Author: Eric Christianson

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Cilostazol Pharmacology

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Cilostazol has antiplatelet and vasodilatory effects. Because of this, it can manage symptoms of intermittent claudication.

GI upset, headache, and edema are common adverse effects associated with the use of cilostazol.

Cilostazol is recommended to be given on an empty stomach.

In patients with heart failure, cilostazol use is contraindicated.

CYP3A4 interactions are prevalent with cilostazol. Inhibitors of CYP3A4 can increase the concentrations of cilostazol.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Metronidazole Pharmacology

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Metronidazole (Flagyl) is an antibiotic that is used for various infections.

Metronidazole can certainly cause GI upset like most antibiotics, but uniquely may also cause a metallic taste.

Metronidazole is also rarely associated with CNS changes and can induce the potential for peripheral neuropathy.

Patients should avoid alcohol with the use of metronidazole and this is on account for the possibility of a disulfiram reaction. I discuss some of the symptoms of this reaction in the podcast.

Metronidazole can substantially raise the concentrations of warfarin. INR monitor and a reduction in dose of warfarin may be necessary.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Testosterone Pharmacology

testosterone pharmacology

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Testosterone replacement is primarily utilized in patients with hypogonadism. I discuss testosterone pharmacology, adverse effects, and drug interactions on this podcast episode.

Testosterone is a controlled substance because it is most often diverted for its potential to build muscle in athletes for competitive sports.

There is cardiovascular risks associated with the use of testosterone.

Testosterone can raise blood pressure and also raise cholesterol levels which may be a contributing factor to its potential to cause cardiovascular events.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Morphine Pharmacology

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Morphine has opioid agonist activity that can cause respiratory depression and death in overdose.

Morphine-6-glucuronide is the metabolite that can accumulate and cause CNS toxicity in renal failure.

Be aware of CNS depressants that may enhance the effect of morphine and other opioids. Some examples of CNS depressants include gabapentin, benzodiazepines, older antihistamine, skeletal muscle relaxants, and pregabalin.

Opioid withdrawal is a significant concern when patients have their morphine or another opioid abruptly stopped. Some signs of withdrawal include agitation, mood swings, anxiety, sweating, GI upset, pain, and insomnia.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Prasugrel Pharmacology

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Prasugrel is a P2Y12 inhibitor that is used in the setting of ACS.

Be aware of patients who may be taking over the counter medications that can increase their bleed risk while taking prasugrel.

Prasugrel is on the Beers list and in general, should be avoided in most situations for patients who are 75 years of age or older.

Morphine has the potential to impact antiplatelet agents like prasugrel and make them less effective. Be sure this is clinically considered prior to using morphine with prasugrel.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Mirabegron Pharmacology

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Mirabegron is a beta-3 agonist that can help relax bladder smooth muscle and manage symptoms of overactive bladder.

Mirabegron inhibits CYP2D6 which can negatively impact the effectiveness of tamoxifen. I discuss this in greater detail in the podcast.

Tramadol and codeine effectiveness can be impacted by mirabegron. Be aware of this when using this medication.

By inhibiting CYP2D6, mirabegron can increase the concentrations of many psychotropic medications such as fluoxetine, aripiprazole, clozapine, and paroxetine. I discuss this further in this episode of the podcast.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Erythromycin Pharmacology

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Erythromycin uniquely has some potential benefit in the setting of gastroparesis. Azithromycin you will likely not see used for this indication.

Erythromycin binds the 50s subunit and ultimately prevents protein synthesis which is necessary for bacteria to grow and replicate.

QTc prolongation is a risk with all macrolide antibiotics (erythromycin included).

By inhibiting CYP3A4, erythromycin can be responsible for numerous drug interactions.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Naloxone Pharmacology

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Naloxone is a life saving drug that can help manage an opioid overdose situation.

Naloxone blocks opioids receptors so opioid agonists cannot bind there.

One of the biggest risks with opioid overdose includes respiratory depression. Naloxone can help reduce the risk of this if administered in a timely manner.

IV naloxone will have the quickest physiological onset of action, but nasal naloxone may be the best opportunity in the community to get this drug on board quickly.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Prochlorperazine Pharmacology

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Prochlorperazine has several potential mechanisms of action. It can block dopamine and alpha receptors as well as have anticholinergic effects.

Prochlorperazine is classified as an antipsychotic and antiemetic. It is very seldom used as an antipsychotic in clinical practice and more used for its antiemetic effects.

Because of the anticholinergic activity of prochlorperazine, there is potential for dry mouth, dry eyes, urinary retention, constipation, and other anticholinergic effects.

Prochlorperazine does have the potential to have some alpha blocking activity. Keep an eye out for hypotension in patients who may be at risk.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!

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Buspirone Pharmacology

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Buspirone is an anti-anxiety medication that has the potential of having some serotonin agonist activity.

Buspirone has a very high first-pass metabolism. This means that the body breaks much of the medication down prior to it getting into the systemic circulation.

Buspirone is broken down by CYP3A4, so concomitant use with inhibitors or inducers can alter its concentrations

Buspirone should not be used as needed as this medication takes a while to start to show benefit.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!