20 Episode results for "Air Christianson"
"Hey welcome back to the real life pharmacology. PODCAST I'm your host Pharmacist Air Christianson thanks so much for listening all the kind words comments ratings reviews on itunes it's greatly appreciated if you haven't done so enjoy the podcast today I appreciate you taking the time to to consider doing that I've seen GI specialists used that in patients with Gastro Paribas probably the most common patient population with Gastro priests or that slow is almost sub unit and within bacteria what this does is actually blocks the production of essential basically common and so eraser Mason has been shown to have some benefit and activity in Gastro Aparicio's so I bacterial proteins so that's how this drug really inhibits growth and stops the bacteria from growing replicating and things of that nature I know there's tendencies for young pharmacists and students in school and pharmacology trying to memorize endings and things of that nature who practice this medication isn't used terribly often but there is some really important things that you need to know if you ever if you think about the the setting of acne most often it's going to be you know in in younger patients so hopefully we don't have as much concern Drug Interactions Section But I you know kind of with the the mechanism and the way the drug works it is classified as a Mac relied antibiotic got a couple of rare indications that do wanNA mention but they're rare in a sense that that we made dose this on a chronic basis which it's rare in general to give patients chronic antibiotic long-term or it's not incredibly out of alluded to earlier earlier really important thing is drug interactions inhibits cyp three a four are issues with a drug interactions compared to maybe our poly pharmacy chronic disease state elderly patient where we there is that temptation to try to memorize those endings and can be helpful in some ways but in some ways it could could lead you astray so you can so through my sin is not going to be in the same class as Vancomycin it is not in the same class as Genta Meyson so juicy a patient on it so definitely some important drug interactions and things like that to look out for all cover that more in more detail of course in the couple times per day versus as through mice and you can get away with doing it once a day in in most cases there the other really thing clinical practice There's two major reasons why I see this medication isn't used near as much as three Mizen so listen so you know it could help with some typical pneumonias pertussis it's got some activity some ut is like cla media things like that wing of the the gut is diabetes so that's kind of one situation where you might see chronic is a through mice news one other one is acne go back and listen to the podcast on his through my son but all sperry that the mechanism simply put it binds the fifty s right and as you throw mice and doesn't do that K. and I'll get into more specifics on that in a little bit here as far as indications do have a lot more concern in a lot more risk for drug interaction so Yeah Acne and gas prices are a couple of situations one of the first reasons is dosing and so much simpler and easier with as a through mizen array through my sin is generally dose Ma of It's going to have a pretty similar anti-infective anti-bacterial profile to as Zithromax That you may see this medication use longer term but I can't stress the importance in Naf that you need to reassess these Medicare nations periodically especially something like this obviously the risk of giving an antibiotic or one of the risks giving an antibiotic long term antibiotic resist ones that are susceptible and some other ones grow that are becoming multi-resistant to multiple drugs silence and so that's a big problem that we're encountering in the more we use these medications the more we can sort out those bacteria kill off the I heard I have seen the abbreviation E E S so keep that in mind as well and I obviously discouraged avoid those abbreviations now the adverse effect profile. So it's an antibiotic I mean you can pretty much take it to the I did forget at the outset I think to mention a couple of brand names so eerie tab is probably the most common brand name is so Urethra Mason's different there some antibiotics are are more or less but certainly can be a thing that can happen there using relations pretty much at all times if possible can lead to errors and and mix ups and all that sort of stuff so definitely bank antibody can cause a GI upset you know nausea potentially vomiting if severe enough maybe some diarrhea actions thinking about that that adverse effect rarely there have been cases of hip panic impairment so liver dysfunction from this medication so important to maybe think about that if you've got a a patient that's display not prolongation risk in that concertedly happen with Irith ramize in as well so important to remember that and I'll cover a little bit more in in drugs clinical resources for Pharmacists Nurses Nurse Practitioners Med students and so on anyone involved in healthcare and looking to learn more about medication now some more rare but serious adverse effects with rich Eisen so if you remember a Zithromax and we've got that playing any signs of liver impairment or maybe labs are out of whack things of that nature so let's take a quick break from our sponsor we've definitely got resources from Amazon books to audible books as well as a board certification study material that's specifically Morgan and then we'll finish up with drug interactions mid one one has been a supporter of real-life pharmacology podcasts the growing list major buckets that I think about eraser mason if you go look it up you'll probably find to four hundred drugs that could potentially dot com slash store S. T. O. R. E. SO finishing up on drug interactions there's two buckets so when I'm talking about these interactions I'm highlighting some some major ones maybe common ones or severe ones That can happen in there are a lot of drugs that are broken down by CYP three a four okay so this enzyme Cyp three a four can break down from those other medications and really an untenable situation so we've got a really strongly consider what's going on some of the statin medications some of the Benzodiazepines as well so try as a lamb help raise a lamb All these drugs are really interact with Rice again it's one of the major reasons why we steer clear of this drug in most situations clinical practice so because there are three mice and inhibits the enzyme CYP three a four it's going to have a lot of drug interactions happen as the concentrations of all these different drugs can potentially rise and that's GONNA lead to Talk City Adverse Effects Torch pharmacists but go check those resources out support real-life pharmacology podcast and support met at one to one so the link to that met at one one dot com you'll get that once you subscribe how pretty simple and we just send your email emails when we've got new things to share such as new podcast is is through not see prolongation so if we've got a patient on some of these drugs that can cause QVC prolongation so keep an eye out for patients who might be on multiple medications That can prolong that q t interval so I think that when we're in what medications a- patience on when we start era through Mizen and potentially when we stop Erythromycin so in the set isn't that sort of thing so go check that out leave a rating review on I tunes wherever you're listening that's incredibly appreciated for all those warfare and Era Pip resolve a picks abandoned anticoagulant Colchicine Lova Statin Simvastatin two hundred drugs great for somebody that's getting to know and understand pharmacology medication safety better so definitely go check that out at real-life Pharmacology that enzyme in addition other drug interactions besides Cyp three four. I mean that's that's the big one I think about that you have already done that or going to do it we certainly greatly greatly appreciate that I'm going to sign off today thanks so much for less than and that maybe you know we need to monitor that ekg and get those figures So we know where patients at when we're starting this medication it's going to wrap it up today thanks so much for less than go check out real-life pharmacology dot com snag your free. PDF thirty one page PDF on the top two hundred drugs fed a lot the unique to overthrow Mason compared to a lot of other antibiotics but another way that Earth mice and can cause drug interaction are broken down by Cyp three four so if you stop that enzyme or block it to an extent with Reuther mice in what's going Catala program and I said Kat ix M yoder own other anti arrhythmic we've gotta remember that Arith- Rayson can worsen this issue not so I like to get into it so we're going to get into Reuther mice in
"Hey all welcome back to the real life pharmacology podcast. I'm your host Eric Christiansen. Thanks so much for listening and definitely if you enjoy the podcast today. Go to real life pharmacology, dot com, and Snag Your Free Thirty One page pdf on the top two hundred drugs really unique little resource. I've had you know pharmacy technician educators reach out to me Nursing Folks Pharmacy Folks good little resource on really important testable in real life clinical pearls top two hundred drugs. So absolutely free for following the podcast we. Send. We've got a new PODCAST available end or any new new products and things going on. So again, go check that out real life pharmacology dot com. The drug of the day today is titanic Ding. brand name of this medication is Zana. Flex and I will say see it used periodically anyway in in geriatrics specifically most often The indication that it's going to be used for is muscle spasms. And this drug is classified as an Alpha to address. Agonised and the way I, kind of remember, some of the effects and things of that nature is tanning and cloning do have some similarities mechanistically. Ultimately, as far as Anti. SPASMODIC TYPE activity. Can Cause neuronal presynaptic in addition is basically how how it ends up working. and. it helps me because I see quantity and a little bit more. I think Clinton's a little bit more well known or well taught maybe drug. And understanding that it's going to have some similar mechanism. You're GONNA have some similar type. Adverse effects. So side effect profile. I think about blood pressure lowering effect. but in addition to that, there's also warnings on if patients are taking sanity and consistently, and they abruptly stop taking the medications or the medication there is a risk for rebound hypertension. And that can happen with Claudine as well. So it is important I think to to remember that along with the lower blood pressure braided. Cardia can happen as well. A lot of kind of older skeletal muscle relaxant. Medications from that class can cause dry mouth So that can happen with ties sanity, and of course, a lot of the generic. CNS depressant type adverse effects. Forrest Dizziness sedation things of that nature Will happen enter probably much more likely in our geriatric patient population. There have been a rare issues associated with a liver disease and and liver dysfunction. So I think it's important. To note that as well, particularly in patients may be at risk for that complication. on talking about pharmacokinetics one of the major or the major pathway that ties Hannity is broken down is by CYP one a two. So. We've got a PHARMACOGENOMIC. Alterations in that enzyme. For, instance, a poorly functioning or a slow metabolize her through that enzyme. We probably will run into the likelihood of Increase concentrations, and of course, I'll talk about drug interactions in a little bit as well in medications that inhibit. The CYP one, a two system. one other thing from a pharmacokinetic standpoint I did want to mention There is some caution with real impairment. Particularly accumulation of the drug as we get to you know lower stages of CKD's. So you know I think of generally less than twenty five to thirty mills and lower. Excuse, me mils per minute and lower. You're probably more likely to run into situations where patients. Can't tolerate. Higher. Doses. and. Or if we start to aggressively, we could overwhelm a little bit with with too much medication. So it is important to to make sure that renal function is is okay or at least be very cautious if it isn't. As good as we would like it to be. All right. So take a quick break and we will follow up with drug. Interactions. If. You're in the market for Pharmacists Board certification study materials like NAP PLEX SPEC- ps B. C., ACP medication therapy management, or the geriatric exam. Definitely go checkout met at one and one dot com slash store. In addition if your healthcare professional who works with medications I. We've got great books on Clinical Pearls, case studies, things that actually happen in real life. go check out all those resources, Med ed one one dot com slash store. All right. So finishing up on drug interactions one of the. First interactions that I have definitely come across a is ciprofloxacin. So Ciprofloxacin. INHIBITS CYP, one a two. Now. If you remember from the kinetic section when I talked Cyp one eighty two is an important enzyme that breaks down ties sanity. So. By blocking CYP one a two we're going to run the risk of tanning toxicity. You know sedation confusion and dizziness hypertension, and all that stuff. So a very important to to remember ciprofloxacin I think. When it comes to sanity use. So in that situation, what would we do We would likely. Re At least a look at the dose of ties entity and reduce the dose. See. How much the patients taking an kind of go from there as far as what we're going to do as far as a judgment call there could be a possibility. You know maybe a urinary tract infection where you know other. Medications may be available maybe you know macro Denton for example or backstrom. So we could have other alternatives Cipro For some reason, it's really felt that you know Hannity needs to continue at the current dose that that it's Ad. So again, very, very important to monitor look out for that possibly doing a dose reductions and or a changing agents depending upon was available in what's clinically appropriate there. food drug interaction. So this drug does have a little bit of issues alterations. I guess I should say with food and. I want to remind you of the mid one guy to drug food interactions. Recently put this book out I think it fills the void as far as covering a lot of really really important drug food interactions. All the drugs are listed by a drug name alphabetically and generic. So it's really meant as kind of a a reference guide type of thing but anyway, the Zanna Dean interaction with food is food can actually. Increase the extent of absorption and it's a little bit more pronounced at least in the literature. It's more pronounced with the tablet formulation of Titanic, which is what I've seen. used most often in clinical practice compared to the capsule formulation. So what we'd look out for their is obviously enhanced effects from ties sanity whether that be more skeletal muscle relaxation. And or side effects could result from that as well. So good one to to remember there as far as the effect of food entice sanity. In addition to the CYP one a two in the food interaction. I look at the adverse effect profile. So blood pressure lowering agents member I mentioned Braida Cardia. So Betablockers, those type of. Can lower pulse may have that additive fact onto tight sanity. So important to definitely remember that. Of, course are sedative type agents alcohol opioids. Benzodiazepines. Any sedative type. Agent. Could obviously have additive effects on top of sanity there. In. One last one I mentioned dry mouth is is somewhat common with ties sanity and certainly a patient getting an anti cholinergic. with ties sanity in that would worsen that dry mouth as well as potentially risk for CNS adverse effects too such as dizziness and fall risk and things of that nature too. So definitely a few important interactions I think with ties sanity in laid out a few that I think are common or somewhat common in clinical practice and I think that's going to wrap up the episode for today. So if you enjoyed the podcast, if you find it helpful, definitely leave us a rating review on I. Tunes Sheriff's with students that you have on on rotation or classmates anyone that may benefit from becoming better at pharmacology and obviously picking up Some of these practice pearls that sometimes often go overlooked or missed. So I thank you so much for all the kind words of support. Greatly. Appreciated You can track me down at linked in Air Christianson farmed he be CPS BBC GP. don't hesitate to shoot me a message if you've got a a suggestion or a comment or anything, and of course, support the sponsor met at one one dot. com. Slash store with all the links We have there. I'm going to sign off for today. Thank you so much for listening and I hope you have a great rest of your day.
