On this episode, I discuss duloxetine pharmacology, adverse effects, and common drug interactions. Duloxetine is an SNRI that is used for depression, anxiety, and various pain syndromes like neuropathy and fibromyalgia. Duloxetine can inhibit CYP2D6 which can lead to higher concentrations of clozapine and propranolol and lower activity of tamoxifen. CYP1A2 inhibitors like ciprofloxacin can raise concentrations of duloxetine leading to an increased potential for adverse effects.
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11:33On this episode, I discuss atenolol pharmacology, adverse effects, pharmacokinetics, and drug interactions. Atenolol is primarily cleared by the kidney which should tell you that we need to pay attention to dose adjustments as renal function declines. Atenolol is a beta-1 selective agent that is NOT a preferred beta-blocker in HFrEF. Pulse and blood pressure monitoring is essential with any beta-blocker like atenolol.
13:49On this episode, I discuss hydromorphone pharmacology, adverse effect, and drug interactions. I discuss the pharmacokinetics of hydromorphone and also discuss the relative potency compared to other opioids. Hydromorphone drug interactions are mostly additive effects. Drugs that cause sedation or constipation can have additive effects on hydromorphone. Be extremely careful with hydromorphone dosage forms. There are numerous different concentrations and strengths. I discuss this in this episode.
15:59On this episode, I discuss duloxetine pharmacology, adverse effects, and common drug interactions. Duloxetine is an SNRI that is used for depression, anxiety, and various pain syndromes like neuropathy and fibromyalgia. Duloxetine can inhibit CYP2D6 which can lead to higher concentrations of clozapine and propranolol and lower activity of tamoxifen. CYP1A2 inhibitors like ciprofloxacin can raise concentrations of duloxetine leading to an increased potential for adverse effects.
13:58Lasmiditan (Reyvow) is an agent that is utilized for acute migraine treatment. It works slightly differently than triptans which I discuss on this episode. Lasmiditan is a relatively new agent and cost will often limit its use at this time. Rosuvastatin and sulfasalazine are two common medications that may have concentrations increase when lasmiditan is used. I discuss this in detail on this episode. Lasmiditan is an oral tablet that is only recommended to give once per day which differs from commonly used triptans where the dose can be repeated.
14:28On this episode, I discuss sumatriptan pharmacology, adverse effects, drug interactions and more. Dosage forms can provide different methods of drug delivery and I talk about many different sumatriptan dosage forms in this episode. Cardiovascular risks need to be assessed when using a drug like sumatriptan. I discuss this in greater detail in the podcast. Sumatriptan has serotonergic activity and we need to assess the risk of serotonin syndrome in our patients.
13:05On this episode of the Real Life Pharmacology Podcast, I discuss bumetanide pharmacology, adverse effects, and drug interactions. Bumetanide is a loop diuretic and it is critical to monitor renal function and electrolytes with this medication. Ototoxicity is a rare adverse effect that is dose-dependent and can be worsened by aminoglycosides. It is critical to look for drugs that can worsen edema when using bumetanide to ensure that we avoid the prescribing cascade.
13:01On this episode, I discuss oxycodone pharmacology, adverse effect, pharmacokinetics, and drug interactions. Oxycodone is broken down by CYP3A4 and CYP2D6. I discuss this further on the podcast and how interactions may alter concentrations. When a patient stops taking oxycodone after being on it for some time, you must recognize common symptoms of withdrawal. Oxycodone comes as in an extended-release and immediate-release oral formulation.
14:49On this episode of the Real Life Pharmacology podcast, I explore doxycycline pharmacology, adverse effects, and drug interactions. Doxycycline can be bound by numerous minerals like calcium, magnesium, and iron. Coadministration can lead to reduced concentrations. Sun sensitivity is a really important adverse effect that can be caused by doxycycline. Be sure to educate your patients. Doxycycline can be used as an alternative to beta-lactams and macrolides in the management of community-acquired pneumonia.
13:13On this episode, I discuss tolterodine pharmacology, adverse effects, and drug interactions. Tolterodine (Detrol) is an anticholinergic medication used to manage the symptoms of overactive bladder. Tolterodine's anticholinergic activity can lead to a significant number of adverse effects like dry mouth, dry eyes, constipation, and urinary retention. Elderly patients may be at greater risk for anticholinergic adverse effects from tolterodine compared to younger patients. Tolterodine can have additive effects from other anticholinergics like diphenhydramine or TCAs which enhance its potential for side effects.
12:18On this episode, I discuss clarithromycin pharmacology, adverse effects, and drug interactions. Clarithromycin is a macrolide antibiotic that can be used for many similar indications as azithromycin. Clarithromycin has numerous drug interactions as it can inhibit CYP3A4. This limits its use in practice. Clarithromycin can be used in the treatment of H. pylori in combination with other antibiotics and a PPI.