Real Life Pharmacology - Pharmacology Education for Health Care Professionals
324 episodes - English - Latest episode: 10 days ago - ★★★★★ - 643 ratingsA Meded101.com Production
Homepage Apple Podcasts Google Podcasts Overcast Castro Pocket Casts RSS feed
Episodes
Codeine Pharmacology
June 18, 2020 16:09 - 15 minutes - 21.2 MBOn this episode, I discuss codeine pharmacology and practical clinical practice pearls. Codeine is metabolized by CYP2D6 to the active metabolite morphine. I discuss how this can be affected by genetics as well as other medications. Constipation is a problem with codeine and all opioids in general. Education and making a plan with patients to combat this side effect is important. Codeine is less potent than other opioids such as fentanyl, hydromorphone, and hydrocodone.
Dexmedetomidine Pharmacology
June 11, 2020 14:37 - 9 minutes - 14.2 MBDexmedetomidine is a selective alpha-2-adrenergic agonist with sedative characteristics. Dexmedetomidine is commonly used in ICU and procedural sedation, as well as postoperative pain. A few of the more serious adverse effects of dexmedetomidine to keep an eye on including bradyarrhythmias/bradycardia and hypotension. Dexmedetomidine undergoes hepatic metabolism, meaning a dose reduction may be required in patients with impaired hepatic function. Major drug interactions to monitoring f...
Calcitonin Pharmacology
June 04, 2020 13:17 - 12 minutes - 12.4 MBOn this episode, I discuss the pharmacology of calcitonin. Calcitonin has an indication for osteoporosis as well as hypercalcemia. When considering drug interactions with calcitonin, recall that it can lower calcium levels which could have a cumulative effect when combined with loop diuretics. Calcitonin nasal spray should be stored upright and primed prior to use.
Rivastigmine Pharmacology
May 28, 2020 15:07 - 13 minutes - 11.5 MBRivastigmine is an acetylcholinesterase inhibitor used in the management of certain dementias. I discuss rivastigmine pharmacology on this episode. Weight loss is a potential adverse effect of rivastigmine. It is important to monitor weights. Anticholinergic medications such as diphenhydramine can blunt the effects of rivastigmine. Rarely, acetylcholinesterase inhibitors like rivastigmine can cause bradycardia.
Caffeine Pharmacology
May 21, 2020 15:58 - 13 minutes - 11.1 MBCaffeine is a commonly used supplement and is found in many food and beverages. I discuss caffeine pharmacology, adverse effects, and drug interactions. Caffeine can inhibit CYP1A2 and also be affected by CYP1A2 inhibitors. I discuss some examples in the podcast. It is critical to inquire about caffeine intake when patients are reporting insomnia. Caffeine has been associated with increases in pulse and blood pressure. Be sure to ask about caffeine intake when assessing these vital signs.
Colestipol Pharmacology
May 14, 2020 12:06 - 12 minutes - 10.1 MBColestipol is a bile acid sequestrant that can be used in the management of hyperlipidemia. By binding bile acid in the gut, colestipol can lower LDL that is bound to bile acid by eliminating it through the feces. Numerous drug interactions existed as colestipol can bind many drugs. This is a downside to its use and why it isn't a preferred hyperlipidemia agent. In patients with elevated triglycerides, colestipol should be avoided.
Metolazone Pharmacology
May 07, 2020 15:02 - 14 minutes - 6.94 MBMetolazone (Zaroxolyn) is a thiazide-like diuretic. It promotes the loss of water and sodium through the kidney. The most common indication I see metolazone used for is for additional fluid loss in heart failure. Potassium must be monitored as it can cause significant hypokalemia which is exacerbated when metolazone is used in combination with loop diuretics. Hyperuricemia is a potential adverse effect with metolazone; this is critical to monitor for in patients at risk for gout attacks.
Ibandronate Pharmacology
April 30, 2020 15:47 - 13 minutes - 11.2 MBIbandronate is a bisphosphonate that can be used in the management of osteoporosis. Bisphosphonates like ibandronate require a full glass of water for oral administration. Patients should remain upright for at least 30-60 minutes following taking ibandronate to help reduce the risk of esophagitis. Osteonecrosis has rarely been associated with bisphosphonates like ibandronate - I've discussed a couple of risk factors that may place a patient at higher risk.
