Asthma Pharmacotherapy Q&A With Beth Zerr, PharmD, BCACP

On this very special episode of the Real Life Pharmacology podcast, we tackle asthma pharmacotherapy and some of the things that Beth sees in her everyday practice as an ambulatory care pharmacist.

When discussing asthma pharmacotherapy with pediatric patients and their families, it is critical to address the concern of suppressed growth with corticosteroid use. Beth shares her expertise and thoughts on this topic.

The GINA update a few years ago has been a game changer in asthma, hear from Beth how this has been implemented in her practice.

Beth also discusses some of the everyday drug interactions and adverse effects of asthma medications in this podcast episode.

Neither Beth nor I have any conflicts of interest in regard to discussing these medications.

If you’d like to contact Beth, you can reach out to her at zerr@arizona.edu

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Dextromethorphan Pharmacology Podcast

I discuss dextromethorphan pharmacology, adverse effects, drug interactions, and more on this podcast episode.

CYP2D6 metabolizes Dextromethorphan. A commonly used antidepressant is a CYP2D6 inhibitor. I discuss this on the podcast.

Dextromethorphan is a commonly used OTC cough suppressant. There is potential for abuse with this medication.

In excessive doses, dextromethorphan may cause euphoria, hallucinations, and other CNS effects, but also cause cardiovascular complications.

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Inhaled Budesonide Pharmacology

On this episode of the podcast, I cover budesonide (Pulmicort) pharmacology. Our sponsor (Pyrls.com/rlp) for this episode is providing a FREE PDF of their inhaled corticosteroid categorizations chart (i.e. low/medium/high dose ICS) when you sign up for a free account!

The onset of action of inhaled budesonide is several hours up to a few days. Patient education is critical to ensure that patients stick with its use.

Budesonide does have a nebulized formulation that is often used in pediatrics and geriatrics.

There aren’t a ton of critical drug interactions, but you should think about medications that inhibit CYP3A4 and may have additive immunosuppressive effects.

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Salmeterol (Serevent) Pharmacology

In this episode, I cover salmeterol (Serevent) pharmacology, adverse effects, drug interactions and special warnings with this medication.

Salmeterol is a long acting beta agonist that can be used in combination with inhaled corticosteroids for management of asthma.

Salmeterol can be used as monotherapy in COPD and should not be used as monotherapy in asthma.

Elevations in pulse and blood pressure can happen with a beta agonist like salmeterol.

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Umeclidinium Pharmacology

On this episode, I discuss umeclidinium pharmacology, adverse effects, patient education pearls, and drug interactions.

Umeclidinium is used in the management of COPD. Below is an excellent quick overview of the COPD guidelines from pyrls.com – You can get the full PDF by signing up for a free account at pryls.com/rlp

Umeclidinium is a long-acting anticholinergic (anti-muscarinic) LAMA and as you can see from the figure above drugs from this class are frequently used in COPD management.

The brand name of umeclidinium is Incruse Ellipta. Ellipta refers to the device and not the drug umeclidinium.

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Roflumilast (Daliresp) Pharmacology

On this episode I discuss roflumilast (Daliresp) pharmacology, adverse effects, and important drug interactions.

Roflumilast is indicated to reduce the incidence of COPD exacerbations.

Roflumilast is significantly broken down by CYP3A4 so there are numerous drug interactions that we have to take into account.

Psychiatric issues, GI upset, and weight loss are all potential adverse effects due to roflumilast.

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Tiotropium Pharmacology

On this episode, I discuss tiotropium pharmacology. In addition, I cover adverse effects, administration pearls, and drug interactions.

Tiotropium blocks acetylcholine from binding the M3 receptor in the lungs. This leads to a relaxation of the bronchial smooth muscle.

Because tiotropium has anticholinergic activity, there is a potential for anticholinergic adverse effects like constipation, urinary retention, and dry mouth.

The tiotropium Handihaler can be confusing to patients. I discuss medication misadventures in this podcast episode.

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!

Varenicline Pharmacology

Varenicline is a partial nicotine agonist that can be used to help patients quit smoking.

The two most common adverse effects that I have seen in clinical practice with varenicline are GI upset and insomnia/vivid dreams.

GI upset with varenicline can be reduced by giving the drug with food and a full glass of water. A dose reduction may also be considered.

Patients should identify a goal stop date for smoking cessation prior to begininng the use of varenicline.

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!

Fluticasone, Umeclidinium, and Vilanterol Pharmacology

Fluticasone, Umeclidinium, and Vilanterol is a combination medication used in the setting of COPD. I discuss the pharmacology of this agent further in this episode.

Fluticasone is the inhaled corticosteroid portion of the drug while umeclidinium is a LAMA and vilanterol is a LABA medication.

Drug interactions aren’t incredibly common or strongly clinically significant, but I discuss some of them with Trelegy Ellipta.

Having a once-daily dose can be advantageous to help improve patient adherence. Fluticasone, umeclidinium, and vilanterol comes as a once-daily combination.

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!

Nicotine Patch Pharmacology

Nicotine replacement therapy is an important tool in helping our patients quit smoking. There are lots of clinical pearls involving the pharmacology of nicotine patches and I explore them in this episode.

Nicotine patches differ from the gum and other acute relief forms in that they are intended to provide a consistent level of nicotine in the body.

The initial dosing of nicotine patches is dependent upon the number of cigarettes smoked by the patient. I discuss it further in the podcast.

When applying nicotine patches, it is important to remember to utilize a clean, non-hairy area to ensure the patch adheres to the skin appropriately.

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!