Real Life Pharmacology

July 18, 2019July 10, 2019

Budesonide Pharmacology (Oral and Rectal Formulations)

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Budesonide is a corticosteroid that can be given orally or rectally for management of Crohn’s disease or ulcerative colitis.

Because budesonide has a high first pass metabolism, the relative impact of systemic effects may be less than other steroids like prednisone.

Remember that CYP3A4 inhibitors can increase the concentrations of budesonide. I discuss this further on the podcast.

Different dosage forms of budesonide (oral versus rectal) can be used for different reasons. The site of the inflammation in Ulcerative colitis can determine which dosage form is most appropriate.

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July 11, 2019July 2, 2019

Cimetidine Pharmacology

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Cimetidine blocks histamine 2 receptors which can suppress acid production and reduce symptoms of heartburn.

One of the major downsides to cimetidine is that it has a ton of drug interactions. I discuss many of the common ones in this episode.

Cimetidine is one of a few drugs that has the potential to cause gynecomastia. I discuss the mechanism of this adverse effect in this episode.

Phenytoin concentrations can rise due to the use of cimetidine. I discuss this in the drug interactions section of this episode.

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

July 4, 2019July 2, 2019

Clopidogrel Pharmacology

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Clopidogrel is an antiplatelet agent that is often used in combination with aspirin to help reduce the risk of an MI.

The risk of bleed is a high priority with the use of clopidogrel. Patients must be monitored for signs and symptoms of bleeding and bruising.

Clopidogrel is a prodrug that is converted to its active metabolite by CYP2C19.

Fluconazole can inhibit CYP2C19 which may reduce the effectiveness of clopidogrel.

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

June 27, 2019June 25, 2019

Sulfasalazine Pharmacology

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Sulfasalazine is a medication that can be used for diseases like rheumatoid arthritis, Crohn’s disease, and Ulcerative Colitis.

Because sulfasalazine can cause GI upset, this is a major reason why we try to break up the dose and give it multiple (at least two) times per day.

LFT and CBC monitoring are recommended with sulfasalazine due to its low potential to cause liver dysfunction, aplastic anemia, and agranulocytosis.

Sulfasalazine can impair folic acid absorption and lead to potential deficiency. A patient deficient in folic acid is at higher risk for developing anemia.

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

June 20, 2019June 20, 2019

Cholestyramine Pharmacology

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On this episode, I discuss the pharmacology of cholestyramine.

Cholestyramine was originally developed as an agent to manage cholesterol, but has fallen out of favor for some of the more effective agents like statins.

Cholestyramine is notorious for binding drug interactions. It can reduce concentrations of drugs like amiodarone, digoxin, oral contraceptives, immunosuppressive and many more!

In patients with chronic diarrhea, cholestyramine is occasionally used off label to help manage symptoms because it tends to have constipating effects.

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

June 13, 2019June 9, 2019

Rifampin Pharmacology

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Rifampin is classified as an antibiotic and an antituberculosis agent. It primarily works by inhibiting bacterial RNA polymerase.

While not extremely common, rifampin is well known to cause hepatic dysfunction.

You should remind patients who are taking rifampin that it can alter the color of tears, sweat, saliva and urine. It can change these fluids to a reddish/brown color.

Rifampin is very well known for causing drug interactions. It is an enzyme inducer that can reduce the concentrations of numerous medications such as warfarin, apixaban, cyclosporin, levothyroxine, and oral contraceptives to name a few.

Rifampin can be used to help prevent meningococcal infection. Learn more on rifampin by listening to this podcast!

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

June 6, 2019May 29, 2019

Heparin Pharmacology

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Heparin is an interesting drug with a lot of unique clinical quirks. This drug ultimately inhibits the formation of fibrin. Fibrin is an essential component of a blood clot.

Because heparin has blood thinning effects, it is critical to assess a patient’s bleed risk. Look out for other agents that may increase the risk of bleeding. Examples include; NSAIDs, antiplatelet agents, and other anticoagulants.

One classic test question about heparin that often comes up is the reversal agent. Protamine can be used to help reverse the effects of heparin.

Heparin-induced thrombocytopenia is a critical adverse effect to understand. I discuss both subtypes on the podcast and let you know what to look out for.

Rarer side effects of heparin include hyperkalemia and osteoporosis (only with long term use).

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

May 30, 2019May 17, 2019

Montelukast Pharmacology

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On this episode, I discuss montelukast pharmacology

Montelukast is a leukotriene receptor antagonist. Leukotrienes play an important role in causing inflammation and smooth muscle contraction in asthma and allergic rhinitis.

Because montelukast blocks the effects of leukotrienes, it can be advantageous to use this medication for allergies and asthma.

It is important to remind patients that montelukast is NOT a substitute for an acute relief medication like albuterol in the management of asthma symptoms.

Montelukast has been reported to cause mood and behavioral changes and it is important to monitor our patients for these rare concerns.

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

May 23, 2019May 17, 2019

Clozapine Pharmacology

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On this episode, I discuss clozapine pharmacology. This drug has multiple mechanisms of action: Dopamine blockade, anticholinergic activity, and alpha blocking activity all contribute to the complexity of this drug.

Smoking cessation can significantly increase the concentrations of clozapine. This is because smoking can induce CYP1A2. Listen to the podcast for more details on how this can impact our patients clinically.

Clozapine has 5 boxed warnings. I discuss them all in this podcast. The most well-known boxed warning is for agranulocytosis.

Because clozapine has alpha blocking activity, it can cause orthostasis. We need to monitor for this.

Clozapine can cause QTc prolongation. Keep an eye out for other medications that the patient may be taking that can also cause this. Examples include: amiodarone, ondansetron, quinolones, and macrolides

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

May 16, 2019May 14, 2019

Carbamazepine Pharmacology

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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!