On this podcast episode, I discuss fosinopril (Monopril) pharmacology, adverse effects, drug interactions and much more. Fosinopril is an ACE inhibitor so it should absolutely NOT be used in pregnancy as it poses fetus risks. Like other ACE inhibitors, hyperkalemia, cough, angioedema, and acute renal failure represent possible risks in using fosinopril. Drugs that can raise potassium when used in combo with fosinopril include spironolactone, trimethoprim, calcineurin inhibitors, and heparin....
Mar 16, 2023•16 min
On this episode of the Real Life Pharmacology podcast, I discuss haloperidol pharmacology, adverse effects, drug interactions and much more. Haloperidol comes in multiple dosage forms. Be very careful with the use of injectable haloperidol as there is an immediate and extended release formulation. Haloperidol is a dopamine antagonist which means that EPS adverse effects are going to be concerning. In hospice patients, haloperidol is frequently used for its antiemetic properties as well as its po...
Mar 09, 2023•14 min
In this promethazine pharmacology podcast, I discuss its mechanisms of action, side effects, important drug interactions, and much more. Promethazine has anticholinergic and dopamine-blocking activity which contributes to the adverse effect profile as well as its efficacy. There is a boxed warning with promethazine to avoid the use of this medication in patients under the age of 2 due to respiratory depression. Promethazine IV is considered a high-risk route of administration and should be avoid...
Mar 02, 2023•15 min
In this episode, I discuss loperamide (Imodium) pharmacology, adverse effects, and drug interactions. Loperamide has opioid-type activity in the gut but has extremely low oral bioavailability. This allows it to be used for diarrhea but at lower doses won't cause systemic opioid-like effects. Loperamide abuse has been reported. Excessive dosages can increase the risk of cardiac arrest and other cardiovascular concerns. Medication causes of diarrhea should be ruled out prior to starting a medicati...
Feb 23, 2023•15 min
I discuss calcium carbonate pharmacology, adverse effects, drug interactions, and more in this podcast episode. Calcium tends to have a constipating effect and the higher the dose, the more likely patients are to experience this adverse effect. Binding interactions are a major problem with oral calcium carbonate. I lay out numerous examples of this on the podcast. There are a few medications that can increase calcium levels in the blood. Thiazide diuretics are a commonly used antihypertensive th...
Feb 16, 2023•19 min
On this episode, I discuss the pharmacology, adverse effects, and drug interactions of ramelteon (Rozerem). Ramelteon is primarily only helpful for sleep onset and generally is not that helpful in sleep maintenance. CNS depressant drug interactions will be a common concern to monitor. Opioids, benzodiazepines, and alcohol are common sedatives that can add to the effects of ramelteon. Some of the CYP enzymes break down Ramelteon. I discuss this in greater length in this podcast episode....
Feb 09, 2023•15 min
In this podcast episode, I discuss thiamine pharmacology and its important role in energy production. In patients with alcohol use disorder, thiamine deficiency can be somewhat common. Wernicke's encephalopathy can result from thiamine deficiency in patients with alcohol use disorder. Common symptoms from Wernicke's encephalopathy can include confusion, lethargy, and other central nervous system issues. Thiamine replacement can help treat this issue.
Feb 02, 2023•13 min
Dutasteride (Avodart) is a 5-alpha-reductase inhibitor. I discuss the pharmacology, adverse effects, and drug interactions on this podcast. Dutasteride reduces the size of the prostate over time. It takes a significant amount of time to provide symptom relief (usually at least 3-6 months). Dutasteride is broken down by CYP3A4 to a minor extent which means that strong CYP3A4 inhibitors may increase drug concentrations. When using dutasteride for BPH, remember to review the medication list for dru...
Jan 26, 2023•11 min
On this episode, I discuss prazosin pharmacology, adverse effects, drug interactions and much more. Prazosin is an alpha-blocker but lacks selectivity. A reduction in blood pressure is expected, but it is notorious for causing orthostatic hypotension. Prazosin may be used off-label for nightmares, when this is the case, you will likely only see this drug dosed at bedtime. Alpha agonist medications (such as pseudoephedrine and ADHD stimulants) may counteract the effects of prazosin.
Jan 19, 2023•13 min
On this episode I discuss the pharmacology of tirzepatide. I'm appreciative of Derek Borkowski who operates Pyrls for providing a free PDF of the 2023 ADA Diabetes Guidelines when you subscribe for an account at Pyrls.com/rlp - Tirzepatide makes its first appearance in the diabetes guidelines for its ability to promote weight loss. Tirzepatide is a combination GIP and GLP-1 agonist that is currently indicated for diabetes with reductions of A1C in the range of about 2 points. Much like GLP-1 ago...
