On part 1 of opioids, I’ll discuss morphine, morphine equivalents, conversion, and hydrocodone. The pharmacokinetic differences will be important between opioids, as well as the dosage forms. I hope you enjoy this podcast episode and share it with your friends!
On this episode of the Real Life Pharmacology podcast, I’m going to cover important practice pearls on skeletal muscle relaxants. Important medications that will be covered in this podcast include baclofen, cyclobenzaprine, tizanidine, and diazepam.
Suzetrigine is a relatively newer analgesic offering a novel approach to treating acute pain without acting as an opioid. By selectively blocking the Nav1.8 sodium channel found in peripheral pain-sensing nerves, suzetrigine helps reduce pain transmission while minimizing many of the risks associated with traditional opioid therapy. In this episode of the Real Life Pharmacology podcast, we’ll review how suzetrigine works, its FDA-approved indication, common adverse effects, and where it may fit into clinical practice. Whether you’re a pharmacist, pharmacy student, nurse, or other healthcare professional, this episode will provide practical insights to help you better understand this analgesic.
Glycopyrrolate is an anticholinergic medication commonly used to reduce excessive secretions, particularly in palliative care, postoperative settings, and certain neurologic conditions. It works by blocking acetylcholine at muscarinic receptors, which decreases salivary and respiratory secretions. Clinically, glycopyrrolate is often used to manage terminal respiratory secretions (“death rattle”).
Adverse effects of glycopyrrolate are primarily related to its anticholinergic properties. These may include dry mouth, constipation, urinary retention, blurred vision, tachycardia, and decreased sweating. While it has fewer central effects than agents like scopolamine, caution is still warranted in patients with glaucoma, gastrointestinal obstruction, or significant urinary retention risk. Monitoring hydration and bowel function is important, especially in elderly or frail patients.
Dosing strategies depend on the clinical need. In palliative care, low doses may be given subcutaneously or intravenously every 4–6 hours as needed, while oral dosing is common for chronic sialorrhea.
Clinicians should consider the patient’s overall medication burden, as cumulative anticholinergic load can worsen cognitive impairment and contribute to falls or constipation. I discuss drug interactions and other commonly used medications that may contribute to anticholinergic burden.
NSAIDs can reduce the effectiveness of antihypertensive medications such as ACE inhibitors, ARBs, beta-blockers, and diuretics by promoting sodium and water retention and decreasing renal blood flow.
Combining NSAIDs with anticoagulants or antiplatelet agents like warfarin or aspirin significantly increases the risk of gastrointestinal bleeding, due to additive effects on platelet inhibition and mucosal irritation.
NSAIDs can elevate lithium levels and increase the risk of toxicity, as they reduce renal clearance of lithium by decreasing renal perfusion.
Co-administration of NSAIDs with methotrexate can impair methotrexate elimination, leading to elevated levels and potential toxicity, especially at high methotrexate doses.
When NSAIDs are used with corticosteroids, the risk of gastrointestinal ulcers and bleeding is greatly amplified due to synergistic impairment of gastric mucosal protection.
Meclizine is classified as a first-generation antihistamine. I discuss meclizine pharmacology, adverse effects, drug interactions, and much more.
Meclizine is included on the Beers list due to its highly anticholinergic activity. Anticholinergic effects include constipation, dry eyes, dry mouth, urinary retention, and confusion.
Sedation is an important adverse effect of meclizine. This adverse effect can be increased when used with other sedating medications such as opioids and benzodiazepines.
Meclizine is primarily used for vertigo and motion sickness in clinical practice. The usual starting dose ranges between 12.5 to 25 mg.
Meclizine is partially broken down by CYP2D6 so medications like bupropion can inhibit the breakdown of meclizine and lead to higher concentrations.
Modafinil (Provigil) is a CNS stimulant medication. I cover modafinil pharmacology, adverse effects, drug interactions, and much more on this podcast episode.
You should be aware that modafinil is a Schedule 4 controlled substance so it does carry a risk of dependence and addiction.
Modafinil can cause CYP3A4 induction and lead to lowering the concentrations of many medications. This includes antiepileptic agents and oral contraceptives.
The most common adverse effects of modafinil include ramping up the body and causing symptoms such as anxiety and insomnia.
Cardiovascular changes are a risk with modafinil as this medication can contribute to hypertension and tachycardia.
On this podcast episode, I cover risedronate pharmacology, adverse effects, drug interactions, and much more.
There is a strict administration procedure with risedronate which is designed to reduce adverse effects and enhance absorption. I discuss this in the podcast.
Many medications may cause osteoporosis and may precipitate treatment with risedronate. Corticosteroids and excessive thyroid hormone replacement are two examples.
Patients should remain upright (sitting or standing) for at least 30 minutes following administration to reduce the risk of esophagitis and ulceration.
