On this episode, I discuss spironolactone pharmacology, adverse effects, drug interactions and much more. Spironolactone has numerous indications including hypertension, CHF, ascites, and acne. I break them all down in this podcast episode. Hyperkalemia is a major concern with spironolactone. Patients with baseline levels at 5 or above should generally avoid this medication. Gynecomastia is one of the most commonly tested adverse effects of spironolactone. Be sure you don't miss this one on your...
Oct 12, 2023•12 min
I discuss meloxicam pharmacology, adverse effects, drug interactions, and much more on this episode of the Real Life Pharmacology Podcast. Meloxicam tends to have a greater affinity to COX-2 versus COX-1. I discuss what this means clinically on this episode. Important meloxicam drug interactions include anticoagulants, antiplatelet medications, renal impairing drugs, and lithium amongst others. Meloxicam has a longer half-life than many NSAIDs and because of this can be dosed once daily for pain...
Oct 05, 2023•12 min
On this episode, I discuss enalapril pharmacology, adverse effects, drug interactions, and much more! Enalapril has a shorter half-life compared to some of the other ACE inhibitors so it may need to be dosed twice daily in patients with adequate renal function. Hyperkalemia, cough, renal impairment, and angioedema and four adverse effects associated with enalapril that you should monitor for. NSAIDs and diuretics can increase the risk of acute renal failure when an ACE inhibitor like enalapril i...
Sep 28, 2023•14 min
On this very special episode of the Real Life Pharmacology podcast, we tackle asthma pharmacotherapy and some of the things that Beth sees in her everyday practice as an ambulatory care pharmacist. When discussing asthma pharmacotherapy with pediatric patients and their families, it is critical to address the concern of suppressed growth with corticosteroid use. Beth shares her expertise and thoughts on this topic. The GINA update a few years ago has been a game changer in asthma, hear from Beth...
Sep 21, 2023•23 min
On this podcast episode, I discuss lisdexamfetamine (Vyvanse) pharmacology, adverse effects, drug interactions, and much more. Lisdexamfetamine is a stimulant medication that is used in the management of ADHD. Stimulants like lisdexamfetamine can increase heart rate, raise blood pressure, and suppress appetite. Lisdexamfetamine is a schedule 2 controlled substance and has a high potential for abuse and dependence.
Sep 14, 2023•11 min
On this podcast episode, I cover etanercept pharmacology, adverse effects, drug interactions and much more. Etanercept is classified as a DMARD but is different from older DMARDs in that it is a biologic agent and needs to be injected. Vaccination assessment in patients is important prior to initiating etanercept due to the fact that the medication may blunt the effectiveness of the vaccines. Immunosuppression from etanercept can lead to an increased risk for infection and malignancy....
Sep 07, 2023•14 min
On this podcast episode, I discuss the pharmacology, adverse effects, and drug interactions of insulin lispro (Humalog). I spend some time on this podcast episode discussing carb ratios and sliding scale insulin when using insulin lispro. Potassium is critical to monitor in diabetic ketoacidosis as insulin therapy can cause significant hypokalemia. Sliding-scale insulin lispro is discouraged in the overwhelming majority of situations. Ideally, we should be more proactive about insulin administra...
Aug 31, 2023•18 min
On this podcast episode, I discuss (Lyrica) pregabalin pharmacology, adverse effects, drug interactions, and much more. I compare pregabalin and gabapentin in this episode and one important difference is the percent absorption of gabapentin compared to pregabalin. Pregabalin can exacerbate the risk of respiratory depression and overdose in patients who are taking opioids. Pregabalin is most frequently used in practice for neuropathic pain syndromes.
Aug 24, 2023•16 min
On this podcast episode, I discuss tamoxifen pharmacology, adverse effects, drug interaction, and much more. Tamoxifen is converted to a more active compound in the body by CYP2D6. CYP2D6 inhibitors such as paroxetine, fluoxetine, or bupropion can essentially reduce the effectiveness of tamoxifen. Hot flashes are a common adverse effect of tamoxifen and I discuss a few pharmacologic options to manage this adverse effect.
Aug 17, 2023•15 min
On this episode of the Real Life Pharmacology Podcast, I cover phenobarbital pharmacology, adverse effects, important drug interactions and much more. Phenobarbital is an enzyme inducer. It is an inducer at CYP3A4 so this can lead to numerous drug interactions. Phenobarbital can exacerbate the risk for opioid overdose and increase the risk for respiratory depression and death. Phenobarbital can deplete numerous vitamins such as vitamin D, folic acid, and vitamin B12. Monitoring of these is impor...
