Category: Neurology and Musculoskeletal Medications

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Valproate Pharmacology

Valproate Pharmacology

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Valproate (valproic acid, Depakote) has numerous uses which includes migraines, seizures, and bipolar disorder.

In a patient who is taking valproate, it is important to monitor for signs and symptoms of confusion as this drug can cause elevated ammonia levels.

When switching between dosage forms of valproate, you must recognize that the bioavailability is not the same between each different dosage form. This could lead to toxicity or treatment failure.

Valproic acid has a boxed warning for hepatotoxicity and liver function needs to be monitored.

Valproic acid can increase lamotrigine levels which ultimately could lead to an increased risk of lamotrigine induced SJS.

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Donepezil Pharmacology

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On this episode I discuss the pharmacology of donepezil.

Donepezil is an acetylcholinesterase inhibitor. In dementia, that is a deficiency in acetylcholine and donepezil helps preserve this neurotransmitter.

Donepezil can cause weight loss, GI upset, and diarrhea. This is an important monitoring parameter in our dementia patients.

There is the possibility for donepezil to cause bradycardia and insomnia. Keep an eye out for these adverse effects as they can and do happen in real practice.

Anticholinergics are notorious for blunting the effects of donepezil. We must look out for drug interactions from older anticholinergics like diphenhydramine, amitriptyline, and hydroxyzine.

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

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Memantine Pharmacology

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Memantine is classified as an NMDA receptor antagonist. Memantine pharmacology is complex as is the pharmacology of any medication working in the brain. This drug can help reduce the activity of glutamate, an excitatory neurotransmitter which can play a role in Alzheimer’s dementia.

Memantine has an extended release dosage form that is dosed once per day compared to twice per day for the immediate release. However, the cost of the extended release is much more expensive, so it is recommended to begin with the immediate release.

Memantine is cleared by the kidney. In patients with reduced kidney function, you must review to assess if the memantine dose needs to be adjusted.

When using memantine or other dementia medications, be sure to look out for medications that can cause dementia type symptoms. CNS depressants like benzodiazepines, sleep medicines, and anticholinergics are all examples of meds that could exacerbate dementia.

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

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Methotrexate Pharmacology

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On this episode of the Real Life Pharmacology Podcast, I cover the pharmacology of methotrexate.

Methotrexate has a few different indications. It can be used for treatment of cancer. These doses are typically going to be much higher than standard low doses for other conditions.

Lower dose methotrexate is often used for autoimmune type conditions like rheumatoid arthritis and psoriasis.

Folic acid should be supplemented with use of methotrexate to help reduce the risk of adverse effects.

Liver toxicity and immune system suppression are two important factors to monitor in a patient taking chronic methotrexate.

I also talk about important cumulative drug interactions with methotrexate such as immunosuppressives and other agents that may impact liver function.

Be sure to listen to the end as I talk about the potential impact of methotrexate on some vaccines!

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

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Cyclobenzaprine Pharmacology

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On this episode, I discuss cyclobenzaprine pharmacology. Cyclobenzaprine is an older skeletal muscle relaxant.

Cyclobenzaprine can have a significant number of anticholinergic side effects.

The anticholinergic side effects of cyclobenzaprine can include sedation, dry eyes, dry mouth, urinary retention, and confusion.

Cyclobenzaprine is not well tolerated in the elderly and cause more problems in that patient population.

Cyclobenzaprine has a similar structure to the Tricyclic antidepressants.

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

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Fentanyl Pharmacology

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On this episode, I discuss fentanyl pharmacology.

I address important considerations that you must remember with fentanyl patches.

Those considerations include how pharmacokinetics can impact our patients.

I also break down common side effects of opioids as well as potential common drug interactions.

Drug diversion and illicit use is an important consideration when using fentanyl.  I also touch on this topic.

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Allopurinol Pharmacology

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I break down the mechanism of action, side effects, and important drug interactions you need to know. I give you a sense of what things you might actually encounter in practice when working with patients who take allopurinol.

Allopurinol is a top 200 drug. Remember to subscribe to the website reallifepharmacology.com for the Free 31 page PDF where I give you three highly testable pearls on the top 200 drugs.

In addition to the 31 page PDF for subscribing, you will get a free 100 question pharmacology test designed for healthcare professionals.

I hope you enjoy this episode the pharmacology of allopurinol!