Fluticasone, Umeclidinium, and Vilanterol Pharmacology
April 23, 2020 13:44 - 11 minutes - 5.95 MBFluticasone, Umeclidinium, and Vilanterol is a combination medication used in the setting of COPD. I discuss the pharmacology of this agent further in this episode. Fluticasone is the inhaled corticosteroid portion of the drug while umeclidinium is a LAMA and vilanterol is a LABA medication. Drug interactions aren't incredibly common or strongly clinically significant, but I discuss some of them with Trelegy Ellipta. Having a once-daily dose can be advantageous to help improve patient a...
Hyoscyamine Pharmacology
April 16, 2020 14:17 - 12 minutes - 6.09 MBHyoscyamine is an anticholinergic medication that is primarily used for GI problems like spasms and pain associated with IBS. Because of the highly anticholinergic nature of hyoscyamine, it can cause dry eyes, dry mouth, urinary retention, and constipation. Be aware of the risk for the prescribing cascade with hyoscyamine. Saliva substitutes for dry mouth, artificial tears for dry eyes, etc. Sedation is a concern with hyoscyamine and this can be exacerbated by drugs like benzodiazepines, o...
Calcium Acetate Pharmacology
April 09, 2020 15:47 - 12 minutes - 11.8 MBCalcium Acetate (PhosLo) is used in the management of hyperphosphatemia associated with CKD. Important monitoring parameters for calcium acetate include phosphorus, calcium, PTH, and renal function. There are numerous binding interactions with calcium acetate. It can reduce concentrations of some HIV drugs, antibiotics, and thyroid supplements. I discuss more examples in the podcast. Thiazide diuretic in combination with calcium acetate may increase the risk for hypercalcemia.
Nortriptyline Pharmacology
April 02, 2020 12:37 - 11 minutes - 5.61 MBNortriptyline is a TCA that can be used for depression and various pain syndromes. I discuss other less common diagnoses in this podcast episode as well. There are a lot of drug interactions with nortriptyline. It is metabolized by CYP2D6, can have additive anticholinergic effects and has been associated with QTc prolongation. Nortriptyline is very anticholinergic and can blunt the effects of dementia medications. Dry mouth, dry eyes, sedation, urinary retention, and constipation are a fe...
Hydroxychloroquine Pharmacology
March 27, 2020 09:26 - 15 minutes - 7.46 MBHydroxychloroquine is classified as a DMARD and when used chronically, can be helpful in managing rheumatoid arthritis and Lupus. There have been reports of QTc prolongation with hydroxychloroquine. While not incredibly common, it is important to remember this consideration in patients at risk for QTc prolongation. Hydroxychloroquine is associated with causing retinopathy. Routine eye exams for monitoring purposes are critical. Rarely, hydroxychloroquine can be associated with blood diso...
Latanoprost Pharmacology
March 19, 2020 15:06 - 12 minutes - 11.6 MBLatanoprost is a prostaglandin F2 analog that can help reduce intraocular pressure and manage glaucoma. Excessive eyelash growth is a potential adverse effect of latanoprost, although some patients may appreciate this. Patients with a lighter color iris may notice that their eyes are turning more brown with the chronic use of latanoprost. Corticosteroids are known to increase intraocular pressure and potentially oppose the beneficial effects of latanoprost.
Terbinafine Pharmacology
March 12, 2020 18:31 - 13 minutes - 12.7 MBTerbinafine can inhibit CYP2D6 which plays an important role in the metabolism of many drugs such as metoprolol, fluoxetine, and clozapine. With terbinafine's ability to inhibit CYP2D6, it can also increase the risk of treatment failure with drugs like tamoxifen. When using anti-fungal drugs like terbinafine, remember that fungal infections can often require more time to treat. Terbinafine has the potential to cause liver impairment. I discuss this further on the podcast.
Alendronate Pharmacology
March 05, 2020 19:15 - 12 minutes - 6.41 MBAlendronate is a bisphosphonate that is used in the management of osteoporosis. In this episode, I discuss osteonecrosis risk and what are some of the risk factors that may increase the chances of this very rare adverse effect. Binding interactions are so critical with alendronate. They can essentially make the drug useless. Esophageal irritation and ulceration is one of the possible complications with the use of alendronate.