"Hey all welcome back to the real life pharmacology podcast. I'm your host Air Christianson Pharmacists. And if you want to get in contact with me linked but in a good way to to do that Air Christianson Farm D. B. C. G. P. B.. CPS You can find me. They're also through the website real real life pharmacology dot com. We've also got that free giveaway thirty one page. PDF On the top two hundred drugs in their pharmacology an a an important clinical pearls That you actually might come across in real life so definitely go download that for free and and obviously also get updates when we've got a new podcast or any other in full To share for you there so go check that out a real-life pharmacology dot COM for today. We're going to get into metro. Nisell the brand name of that medication is flat. Joel and this is an antibiotic for infection. Shen I do see it somewhat frequently. I guess definitely a good one to to know to pay attention to Being an antibiotic probably the most common uses for this medication Bacterial vaginal says historically C diff was probably probably a lot more common for its use We have had changes in the guidelines. And now at least at this point at the time I making it Vancomycin Oral Orleans is typically going to be preferred there but still remains an option If a certain other options aren't available there Intra abdominal all infections. In in general metronidazole 's got some good activity specifically against ANAEROBIC BACTERIA K.. Okay so that's an important little nugget to remember with regards the use where you might see Metronidazole used in kind of along with that that depending on the type and surgery The type of surgery and the location of surgery metros nasal might be used in prophylaxis again. You know if you're doing some sort of Gi surgery were a bacteria gut bacteria are going to be in play We might might use metronidazole because a lot of those bacteria are potentially susceptible to the drug now adverse effect profile. I think this this is definitely important with an antibiotic. You don't nausea vomiting stomach upset can potentially happen and Dan With I would say the majority of antibiotics. It is okay to take them with food and Mitch Metronidazole Certainly falls under that umbrella. So if you're having a patient reporting some issues stomach upset Feeling only had an office with their medication with taking metronidazole definitely encourage them to at least start to try to take with food if they aren't already doing so oh other adverse effects We you know I think the GI tract Continuing along those lines metronidazole. Oh can provide a unique taste To the mouth and for some patients that can be very very troubling and bothersome It's most patients report. Almost a metallic type taste in their mouth but Keep in mind if patients are noticing. Food tastes different or something else going on with with taste. Buds and eating Definitely could be Metronidazole Having that adverse effect there There are some rare things that can happen with metronidazole. One really unique thing That I have encountered in the the past again very very rare But CNS changes can happen with Metronidazole and one thing specifically with those CNS changes Is Peripheral for all neuropathy. So it's kind of an interesting NEUROLOGIC type of act that can potentially happen with metronidazole. Now we'll say that the risk ask of you know some of these issues or particularly the central nervous system issues is likely going to go up as we increase doses and and as we Extend that duration. I'm thinking along the lines of full neuropathy Probably not real likely to happen. You know for other patients only getting it for a very very short period of time you know a few days for example so keep that in mind as you think about the adverse effect profile file and as you see Metro nasal used now. That is more specific to Metronidazole. That's obviously going to be. I static simic oral use so Important to I think make that differentiation versus a topically applied metronidazole for for example. So let's take a quick break from our sponsor met at one one dot com if you're in the market for Pharmacists Board Certification Study Material WHETHER THERE BE NAP PLEX pharmacotherapy exam geriatric exam Tori Care New newer certifications like T M s We have have you covered there. Go check out our resources. support our sponsor that that help. Keep this podcast free and educational for all to enjoy so go check out. Those resources met Ed one dot com slash store in addition to those study materials for specific exams. we've also got General Clinical Pharmacy Education as well that you can purchase so books on Amazon and if you haven't taken advantage of of it yet Definitely check out the links we have on there too Audible you can get your first audible book for free and pharmacotherapy and anthro the case You can get one of those For Free simply by signing up for audible no strings attached there so definitely go take advantage of that check that out and Support sponsor mid one zero one dot com slash store. So let's finish up on drug. Interactions here. I've got a blog post of a case scenario on war for an end metronidazole turn. It is all interaction so you can find that if you google search war friend in Metronidazole met at one on one you should be able to to track that down and find find that Drug interaction there. What primarily happens or the the end outcome or the risk with using Adding Metronidazole all to a patient you know stabilized with decent are on warfront. Is You're going to escalate Those concentrations of warfare and potentially elite to Super Therapeutic I N R and risk of bleed of course now mechanistically how that plays out That's likely caused by metronidazole ability to inhibit CYP two C nine. So that's how that meant Drug Interaction is going to play. Play out and what why. It's likely to happen there One super important patient education point Don't forget about alcohol use Metronidazole and alcohol use should not be combined with one another okay so with a lot of other drugs. It's sometimes up in the air ambiguous. It's like you know we generally don't want our patients drinking a bunch of alcohol with medications regardless but with metronidazole absolutely But not a good idea and you want to make sure that the that there's probably a good period good chunk of time after they stop taking that medication stop taking metronidazole. That they abstain from alcohol is where as well there so You pay attention to that as well as far as Resuming the the use of alcohol. We want that drug to ensure that it's out of the system for sure keep in mind there are Some drug drug products. I specifically think of Some of the Benzodiazepine so injectable and and rectal administration routes that may have propylene glycol within them. And if you see that in you know benzodiazepines or any other drug in that formulation that's being used. You've got to remember. That can have that same interaction that alcohol can have so describing that reaction or why this interaction interaction is important. What can results called the Di sole from reaction and symptoms from this reaction are going to be flushing A stomach upset pain Headache in potentially even things like dizziness. Oh in Kimmy very very severe uncomfortable. reaction action for patients there so Definitely avoid alcohol and Similar type products when Metronidazole is being used one other interaction. I did want to mention is remember. Some of the enzyme inducers So classic example that comes is to mind is finito on so Benetton Ken ultimately reduce the concentrations of Metronidazole. And what's going to end up happening is you've you've got a greater likelihood of treatment. Failure with that antibiotic so I think that's going to wrap up the podcast for today Hi thanks so much for listening. If you enjoy the show leave a rating review on I tunes Greatly appreciated To all of you. Who have done that already? very I'm very thankful for that and obviously pleasantly surprised by the number of you out there listening. I greatly appreciate it. It's a very very humbling. humbling to to say the least so Thanks to all of you. Who have done that again? Check out the real life. PHARMACOLOGY DOT COM website. Go Snag that free thirty one page. PDF Once you subscribe you'll easily get access to that field download that and really nice resource for Folks that want to pick up a few more pearls on on pharmacology and clinical pharmacy medication practice. Thanks so much for listen Take care and have a great rest of your day.
