Author: Eric Christianson

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Budesonide Formoterol Pharmacology

Budesonide and Formoterol Pharmacology

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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.

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

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Benztropine Pharmacology

Benztropine Pharmacology

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Benztropine is a highly anticholinergic medication that is primarily used for movement disorders.

Antipsychotics can cause extrapyramidal adverse effects that can help be managed with benztropine.

Because benztropine is highly anticholinergic, it can cause dry eyes, dry mouth, urinary retention, constipation and contribute to falls and confusion, particularly in our elderly population.

While benztropine is classified as an anti-Parkinson’s agent, it is rarely used for that indication as it has a high incidence of anticholinergic adverse effects (particularly at the doses that are required for benefit).

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

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Budesonide Pharmacology (Oral and Rectal Formulations)

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Budesonide is a corticosteroid that can be given orally or rectally for management of Crohn’s disease or ulcerative colitis.

Because budesonide has a high first pass metabolism, the relative impact of systemic effects may be less than other steroids like prednisone.

Remember that CYP3A4 inhibitors can increase the concentrations of budesonide. I discuss this further on the podcast.

Different dosage forms of budesonide (oral versus rectal) can be used for different reasons. The site of the inflammation in Ulcerative colitis can determine which dosage form is most appropriate.

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

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Cimetidine Pharmacology

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Cimetidine blocks histamine 2 receptors which can suppress acid production and reduce symptoms of heartburn.

One of the major downsides to cimetidine is that it has a ton of drug interactions. I discuss many of the common ones in this episode.

Cimetidine is one of a few drugs that has the potential to cause gynecomastia. I discuss the mechanism of this adverse effect in this episode.

Phenytoin concentrations can rise due to the use of cimetidine. I discuss this in the drug interactions section of this episode.

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

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Clopidogrel Pharmacology

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Clopidogrel is an antiplatelet agent that is often used in combination with aspirin to help reduce the risk of an MI.

The risk of bleed is a high priority with the use of clopidogrel. Patients must be monitored for signs and symptoms of bleeding and bruising.

Clopidogrel is a prodrug that is converted to its active metabolite by CYP2C19.

Fluconazole can inhibit CYP2C19 which may reduce the effectiveness of clopidogrel.

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

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Sulfasalazine Pharmacology

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Sulfasalazine is a medication that can be used for diseases like rheumatoid arthritis, Crohn’s disease, and Ulcerative Colitis.

Because sulfasalazine can cause GI upset, this is a major reason why we try to break up the dose and give it multiple (at least two) times per day.

LFT and CBC monitoring are recommended with sulfasalazine due to its low potential to cause liver dysfunction, aplastic anemia, and agranulocytosis.

Sulfasalazine can impair folic acid absorption and lead to potential deficiency. A patient deficient in folic acid is at higher risk for developing anemia.

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

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Cholestyramine Pharmacology

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On this episode, I discuss the pharmacology of cholestyramine.

Cholestyramine was originally developed as an agent to manage cholesterol, but has fallen out of favor for some of the more effective agents like statins.

Cholestyramine is notorious for binding drug interactions. It can reduce concentrations of drugs like amiodarone, digoxin, oral contraceptives, immunosuppressive and many more!

In patients with chronic diarrhea, cholestyramine is occasionally used off label to help manage symptoms because it tends to have constipating 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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Rifampin Pharmacology

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Rifampin is classified as an antibiotic and an antituberculosis agent. It primarily works by inhibiting bacterial RNA polymerase.

While not extremely common, rifampin is well known to cause hepatic dysfunction.

You should remind patients who are taking rifampin that it can alter the color of tears, sweat, saliva and urine. It can change these fluids to a reddish/brown color.

Rifampin is very well known for causing drug interactions. It is an enzyme inducer that can reduce the concentrations of numerous medications such as warfarin, apixaban, cyclosporin, levothyroxine, and oral contraceptives to name a few.

Rifampin can be used to help prevent meningococcal infection. Learn more on rifampin by listening to this podcast!

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

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Heparin Pharmacology

Heparin Pharmacology

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Heparin is an interesting drug with a lot of unique clinical quirks. This drug ultimately inhibits the formation of fibrin. Fibrin is an essential component of a blood clot.

Because heparin has blood thinning effects, it is critical to assess a patient’s bleed risk. Look out for other agents that may increase the risk of bleeding. Examples include; NSAIDs, antiplatelet agents, and other anticoagulants.

One classic test question about heparin that often comes up is the reversal agent. Protamine can be used to help reverse the effects of heparin.

Heparin-induced thrombocytopenia is a critical adverse effect to understand. I discuss both subtypes on the podcast and let you know what to look out for.

Rarer side effects of heparin include hyperkalemia and osteoporosis (only with long term use).

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

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Montelukast Pharmacology

Montelukast Pharmacology

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On this episode, I discuss montelukast pharmacology

Montelukast is a leukotriene receptor antagonist. Leukotrienes play an important role in causing inflammation and smooth muscle contraction in asthma and allergic rhinitis.

Because montelukast blocks the effects of leukotrienes, it can be advantageous to use this medication for allergies and asthma.

It is important to remind patients that montelukast is NOT a substitute for an acute relief medication like albuterol in the management of asthma symptoms.

Montelukast has been reported to cause mood and behavioral changes and it is important to monitor our patients for these rare concerns.

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