Diazepam Pharmacology
February 27, 2020 19:18 - 15 minutes - 7.54 MBDiazepam has numerous dosage forms. There are rectal, injectable, and oral formulations of the drug that are commonly used in clinical practice. Diazepam has 2 major metabolic pathways. It is broken down primarily by CYP3A4 and CYP2C19, leaving open the potential for numerous drug interactions. I discuss this further in the podcast. Diazepam is on the Beers list because it has a tendency to accumulate in the geriatric patient population and cause adverse effects like sedation, confusion, ...
Dicyclomine Pharmacology
February 20, 2020 19:07 - 14 minutes - 13.6 MBDicyclomine is an anticholinergic agent that is used to help manage GI pain associated with IBS. Dicyclomine has a very short half-life which means that it can be dosed multiple times per day. Be careful with patients who have predominant constipation with their IBS as dicyclomine can exacerbate this. Bentyl is the brand name of dicyclomine. This drug blocks the action of acetylcholine.
Diltiazem Pharmacology
February 13, 2020 19:37 - 14 minutes - 7.09 MBDiltiazem is a non-dihydropyridine calcium channel blocker that can be used in atrial fibrillation as well as hypertension. One big downside to diltiazem is that it does have a few drug interactions via CYP3A4. Aripiprazole, apixaban, and certain statins are all examples of medication that can have concentrations increased by adding diltiazem to a patient's regimen. Diltiazem works a little differently from dihydropyridine calcium channel blockers (like amlodipine) as it works on the hea...
Zolpidem Pharmacology
February 06, 2020 16:12 - 15 minutes - 7.8 MBZolpidem enhances the action of GABA which is an inhibitor neurotransmitter. Zolpidem metabolism can be impacted by the use of CYP3A4 inhibitors. Concentrations can rise on account of this potential interaction. It is important to remember to go slowly when tapering off zolpidem. Particularly in patients who have been on the drug for a long time or those who are on higher doses. Abnormal sleeping behaviors like sleep-walking, eating, or driving have been reported with zolpidem. Remember...
Oral Semaglutide Pharmacology
January 30, 2020 18:08 - 13 minutes - 13.3 MBOn this episode, I discuss the pharmacology of oral semaglutide. It is a GLP-1 agonist that is the first one in the class to have an oral formulation. There is a recommended dose titration with oral semaglutide that can take a month or two to get therapeutic doses. I disucss this further in this episode. The most common adverse effect of oral semaglutide is nausea. Oral semaglutide is dosed once daily which is nice to try to maximize patient adherence.
Probenecid Pharmacology
January 23, 2020 19:55 - 12 minutes - 6.18 MBPatients with G6PD deficiency who are taking probenecid are at increased risk for hemolytic anemia. In a patient taking probenecid, they need to have adequate kidney function for the drug to work. GI upset is likely the most common adverse effect of probenecid. It can be given with food. Probenecid can raise the concentrations of many common antibiotics like penicillins and cephalosporins. Remember that there are many medications that can oppose the beneficial effects of probenecid. T...
Nicotine Patch Pharmacology
January 16, 2020 19:31 - 16 minutes - 8.04 MBNicotine replacement therapy is an important tool in helping our patients quit smoking. There are lots of clinical pearls involving the pharmacology of nicotine patches and I explore them in this episode. Nicotine patches differ from the gum and other acute relief forms in that they are intended to provide a consistent level of nicotine in the body. The initial dosing of nicotine patches is dependent upon the number of cigarettes smoked by the patient. I discuss it further in the podcast. ...
Doxepin Pharmacology
January 09, 2020 20:11 - 13 minutes - 6.79 MBDoxepin is under the class of tricyclic antidepressants. It can inhibit the reuptake of serotonin and norepinephrine. In addition to the serotonin and norepinephrine reuptake inhibition mechanism, doxepin also has antihistamine type effects. Because of the anticholinergic activity of doxepin, it is recommended to avoid this medication in the elderly, particularly at high doses. Be aware that anticholinergics like doxepin can reduce the benefit of dementia medications. CYP2D6 is an impor...
Atomoxetine Pharmacology
January 02, 2020 17:15 - 10 minutes - 10.5 MBAtomoxetine is a norepinephrine reuptake inhibitor that can be used in the management of ADHD. Atomoxetine is a non-controlled substance option for patients seeking this alternative to traditional stimulants. CYP2D6 is an important enzyme in the breakdown of atomoxetine. CYP2D6 inhibition or poor metabolizers via CYP2D6 can lead to higher concentrations of atomoxetine and put our patients at greater risk for adverse effects.
