Real Life Pharmacology - Pharmacology Education for Health Care Professionals

On this episode, I discuss ketamine pharmacology. Ketamine is primarily broken down by CYP2B6 which fortunately does not have a lot of common medications that can interfere with its action. Ketamine can cause psychiatric type adverse effects such as hallucinations, nightmares, and vivid dreams. At lower to moderate dosages, ketamine does have some mild sympathetic activity which can raise blood pr...

On this episode of the Real Life Pharmacology Podcast, I cover topiramate pharmacology. Topiramate is indicated for migraine prevention, seizures, and weight loss which are the most common uses that I see this medication used for. Topiramate has carbonic anhydrase activity, so rarely, use of this drug may induce metabolic acidosis. By far, the most common patient complaint I get with the use of to...

On this episode I discuss colchicine pharmacology, adverse effects, drug interactions, and pharmacokinetics. Colchicine ultimately works by reducing the activity of neutrophils that help contribute to pain and inflammation associated with gout. Colchicine does have some drug interactions with medications and grapefruit juice via CYP3A4. The most common dose limiting side effect of colchicine is di...

Fexofenadine is a 2nd generation antihistamine that is primarily used for allergic rhinitis. I cover fexofenadine pharmacology on this podcast episode. Fruit juices can actually impair the absorption of fexofenadine and increase the risk of treatment failure. Fexofenadine is mildly anticholinergic but overall has low to no CNS penetration. Because fexofenadine has low CNS penetration, the risk for...

On this episode I discuss empagliflozin pharmacology and how this medication lowers blood sugar. In this episode, I talk about empagliflozin pharmacology. Empagliflozin is more commonly known by the brand name Jardiance and is in the class of sodium-glucose co-transporter-2 inhibitors or SGLT2 inhibitors. Jardiance use has definitely escalated over the last few years in the management of type 2 di...

On this episode, I discuss rifaximin pharmacology. Rifaximin is most commonly used in hepatic encephalopathy and C. difficile infection. Rifaximin systemic absorption is minimal so that is why it is primarily only used for GI conditions. Drug interactions with rifaximin are fairly minimal compared to its cousin rifampin which has tons of drug interactions. I discuss important drug interactions on...

On this episode of the Real Life Pharmacology Podcast, I discuss naproxen pharmacology. Naproxen can raise the concentrations of lithium and increase the risk for toxicity. Compared to most other NSAIDs, naproxen tends to have a lower cardiovascular risk. Naproxen can contribute to renal insufficiency, GI bleed risk, and CHF exacerbations. I discuss important drug interactions on the podcast, be s...

On this episode, I discuss cyclosporine pharmacology. This medication is an immunosuppressant used to reduce the risk of transplant rejection. Cyclosporine has a long list of potential adverse effects such as hyperglycemia, renal impairment, GI toxicity, and hypertriglyceridemia. Important monitoring parameters for cyclosporine include drug levels, electrolytes, renal function, and blood sugars. C...

On this episode, I discuss leflunomide pharmacology. It is classified as a DMARD and is primarily used in rheumatoid arthritis. Leflunomide carries a boxed warning for hepatoxicity. LFTs must be monitored with its use. Leflunomide can inhibit CYP2C8 which plays an important role in pioglitazone metabolism. Concentrations of pioglitazone can go up on account of this interaction. TB screening should...

Baclofen is primarily used for its ability to help relieve muscle spasms. I discuss baclofen pharmacology on this podcast episode. Baclofen should not be abruptly discontinued as it can cause a significant withdrawal reaction whose symptoms may include fever, spasticity, rhabdomyolysis, and death. While baclofen generally avoids any issues with CYP enzyme interactions, it is eliminated by the kidn...

On this episode, I discuss bromocriptine pharmacology. It is a dopamine agonist that can be used for hyperprolactinemia and Parkinson’s symptoms. One of the major side effects of bromocriptine is nausea which stems from its dopamine agonist action. Because bromocriptine is a dopamine agonist, it can counteract the action of antipsychotics. Bromocriptine is broken down by CYP3A4, so drug inte...

On this episode, I discuss tacrolimus pharmacology. This medication is an immunosuppressant used to reduce the risk of transplant rejection. Tacrolimus has a long list of potential adverse effects such as hyperglycemia, renal impairment, GI toxicity, and hypertriglyceridemia. Important monitoring parameters for tacrolimus include drug levels, electrolytes, renal function, and blood sugars. CYP3A4...

