Category: Neurology and Musculoskeletal Medications

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Tizanidine Pharmacology

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Tizanidine is primarily broken down by CYP1A2. Ciprofloxacin can inhibit CYP1A2 and cause higher tizanidine concentrations.

Tizanidine has a similar classification as clonidine. Pay attention to adverse effects like hypotension and bradycardia.

When patients taking routine tizanidine stop taking it, there is potential for a discontinuation syndrome that may lead to rebound hypertension.

Dry mouth and CNS depression are common adverse effects of tizanidine.

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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Codeine Pharmacology

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On this episode, I discuss codeine pharmacology and practical clinical practice pearls.

Codeine is metabolized by CYP2D6 to the active metabolite morphine. I discuss how this can be affected by genetics as well as other medications.

Constipation is a problem with codeine and all opioids in general. Education and making a plan with patients to combat this side effect is important.

Codeine is less potent than other opioids such as fentanyl, hydromorphone, and hydrocodone.

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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Dexmedetomidine Pharmacology

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Dexmedetomidine is a selective alpha-2-adrenergic agonist with sedative characteristics.

Dexmedetomidine is commonly used in ICU and procedural sedation, as well as postoperative pain.

A few of the more serious adverse effects of dexmedetomidine to keep an eye on including bradyarrhythmias/bradycardia and hypotension.

Dexmedetomidine undergoes hepatic metabolism, meaning a dose reduction may be required in patients with impaired hepatic function.

Major drug interactions to monitoring for with dexmedetomidine include co-administration with anesthetics, sedatives, hypnotics, and opioids, as it may lead to an enhancement of effects.

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.

It is also important to note that dexmedetomidine may produce withdrawal symptoms if used for longer than 24 hours.

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

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Calcitonin Pharmacology

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On this episode, I discuss the pharmacology of calcitonin.

Calcitonin has an indication for osteoporosis as well as hypercalcemia.

When considering drug interactions with calcitonin, recall that it can lower calcium levels which could have a cumulative effect when combined with loop diuretics.

Calcitonin nasal spray should be stored upright and primed prior to use.

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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Rivastigmine Pharmacology

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Rivastigmine is an acetylcholinesterase inhibitor used in the management of certain dementias. I discuss rivastigmine pharmacology on this episode.

Weight loss is a potential adverse effect of rivastigmine. It is important to monitor weights.

Anticholinergic medications such as diphenhydramine can blunt the effects of rivastigmine.

Rarely, acetylcholinesterase inhibitors like rivastigmine can cause bradycardia.

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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Ibandronate Pharmacology

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Ibandronate is a bisphosphonate that can be used in the management of osteoporosis.

Bisphosphonates like ibandronate require a full glass of water for oral administration.

Patients should remain upright for at least 30-60 minutes following taking ibandronate to help reduce the risk of esophagitis.

Osteonecrosis has rarely been associated with bisphosphonates like ibandronate – I’ve discussed a couple of risk factors that may place a patient at higher risk.

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

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.

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.

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Nortriptyline Pharmacology

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Nortriptyline is a TCA that can be used for depression and various pain syndromes. I discuss other less common diagnoses in this podcast episode as well.

There are a lot of drug interactions with nortriptyline. It is metabolized by CYP2D6, can have additive anticholinergic effects and has been associated with QTc prolongation.

Nortriptyline is very anticholinergic and can blunt the effects of dementia medications.

Dry mouth, dry eyes, sedation, urinary retention, and constipation are a few of the more common adverse effects of nortriptyline.

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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Hydroxychloroquine Pharmacology

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Hydroxychloroquine is classified as a DMARD and when used chronically, can be helpful in managing rheumatoid arthritis and Lupus.

There have been reports of QTc prolongation with hydroxychloroquine. While not incredibly common, it is important to remember this consideration in patients at risk for QTc prolongation.

Hydroxychloroquine is associated with causing retinopathy. Routine eye exams for monitoring purposes are critical.

Rarely, hydroxychloroquine can be associated with blood disorders like neutropenia and thrombocytopenia. In addition, alterations in liver function have been reported.

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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Alendronate Pharmacology

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Alendronate is a bisphosphonate that is used in the management of osteoporosis.

In this episode, I discuss osteonecrosis risk and what are some of the risk factors that may increase the chances of this very rare adverse effect.

Binding interactions are so critical with alendronate. They can essentially make the drug useless.

Esophageal irritation and ulceration is one of the possible complications with the use of alendronate.

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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Diazepam Pharmacology

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Diazepam has numerous dosage forms. There are rectal, injectable, and oral formulations of the drug that are commonly used in clinical practice.

Diazepam has 2 major metabolic pathways. It is broken down primarily by CYP3A4 and CYP2C19, leaving open the potential for numerous drug interactions. I discuss this further in the podcast.

Diazepam is on the Beers list because it has a tendency to accumulate in the geriatric patient population and cause adverse effects like sedation, confusion, and falls.

Respiratory depression, coma, and death are significantly more likely in overdose situations where opioids are used in combination with benzodiazepines like diazepam.

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