Fluoxetine Pharmacology
December 26, 2019 18:36 - 12 minutes - 17 MBFluoxetine is an SSRI used in the management of depression, anxiety, OCD, PTSD, and other psychiatric conditions. Fluoxetine has a very long half-life which can impact clinical management. I discuss how this matters in this podcast episode. Fluoxetine inhibits CYP2D6 which can alter the concentrations of many drugs. Prodrugs like codeine and tamoxifen can have their effects reduced because of fluoxetine. I explain this further in the episode. By inhibiting CYP2D6 concentrations of many d...
Metoprolol Pharmacology
December 19, 2019 20:15 - 10 minutes - 15.5 MBMetoprolol is a beta-blocker commonly used in the management of hypertension, heart failure, and atrial fibrillation. There is an extended release dosage form and immediate release dosage form with metoprolol. The advantage of the extended release product is that it doesn't require as frequent dosing. Metoprolol is selective for beta-1 receptors. It is less likely to interact with asthma medications. CYP2D6 plays an important role in breaking down metoprolol. Alterations in this enzyme'...
Mometasone Pharmacology (Nasal and Oral Inhalation)
December 12, 2019 14:29 - 12 minutes - 18.1 MBMometasone is an inhaled corticosteroid and a nasal corticosteroid. The inhaled steroid is called Asmanex by brand name and the nasal version is Nasonex. Nasonex is primarily used in the management of allergic rhinitis and can help with nasal congestion type symptoms. Remember that nasal mometasone takes a little while to have its full effect. It can take up to a week or two to provide its maximum benefit. Systemic absorption of both nasal and oral inhalation mometasone is very low at l...
Methylphenidate Pharmacology
December 05, 2019 18:55 - 11 minutes - 16 MBMethylphenidate has an FDA approved indication for ADHD. In this podcast episode, I cover the pharmacology, adverse effects, kinetics, and drug interaction. Because methylphenidate has stimulant type effects, it can raise blood pressure and heart rate. Weight, blood pressure, and pulse are important monitoring parameters in patients taking a stimulant type medication like methylphenidate. There are numerous dosage forms of methylphenidate which can help accommodate many different patient...
Cilostazol Pharmacology
November 28, 2019 16:29 - 11 minutes - 16.4 MBCilostazol has antiplatelet and vasodilatory effects. Because of this, it can manage symptoms of intermittent claudication. GI upset, headache, and edema are common adverse effects associated with the use of cilostazol. Cilostazol is recommended to be given on an empty stomach. In patients with heart failure, cilostazol use is contraindicated. CYP3A4 interactions are prevalent with cilostazol. Inhibitors of CYP3A4 can increase the concentrations of cilostazol.
Metronidazole Pharmacology
November 21, 2019 13:54 - 10 minutes - 15.5 MBMetronidazole (Flagyl) is an antibiotic that is used for various infections. Metronidazole can certainly cause GI upset like most antibiotics, but uniquely may also cause a metallic taste. Metronidazole is also rarely associated with CNS changes and can induce the potential for peripheral neuropathy. Patients should avoid alcohol with the use of metronidazole and this is on account for the possibility of a disulfiram reaction. I discuss some of the symptoms of this reaction in the podca...
Testosterone Pharmacology
November 14, 2019 15:04 - 11 minutes - 15.6 MBTestosterone replacement is primarily utilized in patients with hypogonadism. I discuss testosterone pharmacology, adverse effects, and drug interactions on this podcast episode. Testosterone is a controlled substance because it is most often diverted for its potential to build muscle in athletes for competitive sports. There is cardiovascular risks associated with the use of testosterone. Testosterone can raise blood pressure and also raise cholesterol levels which may be a contributing ...
Morphine Pharmacology
November 07, 2019 18:07 - 13 minutes - 19.3 MBMorphine has opioid agonist activity that can cause respiratory depression and death in overdose. Morphine-6-glucuronide is the metabolite that can accumulate and cause CNS toxicity in renal failure. Be aware of CNS depressants that may enhance the effect of morphine and other opioids. Some examples of CNS depressants include gabapentin, benzodiazepines, older antihistamine, skeletal muscle relaxants, and pregabalin. Opioid withdrawal is a significant concern when patients have their mor...