Jan 12, 2023•16 min
On this episode of the Real Life Pharmacology podcast, I cover methimazole adverse effects, mechanism of action, drug interactions, and much more! Methimazole and propylthiouracil are from the same class of medications and are used for hyperthyroidism. I go over some of the differences between these agents in this podcast episode. Methimazole is dosed once daily but can be split if the patient experiences significant GI adverse effects. T3 plays an important role in hyperthyroidism. I discuss th...
Jan 05, 2023•12 min
On this podcast episode, I discuss the pharmacology, adverse effects, and drug interactions of semaglutide. Semaglutide has two primary uses: Type 2 diabetes and Weight Management - the dosing varies depending upon the indication. When using semaglutide, pay attention to GI adverse effects. Nausea, diarrhea, and vomiting are the most common ADRs and are dose-dependent. Pay attention to corticosteroid bursts. They can cause substantial hyperglycemia and counteract the effects of diabetes medicati...
Dec 29, 2022•16 min
Minocycline is a tetracycline antibiotic. I discuss pharmacology, adverse effects, and drug interactions. Minocycline can cause sun sensitivity. Be sure to educate patients about this risk. Metal cations like iron, zinc, calcium, and magnesium can bind minocycline and reduce the oral absorption of the medication. Tooth discoloration is a possible adverse effect if minocycline is given to pediatric patients. I discuss it further in this episode.
Dec 22, 2022•14 min
In this podcast episode, I cover propylthiouracil pharmacology, adverse effect, drug interaction, and much more! Propylthiouracil carries a boxed warning for hepatotoxicity which is a significant downside compared to the other agent in its class (methimazole). What about dosing? I discuss why this medication has to be dosed multiple times per day. Drug interactions aren't incredibly common with propylthiouracil but it can affect warfarin differently than most drug interactions. I discuss it furt...
Dec 15, 2022•12 min
Brexpiprazole (Rexulti) is a second generation antipsychotic. I discuss its pharmacology, adverse effects, drug interactions, and more in this podcast episode. I like to associate brexpiprazole with aripiprazole. They have a lot of overlapping characteristics, particularly in relation to the adverse effect profile. Brexpiprazole tends to have a low incidence of metabolic adverse effects which makes it a nice selection for patients who have diabetes, hypercholesterolemia, or who are overweight. C...
Dec 08, 2022•15 min
On this episode, I discuss indapamide pharmacology, adverse effects, drug interactions, and pharmacokinetics. I discuss how indapamide differs from other thiazide diuretics. Particularly, I discuss indapamide compared to hydrochlorothiazide. Frequent urination, hypokalemia, and dehydration are all possible risks with indapamide. Pay attention to medications that can increase the risk for acute renal failure when added to indapamide. NSAIDs, ACEIs, ARBs, and other diuretics can increase this risk...
Dec 01, 2022•14 min
On this episode, I discuss tadalafil pharmacology, adverse effects, pharmacokinetics, and drug interactions. Tadalafil has a significantly longer half-life than sildenafil. I discuss how this is going to impact a patient that may need a nitrate. PDE-5 inhibitors like tadalafil are most commonly used for erectile dysfunction but I talk about other unique indications in the podcast. Daily use or as-needed use of tadalafil are both acceptable options but there are some quirks you need to know with ...
Nov 24, 2022•14 min
Sitagliptin is a DPP4 inhibitor. I discuss the pharmacology of this medication on the podcast. Which diabetes medication works similarly to sitagliptin? I discuss that further on this episode of the Real Life Pharmacology podcast. Renal elimination plays a significant role with sitagliptin. I discuss how this impacts the appropriate dosing. Cost is a significant issue with sitagliptin at this time. In addition, it's A1C-lowering effects aren't anything to write home about. I discuss how much it ...
Nov 17, 2022•13 min
On this podcast episode, I discuss gabapentin (Neurontin) pharmacology, adverse effects, drug interactions, and much more! Gabapentin's GI absorption is a little wacky. I discuss on the podcast the clinical effects that this may have on our patients. Renal elimination is critical to gabapentin. Worsening renal function will significantly impact the action of the drug. CNS sedation can be a problem with gabapentin, especially in combination with other CNS depressants. I discuss this further on th...
Nov 10, 2022•16 min
Ranolazine is primarily used for chronic angina management. I discuss pharmacology, drug interactions, adverse effects, and more in this podcast episode. Ranolazine is well known to have drug interactions. CYP3A4 is of major importance but there are other subtle drug interactions that are important. QTc prolongation has been reported with ranolazine so it is important to recognize risk factors and other medications that may contribute to this concern. Enzyme inducers like carbamazepine, phenytoi...
