Diltiazem Pharmacology

Diltiazem is a non-dihydropyridine calcium channel blocker that can be used in atrial fibrillation as well as hypertension.

One big downside to diltiazem is that it does have a few drug interactions via CYP3A4.

Aripiprazole, apixaban, and certain statins are all examples of medication that can have concentrations increased by adding diltiazem to a patient’s regimen.

Diltiazem works a little differently from dihydropyridine calcium channel blockers (like amlodipine) as it works on the heart AND the vessels.

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Zolpidem Pharmacology

Zolpidem enhances the action of GABA which is an inhibitor neurotransmitter.

Zolpidem metabolism can be impacted by the use of CYP3A4 inhibitors. Concentrations can rise on account of this potential interaction.

It is important to remember to go slowly when tapering off zolpidem. Particularly in patients who have been on the drug for a long time or those who are on higher doses.

Abnormal sleeping behaviors like sleep-walking, eating, or driving have been reported with zolpidem.

Remember that CNS depressant drug interactions can happen with zolpidem. Take note of any other sedating medications prior to starting zolpidem.

I also discuss drug interactions on the podcast, be sure to check out my latest project which is a 200+ 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!

Oral Semaglutide Pharmacology

On this episode, I discuss the pharmacology of oral semaglutide. It is a GLP-1 agonist that is the first one in the class to have an oral formulation.

There is a recommended dose titration with oral semaglutide that can take a month or two to get therapeutic doses. I disucss this further in this episode.

The most common adverse effect of oral semaglutide is nausea.

Oral semaglutide is dosed once daily which is nice to try to maximize patient adherence.

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

Probenecid Pharmacology

Patients with G6PD deficiency who are taking probenecid are at increased risk for hemolytic anemia.

In a patient taking probenecid, they need to have adequate kidney function for the drug to work.

GI upset is likely the most common adverse effect of probenecid. It can be given with food.

Probenecid can raise the concentrations of many common antibiotics like penicillins and cephalosporins.

Remember that there are many medications that can oppose the beneficial effects of probenecid. Thiazides, niacin, and some immunosuppressants can raise uric acid.

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

I also discuss drug interactions on the podcast, be sure to check out my latest project which is a 200+ book on managing drug interactions in primary care.

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 also discuss drug interactions on the podcast, be sure to check out my latest project which is a 200+ 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+ 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!

Metoprolol Pharmacology

Metoprolol is a beta-blocker commonly used in the management of hypertension, heart failure, and atrial fibrillation.

There is an extended release dosage form and immediate release dosage form with metoprolol. The advantage of the extended release product is that it doesn’t require as frequent dosing.

Metoprolol is selective for beta-1 receptors. It is less likely to interact with asthma medications.

CYP2D6 plays an important role in breaking down metoprolol. Alterations in this enzyme’s activity can alter concentrations of the drug.

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

Mometasone Pharmacology (Nasal and Oral Inhalation)

Mometasone is an inhaled corticosteroid and a nasal corticosteroid. The inhaled steroid is called Asmanex by brand name and the nasal version is Nasonex.

Nasonex is primarily used in the management of allergic rhinitis and can help with nasal congestion type symptoms.

Remember that nasal mometasone takes a little while to have its full effect. It can take up to a week or two to provide its maximum benefit.

Systemic absorption of both nasal and oral inhalation mometasone is very low at less than 1%.

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