Esomeprazole (Nexium) Pharmacology

On this episode, I discuss esomeprazole (Nexium) pharmacology, adverse effects, tapering, kinetics, and drug interactions.

I spend a good amount of time discussing the esomeprazole and clopidogrel interaction in this podcast episode.

Esomeprazole inhibits CYP2C19. This can cause an increase in citalopram concentrations and raise the potential for QTc prolongation.

It is critical to reassess the length of therapy and the dose of PPIs like esomeprazole.

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Carvedilol (Coreg) Pharmacology

On this episode of the Real Life Pharmacology podcast, I discuss carvedilol pharmacology, drug interactions, and adverse effects.

Carvedilol is one of the few beta-blockers that has alpha-blocking activity.

Carvedilol is almost exclusively metabolized by various CYP enzymes so renal function changes typically don’t change drug concentrations to a significant extent.

Beta-blockers like carvedilol are well known to cause the adverse effects of fatigue and sexual dysfunction.

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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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Denosumab (Prolia) Pharmacology

On this episode, I discuss denosumab pharmacology, adverse effects, clinical pearls, and drug interactions.

Whenever I see an osteoporosis medication like denosumab used, I review the medications to ensure that we avoid medications that can cause osteoporosis.

Denosumab is often used as a potential alternative in osteoporosis management for those that cannot tolerate bisphosphonates.

We need to monitor calcium levels when using denosumab as levels can be dangerously low, especially when used in combination with other calcium lowering drugs.

Loop diuretics and cinacalcet can have additive hypocalcemia effects when used in combination with denosumab.

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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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Trihexyphenidyl (Artane) Pharmacology

On this episode, I breakdown trihexyphenidyl (Artane) pharmacology, adverse effects, and drug interactions.

Trihexyphenidyl is highly anticholinergic and can cause constipation, dry eyes, dry mouth, and urinary retention.

Dementia medications like donepezil can have their effects blunted by the use of trihexyphenidyl.

Trihexyphenidyl is an older anticholinergic that is rarely used for the management of EPS caused by antipsychotics.

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Liraglutide Pharmacology

On this episode, I discuss liraglutide pharmacology, drug interactions, and adverse effects.

Liraglutide is well known to cause nausea. It is important to assess the severity of nausea as it may subside in some patients as they gain tolerability to the medication.

We mentioned the 2022 Diabetes Guideline Cheat Sheet in the podcast – you can get that for free at pyrls.com/rlp

Liraglutide has a fairly low risk of hypoglycemia when used alone, but this risk increases when it is used with insulin or sulfonylureas.

Saxenda is the weight loss formulation of liraglutide and dosing is higher for weight management than it is for diabetes management.

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Losartan Pharmacology

On this episode, I discuss losartan pharmacology, adverse effects, drug interactions, and appropriate monitoring.

Losartan is an ARB and can increase potassium levels. Keep an eye out for medications like spironolactone and trimethoprim which can increase this risk further.

Losartan has been shown to lower uric acid levels which could potentially be helpful in patients with gout.

Monitoring renal function is very important with losartan. The risk of ARF goes significantly higher when used with NSAIDs or diuretics.

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Pravastatin Pharmacology

On this episode, I breakdown pravastatin pharmacology, adverse effects, drug interactions and when you might see this drug used in practice.

Pravastatin is a statin and will lower LDL. Its use is a little limited in the fact that it is not as potent as other agents in its LDL lowering effects.

Pravastatin is hydrophilic which differentiates it from simvastatin, atorvastatin, and lovastatin.

I describe rhabdomyolysis in this podcast as it is a potential rare adverse effect of pravastatin.

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Clomiphene Pharmacology

On this episode, I discuss clomiphene pharmacology, adverse effects, clinical practice pearls, and drug interactions.

Clomiphene is a commonly used medication to help manage female infertility.

Clomiphene is oral and relatively inexpensive compared to other agents that are used for infertility management.

Clomiphene is a SERM so you can anticipate that some patients may report vasomotor symptoms like flushing and hot flashes.

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