Category: Gastrointestinal Medications

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Scopolamine Pharmacology

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In this episode of the RLP podcast, I discuss scopolamine pharmacology.

Scopolamine patches can be used in the management of motion sickness and surgery/anesthesia induced nausea and vomiting.

Transdermal scopolamine has a slow onset of action so we need to be deliberate about the timing of placement (usually 4-6 hours prior to anticipated time of symptoms).

Transdermal scopolamine is highly anticholinergic and can cause dry eyes, dry mouth, urinary retention, and confusion.

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!

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Omeprazole Pharmacology

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Omeprazole is a proton pump inhibitor that can be commonly used for GERD, PUD, and GI prophylaxis.

Omeprazole 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.

PPI’s like omeprazole 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!

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Hyoscyamine Pharmacology

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Hyoscyamine is an anticholinergic medication that is primarily used for GI problems like spasms and pain associated with IBS.

Because of the highly anticholinergic nature of hyoscyamine, it can cause dry eyes, dry mouth, urinary retention, and constipation.

Be aware of the risk for the prescribing cascade with hyoscyamine. Saliva substitutes for dry mouth, artificial tears for dry eyes, etc.

Sedation is a concern with hyoscyamine and this can be exacerbated by drugs like benzodiazepines, opioids, and older antihistamines.

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!

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Dicyclomine Pharmacology

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Dicyclomine is an anticholinergic agent that is used to help manage GI pain associated with IBS.

Dicyclomine has a very short half-life which means that it can be dosed multiple times per day.

Be careful with patients who have predominant constipation with their IBS as dicyclomine can exacerbate this.

Bentyl is the brand name of dicyclomine. This drug blocks the action of acetylcholine.

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!

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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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Ondansetron Pharmacology

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Ondansetron (Zofran) is a medication used for nausea and vomiting. In this episode, I lay out the pharmacology, adverse effects, drug interactions and more!

Ondansetron has been reported to increase the risk of serotonin syndrome. I discuss this further on the podcast.

Ondansetron can exacerbate QTc prolongation. Keep an eye out for patients who may have risk factors or be on other medications that can contribute to this. I discuss this further on this podcast.

Ondansetron is often used for chemotherapy induced nausea and vomiting. I discuss this and other indications on 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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Budesonide Pharmacology (Oral and Rectal Formulations)

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Budesonide is a corticosteroid that can be given orally or rectally for management of Crohn’s disease or ulcerative colitis.

Because budesonide has a high first pass metabolism, the relative impact of systemic effects may be less than other steroids like prednisone.

Remember that CYP3A4 inhibitors can increase the concentrations of budesonide. I discuss this further on the podcast.

Different dosage forms of budesonide (oral versus rectal) can be used for different reasons. The site of the inflammation in Ulcerative colitis can determine which dosage form is most appropriate.

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

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Cimetidine Pharmacology

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Cimetidine blocks histamine 2 receptors which can suppress acid production and reduce symptoms of heartburn.

One of the major downsides to cimetidine is that it has a ton of drug interactions. I discuss many of the common ones in this episode.

Cimetidine is one of a few drugs that has the potential to cause gynecomastia. I discuss the mechanism of this adverse effect in this episode.

Phenytoin concentrations can rise due to the use of cimetidine. I discuss this in the drug interactions section of this episode.

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

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Stimulant Laxatives Pharmacology

Stimulant Laxative

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On this episode, I discuss the pharmacology of commonly used stimulant laxatives like sennosides and bisacodyl.

Stimulant laxatives “stimulate” the GI tract smooth muscle which helps propel fecal material out of the body and thus helping to relieve constipation.

Patients who are having diarrhea and are unsure of what medications they are taking should have their regimen assessed for these medications.

Chronic opioid therapy is a situation where chronic stimulant laxative therapy may be used.

Stimulant laxatives have very few drug interactions. However, bisacodyl effectiveness can be reduced by the use of antacids like calcium carbonate.

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

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Metoclopramide (Reglan) Pharmacology

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Metoclopramide Pharmacology

Metoclopramide can block dopamine receptors as part of it’s mechanism of action.  I discuss the clinical implications from this in the podcast.

Metoclopramide can exacerbate Parkison’s disorder so you need to be careful in that type of patient.

Metoclopramide is dosed frequently, which can potentially be a downside as far as patient adherence goes.

Metoclopramide has a few potential interactions that you should be aware of.  I talk about those in this episode.

Be sure to check out The Thrill of the Case on Amazon as I do have a clinical scenario about Reglan (metoclopramide) in that 200+ page book.

As always, check out my free Top 200 study guide!