Nicotine Patch Pharmacology
"Hey all welcome back to the real life pharmacology podcast. I'm your host Air Christiansen WanNa remind you guys you can certainly subscribe to the email mel list at really pharmacology dot com where I'd give away a free thirty one page. PDF on the top two hundred drugs in that PDF note some of the most important clinical pearls. You'll need to know in clinical practice as well as some of those things that come up on Various Board exams and Pharmacology College classes and so on and so forth so really kind of a unique resource for any you know nurse Pharmacists Pharmacy Student. Med student Anybody taking pharmacology algae classes or dealing with medications on a day-to-day basis. So go check that out at real life. PHARMACOLOGY DOT com today I WANNA get into nicotine patches so this medication is obviously to replace nicotine gene and help patients stop smoking Brand name of Nicotine Patches nicoderm. CQ Is the one that I've seen gene used most commonly with nicotine patches. I I think it is important to note that we do have three primary dosage strengths. So we've got a seven milligram patch of fourteen milligram patch in a twenty one milligram patch in really there is A lower end weight restriction. But for most adult patients. They're they're above that so if somebody super low weight You Might WanNa double check and look that up but by and large we look at the number of cigarettes smoked per day and judge our initial dosing off. Offer that in most cases so obviously there could be a situation clinically were maybe a patient has tried patches in the past and they didn't tolerate the high dose or something. You might start at a at a lower dose in that type of situation but Going off of the cigarettes smoked per day. If we've got a patient isn't that is smoking eleven or more. We're going to generally go with the twenty one milligram patch and start with that. That's the the highest dose. Does there if it's ten or less than we might start with. Fourteen milligrams as far as the the patch. Goes there and end so tens. Ten's a good number to Kinda remember in an easy number to remember Based upon the number of cigarettes smoked there so if we got above that twenty one milligrams below that Fourteen milligrams so with that dosing. How long do we do the dosage form so usually or what's approved is twenty one milligrams That dose for six weeks and then we would do fourteen milligram. Dan Patch for a couple of weeks. And then the seven Milligram Patch for a couple weeks so kind of a of a taper down with a longer period of time on the higher dose us now for starting at that lower dose or the medium dose fourteen. Milligrams that's fourteen milligrams for six weeks and then seven milligrams for two weeks weeks there so that that dose is is generally at least initially going to be based on The number of cigarettes smoked From a mechanism of action standpoint. Obviously we're replacing nicotine That's our objective. Our goal to to replace that nicotine so patients feel. They don't need it necessarily through smoking cigarettes so nicotine itself In the rain essentially vines nicotinic and cholinergic receptors which can produce a stimulating type of fact In it can also impact kind of the rewards center on the the LIMBIC system which that can really fuel That reward can fuel that addiction to cigarettes. Which is why so many patients struggle to Come off smoking Back Kinda relating the patch to clinical judgement. So we talked about the number of cigarettes. Smoked It's always important to us. Clinical judgment. I if you've got a patient that's experiencing adverse fact intolerability due to a higher ear dose. Obviously we're probably going to reduce that dose same thing if you've got a patient reporting Significant withdrawal symptoms news. You know that's a situation where we we might escalate the dose an go up you know if you started a fourteen milligram. Patch they're experiencing those withdrawal symptoms symptoms. We might bump them up to the twenty one milligram patch. And here's a shock to you patients. Maybe don't exactly report Exactly exactly how much. They're smoking as well. Just like drinking alcohol and other things we tend to. Maybe Underestimate how much of a negative. The thing that we're doing so Very important to to use that clinical judgment and recognize that that patients might not be exactly Accurately portraying how much they're doing something or they're smoking in this case if you other clinical pearls with regard it to the patch So only one at a time. I think that's kind of common sense. this specific patch. You cannot cut so something like a lighted arm patch for pain. You can cut that type of patch but nicoderm replacement patches nicotine replacement patches. You cannot cut them. Essentially what's going to happen is you're going to lose some of the the drug and obviously reduce effectiveness. There you want to a non in Harry area clean area on the body usually most patients I've seen on the kind of the back of the arm have seen some kind of upper chest area Korea that type of of location as well. They're now wearing the patch. This is something that has definitely come up before in clinical uncle practice. How long do I have to wear this? How long can I wear this patch? So they are intended to be once daily and really in most patients. We're GONNA use them sixteen to twenty four hours and probably the biggest. The two big things is that I remember with how long to determine To wear the patch is are they having adverse effects at night and specifically adverse effects like insomnia vivid dreams. If that's problematic at night that definitely could be because of nicotine concentrations so in that situation we might say hey taken off at night now that can be balanced with morning cravings so. So if you've got a patient that it's like Yup I get up the first thing I do during the day as my cigarette. That's how I get going. That's how I do my thing That's a situation in where you're probably GonNa want that nicotine in the body because remember these. These patches have a slower onset. They're intended to be longer longer acting nicotine replacement. It's not like a piece of Gum. It's not like an inhaler. You're not going to get that quick. Absorption from nicotine. Patch that that you would with some other dosage forms that are meant for acute relief. So that's kind of some of the downsides of the patch and the kind of the ying and the Yang the good and the bad so to speak. Is that slow onset so it's it's not going to be used for quick relief and and one other downside is throughout the day if patients have really strong cravings You can't adjust the dose of the patch. She can't somehow how did it up. And and increase the dose. That's being delivered from that patch. And even if you could that dose would take a while to get get ramped up because it takes time for that drug to pass through the skin so Those are definitely some important pearls To think about when we're talking talking about Nicotine Patch administration and use of it Let's wrap up the first section here talking about adverse effects facts so I mentioned a couple Insomnia the dreams patients are having those. That's probably candidate that we're likely going to take that patch off at night night Other adverse effects I have seen have heard of Gi upset which tends to be obviously a lot more common. If you're oh you know doing a nicotine gum or something because that nicotine is going right into the got their With the patch it is possible. Maybe a little less likely Headache and then of course with any topical administration there's potential for a skin reaction so You know keeping that that let's say clean obviously not placing the patch right on the same exact spot over and over and over again that may lead to some worsening of of the year ISSUE THERE SO I keep that in mind obviously if somebody's reporting really severe reaction Rashes Spreading. It's getting worse You No it's it's painful it's weeping. It's you know other Worrisome symptoms Yeah you've got to educate your patients to report Those issues to you if if they are having problems that maybe something else is going on infection or or whatever so I think that wraps up adverse effects We'll take a quick break. Then we'll finish finish up on drug interactions if you're looking for board certification study material be CPS GP ambulatory care BC the MTA or nap. LEX material We've got lots of cool stuff. GOING ON AT MED one one dot com slash store. You can find links to all the resources we have also uniquely Just released a drug interactions book that I will cover many of the interactions that. I'm I'm covering today. Today is with regards to nicotine and smoking. So you definitely go check that out. I've got a link to that Right on my site right at mid one zero one dot com slash store. In addition I have just released A new one hundred question question. FREE NAP LEX practice exam so definitely go check that out and you can find the link to our admitted one one dot com slash Store or you can go straight to our x Grad Dot com as well so again check out those resources support the sponsor help keep this podcast free and educational to all those that that want and need to learn more about medications and medication safety are. Let's finish up on drug interactions so as a whole nicotine. Replacement generally doesn't have too many drug interactions One same editing. That comes to mind so nicotine can be increased or concentrations can be increased on account of Sam Editing Verana clean which is also used for smoking cessation purposes using that in combination with nicotine It is a partial nicotine nicotine agonists so it could have a additive potentially type facts to nicotine replacement therapy like with nicotine patches his and then one other thing that I think about. It's generally not too much of an issue because patients are already getting getting nicotine into their system. Their systems kind of used to it. We're basically just replacing it. We're not trying to go way above and beyond what their normal blood concentration is however if we do potentially give them more than there used to There is that potential at Plod pressure and pulse could go up a little bit so that is something that I you know modestly. Look out for and if you've got a patient on multiple blood pressure medications which seems it seems like many smoking cessation patients are Sometimes on on many blood pressure medications We've got to recognize that you know if that nicotine is is excessive We could be opposing some of those effects so keep an eye on that blood pressure keeping an eye on that. Just a good thing to do as we're kind of starting and Getting that nicotine our system from nicotine replacement therapy and then one last interaction. While we're finishing up up here. I do want to remind you about smoking cessation so smoking tobacco products has the potential to induce CYP. One one eight two okay. It's not a ultra potent interaction in most situations however we could end up with some altered concentrations concentrations of certain drugs so Closet Ping Orlando Pena couple of Anti psychotics those concentrations could go op as we stop smoking. Okay so smoking. Tobacco products being a sip one eighty to induce her. That's GonNa Kinda lower those concentrations if we were to start smoking but if we did if we were to take away smoking that could raise those concentrations a couple of other medications that come to mind that are Cyp one a two mediated that I do see us out in practice sometimes Du Lac sixteen so there again if we if we stopped I stopped smoking. we're going to maybe just have the awareness that that could shake up The concentrations of some drugs like do Austin and potentially modestly increase the concentrations. Were getting there so from clinically significant perspective. I AH in most situations. I doubt it's going to lead to clinically significant results. However if you've got a patient on an unusually high dose for some reason or maybe they're taking other her medications You know that impact Cyp one a two. Maybe a change in in smoking patterns could kinda alter that concentration so important to think about and one last one with Cyp one a two propranolol. So that's one that's Broken down through that pathway we take takeaway that inducer that smoking cessation inducer propranolol concentrations could go up you know lead to lower heart rate lower blood pressure and things of that nature so just a few important interactions to to think about their. If you've enjoyed the podcast today found it helpful Do us a huge favor. Leave US rating review you and I tunes or wherever you're listening Very appreciative of all of you. Who have taken the time to do that? If you'd like to reach out to me for suggestions comments percents Wondering where you can get more resources things of that nature Definitely find me. At linked in Air Christianson Pharm D. BCP SBC SBC GP or you can find me at real-life pharmacology dot com hit the contact button and that will go straight to Me Met at one on one. You can also reach me there as well where we have. A lot of our Board certification products as well as our books That that have been created as well so definitely go check out those resources for all different Healthcare professionals at one one dot com slash store. I'm going to sign off for today. Thanks so much for listening take care have a great rest your day.
