Real Life Pharmacology - Pharmacology Education For Health Care Professionals

On this episode of the Real Life Pharmacology podcast, I discuss carvedilol pharmacology, drug interactions, and adverse effects. Carvedilol is one of the few beta-blockers that has alpha-blocking activity. Carvedilol is almost exclusively metabolized by various CYP enzymes so renal function changes typically don't change drug concentrations to a significant extent. Beta-blockers like carvedilol are well known to cause the adverse effects of fatigue and sexual dysfunction.

On this episode, I discuss umeclidinium pharmacology, adverse effects, patient education pearls, and drug interactions. Umeclidinium is used in the management of COPD. Below is an excellent quick overview of the COPD guidelines from pyrls.com - You can get the full PDF by signing up for a free account at pryls.com/rlp Umeclidinium is a long-acting anticholinergic (anti-muscarinic) LAMA and as you can see from the figure above drugs from this class are frequently used in COPD management. The brand name of umeclidinium is Incruse Ellipta. Ellipta refers to the device and not the drug umeclidinium.

On this episode, I discuss denosumab pharmacology, adverse effects, clinical pearls, and drug interactions. Whenever I see an osteoporosis medication like denosumab used, I review the medications to ensure that we avoid medications that can cause osteoporosis. Denosumab is often used as a potential alternative in osteoporosis management for those that cannot tolerate bisphosphonates. We need to monitor calcium levels when using denosumab as levels can be dangerously low, especially when used in combination with other calcium lowering drugs. Loop diuretics and cinacalcet can have additive hypocalcemia effects when used in combination with denosumab.

On this episode I discuss roflumilast (Daliresp) pharmacology, adverse effects, and important drug interactions. Roflumilast is indicated to reduce the incidence of COPD exacerbations. Roflumilast is significantly broken down by CYP3A4 so there are numerous drug interactions that we have to take into account. Psychiatric issues, GI upset, and weight loss are all potential adverse effects due to roflumilast.

On this episode, I breakdown trihexyphenidyl (Artane) pharmacology, adverse effects, and drug interactions. Trihexyphenidyl is highly anticholinergic and can cause constipation, dry eyes, dry mouth, and urinary retention. Dementia medications like donepezil can have their effects blunted by the use of trihexyphenidyl. Trihexyphenidyl is an older anticholinergic that is rarely used for the management of EPS caused by antipsychotics.

On this episode, I discuss liraglutide pharmacology, drug interactions, and adverse effects. Liraglutide is well known to cause nausea. It is important to assess the severity of nausea as it may subside in some patients as they gain tolerability to the medication. We mentioned the 2022 Diabetes Guideline Cheat Sheet in the podcast - you can get that for free at pyrls.com/rlp Liraglutide has a fairly low risk of hypoglycemia when used alone, but this risk increases when it is used with insulin or sulfonylureas. Saxenda is the weight loss formulation of liraglutide and dosing is higher for weight management than it is for diabetes management.

On this episode, I discuss losartan pharmacology, adverse effects, drug interactions, and appropriate monitoring. Losartan is an ARB and can increase potassium levels. Keep an eye out for medications like spironolactone and trimethoprim which can increase this risk further. Losartan has been shown to lower uric acid levels which could potentially be helpful in patients with gout. Monitoring renal function is very important with losartan. The risk of ARF goes significantly higher when used with NSAIDs or diuretics.

On this episode, I breakdown pravastatin pharmacology, adverse effects, drug interactions and when you might see this drug used in practice. Pravastatin is a statin and will lower LDL. Its use is a little limited in the fact that it is not as potent as other agents in its LDL lowering effects. Pravastatin is hydrophilic which differentiates it from simvastatin, atorvastatin, and lovastatin. I describe rhabdomyolysis in this podcast as it is a potential rare adverse effect of pravastatin.

On this episode, I discuss clomiphene pharmacology, adverse effects, clinical practice pearls, and drug interactions. Clomiphene is a commonly used medication to help manage female infertility. Clomiphene is oral and relatively inexpensive compared to other agents that are used for infertility management. Clomiphene is a SERM so you can anticipate that some patients may report vasomotor symptoms like flushing and hot flashes.

Fluticasone (Flonase) is a nasal corticosteroid that is used in the management of allergic rhinitis. A primary adverse effect that I have seen in practice with fluticasone is the risk for nose bleeds. Flonase can have some interactions via CYP3A4. Inhibitors of CYP3A4 like clarithromycin can increase concentrations. While the risk for systemic exposure is low with nasal fluticasone, long-term, high dose, and frequent use should be monitored appropriately.

