Real Life Pharmacology - Pharmacology Education For Health Care Professionals

Hydralazine Pharmacology Hydralazine works as a direct vasodilator. It primarily works on the arterioles versus the venous system. Hydralazine can cause a unique adverse reaction. It can cause a Lupus type syndrome that can result in fever, myopathy and symptoms that mimic arthritis. I discuss drug interactions with hydralazine and how you need to be aware of certain medications that can have additive effects and also those that can oppose the effects of the drug. One of the downsides to using hydralazine is that patients don't like to take it as often as it requires. It is typically dosed three to four times per day. Orthostasis is a risk with any drug that reduces blood pressure and hydralazine is no different.

On this episode of the Real Life Pharmacology Podcast, I discuss aspirin pharmacology. The two most common adverse effects with aspirin are GI upset and increasing the risk for bleeding and bruising. A commonly asked test question about aspirin is whether it can be used in pediatrics and what risk we encounter if we use it. Another rare effect with aspirin is tinnitus which I discuss further on this episode. It is critical to pay attention to other medications that can thin the blood in a patient taking aspirin. Examples include anticoagulants like warfarin, apixaban, rivaroxaban; antiplatelets like clopidogrel or prasugrel; or NSAIDs.

Clonidine is classified as an antihypertensive. Clonidine pharmacology involves having agonist activity at central alpha 2 receptors. This leads to lower sympathetic outflow and a reduction in blood pressure. Clonidine has numerous reported uses in addition to its antihypertensive effect. It can potentially be used for ADHD, menopausal type symptoms, and opioid withdrawal. Clonidine has historically been on the Beers' list of drugs as it can cause some CNS side effects like sedation, dizziness, and rarely delirium. Clonidine is unique in the antihypertensive class as it does have a patch formulation. Because of the blood pressure lowering effect of clonidine, we have to be aware of patients who report dizziness. Monitoring is critical. Clonidine can also lower heart rate and contribute to dry mouth. Keep an eye out for drugs that can have a cumulative effect on these symptoms. Drugs like beta-blockers, non-DHP CCB's, and digoxin can all have a cumulative effect with clonidine and lower pul

Memantine is classified as an NMDA receptor antagonist. Memantine pharmacology is complex as is the pharmacology of any medication working in the brain. This drug can help reduce the activity of glutamate, an excitatory neurotransmitter which can play a role in Alzheimer's dementia. Memantine has an extended release dosage form that is dosed once per day compared to twice per day for the immediate release. However, the cost of the extended release is much more expensive, so it is recommended to begin with the immediate release. Memantine is cleared by the kidney. In patients with reduced kidney function, you must review to assess if the memantine dose needs to be adjusted. When using memantine or other dementia medications, be sure to look out for medications that can cause dementia type symptoms. CNS depressants like benzodiazepines, sleep medicines, and anticholinergics are all examples of meds that could exacerbate dementia.

On this episode, I discuss magnesium pharmacology and the clinical applications. Magnesium plays numerous important functions in the body and you may see patients take these supplements under the direction of a healthcare professional and sometimes on their own. It is very important to remember that magnesium can cause GI upset and diarrhea. This is often overlooked in our polypharmacy patient. Magnesium can accumulate in renal disease. This is important to remember especially in patients who have a tendency to take a lot of supplements without discussing them with a healthcare professional. PPI's are a notorious cause of low magnesium. Loop diuretics can increase magnesium excretion and also cause low magnesium levels. Magnesium can bind up numerous drugs reducing concentrations and leading to treatment failure. A few examples include quinolone antibiotics, tetracycline antibiotics, and levothyroxine.

Trazodone pharmacology is complex. It can inhibit serotonin reuptake, block histamine receptors, and possibly have alpha-blocking activity. Side effects of trazodone include sedation, dizziness, and dry mouth. Rarely, priapism may occur. I've seen this nugget come up on pharmacology exams! While trazodone is classified as antidepressant, it is often used to help manage insomnia. Trazodone can possibly prolong the QT interval. Risk of other medications and patient specific parameters should be considered. Trazodone concentrations can be increased with the use of CYP3A4 inhibitors and reduced with 3A4 inducers.

The GLP-1's are a relatively newer class of medications used to lower blood sugars in diabetes. GLP-1's work by simulating the effects of incretin hormones in the body. They can help promote fullness, lower weight, and stimulate insulin release following a meal. GLP-1's can cause significant GI side effects. Nausea is by far the most common adverse effect. It can even lead to diarrhea and vomiting in some cases. There is boxed warning on the GLP-1 agonists. Be aware of patients who have had a history of thyroid cancer as this may be a contraindication. GLP-1 agonists can help lower A1C and stimulate weight loss which is a huge benefit for most patients with Type 2 diabetes.

Iron supplements frequently cause GI upset. Monitor patients for nausea, vomiting, and constipation issues. There are three main salt forms of iron. Ferrous fumurate has the most elemental iron, ferrous sulfate (2nd most), and ferrous gluconate has the least. Iron can bind up antibiotics and reduce their effectiveness. Two classic examples include the quinolone and tetracycline antibiotics. Anemia can be caused by numerous concerns, however, iron deficiency is a very common cause. Ferritin is a lab that we commonly monitor in a patient who may be iron deficient. Iron deficiency can also lead to symptoms of Restless Leg Syndrome.

On this episode, I cover common loop diuretics. They include furosemide, torsemide, and bumetanide. Loop diuretics are potent agents that can help in the management of heart failure and ascites. Loops diuretics help promote the loss of excessive fluid through the urine. A common patient complaint from loop diuretics is that they can cause frequent urination. Because of this, we typically dose these drugs earlier in the day. Kidney function and electrolyte monitoring is critical with the use of loop diuretics. Enjoy the episode!