Nov 03, 2022•14 min
On this podcast episode, I discuss lorazepam (Ativan) pharmacology, adverse effects, and common drug interactions. Lorazepam has numerous dosage forms and the IV formulation does contain propylene glycol which can accumulate if it is used for longer periods of time. There is a boxed warning for lorazepam when it is used with opioids. The risk for opioid overdose, coma, and death increases significantly. Lorazepam is an intermediate acting benzodiazpine. It's half-life for most adult patients is ...
Oct 28, 2022•13 min
On this podcast episode, I discuss valsartan pharmacology, adverse effects, drug interactions, and much more. Valsartan is a fairly common ARB. I mostly see losartan and valsartan used as the most common ARBs in hypertension management. Valsartan has a longer half-life than losartan which is why we can often get away with once daily dosing compared to losartan which sometimes requires twice daily. Hyperkalemia is a major concern with ARBs like valsartan. Trimethoprim and spironolactone are two m...
Oct 20, 2022•11 min
On this podcast episode, I discuss famotidine pharmacology, adverse effects, uses, and drug interactions. Famotidine is generally pretty well tolerated, but one thing I look out for with chronic use is B12 deficiency. Famotidine is eliminated by the kidney so you should pay attention to the dose in patients with CKD. Famotidine is occasionally used as a pretreatment to help prevent infusion-type reactions for certain chemotherapy agents.
Oct 13, 2022•15 min
On this podcast episode, I discuss clonazepam pharmacology, adverse effects, pharmacokinetics, and drug interactions. Clonazepam is a benzodiazepine that enhances the activity of GABA which is an inhibitory neurotransmitter in the central nervous system. It is important to try to avoid using benzodiazepines like clonazepam with opioids as it can increase the risk of respiratory depression and death. Clonazepam is an intermediate-acting benzodiazepine that is only commercially available as an ora...
Oct 06, 2022•13 min
In this podcast episode, I break down the pharmacology, adverse effects, pharmacokinetics, and drug interactions of phentermine. Phentermine has some CNS stimulant activity so adverse effects like insomnia, hypertension, and tachycardia are possible. Pay attention to drugs that can oppose the effects of phentermine and cause weight gain such as mirtazapine and sulfonylureas. Phentermine is a controlled substance so the risk of addiction and dependence is possible.
Sep 29, 2022•12 min
On this podcast episode, I discuss glimepiride pharmacology, adverse effects, hypoglycemia symptoms, and drug interactions. CYP2C9 is an important enzyme in the breakdown of glimepiride. I discuss a few drugs that can cause interactions via this enzyme. Renal function is important to consider with glimepiride. The active metabolites are cleared by the kidney and can accumulate in CKD. Hypoglycemia and weight gain are problematic adverse effects of this medication and are the primary reasons it h...
Sep 22, 2022•17 min
On this podcast episode, I discuss cephalexin pharmacology, adverse effects, drug interactions, and much more! Penicillin allergies and cross-reactivity are common questions with regard to the use of cephalexin and I discuss this briefly in the podcast episode. Cephalexin is a first-generation cephalosporin with its primary sweet spot being gram-positive bacteria like Staph and Strep species. Warfarin, probenecid, zinc, and a couple of others are potential medications that can interact with ceph...
Sep 15, 2022•12 min
On this episode, I discuss ceftriaxone pharmacology, adverse effect, coverage, and drug interactions. Ceftriaxone is currently a drug of choice for the STI Gonorrhea. Pyrls.com has an amazing chart on all the STIs and their drugs of choice that you can get for free when you sign up for a free account! Ceftriaxone is a third-generation cephalosporin that is used for numerous indications such as pneumonia, meningitis, gonorrhea, and many more. It is important to remember that ceftriaxone can cover...
Sep 08, 2022•14 min
Lactulose is an osmotic laxative but it is rarely used for this purpose. I discuss lactulose pharmacology in this episode. Elevated ammonia levels are an issue in hepatic encephalopathy. Lactulose can help manage this issue. Lactulose is dosed to 2-3 soft stools per day when used to reduce ammonia levels. Lactulose can increase the effect of warfarin and raise INR; I discuss this further on this episode.
Sep 01, 2022•12 min
On this episode, I discuss ticagrelor pharmacology, adverse effects, and important drug interactions. Ticagrelor has a warning with regards to the use of aspirin. Higher doses of aspirin can impair the effectiveness of ticagrelor and I discuss this further on this episode. Bleeding is the major adverse effect from ticagrelor and naturally, hematocrit and hemoglobin are important monitoring parameters. I discuss CYP3A4 drug interactions on this episode and how it may affect ticagrelor....
Aug 25, 2022•13 min
