Thiamine (Vitamin B1) Pharmacology Podcast

In this podcast episode, I discuss thiamine pharmacology and its important role in energy production.

In patients with alcohol use disorder, thiamine deficiency can be somewhat common.

Wernicke’s encephalopathy can result from thiamine deficiency in patients with alcohol use disorder.

Common symptoms from Wernicke’s encephalopathy can include confusion, lethargy, and other central nervous system issues. Thiamine replacement can help treat this issue.

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Dutasteride (Avodart) Pharmacology Podcast

Dutasteride (Avodart) is a 5-alpha-reductase inhibitor. I discuss the pharmacology, adverse effects, and drug interactions on this podcast.

Dutasteride reduces the size of the prostate over time. It takes a significant amount of time to provide symptom relief (usually at least 3-6 months).

Dutasteride is broken down by CYP3A4 to a minor extent which means that strong CYP3A4 inhibitors may increase drug concentrations.

When using dutasteride for BPH, remember to review the medication list for drugs that can cause urinary retention such as anticholintiercs and alpha-agonists.

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Prazosin (Minipress) Pharmacology Podcast

On this episode, I discuss prazosin pharmacology, adverse effects, drug interactions and much more.

Prazosin is an alpha-blocker but lacks selectivity. A reduction in blood pressure is expected, but it is notorious for causing orthostatic hypotension.

Prazosin may be used off-label for nightmares, when this is the case, you will likely only see this drug dosed at bedtime.

Alpha agonist medications (such as pseudoephedrine and ADHD stimulants) may counteract the effects of prazosin.

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Tirzepatide (Mounjaro) Pharmacology Podcast

On this episode I discuss the pharmacology of tirzepatide. I’m appreciative of Derek Borkowski who operates Pyrls for providing a free PDF of the 2023 ADA Diabetes Guidelines when you subscribe for an account at Pyrls.com/rlp – Tirzepatide makes its first appearance in the diabetes guidelines for its ability to promote weight loss.

Tirzepatide is a combination GIP and GLP-1 agonist that is currently indicated for diabetes with reductions of A1C in the range of about 2 points.

Much like GLP-1 agonists, tirzepatide can cause GI upset and other gastrointestinal adverse effects like diarrhea.

Tirzepatide doesn’t have a large number of drug interactions which is nice. Corticosteroids can counteract its blood sugar-lowering effects while sulfonylureas and insulin may significantly increase the risk for hypoglycemia.

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Methimazole Pharmacology Podcast

On this episode of the Real Life Pharmacology podcast, I cover methimazole adverse effects, mechanism of action, drug interactions, and much more!

Methimazole and propylthiouracil are from the same class of medications and are used for hyperthyroidism. I go over some of the differences between these agents in this podcast episode.

Methimazole is dosed once daily but can be split if the patient experiences significant GI adverse effects.

T3 plays an important role in hyperthyroidism. I discuss the physiologic of T3 production and how methimazole creates its effects to lower thyroid hormone levels.

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Semaglutide (subQ) Pharmacology Podcast

On this podcast episode, I discuss the pharmacology, adverse effects, and drug interactions of semaglutide.

Semaglutide has two primary uses: Type 2 diabetes and Weight Management – the dosing varies depending upon the indication.

When using semaglutide, pay attention to GI adverse effects. Nausea, diarrhea, and vomiting are the most common ADRs and are dose-dependent.

Pay attention to corticosteroid bursts. They can cause substantial hyperglycemia and counteract the effects of diabetes medications like semaglutide.

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Minocycline Pharmacology Podcast

Minocycline is a tetracycline antibiotic. I discuss pharmacology, adverse effects, and drug interactions.

Minocycline can cause sun sensitivity. Be sure to educate patients about this risk.

Metal cations like iron, zinc, calcium, and magnesium can bind minocycline and reduce the oral absorption of the medication.

Tooth discoloration is a possible adverse effect if minocycline is given to pediatric patients. I discuss it further in this episode.

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Propylthiouracil Pharmacology Podcast

In this podcast episode, I cover propylthiouracil pharmacology, adverse effect, drug interaction, and much more!

Propylthiouracil carries a boxed warning for hepatotoxicity which is a significant downside compared to the other agent in its class (methimazole).

What about dosing? I discuss why this medication has to be dosed multiple times per day.

Drug interactions aren’t incredibly common with propylthiouracil but it can affect warfarin differently than most drug interactions. I discuss it further in this episode.

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Brexpiprazole (Rexulti) Pharmacology Podcast

Brexpiprazole (Rexulti) is a second generation antipsychotic. I discuss its pharmacology, adverse effects, drug interactions, and more in this podcast episode.

I like to associate brexpiprazole with aripiprazole. They have a lot of overlapping characteristics, particularly in relation to the adverse effect profile.

Brexpiprazole tends to have a low incidence of metabolic adverse effects which makes it a nice selection for patients who have diabetes, hypercholesterolemia, or who are overweight.

CYP3A4 and CYP2D6 are the two primary enzymes that break down brexpiprazole. I discuss the pharmacogenomic considerations associated with this medication.

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Indapamide (Lozol) Pharmacology Podcast

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

I discuss how indapamide differs from other thiazide diuretics. Particularly, I discuss indapamide compared to hydrochlorothiazide.

Frequent urination, hypokalemia, and dehydration are all possible risks with indapamide.

Pay attention to medications that can increase the risk for acute renal failure when added to indapamide. NSAIDs, ACEIs, ARBs, and other diuretics can increase this risk.

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