Prasugrel Pharmacology
October 31, 2019 18:44 - 10 minutes - 15.3 MBPrasugrel is a P2Y12 inhibitor that is used in the setting of ACS. Be aware of patients who may be taking over the counter medications that can increase their bleed risk while taking prasugrel. Prasugrel is on the Beers list and in general, should be avoided in most situations for patients who are 75 years of age or older. Morphine has the potential to impact antiplatelet agents like prasugrel and make them less effective. Be sure this is clinically considered prior to using morphine with...
Mirabegron Pharmacology
October 24, 2019 14:37 - 15 minutes - 22.3 MBMirabegron is a beta-3 agonist that can help relax bladder smooth muscle and manage symptoms of overactive bladder. Mirabegron inhibits CYP2D6 which can negatively impact the effectiveness of tamoxifen. I discuss this in greater detail in the podcast. Tramadol and codeine effectiveness can be impacted by mirabegron. Be aware of this when using this medication. By inhibiting CYP2D6, mirabegron can increase the concentrations of many psychotropic medications such as fluoxetine, aripiprazole,...
Erythromycin Pharmacology
October 17, 2019 13:33 - 12 minutes - 17 MBErythromycin uniquely has some potential benefit in the setting of gastroparesis. Azithromycin you will likely not see used for this indication. Erythromycin binds the 50s subunit and ultimately prevents protein synthesis which is necessary for bacteria to grow and replicate. QTc prolongation is a risk with all macrolide antibiotics (erythromycin included). By inhibiting CYP3A4, erythromycin can be responsible for numerous drug interactions.
Naloxone Pharmacology
October 10, 2019 16:00 - 14 minutes - 20.8 MBNaloxone is a life saving drug that can help manage an opioid overdose situation. Naloxone blocks opioids receptors so opioid agonists cannot bind there. One of the biggest risks with opioid overdose includes respiratory depression. Naloxone can help reduce the risk of this if administered in a timely manner. IV naloxone will have the quickest physiological onset of action, but nasal naloxone may be the best opportunity in the community to get this drug on board quickly.
Prochlorperazine Pharmacology
October 03, 2019 13:51 - 12 minutes - 17.3 MBProchlorperazine has several potential mechanisms of action. It can block dopamine and alpha receptors as well as have anticholinergic effects. Prochlorperazine is classified as an antipsychotic and antiemetic. It is very seldom used as an antipsychotic in clinical practice and more used for its antiemetic effects. Because of the anticholinergic activity of prochlorperazine, there is potential for dry mouth, dry eyes, urinary retention, constipation, and other anticholinergic effects. Proc...
Buspirone Pharmacology
September 26, 2019 15:56 - 12 minutes - 18 MBBuspirone is an anti-anxiety medication that has the potential of having some serotonin agonist activity. Buspirone has a very high first-pass metabolism. This means that the body breaks much of the medication down prior to it getting into the systemic circulation. Buspirone is broken down by CYP3A4, so concomitant use with inhibitors or inducers can alter its concentrations Buspirone should not be used as needed as this medication takes a while to start to show benefit.
Ondansetron Pharmacology
September 19, 2019 11:36 - 12 minutes - 17.8 MBOndansetron (Zofran) is a medication used for nausea and vomiting. In this episode, I lay out the pharmacology, adverse effects, drug interactions and more! Ondansetron has been reported to increase the risk of serotonin syndrome. I discuss this further on the podcast. Ondansetron can exacerbate QTc prolongation. Keep an eye out for patients who may have risk factors or be on other medications that can contribute to this. I discuss this further on this podcast. Ondansetron is often used fo...
Acyclovir Pharmacology
September 12, 2019 19:04 - 17 minutes - 24.2 MBOn this episode "Acyclovir Pharmacology" I discuss the mechanism of action, important monitoring parameters, and drug interactions with acyclovir. I discuss why acyclovir has to be dosed so many times per day. Acyclovir can inhibit CYP1A2 which can impact a few drugs. I discuss a couple of those examples on this podcast episode. GI effects are one of the more common side effects of acyclovir. Rarely, neuropathy and nephropathy can be part of the adverse effect profile of acyclovir. I disc...
