Real Life Pharmacology - Pharmacology Education For Health Care Professionals

On this episode of the Real Life Pharmacology podcast, I continue my education on the top 200 drugs. Raloxifene, prednisone, phenytoin, fish oil, and ezetimibe are covered in this podcast episode. Prednisone is a corticosteroid that may cause hyperglycemia, insomnia, GI upset, osteoporosis, HPA suppression, and hypertension as primary adverse effects. Raloxifene is classified as a SERM and can be used for osteoporosis and breast cancer. DVT and hot flashes are significant adverse effect concerns. Fish oil (Lovaza) is used to reduce triglycerides. Elevated triglycerides can increase the risk of pancreatitis. Ezetimibe inhibits the absorption of cholesterol through the gut. It lowers LDL but not to the extent of statins. Phenytoin is a narrow therapeutic index medication (NTI) that is used as an anticonvulsant. Ataxia, confusion, GI upset, and vertical nystagmus are potential signs of toxicity.

On this episode of the Real Life Pharmacology podcast, I continue my coverage with the Top 200 Drugs Podcast. Here's the list of medications we will cover. Lorazepam (Ativan) is a benzodiazepine well known for its anxiolytic and anti-seizure properties. Phenazopyridine (Pyridium) is a urinary analgesic that can change the color of the urine to a reddish/orange color as one of its adverse effects. Hydroxychloroquine (Plaquenil) is a DMARD used in rheumatoid arthritis and Lupus. One highly testable and unique nugget to remember is that it can cause retinopathy. Lidocaine patch (Lidoderm) is used topically to help with various types of pain including neuropathy and postherpetic neuralgia. Diclofenac (Cataflam) is an NSAID used as an analgesic and anti-inflammatory. It can increase the risk of GI bleed, edema, renal failure, and thrombosis.

On this episode of the Real Life Pharmacology podcast, I discuss drugs 31-35 of the top 200 drugs. Ethinyl estradiol/drospirenone is a combined oral contraceptive used for birth control purposes. Hydralazine is a direct vasodilatory that can be used for hypertension and heart failure. Benztropine is an older anticholinergic medication originally indicated for Parkinson's disease but most commonly used to manage EPS symptoms from dopamine-blocking agents such as antipsychotics. Tussionex is a combination medication of chlorpheniramine and hydrocodone. It is used to help alleviate cough. Paroxetine is an SSRI used for the treatment of depression, anxiety, and other psychiatric disorders.

On this episode of the Top 200 Drugs pharmacology podcast, I cover fluticasone nasal spray, allopurinol, alendronate, famotidine, and cefdinir. Fluticasone is a corticosteroid that can be used nasally for the treatment of allergic rhinitis. Allopurinol is a xanthine oxidase inhibitor used to reduce uric acid and prevent gout flares. Alendronate is a bisphosphonate that inhibits the action of osteoclasts. This action helps treat osteoporosis. Famotidine is a histamine-2 receptor antagonist that helps reduce gastric acid secretion and alleviate heartburn symptoms. Cefdinir is a third-generation cephalosporin that is often used as an alternative for those who cannot take penicillin antibiotics. There is a small risk for cross-reactivity that a clinician has to consider.

Lamotrigine is an antiseizure medication and also may be used for bipolar disorder. A rash is a major side effect to remember with this medication. Valganciclovir is an antiviral medication that can be used to prevent cytomegalovirus (CMV) in patients with a suppressed immune system. Fluconazole is an azole antifungal that can be used to treat candidiasis, blastomycosis, and tinea infections. Drug interactions, QTc prolongation, and hepatotoxicity are potential risks. Atenolol is a beta-blocker used to treat atrial fibrillation and hypertension. It is relatively selective for beta-1 receptors meaning that it doesn't affect the lungs as much as non-selective agents. Montelukast is a medication that blocks the actions of leukotrienes. This can be beneficial for the management of allergies and asthma.

In this episode of the Real Life Pharmacology podcast, I cover drugs 16-20 of the top 200 drugs. This podcast includes information about clozapine, furosemide, heparin, tetracycline, and vardenafil. Clozapine has five boxed warnings and these are all items that you may see on your pharmacology and board exams! I've also blogged about these in the past at meded101. Furosemide is a loop diuretic and a common indicator of the prescribing cascade. I discuss this in this podcast episode. Heparin can cause thrombocytopenia. I discuss what HIT (heparin-induced thrombocytopenia) may look like.

Metformin is a medication used in the management of diabetes. It can cause significant diarrhea, B12 deficiency, and in rare cases, lactic acidosis. Atorvastatin (Lipitor) is a statin medication used for cholesterol management. It lowers LDL and is associated with myopathy. Omeprazole is a PPI used for GERD and has drug interactions with citalopram and clopidogrel. Ciprofloxacin is a quinolone antibiotic used to treat gram-negative infections and UTIs. It carries numerous risks such as tendon rupture. Ondansetron is an antiemetic medication used in the management of nausea and vomiting. I discuss the prescribing cascade in relation to this medication.

On this episode of the Real Life Pharmacology podcast, I discuss drugs 6-10 of the top 200 drugs. Included in this podcast episode are two antibiotics that are frequently used in pediatrics. Those two antibiotics are azithromycin and amoxicillin. Alprazolam is a benzodiazepine. It is a controlled substance that is used for the acute relief of anxiety. It is not well tolerated in the elderly. Hydrochlorothiaizde is a thiazide diuretic used primarily for hypertension. It can exacerbate gout and cause frequent urination. Amlodipine is a dihydropyridine calcium channel blocker. The most important adverse effect to remember with this medication is edema.

