Real Life Pharmacology - Pharmacology Education For Health Care Professionals

On this episode, I discuss prazosin pharmacology, adverse effects, drug interactions and much more. Prazosin is an alpha-blocker but lacks selectivity. A reduction in blood pressure is expected, but it is notorious for causing orthostatic hypotension. Prazosin may be used off-label for nightmares, when this is the case, you will likely only see this drug dosed at bedtime. Alpha agonist medications (such as pseudoephedrine and ADHD stimulants) may counteract the effects of prazosin.

On this episode I discuss the pharmacology of tirzepatide. I'm appreciative of Derek Borkowski who operates Pyrls for providing a free PDF of the 2023 ADA Diabetes Guidelines when you subscribe for an account at Pyrls.com/rlp - Tirzepatide makes its first appearance in the diabetes guidelines for its ability to promote weight loss. Tirzepatide is a combination GIP and GLP-1 agonist that is currently indicated for diabetes with reductions of A1C in the range of about 2 points. Much like GLP-1 agonists, tirzepatide can cause GI upset and other gastrointestinal adverse effects like diarrhea. Tirzepatide doesn't have a large number of drug interactions which is nice. Corticosteroids can counteract its blood sugar-lowering effects while sulfonylureas and insulin may significantly increase the risk for hypoglycemia.

On this episode of the Real Life Pharmacology podcast, I cover methimazole adverse effects, mechanism of action, drug interactions, and much more! Methimazole and propylthiouracil are from the same class of medications and are used for hyperthyroidism. I go over some of the differences between these agents in this podcast episode. Methimazole is dosed once daily but can be split if the patient experiences significant GI adverse effects. T3 plays an important role in hyperthyroidism. I discuss the physiologic of T3 production and how methimazole creates its effects to lower thyroid hormone levels.

On this podcast episode, I discuss the pharmacology, adverse effects, and drug interactions of semaglutide. Semaglutide has two primary uses: Type 2 diabetes and Weight Management - the dosing varies depending upon the indication. When using semaglutide, pay attention to GI adverse effects. Nausea, diarrhea, and vomiting are the most common ADRs and are dose-dependent. Pay attention to corticosteroid bursts. They can cause substantial hyperglycemia and counteract the effects of diabetes medications like semaglutide.

Minocycline is a tetracycline antibiotic. I discuss pharmacology, adverse effects, and drug interactions. Minocycline can cause sun sensitivity. Be sure to educate patients about this risk. Metal cations like iron, zinc, calcium, and magnesium can bind minocycline and reduce the oral absorption of the medication. Tooth discoloration is a possible adverse effect if minocycline is given to pediatric patients. I discuss it further in this episode.

In this podcast episode, I cover propylthiouracil pharmacology, adverse effect, drug interaction, and much more! Propylthiouracil carries a boxed warning for hepatotoxicity which is a significant downside compared to the other agent in its class (methimazole). What about dosing? I discuss why this medication has to be dosed multiple times per day. Drug interactions aren't incredibly common with propylthiouracil but it can affect warfarin differently than most drug interactions. I discuss it further in this episode.

Brexpiprazole (Rexulti) is a second generation antipsychotic. I discuss its pharmacology, adverse effects, drug interactions, and more in this podcast episode. I like to associate brexpiprazole with aripiprazole. They have a lot of overlapping characteristics, particularly in relation to the adverse effect profile. Brexpiprazole tends to have a low incidence of metabolic adverse effects which makes it a nice selection for patients who have diabetes, hypercholesterolemia, or who are overweight. CYP3A4 and CYP2D6 are the two primary enzymes that break down brexpiprazole. I discuss the pharmacogenomic considerations associated with this medication.

On this episode, I discuss indapamide pharmacology, adverse effects, drug interactions, and pharmacokinetics. I discuss how indapamide differs from other thiazide diuretics. Particularly, I discuss indapamide compared to hydrochlorothiazide. Frequent urination, hypokalemia, and dehydration are all possible risks with indapamide. Pay attention to medications that can increase the risk for acute renal failure when added to indapamide. NSAIDs, ACEIs, ARBs, and other diuretics can increase this risk.

On this episode, I discuss tadalafil pharmacology, adverse effects, pharmacokinetics, and drug interactions. Tadalafil has a significantly longer half-life than sildenafil. I discuss how this is going to impact a patient that may need a nitrate. PDE-5 inhibitors like tadalafil are most commonly used for erectile dysfunction but I talk about other unique indications in the podcast. Daily use or as-needed use of tadalafil are both acceptable options but there are some quirks you need to know with these two methods of use.

Sitagliptin is a DPP4 inhibitor. I discuss the pharmacology of this medication on the podcast. Which diabetes medication works similarly to sitagliptin? I discuss that further on this episode of the Real Life Pharmacology podcast. Renal elimination plays a significant role with sitagliptin. I discuss how this impacts the appropriate dosing. Cost is a significant issue with sitagliptin at this time. In addition, it's A1C-lowering effects aren't anything to write home about. I discuss how much it will lower A1C in this podcast episode.

