On this episode, I discuss the new medication vonoprazan and where it will likely be used in practice. Vonoprazan is from a brand new class of medication called "PCAB". I discuss this medication and its pharmacology in this podcast episode. Drug interactions and cost are the two major downsides of this medication that will likely limit its use compared to the PPIs. CYP3A4 inducers like rifampin, carbamazepine, and phenytoin should not be used with vonoprazan. They will reduce the effectiveness o...
May 09, 2024•12 min
Today’s sponsor of the 10 Commandments of Polypharmacy podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. FreedAI is offering a discount exclusive to RLP listeners! Users will get $50 off their first month with Freed! Use the discount code: RLPPOD Here is part 2 of 2 on the final 5 of the 10 commandments of polypharmacy. 6. Thou shalt identify limits for medications not intended for chronic use as well as not continue a medication indefinitely for symptoms ...
May 02, 2024•18 min
On this special episode, I provide some real-life examples and layout 5 of my 10 commandments of polypharmacy. Today’s sponsor of the 10 Commandments of Polypharmacy podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. FreedAI is offering a discount exclusive to RLP listeners! Users will get $50 off their first month with Freed! Use the discount code: RLPPOD Here are the first 5 commandments that are addressed in the podcast. 1. Thou shalt not start, ask for,...
Apr 25, 2024•15 min
Today’s sponsor of the Top 10 Anticoagulant Drug Interactions podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. FreedAI is offering a discount exclusive to RLP listeners! Users will get $50 off their first month with Freed! Use the discount code: RLPPOD Apixaban is one of the most commonly used anticoagulants and there are some drug interactions you need to be aware of. Take a listen and find out! Warfarin concentrations can substantially be elevated by dr...
Apr 18, 2024•16 min
Today's sponsor of the Top 10 SSRI Drug Interactions podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. FreedAI is offering a discount exclusive to RLP listeners! Users will get $50 off their first month with Freed! Use the discount code: RLPPOD In this podcast episode, I discuss how to navigate SSRI drug interactions and identify some of the most common medications that have additive serotonergic activity. SSRIs have antiplatelet activity. I discuss how to...
Apr 11, 2024•16 min
On this episode, I discuss travoprost pharmacology, adverse effects, administration, and much more on this podcast episode. Travoprost is used to reduce intraocular pressure in the management of glaucoma. I discuss the mechanism of action and adverse effects. Travoprost is a prostaglandin analog that can help reduce intraocular pressure and reduce the risk of the potential complication of blindness. Growth of eyelashes is a unique adverse effect associated with travoprost.
Apr 04, 2024•14 min
On this podcast episode, I finish up my breakdown of the Beers Criteria. I cover the use of sliding-scale insulin and sulfonylureas in geriatric patients. Hypoglycemia is a major concern with both of these diabetes management strategies. PPIs show up on the Beers criteria list as they can increase the risk of C. diff, pneumonia, fractures, and GI malignancies. Metoclopramide has dopamine antagonist activity and can increase the risk of EPS and tardive dyskinesia.
Mar 28, 2024•17 min
In this podcast episode, I break down some of the most common medications that show up on the Beers criteria list. I discuss cardiovascular medications in this podcast episode, including rivaroxaban and warfarin, and why they show up on the Beers list. Alpha-blockers who up on the Beers list as these medications are inappropriate to use for the management of hypertension. The Beers criteria addresses the use of aspirin in primary prevention. I break down what the criteria state and why it should...
Mar 21, 2024•20 min
On this episode, I discuss the pharmacology surrounding QTc prolongation and drug interactions. I discuss which medications are more likely to cause QTc prolongation and which patient populations we should be more concerned about. Antiarrhythmics are a common class of medication that can exacerbate QTc prolongation when used with other interacting medications. 500 ms is a common value utilized to help identify patients at risk for QTc prolongation and ultimately torsades de pointes.
Mar 14, 2024•19 min
On this podcast episode, I cover risedronate pharmacology, adverse effects, drug interactions, and much more. There is a strict administration procedure with risedronate which is designed to reduce adverse effects and enhance absorption. I discuss this in the podcast. Many medications may cause osteoporosis and may precipitate treatment with risedronate. Corticosteroids and excessive thyroid hormone replacement are two examples. Patients should remain upright (sitting or standing) for at least 3...
Mar 07, 2024•17 min
On this podcast episode, I discuss some of the most common antihypertensive drug interactions you need to know. One major interaction I discuss is the trifecta of a diuretic, an ACE or ARB, and an NSAID. This combination significantly increases the risk for acute renal failure. Nitrates aren't classically referred to as an antihypertensive but they can definitely cause some problems when combined with PDE5 Inhibitors. Lithium can interact with 3 blood pressure medication classes. ACEIs, ARBs, an...