Epoetin Alfa Pharmacology
"Hey all welcome back to the real life pharmacology podcast I'm your host Pharmacist Air Christianson. Thank you so much for listening. As always real-life pharmacology dot com, if you want to subscribe and get updates when we've got new content, available, new podcasts and pharmacology education in general so again life pharmacology dot com, you can subscribe there by email, and we'll shoot you a free thirty one page PDF on the top two hundred drugs, great, little study, resource, or just a refresher If you're out there in clinical practice, go sign up do that. And today's drug that I want to cover is Edwin. Also known as E. Putin Alpha, brand names EPA Jin, portraits and other name, and this drug is basically used to raise hemoglobin levels, and and make people feel better, and it does that by essentially mimicking body's own Erythropoietin. So if you remember a retro Putin is produced by the kidney. And that ultimately stimulates red blood cell production through the bone marrow, and all those processes so reporting stimulates red blood cell production. With those uses or the common uses that you can see this medication used for obviously various types of anemia, where we may be have a shortage of throw poyton. Now. This is something in clinical practice. That gets a little bit tricky. To try to decipher what types of anemia that a patient has whether it's B, twelve deficiency, folic acid, blood, loss, irith rope, poyton shortage could be. A possibility and the most common clinical situation that I've seen in my practices, patients who have impaired kidney function or their kidneys are damaged, remember throw poet and is produced by the kidneys. If the kidneys are damaged, that's GONNA put a patient at risk for anemia of chronic kidney disease, so very important to remember that that's probably the most common situation. I've seen this medication used in. Chemotherapy situations anemia so ahed with HIV. Infections in medications there but again those are I. Think are a little less common in in that type of thing. adverse effect profile. The. Thing, the first thing I think of with A. Epic now for reporting or Yes as earth written stimulating agents or sometimes called Jim procreate the biggest thing I worry about is blood clots, so if patients are at high risk for DV T. p. e.. potentially you know heart attacks, strokes things of that nature, if I see that in a patient's medication history. Your past medical history of that is something I am. Concerned about. Because the way I think about it is if you push blood cells if we produce red blood cells and stimulate that production. that's going to make the blood a little bit more viscous, potentially a little bit thicker in a sense, and when it does that are blood tends to clot a little bit whereas a higher tendency to clot as the blood. Gets thicker. So that's kind of the way, I remember that risk with this medication, but that is at least by far the most important thing that I think of when I think about this medication is, is that clot risk? Other adverse effects this is given by injection, certainly injection site reaction, itching and rash that can all go along with that medication rarely may see some some pain, some soreness that type of thing, as well so get not not incredibly common, or maybe I should say not incredibly serious typically. Warnings and precautions again. That really goes back. To that blood clot risk, and there is a boxed warning on an increased risk for heart attack stroke. Or other serious cardiovascular events so very very important that if we're using this medication. We're using it for a significant purpose. The patient has very clinically significant anemia. And we've got an appropriate indication for it there as well so definitely a very important to think about that one other thing with that clot, risk and risk with the heart attack risk stroke risk. If were too aggressive with therapy. In generally, that's defined as greater than one gram per deciliter in a two week period, if if that hemoglobin is rising that quickly. that has been shown to. Have a greater propensity to cause those clot type events, so be very very cautious, and that's why, obviously in monitoring parameters we are following, you know hemoglobin matic very closely. To monitor the use of that medication, but definitely be aware of that for sure, a couple of other adverse effects that can potentially happened that she should watch out for us. We're going monitor blood pressure to make sure that that blood pressure doesn't go up and obviously increase the risk of some of those cardiovascular. Events and things of that nature as well out rarely. There can be some some GI upset. Nausea vomiting things like that, too. I wouldn't say it's incredibly prevalent. That I've seen that in clinical practice, but. different patients different things certainly can happen there so a couple of clinical pearls that I wanted to mention that I definitely have seen Come up, so. It may seem kind of obvious, but if a patient needs blood right away, they have substantial life threatening anemia. EPA Jains, onset of action is not within minutes. Okay, so this drug is not intended for that. it it takes a while it takes you on days two weeks to get that hemoglobin back up using IPE agenda in Jintai products so definitely remember that one not meant for acute increases in in Hemoglobin also. Iron Deficiency K. Iron deficiency is probably the most, I believe, it is the most common cause of patients, not responding. To EP, Alpha K. so very very important that iron stores are adequate, because if you remember the process of Red Blood cell production, we need iron in place. To be able to utilize. In the production of red blood cells so very very important check on those iron assessments make sure we are have adequate stores, and or are giving adequate supplementation They're very very important to remember that. I did mention that we WANNA. Be careful about raising hemoglobin to quickly. And tied in with that is dosing so the dosing of this medication whether we raise the dose lower the dose. Usually it's you know Ballpark, twenty five percent or so. Of depends upon how quickly that hemoglobin is responding if we see a significant increase in hemoglobin, let's say it goes up one point five. Grams per deciliter for goes up one point five in a two week period K that's too much, so obviously we're going to either back off on that dose depending about where they are potentially hold it for a period of time as well so and same thing with not seeing that response one could be iron deficiency, causing that non-response like I mentioned before so that's important to us to double check and assess. but if we do feel like we have everything in place, onboard patients, not responding. The dose might be too low. So of patients not. Hasn't responded. Let's say maybe a gram and in four weeks, or they're less than one gram per deciliter of increase in four week time period. That's generally not a decent response, and we'd likely increase the dose you know by Ballpark usually twenty five percent in that patient for the next. You know two week four week period as we're monitoring, so the the doses, and you know what we're doing can vary a little bit depending upon the indication that we're trying to do. So that's important to remember, and then those dose adjustments depending upon that indication are going to be based upon how well that hemoglobin is responding or how? The hemoglobin is not responding so to speak. All right. Let's take a quick break from our sponsor. Mid One zero one dot com, and we will finish up with drug interactions. If you're in the market for Pharmacists Board certification study material like the medication therapy management certification exam geriatrics exam. Be CPS, C. ACP. Or NAP LEX definitely go check out MED ED. One one dot com slash store can find links to content there if you're nurse practitioner. Nurse Physician Med, student definitely go check out met at one one dot com slash store. We've got list to Amazon books. audible books in various other resources, great opportunities to really enhance your education. Reinforce your education full of medication case, studies scenarios education points, common errors stuff that I've seen in my clinical practice and I share that in several of the the books I've made so definitely. Go check out those Amazon audible resources, and of course you. You can get your first audible book for free. click on the audible book. Links and I've got drug interactions book kind of a pharmacotherapy case study book, eight to ten hours of of content in each of those books so go check those out, and you can have it absolutely for free. if you've never had a book through audible. All right so with that. Let's wrap up. equal eaten Alpha and Drug Interactions. So one of the Nice things about this agent is it generally doesn't really have any pharmacokinetic drug interaction, so that is a very very good thing. We don't need to worry about CYP. Three a four to see nine or anything like that, so that was very very nice. in my practice. The biggest things I worry about as far as Drug Interactions Go. involve maybe that additive effect of clotting. Or the potential of opposing that effect of clotting, so give you a couple examples if we've got a patient on a pixel ban or or friend for a clotting. Type Syndrome. Recognize that epic now FAA may increase that risk. Same thing goes where if we're trying to treat anemia and this patience on a blood thinner. That's maybe potentially causing some blood loss anemia. That's always a risk benefit balanced, and we're really doing two things that may oppose each other, so that can get awfully challenging and tricky, and I have had. situations where we're trying to figure out how to manageable those but keep that in mind as you're scrolling through a patient's list, and you see a blood thinning medication, and then you know medication essentially to treat anemia, which could be from blood loss, but might be from other reasons. Like chronic kidney disease for example keep keep that in mind definitely and then additive risks i. do think about so. Let's say where on a drug like premarin. For example, so conjugated estrogen well, that can increase blood clot. Risk can increase the risk for DVD, so we add that onto ep now. We may kind of enhance that clotting risk. hypertension I did mention as a potential adverse effect. There again think about some of those drugs that may increase blood pressure. Weather might be. Stimulants or Or things of that nature so I think about the effects of wheat. Now phone what that might have. And some of the drugs that it may have additive effects and some of the drugs. That may can counteract or have opposing effects to as far as Drug Interactions Go. All right well, I hope you picked up some clinical pearls today. If you enjoyed the podcast, leave a rating review on itunes or wherever you're listening. Greatly appreciated to those of you who have already taken the time to do that doesn't take more than. Five or ten seconds to go ahead and do that. definitely go to real life. PHARMACOLOGY DOT COM, a Snag Your Free Thirty One page PDF on the top two hundred drugs I lay out my most common practical clinical pearls from those drugs that you're going to actually see in clinical practice you can snag that for free at really pharmacology, dot, com, and of course support. Our sponsor met at one zero one dot com slash store. any purchases you make their goes to support the podcast and what we're doing here. And of course sheriff's with a friend colleague drop some mass emails to classmates, and and things of that nature and. Help spread pharmacology education all across the globe I. Certainly appreciate those of you who I know have. Done that already. All right I'm going to sign off for today. Thanks so much for listening I. Hope You have a great rest of Your Day
"Pail welcome back to the real life. Pharmacology podcast I apologize if my voice is a little quirky today as have had a little bit of a head cold. But I'm I'm going to battle through and hopefully it isn't too bothersome for you today. This episode I am going to cover atom oxygen. which the brand name for that? That medication is strategic. Now this medication its primary use In clinical practice only use. I've ever seen it used for Is Is Adhd mechanistically. How this drug works is it inhibits the reuptake of norepinephrine now? Essentially what this this does is increases norepinephrine defects in the synapse. So you can F- you remember what nor epinephrine does you can potentially the hypothesize some of the potential adverse effects that might occur on on account that in all discuss that a little bit further As we go along here a couple of things that are really wanted to point out with regards to use of atom oxygen in its oral administration. Obviously there is is a boxed warning on this medication for suicidal idealization K.. And that's in pediatrics adolescent patients. So that's the important thing to remember if you've got a patient with a significant Psych history and and issues relating to that That may definitely be a concern that at a minimum we would More Monnet more closely monitor for one advantage of atom oxygen over traditional stimulants milnes for Adhd. Like Beth affinity and amphetamine salts Atom oxygen is not a controlled substance so for parents who are looking for something. That's that's not addictive or you know risk of diversion looking to avoid that Atom Oxygen Might be a little little bit more useful in that type of situation there. Okay let's get into adverse effects so when when I think about that Nora Ephron increasing type of facts naturally what comes to mind isn't elevations in blood pressure and possibly pulse so so those are things that can happen I will say you know. This is again dose dependent a little bit but atom oxygen probably less last likely To really give that big jump in blood pressure compared to traditional stimulants But again that's a little bit dose dependent as far as What we're using for a specific patient there so with that risk of increased blood pressure increased? Pulse If we've got a patient that for whatever reason has a very significant cardiovascular history which doesn't happen terribly often in you know kids But if we do have that That's a potential patient where we're going to probably try to avoid this medication in general Other adverse effects that you may see without Amok Sixteen Dry Mouth is one. I've I've heard patients complain about a little bit STOMACH UPSET SET If you think about the stimulants in in general in that increase in fact appetites Weight loss poor appetite weight loss. Those are potential issues with atom oxygen again. Probably a little less is likely to encounter that compared to traditional stimulants but again we we've got to look at the dose that were taking their to other things you may. AC possibly some insomnia erectile dysfunction as patients get older certainly that that may be a problem or concern earn That may be reported with the use of Atom Ocsta- team now. Let's talk kinetics a little bit and probably the most important pharmacokinetic parameter that that I think