Bisoprolol (Zebeta) Pharmacology

On this episode, I discuss bisoprolol (Zebeta) pharmacology, adverse effects, drug interactions, and other important clinical pearls.

Bisoprolol is a beta-1 selective antagonist that can be used for atrial fibrillation, angina, and other cardiovascular indications.

It is important to remember that bisoprolol and other beta-blockers are not considered first-line agents for hypertension alone.

Beta-receptor selectivity does start to disappear with bisoprolol as you get to higher dosages. I discuss this further in the podcast.

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Chlorthalidone Pharmacology

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.

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Verapamil Pharmacology Podcast

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.

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Carvedilol (Coreg) Pharmacology

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.

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Losartan Pharmacology

On this episode, I discuss losartan pharmacology, adverse effects, drug interactions, and appropriate monitoring.

Losartan is an ARB and can increase potassium levels. Keep an eye out for medications like spironolactone and trimethoprim which can increase this risk further.

Losartan has been shown to lower uric acid levels which could potentially be helpful in patients with gout.

Monitoring renal function is very important with losartan. The risk of ARF goes significantly higher when used with NSAIDs or diuretics.

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Pravastatin Pharmacology

On this episode, I breakdown pravastatin pharmacology, adverse effects, drug interactions and when you might see this drug used in practice.

Pravastatin is a statin and will lower LDL. Its use is a little limited in the fact that it is not as potent as other agents in its LDL lowering effects.

Pravastatin is hydrophilic which differentiates it from simvastatin, atorvastatin, and lovastatin.

I describe rhabdomyolysis in this podcast as it is a potential rare adverse effect of pravastatin.

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Atenolol Pharmacology

On this episode, I discuss atenolol pharmacology, adverse effects, pharmacokinetics, and drug interactions.

Atenolol is primarily cleared by the kidney which should tell you that we need to pay attention to dose adjustments as renal function declines.

Atenolol is a beta-1 selective agent that is NOT a preferred beta-blocker in HFrEF.

Pulse and blood pressure monitoring is essential with any beta-blocker like atenolol.

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Bumetanide Pharmacology

On this episode of the Real Life Pharmacology Podcast, I discuss bumetanide pharmacology, adverse effects, and drug interactions.

Bumetanide is a loop diuretic and it is critical to monitor renal function and electrolytes with this medication.

Ototoxicity is a rare adverse effect that is dose-dependent and can be worsened by aminoglycosides.

It is critical to look for drugs that can worsen edema when using bumetanide to ensure that we avoid the prescribing cascade.

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Rosuvastatin Pharmacology

On this episode, I discuss rosuvastatin pharmacology, adverse effects, drug interactions and pharmacokinetics.

Rosuvastatin is a hydrophilic statin which differs from some of the most commonly used statins like simvastatin and atorvastatin.

Rosuvastatin is minimally affected by CYP3A4 drug interactions so that is a small potential advantage over simvastatin and atorvastatin.

At dosages of 20-40 mg, rosuvastatin is considered a high intensity statin and can bring down LDL by over 50%.

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Atorvastatin Pharmacology

On this episode, I discuss atorvastatin pharmacology, adverse effects, monitoring parameters, and drug interactions.

Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor, the rate-limiting step in the production of cholesterol. It is used to prevent atherosclerotic cardiovascular diseases by decreasing cholesterol.

Atorvastatin is more lipophilic in comparison to other statins such as rosuvastatin. If a patient does not tolerate a statin, switching from a lipophilic to a hydrophilic or vice versa may decrease the chances of those side effects reoccurring.

It can be a high-intensity statin depending on the dose. 10-20mg is considered moderate and 40-80mg is classified as high intensity. Not all statins can reach high-intensity doses, which is why atorvastatin is so commonly used.            

The FDA as of July 2021, has requested to remove the contraindication of pregnancy from the prescribing information. Here’s more information on that specific change and why it was requested. I’d encourage you to read it. 

Atorvastatin is commonly found to have adherence issues so it should be taken whenever it is going to be best remembered by the patient.

Common adverse effects include myopathy, muscle pain, and soreness. Many elderly patients can be overlooked when they experience aches and pains, so it is important to take their medications into consideration. There are rare risks of liver injury and rhabdomyolysis. CPK and LFTs do not need to be regularly monitored if no symptoms are present.  

Remind patients that their cholesterol will not be lowered right away. They will usually have their levels rechecked in 3-6 months.

Drugs that increase rhabdomyolysis risk when used concurrently include fibrates, red yeast rice, niacin, daptomycin. Monitor these patients closely for symptoms of muscle pain. Can also monitor CPK and decrease the dose of the statin in these patients. 3A4 interactions can increase the concentration of statins. These include clarithromycin, grapefruit juice, amiodarone, amantadine, and verapamil. 3A4 inducers can decrease the concentration of statins. These include St. John’s Wort and carbamazepine. 

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

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