Real Life Pharmacology - Pharmacology Education For Health Care Professionals

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 interactions are critical with tacrolimus. Inhibitors can raise concentrations and inducers can lower concentrations.

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 exacerbations.

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. Aripiprazole can cause significant akathesia. I discuss this adverse effect on this episode.

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 escitalopram. I discuss it further on this episode.

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 and electrolyte imbalances that may increase this risk.

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, urinary retention, and dry mouth. The tiotropium Handihaler can be confusing to patients. I discuss medication misadventures in this podcast episode.

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 help prevent the infection. Injection and skin reactions are possible with the use of palivizumab.

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 for smoking cessation prior to begininng the use of varenicline.

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, laxatives, tamsulosin, and artificial tears can be indicators of anticholinergic side effects from diphenhydramine.

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 rarely been reported with the use of azole antifungals like fluconazole.

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 agents like phenytoin and carbamazepine.

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 anticholinergic and can cause dry eyes, dry mouth, urinary retention, and confusion.

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.

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.

On this episode of the Real Life Pharmacology podcast, I discuss the ins and outs of lamotrigine pharmacology. Lamotrigine has a very slow dose titration schedule due to the risk of drug induced rash. Sedation, GI upset, and CNS changes are the most common adverse effects associated with lamotrigine. Lamotrigine concentrations can be increased by valproic acid, so we tend to use lower starting doses. Phenytoin and carbamazepine can lower concentrations of lamotrigine.

On this episode of the Real Life Pharmacology podcast, I breakdown propofol pharmacology. Propofol is a CNS depressant that is used for general anesthesia. I discuss propofol infusion syndrome in this episode and what to look out for clinically. Adding a benzodiazepine or opioid to propofol may have a synergistic effect and the propofol dose may need to be reduced.

On this episode of the RLP podcast, I discuss glucagon pharmacology. It is important to remember with glucagon that patients will still require glucose following administration to improve their blood sugar numbers. Glucagon is typically reserved for moderate to severe episodes of hypoglycemia when patients have altered consciousness. The major adverse effect with glucagon is nausea and vomiting which often may prevent oral intake of glucose for some time after administration.

Dulaglutide is a GLP-1 agonist used in the management of diabetes. Dulaglutide has 4 different dosages that can be used to help lower A1C. As the dose goes up, so does the potential for adverse effects however. Like most of the GLP-1 agonists, dulaglutide is only available as an injection. Semaglutide is an exception to this. Nausea is the primary adverse effect of dulaglutide which some patients may get used to over time.

Dapagliflozin is an SGLT-2 Inhibitor that reduces blood sugar by increasing the excretion of sugar through the urine. Genital and urinary infections is a potential risk with the use of SGLT2 Inhibitors like dapagliflozin. Dapagliflozin has received FDA approval for use in heart failure (in patients even without diabetes). Be aware of agents that may enhance the risk for hypoglycemia such an insulin and sulfonylureas.

Omeprazole is a proton pump inhibitor that can be commonly used for GERD, PUD, and GI prophylaxis. Omeprazole can inhibit CYP2C19 which can cause concentrations of drugs like escitalopram and citalopram to rise. Hypomagnesemia, low B12, osteoporosis, and an increase in C. Diff risk are potential complications with longer term PPI use. PPI's like omeprazole are best given 30-60 minutes before meals. This is something that patients often forget.