On this episode of the Real Life Pharmacology Podcast, I cover the pharmacology of methotrexate. Methotrexate has a few different indications. It can be used for treatment of cancer. These doses are typically going to be much higher than standard low doses for other conditions. Lower dose methotrexate is often used for autoimmune type conditions like rheumatoid arthritis and psoriasis. Folic acid should be supplemented with use of methotrexate to help reduce the risk of adverse effects. Liver toxicity and immune system suppression are two important factors to monitor in a patient taking chronic methotrexate. I also talk about important cumulative drug interactions with methotrexate such as immunosuppressives and other agents that may impact liver function. Be sure to listen to the end as I talk about the potential impact of methotrexate on some vaccines!

On this episode, I discuss cyclobenzaprine pharmacology. Cyclobenzaprine is an older skeletal muscle relaxant. Cyclobenzaprine can have a significant number of anticholinergic side effects. The anticholinergic side effects of cyclobenzaprine can include sedation, dry eyes, dry mouth, urinary retention, and confusion. Cyclobenzaprine is not well tolerated in the elderly and cause more problems in that patient population. Cyclobenzaprine has a similar structure to the Tricyclic antidepressants.

Lithium is a drug that has a ton of clinical pearls.  On this episode, I talk about the pharmacology, side effects, drug interactions, and critical practice pearls. Kidney function is very important to monitor in our patients taking lithium.  Lithium can accumulate in renal impairment. Thyroid function can be altered by lithium.  Be sure to regularly monitor TSH in a patient on chronic lithium. Over-the-counter NSAID can interact and raise lithium levels.  This is something you need to watch out for as patients can begin taking these medications on their own without supervision. Be sure to assess lithium levels.  Signs of toxicity can include GI upset, tremor, motor movement issues, sedation, and CNS changes.

Pseudoephedrine is commonly used to help relieve nasal congestion. There are some adverse effects you need to be aware of with pseudoephedrine. Insomnia, increase in blood pressure, and urinary retention are all possible. When I assess a patient using pseudoephedrine, I like to investigate blood pressure, history of urinary problems and insomnia history. Pseudoephedrine can cause the prescribing cascade.  I lay out examples in the podcast. Pseudoephedrine should not be utilized with MAOI's if possible - I discuss the reason for this in the podcast. Enjoy the show and don't for get your FREE 31 page resource!

On this episode, I discuss fentanyl pharmacology. I address important considerations that you must remember with fentanyl patches. Those considerations include how pharmacokinetics can impact our patients. I also break down common side effects of opioids as well as potential common drug interactions. Drug diversion and illicit use is an important consideration when using fentanyl.  I also touch on this topic. Nearly 1,000 healthcare professionals have signed up and received this FREE Top 200 Study Guide - Why haven't you?

Quinolones are a class of antibiotics that can be used for various infections. I discuss the pharmacology, adverse effects, drug interactions and other items on this podcast episode. On this episode, I talk about the warnings associated with quinolones. Quinolone use has subsided over time, not due to the fact that they are ineffective, but to rising concerns and warnings about adverse effects. Quinolones can interact with quite a few medications.  I've seen a case of amiodarone and levofloxacin contributing to QTc prolongation which I discuss on this episode. It is critical to remember the binding interactions associated with quinolones as these can potentially lead to treatment failure. Enjoy the show and be sure to snag your FREE 31 page PDF on the top 200 drugs, a gift simply for following the podcast!

On this episode I discuss why we may need to use potassium supplements. I also talk about a medication error situation involving potassium that lead to a death. It is important to remember other medications that can raise potassium levels. I also talk about a dosage form of potassium that might make patients ask some questions. Enjoy the show and I hope you sign up to get our free 31 page PDF!  

On this episode, I talk about apixaban (Eliquis) pharmacology. I also cover adverse effects like bleeding and what to monitor. Drug interactions are a concern with apixaban and I discuss a few items that you may want to look out for. It is important to remember that apixaban does require dose adjustments in certain situations as well. Check out our free giveaway for healthcare professionals and students.  It is a top 200 study guide of highly testable pearls! (Free 31 page PDF)

Metoclopramide Pharmacology Metoclopramide can block dopamine receptors as part of it's mechanism of action.  I discuss the clinical implications from this in the podcast. Metoclopramide can exacerbate Parkison's disorder so you need to be careful in that type of patient. Metoclopramide is dosed frequently, which can potentially be a downside as far as patient adherence goes. Metoclopramide has a few potential interactions that you should be aware of.  I talk about those in this episode. Be sure to check out The Thrill of the Case on Amazon as I do have a clinical scenario about Reglan (metoclopramide) in that 200+ page book. As always, check out my free Top 200 study guide!

On this episode, I discuss the mechanism of action of the SGLT-2 Inhibitors and how they lower blood sugar. These drugs are classically used for diabetes and eliminate blood sugar through the urine. One of the potential side effects is that these drugs can increase the risk of genital infections and urinary tract infections. There is a boxed warning on canagliflozin for its potential to increase the risk of amputation. These drugs also have a mild diuretic type effect and can potentially cause hypotension. Enjoy the show and be sure to sign up to follow the podcast and get your FREE 31 Page Pharmacology Study Guide! If you find the show helpful, please leave us a kind rating and review wherever you are listening! Cheers! Eric Christianson, PharmD, BCGP, BCPS

On this episode, I discuss how the tetracyclines impact bacterial protein synthesis. I also remind you of several medications that fall in the tetracycline class.  Doxycycline is by far the medication I see used the most. You'll also learn about common side effects like GI upset and photosensitivity. I cover why this class of medication is typically avoided in pediatrics and pregnancy. I hope you enjoy the show and don't forget to snag your FREE 31 page PDF study guide!