Real Life Pharmacology - Pharmacology Education for Health Care Professionals
Summary: Pharmacology is one of the most challenge topics you will encounter as a healthcare professional, but it can be the most rewarding with a good understanding. Whether you are preparing to be a nurse, physician, physician assistant, pharmacist, dentist, nurse practitioner, pharmacy technician, pharmacologist, or other healthcare professional, this podcast will help you better understand pharmacology. In addition to giving you the basics like mechanism of action, side effects, drug interactions, etc., you will also be exposed to how medications actually impact patients in real life. In the Real Life Pharmacology podcast, Eric Christianson, PharmD shares his real world experiences about how a medication's mechanism of action, pharmacokinetics, adverse effects, and drug interactions can actually impact patients in both a positive and a potentially negative way. Eric Christianson PharmD is the author of the popular clinical pharmacy blog Meded101.com. People who are passionate about nursing, medicine, or pharmacy will find this podcast beneficial in helping them prepare for passing exams. This podcast is for educational purposes only and is not medical advice or intended to be a substitute for medical advice. Please seek advice from your pharmacist or primary care provider if you have questions about medications that you are taking.
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- Artist: Eric Christianson, PharmD; Pharmacology Expert and Clinical Pharmacist
Podcasts:
Lansoprazole is a proton pump inhibitor that can be commonly used for GERD, PUD, and GI prophylaxis. Lansoprazole 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. PPIs like lansoprazole are best given 30-60 minutes before meals. This is something that patients often forget. I discuss important drug interactions on the podcast, be sure to check out my latest project which is a 200+ page book on managing drug interactions in primary care. Be sure to check out our free Top 200 study guide – a 31-page PDF that is yours for FREE!
Ropinirole (Requip) is a dopamine agonist that can be used in Parkinson's disease and Restless Legs Syndrome. Dopamine agonists like ropinirole can worsen psychiatric symptoms in some patients by causing hallucinations, and obsessive/compulsive symptoms. Nausea, vomiting, hypotension, and fatigue are the most common adverse effects of ropinirole. Ropinirole has drug interactions with antipsychotics and CYP1A2 inhibitors. I discuss these in greater detail in this podcast episode.
On this episode of the podcast, I cover budesonide (Pulmicort) pharmacology. Our sponsor (Pyrls.com/rlp) for this episode is providing a FREE PDF of their inhaled corticosteroid categorizations chart (i.e. low/medium/high dose ICS) when you sign up for a free account! The onset of action of inhaled budesonide is several hours up to a few days. Patient education is critical to ensure that patients stick with its use. Budesonide does have a nebulized formulation that is often used in pediatrics and geriatrics. There aren't a ton of critical drug interactions, but you should think about medications that inhibit CYP3A4 and may have additive immunosuppressive effects.
Epoetin alfa (Epogen, Procrit) is an erythropoiesis-stimulating agent that can be used for various types of anemia. ESA's like epoetin carry a boxed warning as they increase the risk of cardiovascular events like MI, stroke, and blood clots. Assessing iron stores is critical when epoetin is used to ensure that a non-response is not due to deficiency. I discuss dosing adjustments of epoetin in the podcast. One must be careful about raising hemoglobin too quickly.
Canagliflozin is an SGLT2 inhibitor. I discuss the pharmacology, dosing, adverse effects, and drug interactions of this medication. Canagliflozin reduces blood sugar, by facilitating its exit through the urine. This can increase the risk of genitourinary infections. A diuresis type effect can happen due to canagliflozin and this effect may be exacerbated by the use of thiazide and loop diuretics. Hyperkalemia has been reported with the use of canagliflozin; the risk for this is increased with the use of medications like ACE inhibitors, ARBs, and aldosterone antagonists.
Cabergoline is a dopamine agonist. I discuss the pharmacology, adverse effects, and drug interactions in this podcast episode. Be on the lookout for drugs that could oppose the effects of cabergoline such as antipsychotics and metoclopramide. Cabergoline can be used for hyperprolactinemia management and may cause adverse effects like hypotension and GI upset. Cabergoline has a very long half-life so it is most often only dosed 1-2 times per week.
In this episode, I discuss venlafaxine pharmacology, adverse effect, dose conversion of IR to ER, and drug interactions. Venlafaxine is notorious for producing withdrawal symptoms when discontinued abruptly. I discuss these in detail on the podcast. How significant is the interaction of venlafaxine with antiplatelet agents? I discuss that in this episode. The onset of action is a critical education point that patients must be aware of as it takes some time for venlafaxine to work.
On this episode I discuss chlorthalidone pharmacology, adverse effects, and recent literature regarding cardiovascular disease reduction. Our friends at Pyrls.com are offering a free diagram of the nephron including the mechanism of action AND a summary of diuretic effects that I discussed on the podcast - Go sign up and get these for free and support this awesome sponsor! Chlorthalidone is a thiazide diuretic that uniquely raises blood calcium levels compared to loop diuretics which lower calcium levels. There was a recent piece of literature (2020) comparing chlorthalidone versus hydrochlorothiazide. It found that chlorthalidone was no more effective than HCTZ. Remember that chlorthalidone can raise uric acid and increase the risk of gout flares.
On this episode, I discuss verapamil pharmacology, adverse effects, and important drug interactions. There are numerous drug interactions to be aware of with verapamil as it inhibits the enzyme CYP3A4. Verapamil is a calcium channel blocker (non-dihydropyridine) that blocks calcium channels in the heart and vessels. In addition to hypotension and bradycardia, verapamil can cause constipation which may be more prominent in our geriatric patients.
In this episode, I cover salmeterol (Serevent) pharmacology, adverse effects, drug interactions and special warnings with this medication. Salmeterol is a long acting beta agonist that can be used in combination with inhaled corticosteroids for management of asthma. Salmeterol can be used as monotherapy in COPD and should not be used as monotherapy in asthma. Elevations in pulse and blood pressure can happen with a beta agonist like salmeterol.
On this episode, I discuss esomeprazole (Nexium) pharmacology, adverse effects, tapering, kinetics, and drug interactions. I spend a good amount of time discussing the esomeprazole and clopidogrel interaction in this podcast episode. Esomeprazole inhibits CYP2C19. This can cause an increase in citalopram concentrations and raise the potential for QTc prolongation. It is critical to reassess the length of therapy and the dose of PPIs like esomeprazole.
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.