about in relation to other medications is metabolism so all atom oxygen is broken down probably primarily by CYP Two d six so any alteration in that enzyme's times activity whether it's genetic or whether it's through a drug interaction can significantly raise or lower concentration so a cyp hip two d six inhibitor. Or if you've got a poor metabolize earlier at Cyp Two d six those are situations where atom oxygen concentrations could go up pretty significantly and then obviously we'd look out for some of those adverse effects the blood pressure elevation J. Upset poor appetite tight increase in pulse. Insomnia things of that nature so Definitely remember that when it comes to the metabolism and any possible medications. A patient may be on that can impact Cyp Two d six okay. Let's take a quick break from our sponsor and we will follow up with drug interactions. If you're in the market for Pharmacists Board Certification Study Material. We've got geriatrics pharmacotherapy ambulatory CARE MT M exam as well as NAP. Plex material for students definitely go. CHECK OUT THOSE RESOURCES AT MED one one dot com slash store. I'm also going to talk about Drug Interactions As we finish up atom oxygen here and I'm really excited because at this time I'm making this podcast I've just released a new book On Drug Interactions. And you can find that I'll put a link admitted one dot com slash store or you can find that on Amazon and as well and that is the clinicians guide into common drug interactions in primary care if you if you search drug interactions you. You should be able to find it there but The full title is CLINICIANS GUIDE TO COMMON DRUG INTERACTIONS In primary care. So definitely Go check that out. I think you'll find that a valuable resource it's over two hundred plus pages of Drug interaction goodness. Oh also be on the lookout for an audible book for that As well as a Paperback copy is going to be available to so Definitely take the time Go check that out in and support our sponsor. They're all right. Let's finish up with those drug. Drug Interactions On atom oxygen. So first thing I think about Kinda discussed it a little bit already. SIP Tutti six so be appropriate and and flu oxycotine PAROXETINE. Those are Kinda my classic. Go to examples of drugs that inhibit Cyp Tutti six so those are ultimately going to increase atom oxygen concentrations. In what you're going to see in your patient potentially are an increased risk risk for adverse effects from democracy as concentrations rise elevations in blood pressure poor appetite J. upset elevations in pulse and things like that other drug interactions that may have some varying significance QVC prolongation so. That's one thing that I think of if you happen to have a patient on multiple medications You Know Your Ami Odor owns you're anti psychotics as your on dance a trans things of of those type of nature that can prolong the cutie interval adding oxygen onto that could potentially exacerbate Asir Bait that further. So we're going to you know definitely probably want an ekg in monitor For that issue obviously obviously recognizing if patients are at high risk before they start the medication but a lot of cases cases. These are you'll pediatrics adolescent patients and most likely. They aren't going to be on many other QT prolonging drugs typically but it is something thing to think about something to to look out for their other drug interactions. I think of additive effects so elevations in pulse elevations blood pressure. If we've got a simone medic type medications so let's say you've got a patient with sinus problems and they're taking pseudofedrin that could raise blood. What pressure Beta agonise Inhaled Beta agnes could potentially increase pulse particularly if the patients taking them Frequently or a lot Definitely think that atom oxygen and Just like traditional stimulants could have That additive type the facts and then one last one. I'm going to touch on Emma O.. is or absolutely country indicated with the use of atom oxygen So definitely really Avoid those that class of medication with atom oxygen so. I think that's going to wrap it up for today. go to real life. PHARMACOLOGY DOT COM. Snag Your Free Thirty one page. PDF absolutely free. Top Two hundred drugs I really highlight Highly testable clinical monocle pearls. So if you're taking a board exam or fear and pharmacology classes or whatever you're doing that's definitely a good review of things that you actually see out in clinical practice with those top two hundred drugs so simply for following Getting weekly updates to the podcast is when we've got a new episode and you can get that Document absolutely for free so go check that out real life pharmacology dot com if you want to connect with me Feel free to do so on linked in as well as You can drop me. An email at either website met at one one dot com or rely pharmacology dot com. Hit the contact me button and it should send an email directly to me. I try to reply to every possible email that I get so if if you don't get a response in price three to five days I probably missed it or went to spam or junk or something so I definitely don't hesitate due to Reach out more than once. So yen linked in Air Christianson Farm D._B.. C._P._S. B._C. G._p.. Or drop me an email at rely. PHARMACOLOGY DOT COM or mid one zero one dot com. Take care thanks for listening to have a great rest your day.
"Welcome back to the real life pharmacology podcast. I'm your host Pharmacist Air Christianson and today I'm going to be covering Byu sperone which the brand name of this medication is abuse bar. it's generic classification is an anti anxiety tight medication and I would say in clinical practice. That's probably the most common reason you're GonNa see this medication utilized on occasion I rarely have seen it used for depression as far as augmentation using it with other antidepressant antidepressant agents in patients who are struggling to get those symptoms under control but I would say that's pretty rare there in general so with Byu sperone. The mechanism of action is really not totally well understood as far as It's role in managing and helping anxiety symptoms now there is some theories some suggested a ECHINACEA of actions that we might think that this medication works through so when you think of medication that might work for depression might work frings -iety we probably think of Sarah energetic activities so that's one of the the main mechanisms that are educated guess or best guess is that it is a partial agonists at five. ht one receptors potentially five ht two you as well so having that agonise stimulating type activity you might hypothesize. That's the reason why why we may see some anti-anxiety anti depressant type benefit with this medication. Now there is one one other suggested mechanism that it does have some mild dopamine block blocking activity saw talk about that a little bit as far as adverse effect profile and kind of a rare situation that you you may come up against with with dosing I think one of the bigger downsides with Byu sperone is that it's got a very short half life and and so this medication is dosed generally two to three times per day so in patients where you've got difficulty with adherence maybe a very busy schedule schedule that type of thing asking a patient to take a medication two or even three times a day. I can be a little bit more challenging so that's definitely definitely more of a disadvantage with this type of medication one other. disadvantage is kind of similar to who let's let's say the assessor is these abuse burn takes a while to work so you're not generally going to get at that instant relief of anxiety. You know it's GonNa take generally a few weeks to really start to to show some benefit in most cases there so that can definitely be a downside advantages of beauce. Berlin compared to you know other anti anti-anxiety medications like Benzodiazepines for example so tolerability beauce prone is generally very well tolerated needed and particularly in our elderly population we don't really run the risk of many active metabolites or or those type of issues. Yes so that can be really a beneficial thing when we compare abused for maybe two Benzodiazepines pins for example which we should know that you know benzodiazepines have a ton of nasty side effects in geriatric patients from forest sedation Dacian to confusion and so on and so forth there another advantage again kind of using that comparison of Benzodiazepines. Is that abuse Perron is not a controlled substance. Oh No risk of addiction dependence really. Isn't there quite like it is for the the bengals so just some some good comparisons. I think to remember with Buesser on there and you know why it might be advantageous to us that this medication or why you don't might not work in certain situations as well I adverse effect profile usually pretty well tolerated at least in my experience from what I've seen. keep an eye out for any medication that it Kinda works in the brain and work on those receptors looking out for any CNS changes. You know whether it's dizziness sedation confusion those type of things maybe some mile. Gi adverse effects but you know it's. It's nothing major you know. Not You know if if you compare it to you'll met foremen and other drugs that have you know well known ability to cause upside. It's definitely nowhere near that ad type of frequency now a couple of things that I did want to mention that kind of tie into the purported mechanism of action so all Serotonin agonists activity there is a potential you'll see precautions drug interactions things of that nature for Serotonin opponents syndrome so you're s arise your TCI's and so on and so forth that could be accumulative type effect act again. This is clinical reasoning looking at the patient or reusing high doses you know have they had a history of of Serotonin Syndrome or something in the past assessing that patient clinically and other medications that can really help us determine okay. Is this likely going to be a significant issue or something. We need to monitor closely or is it not gonna be that big a deal the other one there have been cases cases of pseudo. Parkinson's type symptoms acas thieves. Ya that those type of symptoms movements disorders so so keep that in mind if you maybe have happened to have a patient on you know cinema for Parkinson's for example or if on other dopamine blocking agents you know anti psychotics things of that nature you you could potentially get a little bit of an additive of fact and again. It's Kinda got this potentially week dopamine blockade and that may lead to you an increased incidence of those movement disorders. I haven't seen this in clinical practice personally but there is some literature wrote their case reports and things that like that the that may indicate that this is at least possible so something to think about again something that's not very common at all from kinetics perspective the short half life. I mentioned we need frequent dosing with this medication. unfortunately there is a very high first pass metabolism with abuse perrone as well so. I think that's just an important thing to note. Thanks so let's take a quick break here from our sponsor and then we'll get into drug interactions after the break your pharmacists in the market for Board Certification Asian study material whether it be nap LEK SPEC- ps ambulatory care geriatrics or medication. Derby management certification definitely go check out met at one zero. One DOT COM SLASH STORE S. T. O. R. E. in addition. We've got other professional resources as well so if you're nurse physician student in any field that requires medication education pharmacology things of that nature we do have a couple a couple of books on audible which you can actually get your first one for. Free if you've never tried audible so definitely a cool little perk there you can get six eight hours hours of case studies and drug interactions and good clinical discussion within one of those books again find that link along with all the other resources we have admitted one zero one dot com slash store S. T. Ori now finishing up on Drug Interactions Muser on I would say there. There is definitely potential of for a significant number of drug interactions. the clinical relevance in an an how significant that is is is maybe a little bit up for debate so beauce. Brown is broken down by CYP three a four okay so that's ultimately going to lead to a lot of potential drugs that could impact that three or four enzyme enzyme and raise or lower concentrations of abuse. Berlin respectively so if you've got a SIP three four inhibitor just keep an I out look out for signs symptoms of adverse effects toxicity from abuse Baron so you're classic three a four inhibitors yeah grapefruit juice some of the calcium channel blockers some of the macro allied antibiotics like clearer through Mason as all antifungal. 's those they're just some some good examples of drugs that can inhibit cyp three a four and could raise concentrations of abuse. Brown now. If you've got an inducer on board carbamazepine Saint John's wart things of that nature that could potentially reduce or lower concentrations of Rome so in that setting you might see a patient. That's had their anxiety very well controlled on abuse Perron. Maybe we start start one of these inducers and now all of a sudden they're not controlled anymore because concentrations have been lowered their by this type of drug interaction interaction so just think about some of those medications remember that three or four is a player with Byu sperone and that we're gonNA probably in most situations clinically monitor that patient and then of course the the other drug interaction. I really wanted to point out was the serotonin urging activity tippety where this drug does potentially have some. Serotonin agonists activities so any drug. That's going to raise serotonin own in your trauma. Does your assessor is center is we do have that theoretical risk however low that may be depending upon that patient clinical situation so that's going to wrap it up for today. Thanks for listening. If you enjoy the podcast you'll definitely enjoy enjoy the free resource from real life pharmacology dot com. It's a thirty one page. PDF of the the top two hundred drugs and pick out the most important pearls that you need to know so it really ideal resource for somebody going through pharmacology college classes for example and that's ultimately free great resource for Teachers and if you've got students with you in that type of thing to just to to help teach and educate more about the really important stuff when it comes to medications there if you enjoy the show leaves rating review on Itunes a sorry I forgot to mention that pdf absolutely free to you for subscribing to the blog and getting updates when we've got a new podcasts or new things coming out so go check that out really pharmacology dot COM support support our sponsor met at one dot com slash store and leave US rating review. If you love the show you enjoy listening and you've learned a few pearls here and there so take care. Thanks for less than and have a great rest of your day.
