Navigating QTc Prolongation and Drug Interactions

On this special episode, I provide some real-life examples and layout 5 of my 10 commandments of polypharmacy. Today’s sponsor of the 10 Commandments of Polypharmacy podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. FreedAI is offering a discount exclusive to RLP listeners! Users will get $50 off their first month with Freed! Use the discount code: RLPPOD Here are the first 5 commandments that are addressed in the podcast. 1. Thou shalt not start, ask for, dispense, or administer medication without reviewing a medication list that is accurate, up to date, and complete with over-the-counter medications and supplements 2. Thou shalt consider utilizing non-drug approaches and interventions to solve patient problems before initiating medication 3. Thou shalt assess if a medication is effective before adding a new medication for the same condition 4. Thou shalt consider any new symptom is an adverse effect of another medication until proved otherwise 5. Thou shalt not start a medication without an appropriate indication and assessing appropriate lab work

Today’s sponsor of the Top 10 Anticoagulant Drug Interactions podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. FreedAI is offering a discount exclusive to RLP listeners! Users will get $50 off their first month with Freed! Use the discount code: RLPPOD Apixaban is one of the most commonly used anticoagulants and there are some drug interactions you need to be aware of. Take a listen and find out! Warfarin concentrations can substantially be elevated by drugs that inhibit CYP2C9. I cover a few of them in my top 10 anticoagulant drug interactions.

Today's sponsor of the Top 10 SSRI Drug Interactions podcast is FreedAI. Freed listens, transcribes, and writes medical documentation for you. FreedAI is offering a discount exclusive to RLP listeners! Users will get $50 off their first month with Freed! Use the discount code: RLPPOD In this podcast episode, I discuss how to navigate SSRI drug interactions and identify some of the most common medications that have additive serotonergic activity. SSRIs have antiplatelet activity. I discuss how to navigate using other medications that may increase bleed risk in combination with SSRIs. Paroxetine and fluoxetine inhibit CYP2D6 I discuss how this can affect the benefits of tamoxifen therapy. Fluvoxamine is a nasty medication with regard to the number of and significance of drug interactions. I outline important fluvoxamine interactions in this podcast episode.

On this episode, I discuss travoprost pharmacology, adverse effects, administration, and much more on this podcast episode. Travoprost is used to reduce intraocular pressure in the management of glaucoma. I discuss the mechanism of action and adverse effects. Travoprost is a prostaglandin analog that can help reduce intraocular pressure and reduce the risk of the potential complication of blindness. Growth of eyelashes is a unique adverse effect associated with travoprost.

On this podcast episode, I finish up my breakdown of the Beers Criteria. I cover the use of sliding-scale insulin and sulfonylureas in geriatric patients. Hypoglycemia is a major concern with both of these diabetes management strategies. PPIs show up on the Beers criteria list as they can increase the risk of C. diff, pneumonia, fractures, and GI malignancies. Metoclopramide has dopamine antagonist activity and can increase the risk of EPS and tardive dyskinesia.

In this podcast episode, I break down some of the most common medications that show up on the Beers criteria list. I discuss cardiovascular medications in this podcast episode, including rivaroxaban and warfarin, and why they show up on the Beers list. Alpha-blockers who up on the Beers list as these medications are inappropriate to use for the management of hypertension. The Beers criteria addresses the use of aspirin in primary prevention. I break down what the criteria state and why it should be avoided in general.

On this episode, I discuss the pharmacology surrounding QTc prolongation and drug interactions. I discuss which medications are more likely to cause QTc prolongation and which patient populations we should be more concerned about. Antiarrhythmics are a common class of medication that can exacerbate QTc prolongation when used with other interacting medications. 500 ms is a common value utilized to help identify patients at risk for QTc prolongation and ultimately torsades de pointes.

On this podcast episode, I cover risedronate pharmacology, adverse effects, drug interactions, and much more. There is a strict administration procedure with risedronate which is designed to reduce adverse effects and enhance absorption. I discuss this in the podcast. Many medications may cause osteoporosis and may precipitate treatment with risedronate. Corticosteroids and excessive thyroid hormone replacement are two examples. Patients should remain upright (sitting or standing) for at least 30 minutes following administration to reduce the risk of esophagitis and ulceration.

On this podcast episode, I discuss some of the most common antihypertensive drug interactions you need to know. One major interaction I discuss is the trifecta of a diuretic, an ACE or ARB, and an NSAID. This combination significantly increases the risk for acute renal failure. Nitrates aren't classically referred to as an antihypertensive but they can definitely cause some problems when combined with PDE5 Inhibitors. Lithium can interact with 3 blood pressure medication classes. ACEIs, ARBs, and diuretics can all increase the risk for lithium toxicity.

Teplizumab is a relatively new agent that helps delay the progression of type 1 diabetes. It slows the rate of beta-cell destruction in the pancreas. Teplizumab is associated with cytokine release syndrome which can result in flu-like symptoms of fever, aches, and headache. Cytokine release syndrome due to teplizumab can be reduced by using appropriate pretreatment medications. Those medications can include analgesics, antihistamines, and/or antiemetics. Teplizumab is associated with suppressing the immune system so it is ideal to get vaccinations completed before using this medication. I go over the specific recommendations in the podcast episode.