Erythromycin Pharmacology

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.

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Acyclovir Pharmacology

On this episode “Acyclovir Pharmacology” I discuss the mechanism of action, important monitoring parameters, and drug interactions with acyclovir.

I discuss why acyclovir has to be dosed so many times per day.

Acyclovir can inhibit CYP1A2 which can impact a few drugs. I discuss a couple of those examples on this podcast episode.

GI effects are one of the more common side effects of acyclovir.

Rarely, neuropathy and nephropathy can be part of the adverse effect profile of acyclovir. I discuss this further on this episode.

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Oseltamivir Pharmacology

Oseltamivir is an antiviral agent that is indicated for the treatment and prophylaxis of influenza.

It is important to remember that oseltamivir is cleared at least in part by the kidney and dose adjustments should be made based upon kidney function.

There is a low potential that oseltamivir could contribute to psych issues like delirium.

Probenecid has the potential to raise the concentrations of oseltamivir.

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Dolutegravir is an integrase inhibitor that is used in the management of HIV infection/

Carbamazepine along with other enzyme inducers can substantially lower the concentrations of dolutegravir.

Dolutegravir can potentially increase blood sugars, this should be closely monitored in our patients with diabetes.

CNS adverse effects like insomnia and dizziness can happen with dolutegravir.

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Rifampin Pharmacology

Rifampin is classified as an antibiotic and an antituberculosis agent. It primarily works by inhibiting bacterial RNA polymerase.

While not extremely common, rifampin is well known to cause hepatic dysfunction.

You should remind patients who are taking rifampin that it can alter the color of tears, sweat, saliva and urine. It can change these fluids to a reddish/brown color.

Rifampin is very well known for causing drug interactions. It is an enzyme inducer that can reduce the concentrations of numerous medications such as warfarin, apixaban, cyclosporin, levothyroxine, and oral contraceptives to name a few.

Rifampin can be used to help prevent meningococcal infection. Learn more on rifampin by listening to this podcast!

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Azithromycin Pharmacology

Azithromycin Pharmacology

On this episode, I cover azithromycin pharmacology. This drug primarily acts by inhibiting protein synthesis. It binds to the 50s ribosomal subunit.

GI adverse effects like nausea and diarrhea are going to be the most common with azithromycin.

Azithromycin has been associated with prolonging the QT interval. Drugs like amiodarone, ondansetron, citalopram, antipsychotics, and quinolone antibiotics can also prolong the QT interval.

One major advantage that azithromycin has over other antibiotics is that it has a long half life which allows for once daily dosing.

Azithromycin has numerous uses like pneumonia, MAC, alternative for ear infections in patients with a beta-lactam allergy, certain STD’s, and also is rarely used in long term COPD exacerbation prevention.

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Linezolid Pharmacology

linezolid pharmacology

Linezolid is an antibiotic used for bacterial infection. It primarily works by inhibiting bacterial protein synthesis.

Linezolid is primarily bacteriostatic against most bacteria which means that it inhibits the growth and doesn’t necessarily kill the bacteria itself.

Caution must be used with linezolid and serotonergic drugs as there is a risk for serotonin syndrome. Clinical risk/benefit analysis needs to be done.

Linezolid overall has good coverage for VRE and MRSA. It is an option for MRSA pneumonia where daptomycin is not.

Linezolid has both an oral and an IV option which allows for good continuity of inpatient and outpatient use.

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Nitrofurantoin Pharmacology

On this episode I breakdown nitrofurantoin pharmacology. Nitrofurantoin is an antibiotic that is used in the treatment of UTI’s.

Nitrofurantoin has activity by creating reactive metabolites that can disrupt protein synthesis and ultimately kills the bacteria causing the infection.

It is important to remember with nitrofurantoin, that in the setting of systemic infection and/or kidney involvement, the drug may not be very effective.

Nitrofurantoin can potentially reduce the effectiveness of certain vaccines. Be sure to look this up prior to administration.

Nitrofurantoin can cause pulmonary symptoms as well as neuropathy. This is very important to monitor for.

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Quinolone Antibiotic Pharmacology

Quinolones are a class of antibiotics that can be used for various infections. I discuss the pharmacology, adverse effects, drug interactions and other items on this podcast episode.

On this episode, I talk about the warnings associated with quinolones.

Quinolone use has subsided over time, not due to the fact that they are ineffective, but to rising concerns and warnings about adverse effects.

Quinolones can interact with quite a few medications.  I’ve seen a case of amiodarone and levofloxacin contributing to QTc prolongation which I discuss on this episode.

It is critical to remember the binding interactions associated with quinolones as these can potentially lead to treatment failure.

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Tetracyclines Pharmacology Episode 038

On this episode, I discuss how the tetracyclines impact bacterial protein synthesis.

I also remind you of several medications that fall in the tetracycline class.  Doxycycline is by far the medication I see used the most.

You’ll also learn about common side effects like GI upset and photosensitivity.

I cover why this class of medication is typically avoided in pediatrics and pregnancy.

I hope you enjoy the show and don’t forget to snag your FREE 31 page PDF study guide!