"Hill welcome back to the real life. Pharmacology podcast I am your host Air Christianson. Today I'm going to cover testosterone so testosterone is a medication used primarily in the setting of GME so essentially This is replacement where patients are deficient in testosterone now from a mechanistic physiological standpoint testosterone and its derivatives are found in the body. They're classified as in Anchorage Trajan in Andrew Jans or really responsible for a creating maintaining up male characteristics and the development element of male sex organs. Now you've probably heard about steroids primarily through Abuse if you follow Allo Sports Athletics Track and Field Baseball. You name the sport and Testosterone has probably been associated aided with it As a potential drug To be diverted and in addition to those male characteristics and formation mation of those male sex organs Anabolic steroids like testosterone promote muscle building. So you can imagine regardless of your sport if you're bigger faster stronger. There's potential for abuse of these agents so definitely keep that in mind with testosterone for sure now one really unique thing about testosterone her own and the commercially available products of testosterone. Is there a ton of different drug formulations. We've got got you know intramuscular we've got Topical Testosterone like Gels and Patches Oral injectable actionable as far as We've got a subcutaneous pellets. For example that are kind of time released delayed release of testosterone so multiple multiple different Avenues to deliver testosterone in those patients. That needed one really important and What I think is an important patient? Education point particularly with topical agents especially topical agents. That have have strong. Systemic absorption is that risk of incidental exposure To others that may be helping pick up medications indications or closely intimate with those that Are Using these medications. And they're on the skin and probably most concerning with testosterone Is it does have some negative impacts if a patient a female is pregnant and they're exposed to that so be really really careful in educating patients that that may be using the topical Gel or the patches that you know skin to skin Contact with that GEL or coming in contact with that patch. That drug is obviously going to be absorbed through the skin. That's how we're using it in pregnancy and we can have some really negative outcomes there so Be Extremely careful with patients. Be Sure to educate them. about Those risks especially for those Topical agents now adverse drug reactions from testosterone asteroid. So you can probably think of some of the things that maybe you've heard associated with the abuse of steroids or her Andrew Genyk Anabolic Steroids So I think Acne you've also heard the term Maybe heard the term road rage. So you can have some emotional Changes You know more aggressive agitated anxiety insomnia things like that can happen from Excessive doses of testosterone in certainly in situations of abuse where people people are abusing these for their muscle building purposes. But in addition to that. You know you might say well. Why don't you know we use destroyed a little bit more often? Well there is more risks than just superficial risk and testosterone. Ken Raise Blood Pressure. And with that there's definitely associations with cardiovascular risks things like heart attacks strokes To stop strong can also increase lipids So again there were were creating Maybe exacerbating multiple risk factors That could increase the risk of cardiovascular events in addition there's association with DVD N.. P. Risks as welder older so lots of potential negatives from the use of testosterone. So we need to be really careful. I need to be paying attention into the patient population that we might be using this medication in as well. So let's take a quick break from our sponsor and we'll finish up On Drug Interactions. If you're in the market for board certification study material if you're a pharmacist pharmacy student. I GO CHECK OUT ALL OUR RESOURCES MED MED. One zero one DOT COM Slash Store S. T. O. R. E. In addition to all those exam resources We've we've got clinical books. clinical education. We've got audible books as well promotion. We have going on. You can get your free your first audible book for free. So if you've never listened to inaudible book go check out pharmacotherapy or thrill of the case. both are are excellent clinical pharmacy resources where I've shared a lot of my case studies and clinical pearls things that you actually see in. Clinical Iraq is so great way to get a little bit of experience without actually being in practice. So definitely go take take a look at those resources. support our sponsor minute one one dot com and support this podcast real-life pharmacology as well getting check. ALL THOSE OUT MED. One zero one DOT COM Slash Store S. T. O. R. E.. So let's finish up on. Drug interactions out with testosterone. There isn't a ton of clinically significant drug interactions that you need to be aware of but I'll highlight a few here So what is it can increase Concentrations are there is that potential to raise those orphaned concentrations which which could increase. Irr there so in a patient that you're starting testosterone. You're probably GONNA want to check in I in our and they're on more for new probably GonNa want to check in our You know within maybe a week of starting that testosterone also educate your patients. Beware Hey you you know. You're at increased. Risk Bleed Bruise. I keep it keep tabs on that and definitely let us know If you're having any troubles or concerns in that department even now corticosteroids When we say steroids in clinical in healthcare terms we generally think of corticosteroids so for an asthma exacerbation for rheumatoid arthritis flare? When we hear steroids we I generally think of okay? Yeah you know. We're talking about corticosteroids to reduce inflammation when we say steroids to the lay public You may get different results. There may be patients that have been on corticosteroids in the past for inflammation and they may recognize that that's what we're talking about But many patients that haven't I've been on steroids. They associate Steroids with testosterone in drugs of abuse. There there is a potential interaction in between the two. And it's more of an additive type of fact particularly with the risk of Fluid retention and Dima so if you're using them in combination with one another There may be some additive effects there to keep an eye out for and then we do have some alterations in Kind of glucose metabolism and things of that nature so patients who have diabetes and are taking agents that had a either are insulin or Stimulate the release of insulin in the body we can run into some risks of hypoglycemia Ziemia. So pay attention in a patient that you know. Maybe they're on design. Maybe they're on a you know a long acting. Insulin like glare gene keep an eye on those patients. Maybe a little bit closer when we first start that testosterone. Could you may see a little bit of a drop in a blood sugar in potentiate. Hinchey eight that risk for hypoglycemia. So I think that's going to wrap it up for today if you enjoyed the podcast if you found it helpful do us a huge huge favor. leave us a kind rating review on itunes or wherever. You're listening so so appreciative of all that have done that Also go go to real life. PHARMACOLOGY DOT COM. Snag Your Free Thirty one page. PDF simply I subscribing To follow the the blog or the podcast cast when we've got new releases and new episodes ready for release so Once you sign up you'll get that free. PDF thirty one pages of the top two hundred drugs And I highlight Really important clinical things that actually happen in real life with if those top two hundred drugs so go check that out again. Totally free resource just for following the real life pharmacology podcast. So I'm going to wrap it up for today. Thanks so much to all of you who have supported our sponsor met at one one dot com. If you haven't done so yet again go check out. Those resources there met at one DOT COM Slash Store S. T. O. R. E.. And thank you so much for listening take care and a great rest of your day.
"Hello welcome back to the real life pharmacology. Podcast I'm your host Eric. Christianson thank you all so much for listening today to track me down. His best. Probably on the link to in Air Christianson Farm D. B. C. GP CPS real-life Pharmacology dot com definitely. Go subscribe and get a free thirty one page. Pdf great little study guide on the top two hundred drugs for students young healthcare professionals where I lay out the most important clinical pearls that you're gonNA see likely on your pharmacology and board exams as well as in real life so go check that out for sure. Let's get into the drug of the day Today I'm going to cover die as a PAM which is a Benzodiazepine The brand name of this medication is Valium. And from a mechanism of action standpoint this drug binds benzodiazepine receptors. That's real original how they named those receptors those receptors located in neurons and ultimately that `binding that action can lead to an increase in the effects of Gabba. Now what's Gab? Gabon's in inhibitory neurotransmitter which can alter flow of chloride ions to and from the cells and this can result in hyper polarization and that can ultimately lead to a reduction in basically sowell excitability so end result reduced excitability of cells? So we don't have action potentials and basically transmission of signals Through neurons cross neurons in the brain is most likely where this is going to have an impact so thinking about that. We're trying to basically slow people down reduce excitability at home the CNS down central nervous system. Down this type of drug is going to be used in seizures to treat an active seizure for example All so in situations like anxiety I've seen it used for muscle spasms and that type of thing as well Rarely Alcohol withdrawal is also another situation. Where we definitely have seen Benza. Days pins used I would never recommend a daisy pam for sleep but certainly it can be a sedative as well there okay. So let's talk about dosage forms for a because as a pam is Kinda unique in that it has numerous different dosage forms. The three I've probably seen in clinical practice most often Our oral of course So the drug is is readily bioavailable as an oral agent. There is also a rectal gel called Diet that that can be utilized in the setting of a patient having an acute seizure and then of course we have injection as well. So you know Ivy Administration I am administration but I will say four Intramuscular I M administration generally. We're GONNA want to avoid this in a patient who has an act of seizure K. There's inconsistent absorption which may obviously delay the onset of that drug working can kinda delay peak concentrations of the drug So that could obviously be a really really big negative with. Im Days Pam compared to giving that drug. Iv So very very important To think about those dosage forms when and wear one might be advantageous versus than other. Obviously we're not going to give a DIS doubt. The brand name for the rectal Gel were not going to give that for Anxiety acute anxiety likely. Okay. We're going to reserve that for seizures The oral formulation. That's going to be more so used in the setting of chronic ongoing if that patient needs and benefits and it's appropriate to use a days pam in that patient so think about those dosage forms You know pluses and minuses to each in how we might use them. Actually in clinical practice adverse effect profile with Diana Pam the easiest way I remember it and it's pretty close in line with that is alcohol in a pill so confusion It's a sedative so it's sedating slurred speech falls. You know can impair driving a motor vehicle or whatever other piece of equipment. You WanNa talk about So definitely can be pretty problematic Adverse effects and particularly maybe more so energy metric patient population. Where we're worried about falls and fractures and things of that nature because of that adverse effect profile days pam is actually listed in the beers criteria Which is a you. Know a list of medications to generally avoid in geriatric patients. Now there's another reason At least in my mind why Diana Pam shows up On the Beers list The adverse effect profile is not very good for geriatric patients first and foremost But the second important point involves pharmacokinetics so as we age Our Body tends not to metabolize drugs very well. And as a PAM definitely fits the bill for an example of this So I did learn a rule of thumb at one point and you know the accuracy of this is I. It can certainly vary based upon drug interactions and other things going on with the patient but half-life of twenty hours at When a patient is twenty years old and as you age you can approximate that. The half life is going to Add an extra hour forever year so in an eighty year. Old You can. Maybe estimate that that half-life ballpark might be around eighty hours again. liver function Enzymatic processes can alter at significantly from patient patient but I think it helps give you a mindset of maybe what was an appropriate dose in a thirty five year. Old Patient would be very inappropriate In an eighty five year old patient okay. So you know that rule of thumb and you can think of think of it from a clinical perspective in being very very cautious with using days a pam as our patients get older very very important. Do that One other thing I want you to think about Is Withdrawal Syndrome. So withdrawal symptoms can certainly happen with abrupt discontinuation and in my practice. Most of the patients on as a Pam that I've seen they have been on it for years and years and years and years and if we were to ever try to take them off that medication we certainly would never want to do it. Abruptly go from you know their current does two to nothing so it's important to remember That we're going to have a have to do a thoughtful Slow taper down of that medication if they've been on it for a significant amount of time and I would say most most I've seen suggested maybe ten to twenty percent he every couple of weeks As far as a plan taper now that can vary again from patient to patient. Some patients may WANNA be more aggressive other patients May encounter significant withdrawal symptoms Even at at very modest reductions But that's certainly something. I've that Ballpark is something. I've seen Utilized in clinical practice before one. Last thing I wanted to mention that can make days of him very complicated. And maybe more. So even in geriatric patients Involves the pathway. That this drug is broken down Days a PAM has many many active metabolites and what that means is an enzyme. So let's say example CYP three or