On this episode of the Real Life Pharmacology Podcast, I start my journey on summarizing the most highly testable pearls with the top 200 medications. I'm going through the top 200 medications, 5 drugs at a time, and sharing my experience and clinically relevant information about these medications. Escitalopram is an SSRI that can cause serotonin syndrome, sexual dysfunction, and SIADH. Simvastatin is a cholesterol medication that can cause myopathy and rhabdomyolysis. Levothyroxine is a thyroid hormone replacement medication that has numerous binding drug interactions. Vicodin is a brand name combination of hydrocodone and acetaminophen. It is an opioid combined with and OTC analgesic. Lisinopril is an ACE inhibitor used for hypertension that can cause a chronic dry cough and hyperkalemia.

On this episode, I discuss timolol pharmacology, adverse effects, drug interactions, and much more. Timolol is a non-selective beta-blocker so it blocks both beta-1 and beta-2 receptors. Since timolol blocks beta-2 receptors, it can blunt the effect of respiratory medications that have beta-agonist action. Beta-blockers are notorious for causing bradycardia and pulse is an important monitoring parameter for timolol.

Continuous Glucose Monitors (CGMs) are becoming an important tool in the management of diabetes. I break down some of the most common clinical practice pearls you should know.

On this episode of the Real Life Pharmacology Podcast, I cover some of the most common food and supplement drug interactions. The 3 G's can potentially increase the risk of bleeding in patients on anticoagulants and antiplatelets. I discuss what supplements these are. There are some vitamins that can cause drug interactions. Vitamin C is a supplement that can alter the absorption of some medications. Metal cations like iron can bind certain medications and reduce absorption. I discuss which medications are most likely to be affected.

On this episode, I discuss the new medication vonoprazan and where it will likely be used in practice. Vonoprazan is from a brand new class of medication called "PCAB". I discuss this medication and its pharmacology in this podcast episode. Drug interactions and cost are the two major downsides of this medication that will likely limit its use compared to the PPIs. CYP3A4 inducers like rifampin, carbamazepine, and phenytoin should not be used with vonoprazan. They will reduce the effectiveness of vonoprazan.

Today’s sponsor of the 10 Commandments of Polypharmacy podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. FreedAI is offering a discount exclusive to RLP listeners! Users will get $50 off their first month with Freed! Use the discount code: RLPPOD Here is part 2 of 2 on the final 5 of the 10 commandments of polypharmacy. 6. Thou shalt identify limits for medications not intended for chronic use as well as not continue a medication indefinitely for symptoms that have an expected short duration 7. Thou shalt not start a medication from a similar medication class without appropriate rationale 8. Thou shalt not initiate a medication without considering medications that may treat duplicate conditions – Kill two birds with one stone 9. Thou shalt consider eliminating or reducing medications at every medication review 10. Thou shalt be willing to accept risk in discontinuing a medication if they were willing to accept the risk of initiating a medication

On this special episode, I provide some real-life examples and layout 5 of my 10 commandments of polypharmacy. Today’s sponsor of the 10 Commandments of Polypharmacy podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. FreedAI is offering a discount exclusive to RLP listeners! Users will get $50 off their first month with Freed! Use the discount code: RLPPOD Here are the first 5 commandments that are addressed in the podcast. 1. Thou shalt not start, ask for, dispense, or administer medication without reviewing a medication list that is accurate, up to date, and complete with over-the-counter medications and supplements 2. Thou shalt consider utilizing non-drug approaches and interventions to solve patient problems before initiating medication 3. Thou shalt assess if a medication is effective before adding a new medication for the same condition 4. Thou shalt consider any new symptom is an adverse effect of another medication until proved otherwise

Today’s sponsor of the Top 10 Anticoagulant Drug Interactions podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. FreedAI is offering a discount exclusive to RLP listeners! Users will get $50 off their first month with Freed! Use the discount code: RLPPOD Apixaban is one of the most commonly used anticoagulants and there are some drug interactions you need to be aware of. Take a listen and find out! Warfarin concentrations can substantially be elevated by drugs that inhibit CYP2C9. I cover a few of them in my top 10 anticoagulant drug interactions.

Today's sponsor of the Top 10 SSRI Drug Interactions podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. In this podcast episode, I discuss how to navigate SSRI drug interactions and identify some of the most common medications that have additive serotonergic activity. SSRIs have antiplatelet activity. I discuss how to navigate using other medications that may increase bleed risk in combination with SSRIs. Paroxetine and fluoxetine inhibit CYP2D6 I discuss how this can affect the benefits of tamoxifen therapy. Fluvoxamine is a nasty medication with regard to the number of and significance of drug interactions. I outline important fluvoxamine interactions in this podcast episode.

On this episode, I discuss travoprost pharmacology, adverse effects, administration, and much more on this podcast episode. Travoprost is used to reduce intraocular pressure in the management of glaucoma. I discuss the mechanism of action and adverse effects. Travoprost is a prostaglandin analog that can help reduce intraocular pressure and reduce the risk of the potential complication of blindness. Growth of eyelashes is a unique adverse effect associated with travoprost.

On this podcast episode, I finish up my breakdown of the Beers Criteria. I cover the use of sliding-scale insulin and sulfonylureas in geriatric patients. Hypoglycemia is a major concern with both of these diabetes management strategies. PPIs show up on the Beers criteria list as they can increase the risk of C. diff, pneumonia, fractures, and GI malignancies. Metoclopramide has dopamine antagonist activity and can increase the risk of EPS and tardive dyskinesia.

In this podcast episode, I break down some of the most common medications that show up on the Beers criteria list. I discuss cardiovascular medications in this podcast episode, including rivaroxaban and warfarin, and why they show up on the Beers list. Alpha-blockers who up on the Beers list as these medications are inappropriate to use for the management of hypertension. The Beers criteria addresses the use of aspirin in primary prevention. I break down what the criteria state and why it should be avoided in general.