Aug 10, 2023•15 min
On this episode, I discuss isotretinoin pharmacology, side effects, drug interactions, and much more. The iPLEDGE program is in place to ensure that pregnant patients do not receive this medication. I discuss this in more detail on this episode. Sun sensitivity is an important adverse effect that patients should be aware of during seasons of high sun exposure. Hepatic issues, myalgia, and psychiatric changes are rare adverse effects associated with isotretinoin.
Aug 03, 2023•12 min
On this episode of the Real Life Pharmacology Podcast, I discuss lovastatin pharmacology, adverse effect, drug interactions, and more! Lovastatin is broken down by CYP3A4 so drugs like clarithromycin, diltiazem, and others may increase concentrations. Lovastatin is a lipophilic statin and I discuss the importance of this on the podcast. Lovastatin has a very short half-life which means that it is ideal to dose this medication at night for maximal efficacy.
Jul 27, 2023•15 min
On this podcast episode, I discuss clindamycin pharmacology, adverse effects, drug interactions, and much more! Clindamycin (oral administration) can cause esophageal irritation and it is recommended to take this medication with a full glass of water. C. Diff risk and frequent dosing are two of the biggest downsides to using clindamycin to manage infections. Clindamycin has good activity against many gram-positive organisms like Staph and Strep as well as anaerobic activity.
Jul 20, 2023•12 min
On this podcast episode, I discuss dextroamphetamine's pharmacology, adverse effects, drug interactions, and much more! Dextroamphetamine is a stimulant medication. Weight loss, insomnia, tachycardia, and hypertension are all possible complications. There is a patch dosage form of dextroamphetamine available called Xelstrym. I discuss it on this episode. Vitamin C can reduce GI absorption of dextroamphetamine due to its ability to increase the acidity of the GI tract.
Jul 13, 2023•13 min
On this podcast episode, I discuss vardenafil pharmacology, adverse effects, drug interactions, and much more. Vardenafil is a PDE-5 inhibitor used primarily for erectile dysfunction in males. Using nitrates with vardenafil is contraindicated due to the risk of profound hypotension. I have discussed how long to wait between vardenafil and nitrates in a previous post on Meded101.com.
Jul 06, 2023•11 min
On this podcast episode, I discuss niacin pharmacology, adverse effects, drug interactions, and much more. Niacin has historically been used to manage lipids but has fallen out of favor due to adverse effects, and newer, more effective therapies being developed. Niacin can elevate uric acid. Be sure to use this medication cautiously in patients with gout. Flushing is one of the most common adverse effects of niacin. High doses, immediate-release formulations, and the use of alcohol can increase ...
Jun 29, 2023•14 min
I discuss dextromethorphan pharmacology, adverse effects, drug interactions, and more on this podcast episode. CYP2D6 metabolizes Dextromethorphan. A commonly used antidepressant is a CYP2D6 inhibitor. I discuss this on the podcast. Dextromethorphan is a commonly used OTC cough suppressant. There is potential for abuse with this medication. In excessive doses, dextromethorphan may cause euphoria, hallucinations, and other CNS effects, but also cause cardiovascular complications.
Jun 22, 2023•15 min
On this podcast episode, I discuss bexagliflozin pharmacology, adverse effects, drug interactions, and much more. I wasn't wowed by the A1C reduction of this medication. I get into the specifics on bexagliflozin in the podcast episode. SGLT2 inhibitors like bexagliflozin increase the glucose in the urine which can facilitate the growth of bacteria and fungi in the genitourinary tract. Limb amputation and euglycemic DKA are two rare, reported adverse effects to be aware of with the use of bexagli...
Jun 15, 2023•13 min
On this episode, I discuss cefuroxime pharmacology, adverse effects, drug interaction, pharmacokinetics, and much more. Cefuroxime is a 2nd generation cephalosporin that binds Penicillin-binding proteins and prevents bacterial cell wall synthesis. Medications that create a higher pH in the stomach such as antacids can ultimately reduce the concentrations of cefuroxime. Cefuroxime is primarily eliminated by the kidney. Dose adjustments are recommended for patients with a CrCL less than 30 mls/min...
Jun 08, 2023•14 min
On this episode, I discuss risperidone pharmacology, adverse effects, monitoring, and common indications. There are numerous drug interactions that I discuss in this podcast episode. CYP2D6 inhibitors may increase drug concentrations. Risperidone increases prolactin more than most 2nd generation antipsychotics. This can lead to sexual adverse effects. QTC prolongation is a concern with all antipsychotics like risperidone. We can monitor EKG to monitor for this risk.
