Hydromorphone Pharmacology

On this episode, I discuss hydromorphone pharmacology, adverse effect, and drug interactions.

I discuss the pharmacokinetics of hydromorphone and also discuss the relative potency compared to other opioids.

Hydromorphone drug interactions are mostly additive effects. Drugs that cause sedation or constipation can have additive effects on hydromorphone.

Be extremely careful with hydromorphone dosage forms. There are numerous different concentrations and strengths. I discuss this in this episode.

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Duloxetine Pharmacology

On this episode, I discuss duloxetine pharmacology, adverse effects, and common drug interactions.

Duloxetine is an SNRI that is used for depression, anxiety, and various pain syndromes like neuropathy and fibromyalgia.

Duloxetine can inhibit CYP2D6 which can lead to higher concentrations of clozapine and propranolol and lower activity of tamoxifen.

CYP1A2 inhibitors like ciprofloxacin can raise concentrations of duloxetine leading to an increased potential for adverse effects.

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Lasmiditan Pharmacology

Lasmiditan (Reyvow) is an agent that is utilized for acute migraine treatment. It works slightly differently than triptans which I discuss on this episode.

Lasmiditan is a relatively new agent and cost will often limit its use at this time.

Rosuvastatin and sulfasalazine are two common medications that may have concentrations increase when lasmiditan is used. I discuss this in detail on this episode.

Lasmiditan is an oral tablet that is only recommended to give once per day which differs from commonly used triptans where the dose can be repeated.

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Sumatriptan Pharmacology

On this episode, I discuss sumatriptan pharmacology, adverse effects, drug interactions and more.

Dosage forms can provide different methods of drug delivery and I talk about many different sumatriptan dosage forms in this episode.

Cardiovascular risks need to be assessed when using a drug like sumatriptan. I discuss this in greater detail in the podcast.

Sumatriptan has serotonergic activity and we need to assess the risk of serotonin syndrome in our patients.

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Oxycodone Pharmacology

On this episode, I discuss oxycodone pharmacology, adverse effect, pharmacokinetics, and drug interactions.

Oxycodone is broken down by CYP3A4 and CYP2D6. I discuss this further on the podcast and how interactions may alter concentrations.

When a patient stops taking oxycodone after being on it for some time, you must recognize common symptoms of withdrawal.

Oxycodone comes as in an extended-release and immediate-release oral formulation.

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Primidone Pharmacology

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

Primidone, or Mysoline, is an anticonvulsant most commonly used for essential tremors. The primary pharmacological mechanism of action of primidone is similar to other anticonvulsants, like phenobarbital. It causes a reduction in the activity of neurons. Both primidone and its metabolites are potent anticonvulsants. Primidone alters the transmembrane Na/Cl transport channel to reduce the frequency of nerve firing. Phenobarbital, one of primidone’s active metabolites, interacts with GABA-A receptors and chloride channels to reduce nerve excitability.   

Typically B-blockers are used first for essential tremors, then primidone is the next option if B-blockers are ineffective. The dose of primidone can change depending on the use. At lower doses, around 250-700 mg/day (often lower doses than 250 mg will be used), it can indicate that it is being used for essential tremor. When it’s administered at higher doses, up to around 750-1500 mg/day, it can indicate that it is being used for seizures. When used for seizures, it’s important to taper more slowly to not cause seizures with lower minimum effective concentrations. When first dispensing phenytoin, it’s also important to look through a patient’s medication to check that it’s truly essential tremors, and not drug-induced. 

Primidone has common adverse drug reactions of CNS depression, sedation, dizziness, confusion, fatigue, GI issues, ataxia; the adverse drug reactions are similar to alcohol toxicity. Special consideration should be taken in patients with a history of depression; primidone can cause or exacerbate suicidal ideation. It’s important to monitor the blood concentrations of phenobarbital when primidone is taken at higher doses, at lower doses, it’s not as important. Vitamin deficiencies should also be monitored. Primidone can cause a vitamin D deficiency, along with vitamin B12 and folic acid deficiencies. 

Drug-drug interactions of primidone are those that can cause additive effects of CNS depression. For example, other anti-seizure medications, opioids, and first-generation antihistamines. Primidone also has enzymatic interactions. It is metabolized into its active metabolites by CYP2C9, CYP2C19, and CYP2E1. It should be monitored more closely when taken with drugs that can induce, or inhibit, the activity of those enzymes. Primidone, and phenobarbital, also induces CYP3A4 as well as CYP1A2. Certain drugs like apixaban, rivaroxaban, aripiprazole, prednisone, quetiapine, amlodipine, alprazolam, and olanzapine should be monitored more closely. 

The signs of primidone overdose are extensions of its adverse drug reactions. Common signs of an overdose are CNS depression, respiratory depression, lowered reflexes, and hypotension. In cases of severe primidone overdose, removal of the unabsorbed drug with hemoperfusion has been shown to be effective and show improvement in a patient’s clinical condition. In non-severe cases, symptomatic and supportive treatment may be necessary.

Show notes provided by Chong Yol G Kim, PharmD Student.

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References

Paragraph 1: taken from episode, information on MOA taken from drugbank (https://go.drugbank.com/drugs/DB00794#mechanism-of-action)

Paragraph 2: taken from episode

Paragraph 3: taken from episode

Paragraph 4: taken from episode, information on metabolism taken from drugbank (https://go.drugbank.com/drugs/DB00794#metabolism)

Paragraph 5: taken from drugbank (https://go.drugbank.com/drugs/DB00794#toxicity)

Ketamine Pharmacology

On this episode, I discuss ketamine pharmacology.

Ketamine is primarily broken down by CYP2B6 which fortunately does not have a lot of common medications that can interfere with its action.

Ketamine can cause psychiatric type adverse effects such as hallucinations, nightmares, and vivid dreams.

At lower to moderate dosages, ketamine does have some mild sympathetic activity which can raise blood pressure and heart rate.

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!

Topiramate Pharmacology

On this episode of the Real Life Pharmacology Podcast, I cover topiramate pharmacology.

Topiramate is indicated for migraine prevention, seizures, and weight loss which are the most common uses that I see this medication used for.

Topiramate has carbonic anhydrase activity, so rarely, use of this drug may induce metabolic acidosis.

By far, the most common patient complaint I get with the use of topiramate is that it causes cognitive slowing or impairment.

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!

Colchicine Pharmacology

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

Colchicine ultimately works by reducing the activity of neutrophils that help contribute to pain and inflammation associated with gout.

Colchicine does have some drug interactions with medications and grapefruit juice via CYP3A4.

The most common dose limiting side effect of colchicine is diarrhea.

Colchicine can be used as a potential alternative to NSAIDs or corticosteroids in the management of a gout flare.

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Naproxen Pharmacology

On this episode of the Real Life Pharmacology Podcast, I discuss naproxen pharmacology.

Naproxen can raise the concentrations of lithium and increase the risk for toxicity.

Compared to most other NSAIDs, naproxen tends to have a lower cardiovascular risk.

Naproxen can contribute to renal insufficiency, GI bleed risk, and CHF exacerbations.

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!