Feb 29, 2024•14 min
Teplizumab is a relatively new agent that helps delay the progression of type 1 diabetes. It slows the rate of beta-cell destruction in the pancreas. Teplizumab is associated with cytokine release syndrome which can result in flu-like symptoms of fever, aches, and headache. Cytokine release syndrome due to teplizumab can be reduced by using appropriate pretreatment medications. Those medications can include analgesics, antihistamines, and/or antiemetics. Teplizumab is associated with suppressing...
Feb 22, 2024•16 min
On this podcast episode, I discuss captopril pharmacology, kinetics, interactions, and much more! Captopril is an ACE Inhibitor. It can cause hyperkalemia, cough, and renal impairment. One of the notable issues with captopril is its relatively short half-life which requires it to be dose frequently throughout the day. Lithium is an important drug interaction and the use of captopril with this medication may increase concentrations and the chance for toxicity.
Feb 15, 2024•15 min
On this episode of the Real Life Pharmacology podcast, I take a dive into the most common mechanisms of drug interactions. Below I list some of the common drug interactions seen in practice and how they work! Opposing Effects Many drugs will work on various receptors throughout the body. To use as an educational point, there is no better example to point to than the beta receptor. Beta-blockers are frequently used in clinical practice for their ability to lower blood pressure and slow the heart ...
Feb 08, 2024•20 min
On this podcast episode, I discuss insulin aspart pharmacology, adverse effects, drug interactions, and much more. Insulin apart is a rapid acting insulin product meant to bring down blood sugars quickly (most often after meals). It is important to remember a couple of medications that may counteract the effects of insulin and apart and raise blood sugar. I talk about corticosteroids and thiazide diuretics in the drug interaction section. Fiasp is a slightly modified insulin aspart molecule that...
Feb 01, 2024•14 min
On this podcast episode, I discuss gentamicin pharmacology, adverse effects, monitoring, drug interactions and much more! Drug monitoring is critical with gentamicin. Trough and peak concentrations can guide therapy and identify someone at risk of toxicity. Nephrotoxicity is a major concern with gentamicin. There are numerous nephrotoxic agents that can increase this risk. I discuss them on the podcast. Ototoxicity is another risk associated with gentamicin. Loop diuretics like furosemide can in...
Jan 25, 2024•15 min
On this podcast episode, I discuss fenofibrate pharmacology, adverse effects, kinetics, drug interactions, and much more! Fenofibrate is typically only used for hypertriglyceridemia. The primary risk of hypertriglyceridemia is pancreatitis so we treat these levels because of this risk. LFTs elevation has been associated with fenofibrate use as well as myopathy. In the presence of myopathy, checking CPK may be considered. Fenofibrate is a weak CYP2C9 inhibitor. Warfarin and phenytoin are two impo...
Jan 18, 2024•13 min
On this podcast episode, I discuss levofloxacin pharmacology, adverse effects, boxed warnings, interactions, and much more. Levofloxacin is well known to cause QTc prolongation and many drugs can increase this risk such as antiarrhythmics, citalopram, antipsychotics, and many more. Binding interactions are important when discussing levofloxacin pharmacology. Calcium, iron, magnesium, and many other cations can block the absorption of this medication. I discuss tendon rupture in relation to levof...
Jan 11, 2024•13 min
On this podcast episode, I discuss darifenacin pharmacology, adverse effects, drug interactions and much more. CYP3A4 and CYP2D6 are important enzymes in relation to darifenacin. I breakdown the importance of these enzymes and how they can impact drug therapy. Darifenacin has anticholinergic activity but affects the central nervous system less than other agents in its class such as oxybutynin and tolterodine. Darifenacin's pharmacology is selective for the Muscarinic-3 (M3) receptor in bladder t...
Jan 04, 2024•13 min
In this podcast episode, I discuss naltrexone pharmacology, adverse effects, drug interactions, and much more. Naltrexone is an opioid antagonist and can blunt the effects of opioid agonists. Because of this, the medication can be used to manage opioid use disorder. Hepatotoxicity is a concern of naltrexone and because of this, it is recommended to monitor LFTs. There is an injectable, long-acting formulation of naltrexone that can be used for opioid and alcohol use disorder treatment....
