Nortriptyline Pharmacology

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 also discuss 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!

Doxepin Pharmacology

Doxepin is under the class of tricyclic antidepressants. It can inhibit the reuptake of serotonin and norepinephrine.

In addition to the serotonin and norepinephrine reuptake inhibition mechanism, doxepin also has antihistamine type effects.

Because of the anticholinergic activity of doxepin, it is recommended to avoid this medication in the elderly, particularly at high doses.

Be aware that anticholinergics like doxepin can reduce the benefit of dementia medications.

CYP2D6 is an important enzyme in the metabolism of doxepin and drugs like bupropion that inhibit CYP2D6 can increase the concentrations of doxepin.

I also discuss 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!

Atomoxetine Pharmacology

Atomoxetine is a norepinephrine reuptake inhibitor that can be used in the management of ADHD.

Atomoxetine is a non-controlled substance option for patients seeking this alternative to traditional stimulants.

CYP2D6 is an important enzyme in the breakdown of atomoxetine.

CYP2D6 inhibition or poor metabolizers via CYP2D6 can lead to higher concentrations of atomoxetine and put our patients at greater risk for adverse effects.

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

Fluoxetine Pharmacology

Fluoxetine is an SSRI used in the management of depression, anxiety, OCD, PTSD, and other psychiatric conditions.

Fluoxetine has a very long half-life which can impact clinical management. I discuss how this matters in this podcast episode.

Fluoxetine inhibits CYP2D6 which can alter the concentrations of many drugs.

Prodrugs like codeine and tamoxifen can have their effects reduced because of fluoxetine. I explain this further in the episode.

By inhibiting CYP2D6 concentrations of many drugs can be raised by the use of fluoxetine.

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

Methylphenidate Pharmacology

Methylphenidate has an FDA approved indication for ADHD. In this podcast episode, I cover the pharmacology, adverse effects, kinetics, and drug interaction.

Because methylphenidate has stimulant type effects, it can raise blood pressure and heart rate.

Weight, blood pressure, and pulse are important monitoring parameters in patients taking a stimulant type medication like methylphenidate.

There are numerous dosage forms of methylphenidate which can help accommodate many different patients’ needs.

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

Benzodiazepine Pharmacology

Benzodiazepines act by enhancing the effect of GABA, an inhibitory neurotransmitter.

Benzodiazepines can cause confusion, sedation, and respiratory depression.

There are many potential indications for benzodiazepines. They can be used in anxiety, status epilepticus, insomnia, and alcohol withdrawal amongst other things.

There is a boxed warning for the use of opioids with benzodiazepines. The primary risk of the combination is respiratory depression.

Lithium Pharmacology

Lithium is a drug that has a ton of clinical pearls.  On this episode, I talk about the pharmacology, side effects, drug interactions, and critical practice pearls.

Kidney function is very important to monitor in our patients taking lithium.  Lithium can accumulate in renal impairment.

Thyroid function can be altered by lithium.  Be sure to regularly monitor TSH in a patient on chronic lithium.

Over-the-counter NSAID can interact and raise lithium levels.  This is something you need to watch out for as patients can begin taking these medications on their own without supervision.

Be sure to assess lithium levels.  Signs of toxicity can include GI upset, tremor, motor movement issues, sedation, and CNS changes.

Bupropion Pharmacology – Real Life Pharmacology

In this episode I discuss bupropion pharmacology.  I cover the mechanism of action, side effects, and some relevant drug interactions.

Important information in this episode includes:

  • Possible indications for bupropion like depression and smoking cessation
  • Risk of lowering seizure threshold
  • Inhibition of CYP2D6
  • Dosage form considerations
  • Pearls for onset of bupropion’s action

Mirtazapine Pharmacology

On this episode, I cover mirtazapine pharmacology.

We will review how mirtazapine works in the body and how those cause adverse effects and benefit out patient.

I will also look at the side effect profile and why mirtazapine may be harmful or helpful in our patients.

We cover drug interactions for mirtazapine in the podcast as well.

Mirtazapine is an antidepressant and I mention discontinuation syndrome as well as what I see as being done when converting a patient from one antidepressant to another.

Enjoy the show and don’t for get to get your free gift by subscribing!

Serotonin and Norepinephrine Reuptake Inhibitors Pharmacology

The Serotonin and Norepinephrine Reuptake Inhibitors are a class of medication used for various mental health disorder and pain syndromes.  I talk about the pharmacology of the SNRI’s and how it relates to their adverse effect profile.  The pharmacology of SNRI’s also plays an important role in why they are efficacious for treatment of pain compared to the SSRI’s.  In addition to the adverse effects, I will outline some common drug interactions and which medications might be affected by the SNRI’s. Enjoy the episode and I hope you pick up some clinical practice pearls with the SNRI’s!  Don’t forget to take advantage of our free giveaway as well, nearly 1,000 healthcare professionals and students have already done so!