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Codeine Pharmacology

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On this episode, I discuss codeine pharmacology and practical clinical practice pearls.

Codeine is metabolized by CYP2D6 to the active metabolite morphine. I discuss how this can be affected by genetics as well as other medications.

Constipation is a problem with codeine and all opioids in general. Education and making a plan with patients to combat this side effect is important.

Codeine is less potent than other opioids such as fentanyl, hydromorphone, and hydrocodone.

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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Dexmedetomidine Pharmacology

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Dexmedetomidine is a selective alpha-2-adrenergic agonist with sedative characteristics.

Dexmedetomidine is commonly used in ICU and procedural sedation, as well as postoperative pain.

A few of the more serious adverse effects of dexmedetomidine to keep an eye on including bradyarrhythmias/bradycardia and hypotension.

Dexmedetomidine undergoes hepatic metabolism, meaning a dose reduction may be required in patients with impaired hepatic function.

Major drug interactions to monitoring for with dexmedetomidine include co-administration with anesthetics, sedatives, hypnotics, and opioids, as it may lead to an enhancement of effects.

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.

It is also important to note that dexmedetomidine may produce withdrawal symptoms if used for longer than 24 hours.

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

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Calcitonin Pharmacology

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On this episode, I discuss the pharmacology of calcitonin.

Calcitonin has an indication for osteoporosis as well as hypercalcemia.

When considering drug interactions with calcitonin, recall that it can lower calcium levels which could have a cumulative effect when combined with loop diuretics.

Calcitonin nasal spray should be stored upright and primed prior to use.

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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Rivastigmine Pharmacology

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Rivastigmine is an acetylcholinesterase inhibitor used in the management of certain dementias. I discuss rivastigmine pharmacology on this episode.

Weight loss is a potential adverse effect of rivastigmine. It is important to monitor weights.

Anticholinergic medications such as diphenhydramine can blunt the effects of rivastigmine.

Rarely, acetylcholinesterase inhibitors like rivastigmine can cause bradycardia.

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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Caffeine Pharmacology

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Caffeine is a commonly used supplement and is found in many food and beverages. I discuss caffeine pharmacology, adverse effects, and drug interactions.

Caffeine can inhibit CYP1A2 and also be affected by CYP1A2 inhibitors. I discuss some examples in the podcast.

It is critical to inquire about caffeine intake when patients are reporting insomnia.

Caffeine has been associated with increases in pulse and blood pressure. Be sure to ask about caffeine intake when assessing these vital signs.

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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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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Ibandronate Pharmacology

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Ibandronate is a bisphosphonate that can be used in the management of osteoporosis.

Bisphosphonates like ibandronate require a full glass of water for oral administration.

Patients should remain upright for at least 30-60 minutes following taking ibandronate to help reduce the risk of esophagitis.

Osteonecrosis has rarely been associated with bisphosphonates like ibandronate – I’ve discussed a couple of risk factors that may place a patient at higher risk.

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.

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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Fluticasone, Umeclidinium, and Vilanterol Pharmacology

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Fluticasone, Umeclidinium, and Vilanterol is a combination medication used in the setting of COPD. I discuss the pharmacology of this agent further in this episode.

Fluticasone is the inhaled corticosteroid portion of the drug while umeclidinium is a LAMA and vilanterol is a LABA medication.

Drug interactions aren’t incredibly common or strongly clinically significant, but I discuss some of them with Trelegy Ellipta.

Having a once-daily dose can be advantageous to help improve patient adherence. Fluticasone, umeclidinium, and vilanterol comes as a once-daily combination.

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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Hyoscyamine Pharmacology

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Hyoscyamine is an anticholinergic medication that is primarily used for GI problems like spasms and pain associated with IBS.

Because of the highly anticholinergic nature of hyoscyamine, it can cause dry eyes, dry mouth, urinary retention, and constipation.

Be aware of the risk for the prescribing cascade with hyoscyamine. Saliva substitutes for dry mouth, artificial tears for dry eyes, etc.

Sedation is a concern with hyoscyamine and this can be exacerbated by drugs like benzodiazepines, opioids, and older antihistamines.

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!