Real Life Pharmacology - Pharmacology Education for Health Care Professionals

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. Simil...

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. Sim...

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...

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 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 respirato...

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 oth...

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...

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 C...

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 nerv...

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...

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...

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 tha...

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 exp...

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 corti...

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...

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 w...

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 make...

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 ren...

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-...

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...

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 p...

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...

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 signific...

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....

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 r...