Ropinirole Pharmacology

Ropinirole (Requip) is a dopamine agonist that can be used in Parkinson’s disease and Restless Legs Syndrome.

Dopamine agonists like ropinirole can worsen psychiatric symptoms in some patients by causing hallucinations, and obsessive/compulsive symptoms.

Nausea, vomiting, hypotension, and fatigue are the most common adverse effects of ropinirole.

Ropinirole has drug interactions with antipsychotics and CYP1A2 inhibitors. I discuss these in greater detail in this podcast episode.

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

Cabergoline Pharmacology

Cabergoline is a dopamine agonist. I discuss the pharmacology, adverse effects, and drug interactions in this podcast episode.

Be on the lookout for drugs that could oppose the effects of cabergoline such as antipsychotics and metoclopramide.

Cabergoline can be used for hyperprolactinemia management and may cause adverse effects like hypotension and GI upset.

Cabergoline has a very long half-life so it is most often only dosed 1-2 times per week.

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

Study Materials For Pharmacists and Students

Useful Books For Any Healthcare Professional

Nursing Professionals

Dietitian Professionals

Denosumab (Prolia) Pharmacology

On this episode, I discuss denosumab pharmacology, adverse effects, clinical pearls, and drug interactions.

Whenever I see an osteoporosis medication like denosumab used, I review the medications to ensure that we avoid medications that can cause osteoporosis.

Denosumab is often used as a potential alternative in osteoporosis management for those that cannot tolerate bisphosphonates.

We need to monitor calcium levels when using denosumab as levels can be dangerously low, especially when used in combination with other calcium lowering drugs.

Loop diuretics and cinacalcet can have additive hypocalcemia effects when used in combination with denosumab.

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

Study Materials For Pharmacists and Students

Useful Books For Any Healthcare Professional

Nursing Professionals

Dietitian Professionals

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.

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

Study Materials For Pharmacists and Students

Useful Books For Any Healthcare Professional

Nursing Professionals

Dietitian Professionals

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.

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

Study Materials For Pharmacists and Students

Useful Books For Any Healthcare Professional

Nursing Professionals

Dietitian Professionals

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.

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

Study Materials For Pharmacists and Students

Useful Books For Any Healthcare Professional

Nursing Professionals

Dietitian Professionals

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.

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

Study Materials For Pharmacists and Students

Useful Books For Any Healthcare Professional

Nursing Professionals

Dietitian Professionals

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.

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

Study Materials For Pharmacists and Students

Useful Books For Any Healthcare Professional

Nursing Professionals

Dietitian Professionals

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.

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

Study Materials For Pharmacists and Students

Useful Books For Any Healthcare Professional

Nursing Professionals

Dietitian Professionals

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!