Verapamil Pharmacology Podcast

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

There are numerous drug interactions to be aware of with verapamil as it inhibits the enzyme CYP3A4.

Verapamil is a calcium channel blocker (non-dihydropyridine) that blocks calcium channels in the heart and vessels.

In addition to hypotension and bradycardia, verapamil can cause constipation which may be more prominent in our geriatric patients.

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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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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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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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Fluticasone Nasal Pharmacology

Fluticasone (Flonase) is a nasal corticosteroid that is used in the management of allergic rhinitis.

A primary adverse effect that I have seen in practice with fluticasone is the risk for nose bleeds.

Flonase can have some interactions via CYP3A4. Inhibitors of CYP3A4 like clarithromycin can increase concentrations.

While the risk for systemic exposure is low with nasal fluticasone, long-term, high dose, and frequent use should be monitored appropriately.

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Sucralfate Pharmacology

On this episode, I discuss (Carafate) sucralfate pharmacology, adverse effect, kinetics, and drug interactions.

Sucralfate is notorious for drug binding interactions and can reduce the concentrations of many drugs which I cover in the podcast.

Four times daily dosing is a big downside to sucralfate and why it isn’t used terribly often for GI issues like esophagitis.

The suspension formulation of sucralfate does contain some sugar so be aware of this in our diabetes patients.

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Atenolol Pharmacology

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

Atenolol is primarily cleared by the kidney which should tell you that we need to pay attention to dose adjustments as renal function declines.

Atenolol is a beta-1 selective agent that is NOT a preferred beta-blocker in HFrEF.

Pulse and blood pressure monitoring is essential with any beta-blocker like atenolol.

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Hydromorphone Pharmacology

On this episode, I discuss hydromorphone pharmacology, adverse effect, and drug interactions.

I discuss the pharmacokinetics of hydromorphone and also discuss the relative potency compared to other opioids.

Hydromorphone drug interactions are mostly additive effects. Drugs that cause sedation or constipation can have additive effects on hydromorphone.

Be extremely careful with hydromorphone dosage forms. There are numerous different concentrations and strengths. I discuss this in this episode.

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