Jun 01, 2023•15 min
On this podcast episode, I discuss vortioxetine pharmacology, adverse effects, drug interactions, and much more. Because of vortioxetine's long half-life, antidepressant discontinuation syndrome is going to be less prominent compared to ADPs with shorter half-lives. Vortioxetine is metabolized by CYP2D6. Drugs that inhibit this enzyme will likely raise concentrations and place the patient more at risk for adverse effects. I discuss rare vortioxetine adverse effects like hyponatremia and bleeding...
May 25, 2023•16 min
On this episode, I discuss isosorbide mononitrate pharmacology, adverse effects, and important drug interactions. Isosorbide mononitrate is a vasodilator that works by relaxing and widening the blood vessels (primarily veins) through nitric oxide action. This reduces the preload and oxygen demand on the heart. The primary use for isosorbide mononitrate is angina prevention. It is important to remember that it is NOT meant for acute relief of chest pain. Headache is a major adverse effect of isos...
May 18, 2023•12 min
On this episode of the RLP podcast, I discuss azelastine nasal spray pharmacology, adverse effects, administration, and much more! While most nasal sprays for allergic rhinitis are corticosteroids, azelastine is classified as an antihistamine. Systemic absorption of azelastine is about 40%, so while not common, systemic adverse effects like sedation can happen. On this podcast episode, I use azelastine to remind you about important education points regarding the use of nasal sprays.
May 11, 2023•14 min
On this episode of the Real Life Pharmacology Podcast, I discuss amlodipine pharmacology, adverse effects, and important drug interactions. I break down why edema occurs with amlodipine on this episode of the Real Life Pharmacology podcast. While beta-blockers are typically the first-line agent for the prevention of chronic angina symptoms, CCBs like amlodipine can be used as an alternative. There are some potential CYP3A4 interactions with amlodipine. I discuss the severity of these interaction...
May 04, 2023•19 min
On this episode, I discuss pyridoxine pharmacology, adverse effects, and important clinical uses. Pyridoxine is most well known for its potential to reduce the likelihood of isoniazid-induced neuropathy. Another common indication of pyridoxine is its use for nausea and vomiting associated with pregnancy. Pyridoxine plays an important role in the production of heme, so deficiency will increase the risk for anemia.
Apr 28, 2023•12 min
On this episode of the Real Life Pharmacology podcast, I discuss vibegron pharmacology, adverse effects, drug interactions and more! I spend some time comparing and contrasting vibegron to mirabegron. Both are beta-3 agonists used for overactive bladder. Vibegron dosing is very simple. It is dosed once daily with no alternative dosage forms available. The starting dose is the target dose. Being primarily excreted in the feces and urine, vibegron doesn't have many drug interactions.
Apr 20, 2023•13 min
Bempedoic acid, also known as Nexletol, is a once-daily medication used in lipid management. I discuss its pharmacology, side effects, and much more on this podcast episode. Bempedoic is a once-daily medication that doesn’t need to be titrated. Standard dosing is 180mg once daily which can be taken with or without food. What are the most common side effects of bempedoic acid? One of the most notable adverse effects is hyperuricemia. This is usually seen within the first 4 weeks of being on the m...
Apr 13, 2023•12 min
On this podcast episode, I discuss exenatide pharmacology, adverse effects, drug interactions, and much more! Exenatide has an immediate release formulation (Byetta) and a long acting formulation (Bydureon). I discuss the differences in this podcast episode. Byetta use has fallen out of favor due to frequent dosing, patient inconvenience and needing to time the dose 60 minutes prior to meals. I discuss the risk of pancreatitis related to GLP-1 agonists like exenatide in this podcast episode....
Apr 06, 2023•15 min
I discuss Pyridostigmine Pharmacology in this podcast episode in addition to adverse effects, drug interactions, and much more! Pyridostigmine is an acetylcholinesterase inhibitor that can be used for myasthenia gravis or orthostasis. Pyridostigmine can blunt the effect of neuromuscular blocking agents so patients undergoing surgery should be sure to have a game plan with their surgery team. Similar to donepezil, pyridostigmine can cause diarrhea and bradycardia.
Mar 30, 2023•13 min
On this podcast episode, I discuss simethicone pharmacology, adverse effects, drug interactions, and much more! Simethicone is primarily used for anti-gas purposes. It is most often used on an as needed basis for relief of flatulence and bloating associated with gas. Systemic absorption is minimal with simethicone so the occurrence of any systemic-type side effects at therapeutic doses is low. Simethicone may interfere with levothyroxine absorption. Timing levothyroxine at least a few hours prio...
Mar 23, 2023•11 min
