On this podcast episode, I discuss lurasidone pharmacology, adverse effects, and drug interactions. CYP3A4 is an important enzyme in the breakdown of lurasidone. I discuss this further on this episode. Lurasidone is best taken with food as this enhances absorption and helps improve drug concentrations. Lurasidone tends to have a lower risk for metabolic syndrome compared to other antipsychotics which is a nice advantage.
Isavuconazole is an azole antifungal that can be used for various fungal infections. In this episode, I discuss isavuconazole pharmacology, adverse effect, drug interactions, and pharmacokinetics. Isavuconazole is interestingly associated with QT shortening which is different from most azole antifungals that cause QT prolongation. Oral bioavailability of isavuconazole is nearly 100% so dose conversions between IV and oral are typically not difficult to navigate.
On this episode, I cover ethinyl estradiol pharmacology. This is a common component of oral contraceptives. You have to check out this free resource (with free account) from Pyrls.com/rlp which lists all the different combinations and brand names. All it takes is to simply sign up for a free account here. Ethinyl estradiol dosing can vary. Breakthrough bleeding is a major reason why a patient might prefer a higher dose. Blood clot risk is a real problem with ethinyl estradiol. There are numerous...
On this episode, I discuss olmesartan (Benicar) pharmacology, adverse effects, drug interactions, and pharmacokinetics. Olmesartan can cause a unique GI adverse effect called enteropathy. I discuss this on this podcast episode. Important monitoring parameters for olmesartan include potassium, renal function, and blood pressure. Olmesartan has a longer half-life than losartan. I discuss how this might be advantageous in clinical practice.
On this episode, I discuss desvenlafaxine pharmacology, adverse effects, pharmacokinetics, and drug interactions. Desvenlafaxine is a serotonin and norepinephrine reuptake inhibitor that can be used for depression. Renal elimination is an important method of deactivation of desvenlafaxine. Dose adjustments may be recommended as renal function drops below 50 mls/min. Withdrawal syndrome due is a risk with desvenlafaxine as it has a significantly short half-life.
Pramipexole (Mirapex) is a dopamine agonist that can be used in Parkinson’s disease and Restless Legs Syndrome. Dopamine agonists like pramipexole can worsen psychiatric symptoms in some patients by causing hallucinations, and obsessive/compulsive symptoms. Nausea, vomiting, hypotension, and fatigue are the most common adverse effects of pramipexole. Pramipexole is primarily eliminated through the urine. I discuss how this matters clinically in greater detail in this podcast episode.
I mentioned prednisolone to prednisone conversion in this podcast. Please go check out Pyrls.com for a free steroid conversion downloadable PDF with a free account! On this episode, I discuss prednisolone (Orapred, Pediapred) pharmacology, adverse effects, practice pearls, and drug interactions. Prednisolone is a systemic corticosteroid that can cause insomnia, elevations in blood sugars, and numerous effects if used long-term. CYP3A4 is an important enzyme in the breakdown of prednisolone. Inhi...
On this episode, I discuss bisoprolol (Zebeta) pharmacology, adverse effects, drug interactions, and other important clinical pearls. Bisoprolol is a beta-1 selective antagonist that can be used for atrial fibrillation, angina, and other cardiovascular indications. It is important to remember that bisoprolol and other beta-blockers are not considered first-line agents for hypertension alone. Beta-receptor selectivity does start to disappear with bisoprolol as you get to higher dosages. I discuss...
Lansoprazole is a proton pump inhibitor that can be commonly used for GERD, PUD, and GI prophylaxis. Lansoprazole 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. PPIs like lansoprazole are best given 30-60 minutes before meals. This is something that patients often forget. I discuss important drug interactions on the po...
Ropinirole (Requip) is a dopamine agonist that can be used in Parkinson's disease and Restless Legs Syndrome. Dopamine agonists like ropinirole can worsen psychiatric symptoms in some patients by causing hallucinations, and obsessive/compulsive symptoms. Nausea, vomiting, hypotension, and fatigue are the most common adverse effects of ropinirole. Ropinirole has drug interactions with antipsychotics and CYP1A2 inhibitors. I discuss these in greater detail in this podcast episode.
On this episode of the podcast, I cover budesonide (Pulmicort) pharmacology. Our sponsor (Pyrls.com/rlp) for this episode is providing a FREE PDF of their inhaled corticosteroid categorizations chart (i.e. low/medium/high dose ICS) when you sign up for a free account! The onset of action of inhaled budesonide is several hours up to a few days. Patient education is critical to ensure that patients stick with its use. Budesonide does have a nebulized formulation that is often used in pediatrics an...
Epoetin alfa (Epogen, Procrit) is an erythropoiesis-stimulating agent that can be used for various types of anemia. ESA's like epoetin carry a boxed warning as they increase the risk of cardiovascular events like MI, stroke, and blood clots. Assessing iron stores is critical when epoetin is used to ensure that a non-response is not due to deficiency. I discuss dosing adjustments of epoetin in the podcast. One must be careful about raising hemoglobin too quickly.
Canagliflozin 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 increased with th...
Cabergoline 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.
In 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.
On 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 calci...
On 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.
In 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.
On 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.
On 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.
On 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. The bran...
On 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 used in ...
On 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.
On 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.
On 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 insulin or...
On 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 used with N...
On 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....
On 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 (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.
On 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.
