Author: Eric Christianson

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Diazepam Pharmacology

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Diazepam has numerous dosage forms. There are rectal, injectable, and oral formulations of the drug that are commonly used in clinical practice.

Diazepam has 2 major metabolic pathways. It is broken down primarily by CYP3A4 and CYP2C19, leaving open the potential for numerous drug interactions. I discuss this further in the podcast.

Diazepam is on the Beers list because it has a tendency to accumulate in the geriatric patient population and cause adverse effects like sedation, confusion, and falls.

Respiratory depression, coma, and death are significantly more likely in overdose situations where opioids are used in combination with benzodiazepines like diazepam.

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

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Dicyclomine Pharmacology

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Dicyclomine is an anticholinergic agent that is used to help manage GI pain associated with IBS.

Dicyclomine has a very short half-life which means that it can be dosed multiple times per day.

Be careful with patients who have predominant constipation with their IBS as dicyclomine can exacerbate this.

Bentyl is the brand name of dicyclomine. This drug blocks the action of acetylcholine.

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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Oral Semaglutide Pharmacology

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On this episode, I discuss the pharmacology of oral semaglutide. It is a GLP-1 agonist that is the first one in the class to have an oral formulation.

There is a recommended dose titration with oral semaglutide that can take a month or two to get therapeutic doses. I disucss this further in this episode.

The most common adverse effect of oral semaglutide is nausea.

Oral semaglutide is dosed once daily which is nice to try to maximize patient adherence.

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

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Probenecid Pharmacology

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Patients with G6PD deficiency who are taking probenecid are at increased risk for hemolytic anemia.

In a patient taking probenecid, they need to have adequate kidney function for the drug to work.

GI upset is likely the most common adverse effect of probenecid. It can be given with food.

Probenecid can raise the concentrations of many common antibiotics like penicillins and cephalosporins.

Remember that there are many medications that can oppose the beneficial effects of probenecid. Thiazides, niacin, and some immunosuppressants can raise uric acid.

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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Nicotine Patch Pharmacology

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Nicotine replacement therapy is an important tool in helping our patients quit smoking. There are lots of clinical pearls involving the pharmacology of nicotine patches and I explore them in this episode.

Nicotine patches differ from the gum and other acute relief forms in that they are intended to provide a consistent level of nicotine in the body.

The initial dosing of nicotine patches is dependent upon the number of cigarettes smoked by the patient. I discuss it further in the podcast.

When applying nicotine patches, it is important to remember to utilize a clean, non-hairy area to ensure the patch adheres to the skin appropriately.

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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Doxepin Pharmacology

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Doxepin is under the class of tricyclic antidepressants. It can inhibit the reuptake of serotonin and norepinephrine.

In addition to the serotonin and norepinephrine reuptake inhibition mechanism, doxepin also has antihistamine type effects.

Because of the anticholinergic activity of doxepin, it is recommended to avoid this medication in the elderly, particularly at high doses.

Be aware that anticholinergics like doxepin can reduce the benefit of dementia medications.

CYP2D6 is an important enzyme in the metabolism of doxepin and drugs like bupropion that inhibit CYP2D6 can increase the concentrations of doxepin.

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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Atomoxetine Pharmacology

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Atomoxetine is a norepinephrine reuptake inhibitor that can be used in the management of ADHD.

Atomoxetine is a non-controlled substance option for patients seeking this alternative to traditional stimulants.

CYP2D6 is an important enzyme in the breakdown of atomoxetine.

CYP2D6 inhibition or poor metabolizers via CYP2D6 can lead to higher concentrations of atomoxetine and put our patients at greater risk for adverse effects.

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

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Fluoxetine Pharmacology

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Fluoxetine is an SSRI used in the management of depression, anxiety, OCD, PTSD, and other psychiatric conditions.

Fluoxetine has a very long half-life which can impact clinical management. I discuss how this matters in this podcast episode.

Fluoxetine inhibits CYP2D6 which can alter the concentrations of many drugs.

Prodrugs like codeine and tamoxifen can have their effects reduced because of fluoxetine. I explain this further in the episode.

By inhibiting CYP2D6 concentrations of many drugs can be raised by the use of fluoxetine.

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