four. It's also impacted by CYP two. C Nineteen an enzyme converts Diana Pam into another compound in its process to eventually be broken down and eliminated well many of those intermediate breakdown products can still have active action in the body. So it still going to have similar facts to what the parent drug days. Pam has even after it's been altered in converted By some of these enzymes so it's very very important to remember and can make the kinetics of when Symptoms were resolve or when the drug is when the drug side effects will wear off. That can make that very very complicated in geriatric patients so patients can sometimes get slammed with adverse effects as the drug kind of accumulates and tries to to get to steady state so again another example why we need to be very very cautious If we're starting if we're increasing a drug days pam in our geriatric patient population so I mentioned a couple enzymes. And when we get back from the break I'm GonNa talk about Drug interactions that may impact those enzymes. If you're in the market for Pharmacists Board certification study material like CPS GERIATRICS AMATORI CARE BCM TM. Definitely go check out met at one and one dot com slash store as we get into the. Drug Interactions Section. Here also want to remind you of recently had a new release of drug interaction book and you can go find all these links admitted one zero one dot com slash store so definitely go check out support the sponsor get metted one one dot com slash store so finishing up on drug interactions The first thing I wanNA know is there is a boxed warning with the use of Benzodiazepines and also obviously as a pound when used in combinations with opioids. Okay so we run an increased risk of excessive sedation obviously overdose respiratory depression and those type of symptoms which can ultimately lead to a comatose type situation and ultimately death. If we're giving too high of a dose in combination with opiates so got to be really really careful With utilizing those agents together and ultimately probably avoid if we can at all possible another important thing to think about and just important point to remember because I have seen duplicate benzodiazepines being utilized We shouldn't be using duplicate. Bentos if at all possible together Also drugs like Zoll put down for example have very similar effects to Benzodiazepines in general definitely. Avoid Those types of combinations they can really have additive effects and increase greatly increased the risk of of adverse drug reactions. Now let's talk about those enzymes so cyp two C as well as CYP. Three a four are enzymes that are going to impact the breakdown of Diazepam. So if we have a CYP two C nineteen inhibitor Classic example there is like fluconazole this drug can block that breakdown of Diana Pam and potentially extend the half-life of the drug in increased concentrations. Because it's not bring being broken down as quickly if we're blocking that enzyme. Same THING WITH CYP. Three a four inhibitor. So grapefruit juice Clarence Rome Isan dilettantism. Those drugs can all have some inhibitory action on the enzyme. Cyp Three or four and this can prevent the breakdown of Diana Pam Increasing concentrations increasing likelihood of toxicity those adverse effects like sedation and confusion and false with our patients. And most of the time. It's in geriatric patients because they're the crew of patients who are on multiple multiple medications and that can be Certainly problematic in increase that risk for drug interactions. So I think that's going to wrap up the podcast for today. If you enjoyed the show found some important pearls some good clinical pearls from the show definitely leave us a kind rating in review on Itunes or wherever you're listening it's greatly appreciative To those of you who have already done that Very very appreciative of that definitely. Go check out that free resource. Follow the podcast realize pharmacology dot com once you sign up To get emails. When we've got a new podcast available you'll get that free a thirty one page. Pdf sent to you. So certainly go check that out and support. Our sponsor met at one dot com slash. Store are audible books. Amazon books Board certification resources definitely go. Check that out. Support our sponsor Help US keep this podcast free and available To all those who enjoy and who need to learn Medications thanks so much for listening. Take care have a great rest your day.
"Hail. Welcome back to the real life pharmacology podcast. I'm your host pharmacist, Air Christianson thank you so much for listening today as always go to real life pharmacology dot com snag your free top two, hundred study guide. It's a thirty one page PDF. Costs you nothing but an email and We'll get you updates on when we have a new blog posts and or other education coming out. So definitely, go take advantage of that resource at real life pharmacology. Dot Com. or It's getting in the to the drug for the day. We've got. Oh, MEP resolve. brand name of this medication price sack Definitely I can tell you from clinical practice experience very heavily. Used Drug and certainly ranks high. On the list of the top two hundred drugs this drug is classified as a Proton pump inhibitor also well known as a breed P. P. I.. This drug blocks parietal cells in the stomach in these parietal cells release hydrogen ions, which causes an acidic environment. That X. Acidic Environment. Can certainly lead to symptoms of heartburn potential for a job creation and things of that nature. So again, that hydrogen potassium ATP pump is what's inhibited. In that ultimately blocks the pumping of. Ions or protons into stomach which raises the Ph of the stomach and potentially suppresses that acid which may be causing. That pain or irritation in patients that have excessive production. So with that said, what are we gonNA treat? What are we going to manage obviously things like heartburn Gastro, soft Gio, reflux disease, or Gerd. A peptic ulcer disease Barrett's esophagus, and honestly in clinical practice definitely see it as a catchall. If a patient is experiencing. Stomach type symptoms, and they're trying to figure out what's going on You'll often see these started to help reduce symptoms. Now, that may be right or wrong in certain situations, but definitely have. Seen it thrown on board quite a bit for various indications. At one other one, you may see it used for is gi prophylaxis. So this is a situation where a patient may be at high risk for. Gi Bleed Maybe they're taking an end said for higher does end said, for example. maybe they're on anti coagulation like war friend a picks a band for example, These are situations maybe in patients predisposed to ulceration J. Bleed risk that you may see a like. Oh, MEP resolve utilized. All right. So there's a couple of things I wanted to talk about from an onset. Actions standpoint. So it is recommended to give. A PPI specifically Il map resolve here thirty to sixty minutes before. Breakfast or first meal of the day that's typically the the usual standard dosing. I will see a have had patients take it right with breakfast and it works. Okay. but ideally, it's going to work best prior to giving it to breakfast. So one practice Pearl, I'd I'd educate you about is his sure to ask patients. Especially, non responders when they are actually taking the Omegas all. I've had numerous patients, take it right with breakfast and instead of. Taking it at the appropriate time before breakfast I've definitely had clinicians and providers. Increase that dose before. That question and I think is best that we give medications appropriately the best way we know how prior to actually increasing the dose. So definitely something to think about there. and. We're going to maximize that potential benefit if we give it before eating in the morning there. One other thing that I think's important to remind patients of as well especially if they're starting new on this medication. That maximum effect of acid secretion may take a little while so may take a few days anyway to have the most kind of bang for your buck on relieving a patient's heartburn or indigestion symptoms or whatever where we're managing their. Up So keep that in mind and this is one of the reasons you will see occasionally used on an as needed basis but drug like Brazil and the other P P is they do. tend. To have a little bit more of a delayed onset of action compared to something like an h two blocker, for example. So in that as needed situation, it may not Ideal, but you may get some patients that it does work. Okay. For or maybe they only have symptoms of very periodically and they seem to get by with it. Obviously, we want to limit exposure. if that's an appropriate situation for use of PRN. PPI. All right. So let's talk about adverse effects. Are Really in clinical practice from my experience ice seen, these medications should be very very. Well tolerated in the short term K.. So you know we're using it for maybe a few weeks You know maybe up to six to eight weeks for heartburn symptoms and they resolve it. And we can get off that medication That's a situation where we're probably not going to have. Too much collateral damage as far as adverse effects. Now. We've always got away risks versus benefits of Omeprazole in the longer term because we do have certain associations with. A B twelve deficiency potential increased fracture risk. Increased risk, for C., diff potential for low magnesium. There's lots of longer term associations as we use a drug like a members all for longer and longer periods of time. So really put an emphasis on. Short term courses where possible again, you've got a patient with something like Barrett's esophagus. It it's likely going to be onboard long-term. So lower doses and obviously limit the duration of use where possible to potentially reduce the risk of some of those longer term. All right. So let's take a quick break from our sponsor. We'll finish up with drug interactions. Fear in the market for pharmacists, board certification study materials like NAP PLEX exam ambulatory care be CPS, medication therapy management, or geriatric exam. Definitely go check out Med ed one zero, one, dot com slash store. In addition if you're a healthcare professional, maybe a nurse Med student physician. In you're looking for a better resource on drug interactions things of that nature We've also got audible books. which are free if you've never tried audible book before so definitely go take advantage of that You can go click on the links admitted one one, dot com slash store and get access to those resources. In addition we've got Amazon books and links to other content as well. So again, go sports sponsor Med one one, dot com slash store. S. T. R. E.. All right. So finishing up on drug interactions the first thing. That you need to think about when we think about map resolve is sip to see nineteen in. And in clinical practice, there's a couple of really common examples that definitely will come up. So Omegas all being used with clopidogrel. Is something I have seen used quite a bit together. it still at this point pretty clinically controversial. How much of an impact? That has on overall effectiveness. in my mind I generally try to avoid it that combination if possible. Just because it is kind of a little bit of a clinical gray area as to how much effect that has. So how that works. On Map Rawal inhibits CYP to see Nineteen in by inhibiting the enzyme. That enzyme is responsible for activation. Of clopidogrel caputo girls what's called a pro drug and so it's activated by Cyp. Nineteen. So by blocking that enzyme, we could potentially Lead to the effect of reduced effectiveness. Now, that could be a problem if we're trying to manage heart attacks strokes and trying to prevent those things if clopidogrel isn't working as well as we would like it to work. So again, clinically is controversial. There's been some evidence both ways as whether it impacts patients doesn't impact patients. but if we can avoid that, it's another good rationale good reason to try to limit exposure to Omegas all in the long term if we don't need it, so can't stress that enough to clinically evaluate medications and there need long-term 'cause I have had. Numerous. Circumstances where we can actually get off the PPI. And we don't need it in the long term they're. nother classic. Interactional to classic interactions are Satele Pram Telegram So brand names, there are S- Alexa Alexa pro couple of depressants. And inhibition of CYP, two C nineteen can lead to higher concentrations of these drugs. So you're more likely for adverse effects from these medications. And there has been evidence of increased cutie prolongation from higher concentrations of these drugs. So sits pram actually has a limits or recommended limit on the dosing. Of Maximum of twenty milligrams per day in a patient who is taking Omeprazole with Satala Pram there. At, other medication pry less common I see it in clinical practice much less common than. girl. Is Silos all that's a drug that can be used for him in intermittent qualification It's concentration similar to SOTELA. Prem can be increased with the use of drug like members all. and. Then I think the other most notable clinical interaction with members all and this is true of multiple antacid, suppressing acid suppressing medications. Some drugs require an acidic environment for absorption. So a drug like Suffolk seems cephalosporin antibiotic, Masala mean and iron supplementation for example, these all. Need that acidic environment or it helps absorption and efficacy to have that acidic environment. To ensure that these drugs. Work the best or work to the best of their ability there. So I did do a recent blog post on this. So that's titled Anto, rented one one dot COM Blah the blog. You can find that High Ph reduced absorption of these drugs is the name of of the article I list off five or six examples thereof of common medications of that need that acidic environment. seeing swing over and check that out if you wanted to a list of a couple more there but got to remember that when we Increase the Ph of that stomach. We can impact the absorption of certain medications that I mentioned there. So I think that's going to wrap up the podcast for today. Hopefully, you picked up on some clinical practice pearls again, members all very commonly used drug. And If you enjoyed the podcast today lever rating review, I share us with a friend, a colleague, a student precept or that you're working with definitely share us and help spread the education. support the sponsor one, one, dot com, slash store any links you click there. goes to directly, financially, support a podcast and help keep it free and educational for all to enjoy. So I'M GONNA sign offer today Thank you so much for listening. Go Snag Your Free Pediatric Pharmacology. Dot. com. and. I hope you have a great rest of your day.
