Real Life Pharmacology - Pharmacology Education for Health Care Professionals

On this episode of the Real Life Pharmacology Podcast, I discuss amlodipine pharmacology, adverse effects, and important drug interactions. I break down why edema occurs with amlodipine on this episode of the Real Life Pharmacology podcast. While beta-blockers are typically the first-line agent for the prevention of chronic angina symptoms, CCBs like amlodipine can be used as an alternative. There are some potential CYP3A4 interactions with amlodipine. I discuss the severity of these interactions and how to monitor patients.

On this episode, I discuss pyridoxine pharmacology, adverse effects, and important clinical uses. Pyridoxine is most well known for its potential to reduce the likelihood of isoniazid-induced neuropathy. Another common indication of pyridoxine is its use for nausea and vomiting associated with pregnancy. Pyridoxine plays an important role in the production of heme, so deficiency will increase the risk for anemia.

On this episode of the Real Life Pharmacology podcast, I discuss vibegron pharmacology, adverse effects, drug interactions and more! I spend some time comparing and contrasting vibegron to mirabegron. Both are beta-3 agonists used for overactive bladder. Vibegron dosing is very simple. It is dosed once daily with no alternative dosage forms available. The starting dose is the target dose. Being primarily excreted in the feces and urine, vibegron doesn't have many drug interactions.

Bempedoic acid, also known as Nexletol, is a once-daily medication used in lipid management. I discuss its pharmacology, side effects, and much more on this podcast episode. Bempedoic is a once-daily medication that doesn’t need to be titrated. Standard dosing is 180mg once daily which can be taken with or without food.  What are the most common side effects of bempedoic acid? One of the most notable adverse effects is hyperuricemia. This is usually seen within the first 4 weeks of being on the medication but could happen throughout the treatment. Tendon problems can happen as well, especially in patients who are greater than 60 years old, on fluoroquinolones, have renal failure, or are taking corticosteroids. If Bempedoic acid is taken along with Simvastatin, it is recommended to avoid doses greater than 20mg. This is partly because Bempedoic Acid 180mg along with 40mg of Simvastatin was found to increase Simvastatin AUC by 2-fold. The mechanism of this interaction has yet to be reported. Pravastatin doses greater than 40mg are to be avoided as well due to an increased risk of myopathy. Atorvastatin and Rosuvastatin didn’t have any maximum dose considerations.

On this podcast episode, I discuss exenatide pharmacology, adverse effects, drug interactions, and much more! Exenatide has an immediate release formulation (Byetta) and a long acting formulation (Bydureon). I discuss the differences in this podcast episode. Byetta use has fallen out of favor due to frequent dosing, patient inconvenience and needing to time the dose 60 minutes prior to meals. I discuss the risk of pancreatitis related to GLP-1 agonists like exenatide in this podcast episode.

I discuss Pyridostigmine Pharmacology in this podcast episode in addition to adverse effects, drug interactions, and much more! Pyridostigmine is an acetylcholinesterase inhibitor that can be used for myasthenia gravis or orthostasis. Pyridostigmine can blunt the effect of neuromuscular blocking agents so patients undergoing surgery should be sure to have a game plan with their surgery team. Similar to donepezil, pyridostigmine can cause diarrhea and bradycardia.

On this podcast episode, I discuss simethicone pharmacology, adverse effects, drug interactions, and much more! Simethicone is primarily used for anti-gas purposes. It is most often used on an as needed basis for relief of flatulence and bloating associated with gas. Systemic absorption is minimal with simethicone so the occurrence of any systemic-type side effects at therapeutic doses is low. Simethicone may interfere with levothyroxine absorption. Timing levothyroxine at least a few hours prior to simethicone should help reduce the significance of this interaction.

On this podcast episode, I discuss fosinopril (Monopril) pharmacology, adverse effects, drug interactions and much more. Fosinopril is an ACE inhibitor so it should absolutely NOT be used in pregnancy as it poses fetus risks. Like other ACE inhibitors, hyperkalemia, cough, angioedema, and acute renal failure represent possible risks in using fosinopril. Drugs that can raise potassium when used in combo with fosinopril include spironolactone, trimethoprim, calcineurin inhibitors, and heparin.

On this episode of the Real Life Pharmacology podcast, I discuss haloperidol pharmacology, adverse effects, drug interactions and much more. Haloperidol comes in multiple dosage forms. Be very careful with the use of injectable haloperidol as there is an immediate and extended release formulation. Haloperidol is a dopamine antagonist which means that EPS adverse effects are going to be concerning. In hospice patients, haloperidol is frequently used for its antiemetic properties as well as its potential to help end-of-life restlessness and agitation.

In this promethazine pharmacology podcast, I discuss its mechanisms of action, side effects, important drug interactions, and much more. Promethazine has anticholinergic and dopamine-blocking activity which contributes to the adverse effect profile as well as its efficacy. There is a boxed warning with promethazine to avoid the use of this medication in patients under the age of 2 due to respiratory depression. Promethazine IV is considered a high-risk route of administration and should be avoided if possible.

In this episode, I discuss loperamide (Imodium) pharmacology, adverse effects, and drug interactions. Loperamide has opioid-type activity in the gut but has extremely low oral bioavailability. This allows it to be used for diarrhea but at lower doses won't cause systemic opioid-like effects. Loperamide abuse has been reported. Excessive dosages can increase the risk of cardiac arrest and other cardiovascular concerns. Medication causes of diarrhea should be ruled out prior to starting a medication like loperamide. I discuss numerous medications that can cause diarrhea in this podcast.

I discuss calcium carbonate pharmacology, adverse effects, drug interactions, and more in this podcast episode. Calcium tends to have a constipating effect and the higher the dose, the more likely patients are to experience this adverse effect. Binding interactions are a major problem with oral calcium carbonate. I lay out numerous examples of this on the podcast. There are a few medications that can increase calcium levels in the blood. Thiazide diuretics are a commonly used antihypertensive that may contribute to hypercalcemia.

On this episode, I discuss the pharmacology, adverse effects, and drug interactions of ramelteon (Rozerem). Ramelteon is primarily only helpful for sleep onset and generally is not that helpful in sleep maintenance. CNS depressant drug interactions will be a common concern to monitor. Opioids, benzodiazepines, and alcohol are common sedatives that can add to the effects of ramelteon. Some of the CYP enzymes break down Ramelteon. I discuss this in greater length in this podcast episode.

In this podcast episode, I discuss thiamine pharmacology and its important role in energy production. In patients with alcohol use disorder, thiamine deficiency can be somewhat common. Wernicke's encephalopathy can result from thiamine deficiency in patients with alcohol use disorder. Common symptoms from Wernicke's encephalopathy can include confusion, lethargy, and other central nervous system issues. Thiamine replacement can help treat this issue.

Dutasteride (Avodart) is a 5-alpha-reductase inhibitor. I discuss the pharmacology, adverse effects, and drug interactions on this podcast. Dutasteride reduces the size of the prostate over time. It takes a significant amount of time to provide symptom relief (usually at least 3-6 months). Dutasteride is broken down by CYP3A4 to a minor extent which means that strong CYP3A4 inhibitors may increase drug concentrations. When using dutasteride for BPH, remember to review the medication list for drugs that can cause urinary retention such as anticholintiercs and alpha-agonists.