Vonoprazan Pharmacology – New Esophagitis Medication Class! Episode 326

On this episode, I discuss the new medication vonoprazan and where it will likely be used in practice.

Vonoprazan is from a brand new class of medication called “PCAB”. I discuss this medication and its pharmacology in this podcast episode.

Drug interactions and cost are the two major downsides of this medication that will likely limit its use compared to the PPIs.

CYP3A4 inducers like rifampin, carbamazepine, and phenytoin should not be used with vonoprazan. They will reduce the effectiveness of vonoprazan.

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Beers Criteria Podcast Part 2 or 2

On this podcast episode, I finish up my breakdown of the Beers Criteria.

I cover the use of sliding-scale insulin and sulfonylureas in geriatric patients. Hypoglycemia is a major concern with both of these diabetes management strategies.

PPIs show up on the Beers criteria list as they can increase the risk of C. diff, pneumonia, fractures, and GI malignancies.

Metoclopramide has dopamine antagonist activity and can increase the risk of EPS and tardive dyskinesia.

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Simethicone (Gas-X) Pharmacology Podcast

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.

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Promethazine (Phenergan) Pharmacology Podcast

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.

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Loperamide (Imodium) Pharmacology Podcast

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.

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Famotidine Pharmacology Podcast

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.

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Lactulose Pharmacology

Lactulose is an osmotic laxative but it is rarely used for this purpose. I discuss lactulose pharmacology in this episode.

Elevated ammonia levels are an issue in hepatic encephalopathy. Lactulose can help manage this issue.

Lactulose is dosed to 2-3 soft stools per day when used to reduce ammonia levels.

Lactulose can increase the effect of warfarin and raise INR; I discuss this further on this episode.

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Lansoprazole Pharmacology

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!

Esomeprazole (Nexium) Pharmacology

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.

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Sucralfate Pharmacology

On this episode, I discuss (Carafate) sucralfate pharmacology, adverse effect, kinetics, and drug interactions.

Sucralfate is notorious for drug binding interactions and can reduce the concentrations of many drugs which I cover in the podcast.

Four times daily dosing is a big downside to sucralfate and why it isn’t used terribly often for GI issues like esophagitis.

The suspension formulation of sucralfate does contain some sugar so be aware of this in our diabetes patients.

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Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated)

Guide to Drug Food Interactions (Amazon Best Seller)

Drug Interactions In Primary Care (Amazing Resource for Practicing Clinicians)

Perils of Polypharmacy (Great Resource for Those Who Work in Geriatrics)