Real Life Pharmacology - Pharmacology Education for Health Care Professionals

In the podcast this week, I talk about doxylamine pharmacology. Doxylamine is a first-generation antihistamine; it is commonly an active ingredient in night-time medications like Unisom, Nyquil, and Mucinex. The pharmacology of doxylamine is similar to other first-generation antihistamines, it competitively inhibits the binding of histamine at H1 receptors. Its main uses are as sleep aides, in cou...

On this episode, I breakdown the sacubitril valsartan pharmacology. The drug for this week is the combination drug sacubitril/valsartan, also known as Entresto. Entresto has a novel dual mechanism of action to treat HFrEF. Sacubitril, currently, is the only FDA-approved medication that is a neprilysin inhibitor. For background, neprilysin is an enzyme that breaks down natriuretic peptides. The inh...

Glipizide, or Glucotrol, is a sulfonylurea used for the treatment of Type 2 Diabetes. Pharmacologically, glipizide acts by stimulating beta-cells in the pancreas to release insulin. Specifically, glipizide will block the opening of ATP-sensitive potassium channels on the plasma membrane of beta-cells on the pancreas. The result of that is depolarization, which then causes stimulation of voltage-se...

On this episode of the Real Life Pharmacology Podcast, I discuss cetirizine pharmacology. Cetirizine, commonly known as Zyrtec, is a 2 nd generation antihistamine. Compared to 1 st generation antihistamines, like diphenhydramine and chlorpheniramine, 2 nd generation antihistamines have fewer anticholinergic effects. Pharmacologically, cetirizine works by selectively blocking histamine from binding...

Folic acid is a water-soluble vitamin; compared to fat-soluble vitamins, accumulation is not as much of an issue. It is responsible for the formation of coenzymes, DNA synthesis, erythropoiesis, and certain metabolic processes. Due to the mechanism of folic acid, if there is a deficiency present, anemia can manifest. Although the recommended dietary intake is 0.2 mg, supplementation may be necessa...

On this episode, I discuss insulin glargine pharmacology. Insulin glargine is a long-acting insulin that has the common brand names Lantus, Basaglar, and Toujeo. Due to the pharmacology of insulin glargine, it provides a baseline coverage of insulin. It cannot manage acute elevations in blood glucose like target-specific meals. Instead, insulin glargine is used to decrease blood sugar throughout t...

On this episode, I discuss primidone pharmacology, adverse effects, and drug interactions. Primidone, or Mysoline, is an anticonvulsant most commonly used for essential tremors. The primary pharmacological mechanism of action of primidone is similar to other anticonvulsants, like phenobarbital. It causes a reduction in the activity of neurons. Both primidone and its metabolites are potent anticonv...

I cover melatonin pharmacology on this episode of the Real Life Pharmacology Podcast. Melatonin, commonly taken by patients for insomnia, is an endogenous hormone produced by the pineal gland. It is an over-the-counter supplement available in dosage forms such as liquid drops, gummies, and tablets. The pharmacology of melatonin is primarily through the activation of melatonin receptors in the supr...

Furosemide is a loop diuretic most commonly recognized by its brand name, Lasix. Pharmacologically, it acts by inhibiting the reabsorption of Na/Cl in the thick ascending limb of the loop of Henle. The inhibition of electrolyte reabsorption results in a loss of fluids causing diuresis. Since it has a diuretic effect, it is commonly used to treat congestive heart failure, general edema, ascites due...

Background: – Hydroxyzine Pharmacology  Hydroxyzine, common brands Atarax, and Vistaril, is a first-generation antihistamine. It is a part of the piperazine drug class [1] , sharing structural similarities to other antihistamines like Cetirizine, but also drugs of other classes like ranolazine, buspirone, clozapine. Being an H1 blocker, hydroxyzine is commonly used for itching, anxiety,...

On this episode, I cover clinical tips and practice pearls surrounding vitamin B12 pharmacology. Vitamin B12 deficiency plays a critical role in the development of macrocytic anemia. There are medications that you have to be aware that can deplete vitamin B12. Metformin, colchicine, and PPIs are some common examples. A lack of intrinsic factor can lead to B12 deficiency. Intrinsic factor is necess...

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...