Ethinyl Estradiol

On this episode, I cover ethinyl estradiol pharmacology. This is a common component of oral contraceptives. You have to check out this free resource (with free account) from Pyrls.com/rlp which lists all the different combinations and brand names. All it takes is to simply sign up for a free account here.

Ethinyl estradiol dosing can vary. Breakthrough bleeding is a major reason why a patient might prefer a higher dose.

Blood clot risk is a real problem with ethinyl estradiol. There are numerous situations where we should avoid ethinyl estradiol and I cover them in this episode.

Be careful with enzyme inducers like carbamazepine, rifampin, etc. as they can reduce the concentrations of oral contraceptives

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Olmesartan Pharmacology

On this episode, I discuss olmesartan (Benicar) pharmacology, adverse effects, drug interactions, and pharmacokinetics.

Olmesartan can cause a unique GI adverse effect called enteropathy. I discuss this on this podcast episode.

Important monitoring parameters for olmesartan include potassium, renal function, and blood pressure.

Olmesartan has a longer half-life than losartan. I discuss how this might be advantageous in clinical practice.

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Desvenlafaxine Pharmacology

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

Desvenlafaxine is a serotonin and norepinephrine reuptake inhibitor that can be used for depression.

Renal elimination is an important method of deactivation of desvenlafaxine. Dose adjustments may be recommended as renal function drops below 50 mls/min.

Withdrawal syndrome due is a risk with desvenlafaxine as it has a significantly short half-life.

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Pramipexole (Mirapex) Pharmacology

Pramipexole (Mirapex) is a dopamine agonist that can be used in Parkinson’s disease and Restless Legs Syndrome.

Dopamine agonists like pramipexole can worsen psychiatric symptoms in some patients by causing hallucinations, and obsessive/compulsive symptoms.

Nausea, vomiting, hypotension, and fatigue are the most common adverse effects of pramipexole.

Pramipexole is primarily eliminated through the urine. I discuss how this matters clinically in greater detail in this podcast episode.

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Prednisolone Pharmacology

I mentioned prednisolone to prednisone conversion in this podcast. Please go check out Pyrls.com for a free steroid conversion downloadable PDF with a free account!

On this episode, I discuss prednisolone (Orapred, Pediapred) pharmacology, adverse effects, practice pearls, and drug interactions.

Prednisolone is a systemic corticosteroid that can cause insomnia, elevations in blood sugars, and numerous effects if used long-term.

CYP3A4 is an important enzyme in the breakdown of prednisolone. Inhibitors or inducers may raise or lower drug levels respectively.

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Bisoprolol (Zebeta) Pharmacology

On this episode, I discuss bisoprolol (Zebeta) pharmacology, adverse effects, drug interactions, and other important clinical pearls.

Bisoprolol is a beta-1 selective antagonist that can be used for atrial fibrillation, angina, and other cardiovascular indications.

It is important to remember that bisoprolol and other beta-blockers are not considered first-line agents for hypertension alone.

Beta-receptor selectivity does start to disappear with bisoprolol as you get to higher dosages. I discuss this further in the podcast.

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Lansoprazole Pharmacology

Lansoprazole is a proton pump inhibitor that can be commonly used for GERD, PUD, and GI prophylaxis.

Lansoprazole can inhibit CYP2C19 which can cause concentrations of drugs like escitalopram and citalopram to rise.

Hypomagnesemia, low B12, osteoporosis, and an increase in C. Diff risk are potential complications with longer-term PPI use.

PPIs like lansoprazole are best given 30-60 minutes before meals. This is something that patients often forget.

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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Ropinirole Pharmacology

Ropinirole (Requip) is a dopamine agonist that can be used in Parkinson’s disease and Restless Legs Syndrome.

Dopamine agonists like ropinirole can worsen psychiatric symptoms in some patients by causing hallucinations, and obsessive/compulsive symptoms.

Nausea, vomiting, hypotension, and fatigue are the most common adverse effects of ropinirole.

Ropinirole has drug interactions with antipsychotics and CYP1A2 inhibitors. I discuss these in greater detail in this podcast episode.

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Inhaled Budesonide Pharmacology

On this episode of the podcast, I cover budesonide (Pulmicort) pharmacology. Our sponsor (Pyrls.com/rlp) for this episode is providing a FREE PDF of their inhaled corticosteroid categorizations chart (i.e. low/medium/high dose ICS) when you sign up for a free account!

The onset of action of inhaled budesonide is several hours up to a few days. Patient education is critical to ensure that patients stick with its use.

Budesonide does have a nebulized formulation that is often used in pediatrics and geriatrics.

There aren’t a ton of critical drug interactions, but you should think about medications that inhibit CYP3A4 and may have additive immunosuppressive effects.

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Epoetin Pharmacology

Epoetin alfa (Epogen, Procrit) is an erythropoiesis-stimulating agent that can be used for various types of anemia.

ESA’s like epoetin carry a boxed warning as they increase the risk of cardiovascular events like MI, stroke, and blood clots.

Assessing iron stores is critical when epoetin is used to ensure that a non-response is not due to deficiency.

I discuss dosing adjustments of epoetin in the podcast. One must be careful about raising hemoglobin too quickly.

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