Prochlorperazine Pharmacology

Prochlorperazine has several potential mechanisms of action. It can block dopamine and alpha receptors as well as have anticholinergic effects.

Prochlorperazine is classified as an antipsychotic and antiemetic. It is very seldom used as an antipsychotic in clinical practice and more used for its antiemetic effects.

Because of the anticholinergic activity of prochlorperazine, there is potential for dry mouth, dry eyes, urinary retention, constipation, and other anticholinergic effects.

Prochlorperazine does have the potential to have some alpha blocking activity. Keep an eye out for hypotension in patients who may be at risk.

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Buspirone Pharmacology

Buspirone is an anti-anxiety medication that has the potential of having some serotonin agonist activity.

Buspirone has a very high first-pass metabolism. This means that the body breaks much of the medication down prior to it getting into the systemic circulation.

Buspirone is broken down by CYP3A4, so concomitant use with inhibitors or inducers can alter its concentrations

Buspirone should not be used as needed as this medication takes a while to start to show benefit.

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Ondansetron Pharmacology

Ondansetron (Zofran) is a medication used for nausea and vomiting. In this episode, I lay out the pharmacology, adverse effects, drug interactions and more!

Ondansetron has been reported to increase the risk of serotonin syndrome. I discuss this further on the podcast.

Ondansetron can exacerbate QTc prolongation. Keep an eye out for patients who may have risk factors or be on other medications that can contribute to this. I discuss this further on this podcast.

Ondansetron is often used for chemotherapy induced nausea and vomiting. I discuss this and other indications on the podcast.

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Acyclovir Pharmacology

On this episode “Acyclovir Pharmacology” I discuss the mechanism of action, important monitoring parameters, and drug interactions with acyclovir.

I discuss why acyclovir has to be dosed so many times per day.

Acyclovir can inhibit CYP1A2 which can impact a few drugs. I discuss a couple of those examples on this podcast episode.

GI effects are one of the more common side effects of acyclovir.

Rarely, neuropathy and nephropathy can be part of the adverse effect profile of acyclovir. I discuss this further on this episode.

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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.

Celecoxib Pharmacology

Celecoxib is easy to remember as its mechanism of action is “COX”-2 Inhibition. This can result in result in reduced prostaglandin formation and help with pain and inflammation.

Kidney function is important to monitor in our patient on celecoxib. It is especially important in patients taking ACE inhibitors, ARBs, and/or diuretics.

While GI bleed may be less likely with celecoxib compared to traditional NSAIDs like indomethacin and ibuprofen, it still needs to be monitored for.

Digoxin concentrations may be increased with the use of celecoxib.

Celecoxib is generally dosed twice per day as the half-life of the drug is in the ballpark of 10-12 hours.

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Oseltamivir Pharmacology

Oseltamivir is an antiviral agent that is indicated for the treatment and prophylaxis of influenza.

It is important to remember that oseltamivir is cleared at least in part by the kidney and dose adjustments should be made based upon kidney function.

There is a low potential that oseltamivir could contribute to psych issues like delirium.

Probenecid has the potential to raise the concentrations of oseltamivir.

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Dolutegravir

Dolutegravir is an integrase inhibitor that is used in the management of HIV infection/

Carbamazepine along with other enzyme inducers can substantially lower the concentrations of dolutegravir.

Dolutegravir can potentially increase blood sugars, this should be closely monitored in our patients with diabetes.

CNS adverse effects like insomnia and dizziness can happen with dolutegravir.

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Medroxyprogesterone Acetate Injection Pharmacology

On this podcast episode, I cover medroxyprogesterone acetate injection pharmacology (DMPA or Depo-Provera)

Medroxyprogesterone acetate injection is given every three months for the prevention of pregnancy.

Medroxyprogesterone acetate has a boxed warning for its risk of causing low bone mineral density.

Classic enzyme inducers can cause lower concentrations of medroxyprogesterone which can potentially lead to contraceptive failure.

Examples of enzyme inducers that can lower concentrations of medroxyprogesterone include carbamazepine, phenytoin, rifampin, and some agents used in the management of HIV.

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Budesonide Formoterol Pharmacology

Budesonide and Formoterol Pharmacology

Budesonide/formoterol inhalation is sold under the brand name Symbicort.

Budesonide/formoterol is a combination agent that is used in the management of COPD and asthma.

Budesonide/formoterol is a combination of an inhaled corticosteroid and long-acting beta-agonist.

GINA guidelines now allow for the use of budesonide/formoterol in the management of acute asthma exacerbation.

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