modest anticholinergic effects, it does show up on the Beers list as a potentially inappropriate medication. By inhibiting CYP2D6, paroxetine can have numerous drug interactions. Drugs like atomoxetine, aripiprazole, and metoclopramide can all have their concentrations increased. Tamoxifen is activated by CYP2D6 and paroxetin...
Olanzapine Pharmacology
September 03, 2020 11:54 - 11 minutes - 16.7 MBOlanzapine is a 2nd generation antipsychotic that blocks dopamine-2 receptors. Olanzapine Relprevv (long acting injectable) needs to be closely monitored after the injection is given due to risks of sedation and delirium. Sedation is a common occurance with the use of olanzapine. It is one of the more sedating second generation antipsychotics. Weight gain, hyperlipidemia, and hyperglycemia are all potential adverse effects with olanzapine.
Tizanidine Pharmacology
August 27, 2020 14:45 - 11 minutes - 16.1 MBTizanidine is primarily broken down by CYP1A2. Ciprofloxacin can inhibit CYP1A2 and cause higher tizanidine concentrations. Tizanidine has a similar classification as clonidine. Pay attention to adverse effects like hypotension and bradycardia. When patients taking routine tizanidine stop taking it, there is potential for a discontinuation syndrome that may lead to rebound hypertension. Dry mouth and CNS depression are common adverse effects of tizanidine.
Valacyclovir Pharmacology
August 20, 2020 15:56 - 13 minutes - 19.7 MBValacyclovir can be used for various viral infections such as herpes virus and varicella. The primary clinical advantage of valacyclovir compared to acyclovir is that it is dosed less frequently. Valacyclovir may have some mild CYP1A2 inhibitory effect. I discuss the clinical relevance of this on this episode. GI upset can occur so I usually recommend to give it with food even though it may be given with or without food.
Abacavir Pharmacology
August 13, 2020 16:47 - 12 minutes - 17.1 MBAbacavir is a nucleoside reverse transcriptase inhibitor used in the management of HIV. In patients who have the HLA-B*5701 allele, they are at much greater risk for hypersensitivity reactions. Lactic acidosis and hepatomegaly are potential complications with the use of abacavir. While abacavir is not known for a large number of drug interactions, I discuss a few that you have a chance to run into.
Sertraline Pharmacology
August 06, 2020 13:19 - 16 minutes - 22.8 MBSertraline is an SSRI. It has the highest potential to cause diarrhea of any SSRI. Sertraline is often called "Squirtraline" because of its potential to cause diarrhea. Sertraline has a much shorter half-life than fluoxetine. I discuss why that may be important in this podcast episode. I discuss the role of serotonin in platelet aggregation and how sertraline may affect this.
Fosfomycin Pharmacology
July 30, 2020 12:49 - 13 minutes - 18.8 MBFosfomycin is an antibacterial agents that can be utilized in the management of uncomplicated UTIs. Uniquely, fosfomycin comes as a packet that needs to be mixed with COOL water. I discuss this further on the podcast. Typhoid and Cholera vaccine effectiveness may be reduced when used with fosfomycin. When there is kidney or systemic infection involvement, it is recommended to avoid the use of fosfomycin.
Simvastatin Pharmacology
July 23, 2020 16:06 - 15 minutes - 21.3 MBSimvastatin use has declined over time due to more potent statins being available and due to numerous drug interactions. Grapefruit juice can inhibit CYP3A4 which will increase the concentrations of simvastatin. Genetic variations in SLCO1B1 can lead to patients being more susceptible to simvastatin toxicity. Simvastatin is a lipophilic statin. I discuss why this is important and how it might impact clinical decisions.
Citalopram Pharmacology
July 16, 2020 14:34 - 17 minutes - 24.3 MBCitalopram is an SSRI used in the management of depression, anxiety, OCD, and PTSD. How do you manage the risk of citalopram causing QTc prolongation? I discuss it further in the podcast. Omeprazole can inhibit CYP2C19 which affects the metabolism of citalopram. I discuss the clinical impacts of this interaction in the podcast. Geriatric dosing with citalopram is recommended to be lower than traditional adult dosing. I discuss this further in the podcast.
Epoetin Alfa Pharmacology
July 09, 2020 17:41 - 14 minutes - 21.1 MBEpoetin alfa is essential exogenous erythropoetin which can stimulate the production of red blood cells. It is critical to ensure adequate iron stores when using EPO. Risks for blood clots, strokes and heart attacks are critical to recognize with the use of epoetin. Dosage adjustments with epoetin are typically made with respect to the amount of change in hemoglobin. I discuss this further in the podcast.
Dexamethasone Pharmacology
July 02, 2020 12:03 - 12 minutes - 18.3 MBDexamethasone has numerous possible indications such as asthma, chemotherapy-induced nausea and vomiting, and pain associated with inflammation. Dexamethasone is more potent than prednisone. Approximately 0.75 mg of dexamethasone is equivalent to 5 mg of prednisone. When using dexamethasone, recall that it can raise blood sugars. Monitor this closely in patients with diabetes. A dexamethasone suppression test helps detect excessive endogenous production of cortisol.
Sildenafil Pharmacology
June 25, 2020 16:08 - 13 minutes - 18.9 MBOn this episode, I discuss sildenafil pharmacology, adverse effects, and important drug interactions. Sildenafil's most common and concerning adverse effect is in relation to its ability to lower blood pressure. I discuss this further in the podcast. Sildenafil can cause rare visual changes that patients should be aware of and report immediately to their pharmacist or physician. The sildenafil nitrate interaction is essential to know. I discuss it in this podcast episode.