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Omeprazole Pharmacology

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Omeprazole is a proton pump inhibitor that can be commonly used for GERD, PUD, and GI prophylaxis.

Omeprazole can inhibit CYP2C19 which can cause concentrations of drugs like escitalopram and citalopram to rise.

Hypomagnesemia, low B12, osteoporosis, and an increase in C. Diff risk are potential complications with longer term PPI use.

PPI’s like omeprazole are best given 30-60 minutes before meals. This is something that patients often forget.

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

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Conjugated Estrogens Pharmacology

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Conjugated estrogens (Premarin) are most often used in the management of menopausal symptoms.

Estrogen therapy can increase the risk for breast cancer and the risk should be assessed before beginning therapy.

Blood clots are a potential consequence from the use of Premarin. Premarin can oppose the benefit of anticoagulation.

Conjugated estrogens are broken down by CYP3A4. Inhibitors may increase concentrations while inducers may reduce concentrations.

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

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Paroxetine Pharmacology

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Paroxetine (Paxil) is an SSRI that can be used in the management of depression. I discuss more on paroxetine pharmacology in this episode.

Because paroxetine has some modest anticholinergic effects, it does show up on the Beers list as a potentially inappropriate medication.

By inhibiting CYP2D6, paroxetine can have numerous drug interactions. Drugs like atomoxetine, aripiprazole, and metoclopramide can all have their concentrations increased.

Tamoxifen is activated by CYP2D6 and paroxetine can ultimately reduce the effectiveness of the medication.

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

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Citalopram Pharmacology

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Citalopram is an SSRI used in the management of depression, anxiety, OCD, and PTSD.

How do you manage the risk of citalopram causing QTc prolongation? I discuss it further in the podcast.

Omeprazole can inhibit CYP2C19 which affects the metabolism of citalopram. I discuss the clinical impacts of this interaction in the podcast.

Geriatric dosing with citalopram is recommended to be lower than traditional adult dosing. I discuss this further in the podcast.

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

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

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Calcium Acetate Pharmacology

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Calcium Acetate (PhosLo) is used in the management of hyperphosphatemia associated with CKD.

Important monitoring parameters for calcium acetate include phosphorus, calcium, PTH, and renal function.

There are numerous binding interactions with calcium acetate. It can reduce concentrations of some HIV drugs, antibiotics, and thyroid supplements. I discuss more examples in the podcast.

Thiazide diuretic in combination with calcium acetate may increase the risk for hypercalcemia.

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

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Nortriptyline Pharmacology

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Nortriptyline is a TCA that can be used for depression and various pain syndromes. I discuss other less common diagnoses in this podcast episode as well.

There are a lot of drug interactions with nortriptyline. It is metabolized by CYP2D6, can have additive anticholinergic effects and has been associated with QTc prolongation.

Nortriptyline is very anticholinergic and can blunt the effects of dementia medications.

Dry mouth, dry eyes, sedation, urinary retention, and constipation are a few of the more common adverse effects of nortriptyline.

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

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Diltiazem Pharmacology

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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.

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

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Zolpidem Pharmacology

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

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Metronidazole Pharmacology

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Metronidazole (Flagyl) is an antibiotic that is used for various infections.

Metronidazole can certainly cause GI upset like most antibiotics, but uniquely may also cause a metallic taste.

Metronidazole is also rarely associated with CNS changes and can induce the potential for peripheral neuropathy.

Patients should avoid alcohol with the use of metronidazole and this is on account for the possibility of a disulfiram reaction. I discuss some of the symptoms of this reaction in the podcast.

Metronidazole can substantially raise the concentrations of warfarin. INR monitor and a reduction in dose of warfarin may be necessary.

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

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Mirabegron Pharmacology

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Mirabegron is a beta-3 agonist that can help relax bladder smooth muscle and manage symptoms of overactive bladder.

Mirabegron inhibits CYP2D6 which can negatively impact the effectiveness of tamoxifen. I discuss this in greater detail in the podcast.

Tramadol and codeine effectiveness can be impacted by mirabegron. Be aware of this when using this medication.

By inhibiting CYP2D6, mirabegron can increase the concentrations of many psychotropic medications such as fluoxetine, aripiprazole, clozapine, and paroxetine. I discuss this further in this episode of the podcast.

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