On this episode, I discuss (Carafate) sucralfate pharmacology, adverse effect, kinetics, and drug interactions. Sucralfate is notorious for drug binding interactions and can reduce the concentrations of many drugs which I cover in the podcast. Four times daily dosing is a big downside to sucralfate and why it isn't used terribly often for GI issues like esophagitis. The suspension formulation of sucralfate does contain some sugar so be aware of this in our diabetes patients.

On this episode, I discuss atenolol pharmacology, adverse effects, pharmacokinetics, and drug interactions. Atenolol is primarily cleared by the kidney which should tell you that we need to pay attention to dose adjustments as renal function declines. Atenolol is a beta-1 selective agent that is NOT a preferred beta-blocker in HFrEF. Pulse and blood pressure monitoring is essential with any beta-blocker like atenolol.

On this episode, I discuss hydromorphone pharmacology, adverse effect, and drug interactions. I discuss the pharmacokinetics of hydromorphone and also discuss the relative potency compared to other opioids. Hydromorphone drug interactions are mostly additive effects. Drugs that cause sedation or constipation can have additive effects on hydromorphone. Be extremely careful with hydromorphone dosage forms. There are numerous different concentrations and strengths. I discuss this in this episode.

On this episode, I discuss duloxetine pharmacology, adverse effects, and common drug interactions. Duloxetine is an SNRI that is used for depression, anxiety, and various pain syndromes like neuropathy and fibromyalgia. Duloxetine can inhibit CYP2D6 which can lead to higher concentrations of clozapine and propranolol and lower activity of tamoxifen. CYP1A2 inhibitors like ciprofloxacin can raise concentrations of duloxetine leading to an increased potential for adverse effects.

Lasmiditan (Reyvow) is an agent that is utilized for acute migraine treatment. It works slightly differently than triptans which I discuss on this episode. Lasmiditan is a relatively new agent and cost will often limit its use at this time. Rosuvastatin and sulfasalazine are two common medications that may have concentrations increase when lasmiditan is used. I discuss this in detail on this episode. Lasmiditan is an oral tablet that is only recommended to give once per day which differs from commonly used triptans where the dose can be repeated.

On this episode, I discuss sumatriptan pharmacology, adverse effects, drug interactions and more. Dosage forms can provide different methods of drug delivery and I talk about many different sumatriptan dosage forms in this episode. Cardiovascular risks need to be assessed when using a drug like sumatriptan. I discuss this in greater detail in the podcast. Sumatriptan has serotonergic activity and we need to assess the risk of serotonin syndrome in our patients.

On this episode of the Real Life Pharmacology Podcast, I discuss bumetanide pharmacology, adverse effects, and drug interactions. Bumetanide is a loop diuretic and it is critical to monitor renal function and electrolytes with this medication. Ototoxicity is a rare adverse effect that is dose-dependent and can be worsened by aminoglycosides. It is critical to look for drugs that can worsen edema when using bumetanide to ensure that we avoid the prescribing cascade.

On this episode, I discuss oxycodone pharmacology, adverse effect, pharmacokinetics, and drug interactions. Oxycodone is broken down by CYP3A4 and CYP2D6. I discuss this further on the podcast and how interactions may alter concentrations. When a patient stops taking oxycodone after being on it for some time, you must recognize common symptoms of withdrawal. Oxycodone comes as in an extended-release and immediate-release oral formulation.

On this episode of the Real Life Pharmacology podcast, I explore doxycycline pharmacology, adverse effects, and drug interactions. Doxycycline can be bound by numerous minerals like calcium, magnesium, and iron. Coadministration can lead to reduced concentrations. Sun sensitivity is a really important adverse effect that can be caused by doxycycline. Be sure to educate your patients. Doxycycline can be used as an alternative to beta-lactams and macrolides in the management of community-acquired pneumonia.

On this episode, I discuss tolterodine pharmacology, adverse effects, and drug interactions. Tolterodine (Detrol) is an anticholinergic medication used to manage the symptoms of overactive bladder. Tolterodine's anticholinergic activity can lead to a significant number of adverse effects like dry mouth, dry eyes, constipation, and urinary retention. Elderly patients may be at greater risk for anticholinergic adverse effects from tolterodine compared to younger patients. Tolterodine can have additive effects from other anticholinergics like diphenhydramine or TCAs which enhance its potential for side effects.