On this podcast episode, I discuss gabapentin (Neurontin) pharmacology, adverse effects, drug interactions, and much more! Gabapentin's GI absorption is a little wacky. I discuss on the podcast the clinical effects that this may have on our patients. Renal elimination is critical to gabapentin. Worsening renal function will significantly impact the action of the drug. CNS sedation can be a problem with gabapentin, especially in combination with other CNS depressants. I discuss this further on the podcast.

Ranolazine is primarily used for chronic angina management. I discuss pharmacology, drug interactions, adverse effects, and more in this podcast episode. Ranolazine is well known to have drug interactions. CYP3A4 is of major importance but there are other subtle drug interactions that are important. QTc prolongation has been reported with ranolazine so it is important to recognize risk factors and other medications that may contribute to this concern. Enzyme inducers like carbamazepine, phenytoin, and St. John's wort are all associated with reducing the concentrations of ranolazine.

On this podcast episode, I discuss lorazepam (Ativan) pharmacology, adverse effects, and common drug interactions. Lorazepam has numerous dosage forms and the IV formulation does contain propylene glycol which can accumulate if it is used for longer periods of time. There is a boxed warning for lorazepam when it is used with opioids. The risk for opioid overdose, coma, and death increases significantly. Lorazepam is an intermediate acting benzodiazpine. It's half-life for most adult patients is in the 12-18 hour range.

On this podcast episode, I discuss valsartan pharmacology, adverse effects, drug interactions, and much more. Valsartan is a fairly common ARB. I mostly see losartan and valsartan used as the most common ARBs in hypertension management. Valsartan has a longer half-life than losartan which is why we can often get away with once daily dosing compared to losartan which sometimes requires twice daily. Hyperkalemia is a major concern with ARBs like valsartan. Trimethoprim and spironolactone are two medications that can increase this risk.

On this podcast episode, I discuss famotidine pharmacology, adverse effects, uses, and drug interactions. Famotidine is generally pretty well tolerated, but one thing I look out for with chronic use is B12 deficiency. Famotidine is eliminated by the kidney so you should pay attention to the dose in patients with CKD. Famotidine is occasionally used as a pretreatment to help prevent infusion-type reactions for certain chemotherapy agents.

On this podcast episode, I discuss clonazepam pharmacology, adverse effects, pharmacokinetics, and drug interactions. Clonazepam is a benzodiazepine that enhances the activity of GABA which is an inhibitory neurotransmitter in the central nervous system. It is important to try to avoid using benzodiazepines like clonazepam with opioids as it can increase the risk of respiratory depression and death. Clonazepam is an intermediate-acting benzodiazepine that is only commercially available as an oral dosage form.

In this podcast episode, I break down the pharmacology, adverse effects, pharmacokinetics, and drug interactions of phentermine. Phentermine has some CNS stimulant activity so adverse effects like insomnia, hypertension, and tachycardia are possible. Pay attention to drugs that can oppose the effects of phentermine and cause weight gain such as mirtazapine and sulfonylureas. Phentermine is a controlled substance so the risk of addiction and dependence is possible.

On this podcast episode, I discuss glimepiride pharmacology, adverse effects, hypoglycemia symptoms, and drug interactions. CYP2C9 is an important enzyme in the breakdown of glimepiride. I discuss a few drugs that can cause interactions via this enzyme. Renal function is important to consider with glimepiride. The active metabolites are cleared by the kidney and can accumulate in CKD. Hypoglycemia and weight gain are problematic adverse effects of this medication and are the primary reasons it has fallen out of favor.

On this podcast episode, I discuss cephalexin pharmacology, adverse effects, drug interactions, and much more! Penicillin allergies and cross-reactivity are common questions with regard to the use of cephalexin and I discuss this briefly in the podcast episode. Cephalexin is a first-generation cephalosporin with its primary sweet spot being gram-positive bacteria like Staph and Strep species. Warfarin, probenecid, zinc, and a couple of others are potential medications that can interact with cephalexin. I discuss this further in this podcast episode.

On this episode, I discuss ceftriaxone pharmacology, adverse effect, coverage, and drug interactions. Ceftriaxone is currently a drug of choice for the STI Gonorrhea. Pyrls.com has an amazing chart on all the STIs and their drugs of choice that you can get for free when you sign up for a free account! Ceftriaxone is a third-generation cephalosporin that is used for numerous indications such as pneumonia, meningitis, gonorrhea, and many more. It is important to remember that ceftriaxone can cover many staph and strep species but it does NOT cover MRSA. Ceftriaxone does have some risks, particularly in pediatric patients. I discuss elevated bilirubin and calcium binding risks in the podcast.