On this episode of the Real Life Pharmacology Podcast, I discuss ibuprofen pharmacology. Ibuprofen can raise the concentrations of lithium and increase the risk for toxicity. Compared to most other NSAIDs, ibuprofen has a relatively short half-life. This explains why it needs to be dosed more frequently than other agents. Ibuprofen can contribute to renal insufficiency, GI bleed risk, and CHF exac...

Aripiprazole is metabolized by CYP2D6 and CYP3A4. Because of this, drug interactions can happen. I discuss specific examples in this episode. Partial dopamine agonist activity and serotonergic activity make up a significant amount of aripiprazole’s pharmacology. Aripiprazole is classified as an antipsychotic and can be used in schizophrenia, bipolar disorder, and depression augmentation. Ari...

On this episode of the Real Life Pharmacology Podcast, I discuss escitalopram pharmacology. Escitalopram is an SSRI and can be used to manage depression, anxiety, OCD, PTSD, and other psychiatric disorders. If you consider fluoxetine the most activation SSRI and paroxetine the most sedating, escitalopram probably falls somewhere in the middle. Sexual dysfunction is a potential adverse effect with...

On this episode of the Real Life Pharmacology Podcast, I cover ziprasidone pharmacology. Ziprasidone has dopamine blocking activity and is classified as a second generation antipsychotic. Ziprasidone tends to have lower metabolic syndrome risks compared to other antipsychotics like clozapine and olanzapine. QTc prolongation is a significant risk with ziprasidone and be aware of drug interactions a...

On this episode, I discuss tiotropium pharmacology. In addition, I cover adverse effects, administration pearls, and drug interactions. Tiotropium blocks acetylcholine from binding the M3 receptor in the lungs. This leads to a relaxation of the bronchial smooth muscle. Because tiotropium has anticholinergic activity, there is a potential for anticholinergic adverse effects like constipation, urina...

On this episode, I discuss palivizumab pharmacology and how it is used in pediatric patients. Palivizumab is a monoclonal antibody that is used to prevent RSV infections in pediatric patients. Palivizumab is an IM injection that is dosed by weight. Learn more on this podcast episode. RSV can be devastating in pediatric patients under the age of two. Palivizumab can be used in select populations to...

Varenicline is a partial nicotine agonist that can be used to help patients quit smoking. The two most common adverse effects that I have seen in clinical practice with varenicline are GI upset and insomnia/vivid dreams. GI upset with varenicline can be reduced by giving the drug with food and a full glass of water. A dose reduction may also be considered. Patients should identify a goal stop date...

Diphenhydramine is a first generation antihistamine that is highly anticholinergic. When using medications like diphenhydramine, be sure to watch for side effects like dry eyes, dry mouth, constipation, urinary retention, and CNS changes. Sedation is a primary effect of diphenhydramine. It can be advantageous in certain situations, and detrimental in others. Drugs like donepezil, memantine, laxati...

On this episode of the RLP podcast, I discuss fluconazole pharmacology. Fluconazole prevents fungi from producing essential components for their cell membrane and thus inhibits their growth. Drug interactions are common with fluconazole. Fluconazole inhibits CYP3A4, 2C9, and 2C19 to varying degrees. I discuss an interaction between fluconazole and phenytoin in this podcast episode. Hepatitis has r...

On this episode of the RLP podcast, I discuss levetiracetam pharmacology. Levetiracetam is indicated for numerous types of seizures and possibly works by enhancing GABA activity. Sedation and dizziness are two common adverse effects of levetiracetam. On this episode, I discuss when and if we might do levetiracetam levels. Levetiracetam tends to have much fewer drug interactions compared to older a...

In this episode of the RLP podcast, I discuss scopolamine pharmacology. Scopolamine patches can be used in the management of motion sickness and surgery/anesthesia induced nausea and vomiting. Transdermal scopolamine has a slow onset of action so we need to be deliberate about the timing of placement (usually 4-6 hours prior to anticipated time of symptoms). Transdermal scopolamine is highly antic...

On this episode of the RLP podcast, I discuss tamsulosin pharmacology. Tamsulosin inhibits alpha receptors which helps improve urine flow in patients with BPH. As an off-label use, you may see tamsulosin used to try to aid in the passage of renal stones. Tamsulosin concentrations may be increased by CYP3A4 inhibitors and reduced by CYP3A4 inducers. I discuss important drug interactions on the podc...

On this episode of the RLP podcast, I discuss finasteride pharmacology. Finasteride can be used in the management of BPH or male pattern baldness. By reducing overall androgen burden, finasteride can help to shrink the prostate and improve BPH symptoms. Finasteride takes a long time to work, so this is an important education point for patients. I discuss important drug interactions on the podcast,...