Dec 28, 2023•13 min
On this podcast episode, I discuss acamprosate pharmacology, adverse effects, drug interactions, and much more! Acamprosate's most common adverse effect is diarrhea. It is a primary reason why patients will ask to stop taking this medication. It is critical to assess renal function prior to using acamprosate. Dose adjustments are recommended when patients have a CrCl of less than 50 ml/min. Unlike naltrexone, acamprosate avoids liver metabolism making it an alternative option in alcohol use diso...
Dec 21, 2023•11 min
On this podcast episode, I discuss alfuzosin pharmacology, adverse effects, drug interactions, and much more! Alfuzosin is an alpha blocker used to help relieve the symptoms of BPH. Low blood pressure is a possible adverse effect of alfuzosin and is more likely when combined with PDE-5 inhibitors like sildenafil. CYP3A4 is an important enzyme in the metabolism of alfuzosin. Inhibitors of CYP3A4 can raise concentrations and increase the chance of alfuzosin toxicity.
Dec 14, 2023•13 min
In this podcast episode, I discuss methadone pharmacology, adverse effects, drug interactions, and pharmacokinetics. Methadone is a full opioid agonist that may be used for pain management and opioid use disorder. Transitioning from methadone to another opioid is complicated. I discuss conversion in this podcast episode. Methadone can increase the risk of QTc prolongation and also has a lot of drug interactions. I discuss them in detail in this podcast episode.
Dec 07, 2023•17 min
On this podcast episode, I discuss meperidine pharmacology, adverse effects, pharmacokinetics, drug interactions, and much more! Meperidine is an opioid that is seldom used due to neurotoxicity. I describe how this can happen in this podcast episode. Meperidine has numerous drug interactions and using a CYP3A4 inhibitor may increase the risk for toxicity. Seizures are a risk with meperidine due to its neurotoxic metabolite normeperidine. I discuss this further in this podcast episode.
Nov 30, 2023•14 min
On this episode of the podcast, I cover guanfacine pharmacology, adverse effects, drug interactions, and much more. Guanfacine is a central acting alpha-2 agonist that has the brand names of Tenex and Intuniv. Because of guanfacine's mechanism of action, it suppresses the sympathetic response leading to a drop in pulse and blood pressure. It is important to remind patients that the onset of action is slow in the management of ADHD with guanfacine. I discuss this further in this podcast episode....
Nov 23, 2023•13 min
On this podcast episode, I discuss fluvastatin pharmacology, adverse effects, pharmacokinetics, and much more. Fluvastatin is only a low to moderate-intensity statin which explains its limited use compared to rosuvastatin or atorvastatin. I discuss drug interactions in the podcast but one important one to recognize is drugs that can inhibit CYP2C9. Fluvastatin is considered a lipophilic statin. I have previously discussed this on the Meded101 blog which you can find here.
Nov 16, 2023•13 min
In this episode, I discuss oxymorphone pharmacology, adverse effects, drug interactions, and more! Oxymorphone is approximately 3 times more potent than morphine. I break down some common opioid comparisons in this episode. Oxymorphone avoids many of the CYP interactions. I discuss some of the common interactions in this episode. I discuss histamine release in relation to opioids and oxymorphone and specifically how this may impact our patients.
Nov 09, 2023•14 min
On this podcast episode, I discuss diclofenac pharmacology, adverse effects, drug interactions, and much more. Diclofenac is one of the highest-risk NSAIDs when it comes to cardiovascular risk. You can find more information on this in the Meded101 NSAID comparison table. Diclofenac carries two boxed warnings. One is for GI bleed risk and the other is for cardiovascular risks. Anticoagulants, antiplatelets, diuretics, and ACEs/ARBs are all common medication classes that can interact with diclofen...
Nov 02, 2023•13 min
On this episode, I discuss aliskiren pharmacology, adverse effects, drug interactions, and much more. Aliskiren should not be used with ACE Inhibitors or ARBs. I discuss why that is in this episode. Aliskiren has a long enough half-life at approximately 24 hours so it is recommended to only take this once daily. Hyperkalemia is a major concern with aliskiren. It is important to monitor potassium levels and renal function.
Oct 26, 2023•11 min
On this episode, I discuss the use of buprenorphine/naloxone in managing opioid use disorder. I cover the kinetics, dosage forms, adverse effect, interactions and much more. Buprenorphine/naloxone has numerous dosage form and they are not interchangeable. I discuss this further on the podcast. Liver impairment is a potential reason to avoid the use of buprenorphine. I discuss this on the podcast. You must keep an eye out for withdrawal symptoms when initiating and adjusting doses of buprenorphin...
Oct 19, 2023•12 min
