Memantine Pharmacology

Memantine is classified as an NMDA receptor antagonist. Memantine pharmacology is complex as is the pharmacology of any medication working in the brain. This drug can help reduce the activity of glutamate, an excitatory neurotransmitter which can play a role in Alzheimer’s dementia.

Memantine has an extended release dosage form that is dosed once per day compared to twice per day for the immediate release. However, the cost of the extended release is much more expensive, so it is recommended to begin with the immediate release.

Memantine is cleared by the kidney. In patients with reduced kidney function, you must review to assess if the memantine dose needs to be adjusted.

When using memantine or other dementia medications, be sure to look out for medications that can cause dementia type symptoms. CNS depressants like benzodiazepines, sleep medicines, and anticholinergics are all examples of meds that could exacerbate dementia.

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GLP-1 Agonist Pharmacology

The GLP-1’s are a relatively newer class of medications used to lower blood sugars in diabetes.

GLP-1’s work by simulating the effects of incretin hormones in the body. They can help promote fullness, lower weight, and stimulate insulin release following a meal.

GLP-1’s can cause significant GI side effects. Nausea is by far the most common adverse effect. It can even lead to diarrhea and vomiting in some cases.

There is boxed warning on the GLP-1 agonists. Be aware of patients who have had a history of thyroid cancer as this may be a contraindication.

GLP-1 agonists can help lower A1C and stimulate weight loss which is a huge benefit for most patients with Type 2 diabetes.

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Iron Supplement Pharmacology

Iron supplements frequently cause GI upset. Monitor patients for nausea, vomiting, and constipation issues.

There are three main salt forms of iron. Ferrous fumurate has the most elemental iron, ferrous sulfate (2nd most), and ferrous gluconate has the least.

Iron can bind up antibiotics and reduce their effectiveness. Two classic examples include the quinolone and tetracycline antibiotics.

Anemia can be caused by numerous concerns, however, iron deficiency is a very common cause.

Ferritin is a lab that we commonly monitor in a patient who may be iron deficient. Iron deficiency can also lead to symptoms of Restless Leg Syndrome.

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Loop Diuretics Pharmacology

On this episode, I cover common loop diuretics. They include furosemide, torsemide, and bumetanide.

Loop diuretics are potent agents that can help in the management of heart failure and ascites.

Loops diuretics help promote the loss of excessive fluid through the urine.

A common patient complaint from loop diuretics is that they can cause frequent urination. Because of this, we typically dose these drugs earlier in the day.

Kidney function and electrolyte monitoring is critical with the use of loop diuretics.

Enjoy the episode!

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Methotrexate Pharmacology

On this episode of the Real Life Pharmacology Podcast, I cover the pharmacology of methotrexate.

Methotrexate has a few different indications. It can be used for treatment of cancer. These doses are typically going to be much higher than standard low doses for other conditions.

Lower dose methotrexate is often used for autoimmune type conditions like rheumatoid arthritis and psoriasis.

Folic acid should be supplemented with use of methotrexate to help reduce the risk of adverse effects.

Liver toxicity and immune system suppression are two important factors to monitor in a patient taking chronic methotrexate.

I also talk about important cumulative drug interactions with methotrexate such as immunosuppressives and other agents that may impact liver function.

Be sure to listen to the end as I talk about the potential impact of methotrexate on some vaccines!

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Cyclobenzaprine Pharmacology

On this episode, I discuss cyclobenzaprine pharmacology. Cyclobenzaprine is an older skeletal muscle relaxant.

Cyclobenzaprine can have a significant number of anticholinergic side effects.

The anticholinergic side effects of cyclobenzaprine can include sedation, dry eyes, dry mouth, urinary retention, and confusion.

Cyclobenzaprine is not well tolerated in the elderly and cause more problems in that patient population.

Cyclobenzaprine has a similar structure to the Tricyclic antidepressants.

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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.

Pseudoephedrine Pharmacology

Pseudoephedrine is commonly used to help relieve nasal congestion.

There are some adverse effects you need to be aware of with pseudoephedrine. Insomnia, increase in blood pressure, and urinary retention are all possible.

When I assess a patient using pseudoephedrine, I like to investigate blood pressure, history of urinary problems and insomnia history.

Pseudoephedrine can cause the prescribing cascade.  I lay out examples in the podcast.

Pseudoephedrine should not be utilized with MAOI’s if possible – I discuss the reason for this in the podcast.

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Fentanyl Pharmacology

On this episode, I discuss fentanyl pharmacology.

I address important considerations that you must remember with fentanyl patches.

Those considerations include how pharmacokinetics can impact our patients.

I also break down common side effects of opioids as well as potential common drug interactions.

Drug diversion and illicit use is an important consideration when using fentanyl.  I also touch on this topic.

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Quinolone Antibiotic Pharmacology

Quinolones are a class of antibiotics that can be used for various infections. I discuss the pharmacology, adverse effects, drug interactions and other items on this podcast episode.

On this episode, I talk about the warnings associated with quinolones.

Quinolone use has subsided over time, not due to the fact that they are ineffective, but to rising concerns and warnings about adverse effects.

Quinolones can interact with quite a few medications.  I’ve seen a case of amiodarone and levofloxacin contributing to QTc prolongation which I discuss on this episode.

It is critical to remember the binding interactions associated with quinolones as these can potentially lead to treatment failure.

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