Benzodiazepine Pharmacology
September 05, 2019 21:27 - 13 minutes - 19.7 MBBenzodiazepines act by enhancing the effect of GABA, an inhibitory neurotransmitter. Benzodiazepines can cause confusion, sedation, and respiratory depression. There are many potential indications for benzodiazepines. They can be used in anxiety, status epilepticus, insomnia, and alcohol withdrawal amongst other things. There is a boxed warning for the use of opioids with benzodiazepines. The primary risk of the combination is respiratory depression.
Celecoxib Pharmacology
August 29, 2019 17:46 - 11 minutes - 16.8 MBCelecoxib is easy to remember as its mechanism of action is "COX"-2 Inhibition. This can result in result in reduced prostaglandin formation and help with pain and inflammation. Kidney function is important to monitor in our patient on celecoxib. It is especially important in patients taking ACE inhibitors, ARBs, and/or diuretics. While GI bleed may be less likely with celecoxib compared to traditional NSAIDs like indomethacin and ibuprofen, it still needs to be monitored for. Digoxin conc...
Oseltamivir Pharmacology
August 22, 2019 11:43 - 13 minutes - 18.8 MBOseltamivir is an antiviral agent that is indicated for the treatment and prophylaxis of influenza. It is important to remember that oseltamivir is cleared at least in part by the kidney and dose adjustments should be made based upon kidney function. There is a low potential that oseltamivir could contribute to psych issues like delirium. Probenecid has the potential to raise the concentrations of oseltamivir.
Dolutegravir
August 15, 2019 13:29 - 10 minutes - 15.5 MBDolutegravir is an integrase inhibitor that is used in the management of HIV infection/ Carbamazepine along with other enzyme inducers can substantially lower the concentrations of dolutegravir. Dolutegravir can potentially increase blood sugars, this should be closely monitored in our patients with diabetes. CNS adverse effects like insomnia and dizziness can happen with dolutegravir.
Medroxyprogesterone Acetate Injection Pharmacology
August 08, 2019 16:02 - 13 minutes - 19.6 MBOn this podcast episode, I cover medroxyprogesterone acetate injection pharmacology (DMPA or Depo-Provera) Medroxyprogesterone acetate injection is given every three months for the prevention of pregnancy. Medroxyprogesterone acetate has a boxed warning for its risk of causing low bone mineral density. Classic enzyme inducers can cause lower concentrations of medroxyprogesterone which can potentially lead to contraceptive failure. Examples of enzyme inducers that can lower concentrations ...
Budesonide Formoterol Pharmacology
August 01, 2019 15:33 - 13 minutes - 18.5 MBBudesonide/formoterol inhalation is sold under the brand name Symbicort. Budesonide/formoterol is a combination agent that is used in the management of COPD and asthma. Budesonide/formoterol is a combination of an inhaled corticosteroid and long-acting beta-agonist. GINA guidelines now allow for the use of budesonide/formoterol in the management of acute asthma exacerbation.
Benztropine Pharmacology
July 25, 2019 12:04 - 11 minutes - 16.8 MBBenztropine is a highly anticholinergic medication that is primarily used for movement disorders. Antipsychotics can cause extrapyramidal adverse effects that can help be managed with benztropine. Because benztropine is highly anticholinergic, it can cause dry eyes, dry mouth, urinary retention, constipation and contribute to falls and confusion, particularly in our elderly population. While benztropine is classified as an anti-Parkinson's agent, it is rarely used for that indication as ...
Budesonide Pharmacology (Oral and Rectal Formulations)
July 18, 2019 16:48 - 14 minutes - 20 MBBudesonide is a corticosteroid that can be given orally or rectally for management of Crohn's disease or ulcerative colitis. Because budesonide has a high first pass metabolism, the relative impact of systemic effects may be less than other steroids like prednisone. Remember that CYP3A4 inhibitors can increase the concentrations of budesonide. I discuss this further on the podcast. Different dosage forms of budesonide (oral versus rectal) can be used for different reasons. The site of the ...
Cimetidine Pharmacology
July 11, 2019 18:15 - 11 minutes - 15.6 MBCimetidine blocks histamine 2 receptors which can suppress acid production and reduce symptoms of heartburn. One of the major downsides to cimetidine is that it has a ton of drug interactions. I discuss many of the common ones in this episode. Cimetidine is one of a few drugs that has the potential to cause gynecomastia. I discuss the mechanism of this adverse effect in this episode. Phenytoin concentrations can rise due to the use of cimetidine. I discuss this in the drug interactions sec...