Lamotrigine Pharmacology

On this episode of the Real Life Pharmacology podcast, I discuss the ins and outs of lamotrigine pharmacology.

Lamotrigine has a very slow dose titration schedule due to the risk of drug induced rash.

Sedation, GI upset, and CNS changes are the most common adverse effects associated with lamotrigine.

Lamotrigine concentrations can be increased by valproic acid, so we tend to use lower starting doses.

Phenytoin and carbamazepine can lower concentrations of lamotrigine.

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!

Diazepam Pharmacology

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!

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.

Carbamazepine Pharmacology

Carbamazapine Pharmacology

On this episode, I discuss carbamazepine pharmacology. This drug is most commonly used for seizures, bipolar disorder, or trigeminal neuralgia.

Carbamazepine is an autoinducer and can reduce the concentrations of numerous drugs. Some examples include apixaban, warfarin, rivaroxaban, diltiazem, verapamil, and many more!

Carbamazepine has the potential to cause Steven Johnson’s Syndrome. This has a much greater chance of happening in patients with certain genetics.

Carbamazepine can contribute to SIADH and cause significant hyponatremia.

Carbamazepine has boxed warning for numerous potential events like aplastic anemia, agranulocytosis, and the above-mentioned SJS.

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

Valproate Pharmacology

Valproate Pharmacology

Valproate (valproic acid, Depakote) has numerous uses which includes migraines, seizures, and bipolar disorder.

In a patient who is taking valproate, it is important to monitor for signs and symptoms of confusion as this drug can cause elevated ammonia levels.

When switching between dosage forms of valproate, you must recognize that the bioavailability is not the same between each different dosage form. This could lead to toxicity or treatment failure.

Valproic acid has a boxed warning for hepatotoxicity and liver function needs to be monitored.

Valproic acid can increase lamotrigine levels which ultimately could lead to an increased risk of lamotrigine induced SJS.

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

Phenytoin RLP Episode 020

Oh boy…Phenytoin is one of those medications that has a ton of clinical pearls.  I’ve seen mistakes with phenytoin that has led to hospitalizations.  You need to pay attention for this one!  Also be sure to check out our Top 200 drugs and 3 highly testable pearls!  A FREE 31 page PDF resource, simply for following the blog!