Category: Cardiovascular Medications

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Colestipol Pharmacology

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Colestipol is a bile acid sequestrant that can be used in the management of hyperlipidemia.

By binding bile acid in the gut, colestipol can lower LDL that is bound to bile acid by eliminating it through the feces.

Numerous drug interactions existed as colestipol can bind many drugs. This is a downside to its use and why it isn’t a preferred hyperlipidemia agent.

In patients with elevated triglycerides, colestipol should be avoided.

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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Metolazone Pharmacology

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Metolazone (Zaroxolyn) is a thiazide-like diuretic. It promotes the loss of water and sodium through the kidney.

The most common indication I see metolazone used for is for additional fluid loss in heart failure.

Potassium must be monitored as it can cause significant hypokalemia which is exacerbated when metolazone is used in combination with loop diuretics.

Hyperuricemia is a potential adverse effect with metolazone; this is critical to monitor for in patients at risk for gout attacks.

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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Metoprolol Pharmacology

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Metoprolol is a beta-blocker commonly used in the management of hypertension, heart failure, and atrial fibrillation.

There is an extended release dosage form and immediate release dosage form with metoprolol. The advantage of the extended release product is that it doesn’t require as frequent dosing.

Metoprolol is selective for beta-1 receptors. It is less likely to interact with asthma medications.

CYP2D6 plays an important role in breaking down metoprolol. Alterations in this enzyme’s activity can alter concentrations of the drug.

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

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Cilostazol Pharmacology

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Cilostazol has antiplatelet and vasodilatory effects. Because of this, it can manage symptoms of intermittent claudication.

GI upset, headache, and edema are common adverse effects associated with the use of cilostazol.

Cilostazol is recommended to be given on an empty stomach.

In patients with heart failure, cilostazol use is contraindicated.

CYP3A4 interactions are prevalent with cilostazol. Inhibitors of CYP3A4 can increase the concentrations of cilostazol.

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

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Prasugrel Pharmacology

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Prasugrel is a P2Y12 inhibitor that is used in the setting of ACS.

Be aware of patients who may be taking over the counter medications that can increase their bleed risk while taking prasugrel.

Prasugrel is on the Beers list and in general, should be avoided in most situations for patients who are 75 years of age or older.

Morphine has the potential to impact antiplatelet agents like prasugrel and make them less effective. Be sure this is clinically considered prior to using morphine with prasugrel.

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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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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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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Ezetimibe Pharmacology

Ezetimibe Pharmacology

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On this episode, I discuss ezetimibe pharmacology. Ezetimibe works by inhibiting Niemann-Pick C1-Like1 (NPC1L1) transporter. This transporter aids in cholesterol absorption so by blocking it, we can reduce cholesterol levels (and LDL) in the bloodstream.

Ezetimibe is usually very well tolerated. Diarrhea, myopathy, and elevations in LFT’s are adverse effects that have been reported but do not occur at high rates.

Ezetimibe is dosed at 10 mg once daily. This is a nice advantage because this is a starting dose and the usual treatment dose.

With the most recent cholesterol guideline updates, I do expect ezetimibe to be utilized a little more than it used to be. They place more emphasis on a target LDL and getting patients to goal.

Statins are going to be used first line for cholesterol and ezetimibe will be an add on therapy to consider. They don’t, unfortunately, lower cholesterol as much as high-intensity statins do.

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