"Hey welcome back to the real life. Pharmacology podcast I'm your host Christianson. And you can find me at linked in DOT com. Check out my profile there. Erik Christiansen Farm D. A. B. C. G.. P. P. S. probably the social media platform, most active on. US If! You had a questions. GESTION I do my best to try to respond. To all of those that I can in a timely manner there. ARE REAL-LIFE PHARMACOLOGY DOT COM. Go, check it out a sign up on the subscriber list, and you'll get a free thirty one page PDF on the top two hundred drugs so definitely. feel free to to do that. You'll also get updates as to when we have a new podcast available on a different drug or disease state as far as pharmacology goes. All right, so let's get into it today Calcitonin. is the drug of choice The podcast today. Ran Names of this medication Maya Kelsen and four to cal. Now this medication. is classified as an osteoporosis agent. it is definitely down the line after his fascinates and other medications. there. I have seen it used in clinical practice to help with pain associated with compression fractures. There may be some evidence. Demonstrating some, efficacy, there! It also is indicated for hyper Kelsey Mia as well which I haven't seen. Personally used us very often. with this medication. mechanistically it works by blocking or posing the action of parathyroid hormone. Now ultimately what that ends up doing? Is, it results in the blocking or ambitious of Osteo class activity now if you remember Osteo class from I think it was lend rene to the bus phosphates. PODCAST, Osteo, class, break down that bone. And you know their. Their activity is what contributes to osteoporosis so obviously it makes sense if we prevent the Osteo class from functioning properly functioning at full capacity, we're going to potentially help bone mineral density and manage osteoporosis. let's talk about administration because This is a really important thing. This is not an oral medication. K It's available as an injection ans- available as a nasal spray as well which is kind of unique I would say in in practice. The Nasal Spray is what I have seen way more common than the injection. In general you know who wants to get an injection if if they don't have to compared to to. Maybe a nasal spray might be a little bit easier there. But there is some quirks. with that nasal spray that I have seen quite a few mistakes on. So one The dosing is one spray into one nostril. Once daily in you want to alternate those nostrils every day so day one. You do in the left Nostril Day to do the right nostril. Do not do. To sprays on the same day care, so that's something we. We might do. Some of the Allergic Rhinitis medications like a nasal steroid for example. is to do it into both nostrils on the same day, but that is not how calcitonin nearby Kelsen is to be used. couple of other things with You know kind of some quirkiness with with my Kelsen, so does expire after it's out of the fridge and opened. In thirty five days, so it's got quick expiration date. In addition. it's ideal to. Keep that bottle in an operate storage position. So this is also something I've seen, and and the reason being is, it could The bottle could lose its prime if it's inverted or sideways, and then what happens is the patient doesn't get adequate dose when they squeezed down on the trigger basically and releases that Dole so. Some really. Important I think education points on this medication regarding storage, and then initially when it's I open We've also got a primate in. Make sure we're actually getting that dose out of that. Medication there. Are Let's get into adverse affects. Probably one of the biggest things I think about is If there's medications used potentially can be for hyper Kelsey Mia. Obviously the drug can lower calcium levels, which in a patient with normal or borderline low calcium levels. That could potentially be an issue. So. That is something to think about and look out for their. NASAL ADMINISTRATION Whenever you, you know use nasal administration. You can definitely run into. Your occasion rhinitis and nose bleeds so that's definitely something that can can happen from that medication as well. there are some warnings precautions on certain malignancies. I think that's. Probably an important education point. Clinical practice I haven't seen any issues with it, but there have been been some associations in reports with that that probably should be addressed there. If using medication for osteoporosis, I'm always think about supplementation 's in diets. Meaning looking out for Vitamin D supplementation calcium intake things like that to make sure patients have adequate amounts of that to ensure that their osteoporosis is well-managed in general there. Are Rarely there have been associations with antibody formation with this medication. So This isn't incredibly common, and I don't think I've talked about it in the past, but there is potential sometimes for the body. To create antibodies on certain medications, and if this happens, basically, those antibodies do what they're meant to do, and they essentially neutralize the drug change it. Alter it, so it can't get into cells, and in have activity in and things of that nature so If you've got a patient, that's clearly not responding to the medication, and if you remember antibody, formation generally takes time when we give a a vaccine. For example, we're on instantly. Covered for that disease state so so it may take some time. For those antibodies to develop an to actually see that non-response, but again. It is something to kind of think about if you're not seeing the response you want that could. Potentially happen with this medication. All right, so let's take a quick break in. We will wrap up with drug interactions. If you're in the market for Pharmacists Board certification study material, or if you're just looking for a good read on clinical medication management whether you're a nurse, physician, pharmacist or any other profession that handles medications administers medications. Definitely go check out mid. One zero one dot com slash store got a growing list of resources for all sorts of healthcare professionals as well as a lot of study materials for certain board certifications for pharmacists like CPS. NAPA. LEX, BC GP ambulatory care NBC Mt. M S so Go check those resources out at one dot com slash store. support the sponsor and. Get some unique educational products there as well. All right, so let's finish up on drug interactions and as a reminder. I do have that book. You can find Common Drug Interactions In primary care You can find the link to that admitted one one dot com slash store Click on audible books, and you'll be able to see that you can get your first book for free on Drug interactions where I. Talk about a lot of the most common things and some clinical pearls associated. With that, it's a it's a ten hour books. There's a lot of content in there. so anyway. Drug interactions with Calcitonin. They're really in all. Honesty aren't a lot and the first thing I really think about with drug interactions. Is that a fact that can have on calcium? So remember it can drop calcium levels, and if we're using other drugs that may also drop calcium levels that could potentially have a little bit of an additive effect. So what drugs can lower calcium levels so I think of loop diuretics for example. some of the other medications for osteoporosis, Besiktas, phosphates and Awesome Abbott, those have the potential. To lower blood calcium levels. And one other one not incredibly used, but you might see a chronic kidney. Disease is sin calcitrate. If you remember. This is a medication classified as a Kelsen medic and that medication absolutely can lower calcium levels, so I keep that in mind. If you happen to see a on two of these medications that may lower calcium levels you might WanNa. Do a little more Due Diligence and check those levels a little bit more often there. like I said there aren't many drug interactions. There one other one. I wanted to mentioned was lithium levels. It has the potential to potentially. Decrease, lithium levels so I haven't I? Don't think I've ever seen a patient. At least that I recall. That's on lithium. Ellen an Calcitonin because they are kind of two rarely use medications I. don't see him a ton but certainly you know it would be something you'd WanNa look out for if you're starting Calcitonin in a patient on lithium we'd may check some levels and monitor, and that type of thing, so I think that's going to wrap it up for today. Be Sure to head to real life. PHARMACOLOGY DOT COM sign up saying that free thirty one page PDF. All all it takes is an email. also if you enjoyed the podcast today, found some useful clinical pearls definitely leave us a rating and review on I tunes, or wherever listening and also share us. Shoot an email to colleague. friend classmate if you. Teach in pharmacology and in college or something like that definitely feel free to share this free resource with all your students and help everybody get better and pick up a few pearls on pharmacology, so I'm going to sign off for today. Thank you so much for less than an Air Christianson. You can find me on linked in. Shoot me a message there. also hit the contact button on at one one dot com. Those emails go. Directly to me. I'm going to sign off. Thank you so much for listening and take your rest of your, day.
"Hey. All welcome back to the real life pharmacology podcast. I'm your host, Pharmacist Air Christianson and I thank you so much for listening today If you enjoyed the PODCAST, of course, go to realize pharmacology DOT COM. You can sign up there and also snag a free, Thirty One page PDF study guide on the top two, hundred drugs. So I go snagged out for free and we'll also get you email updates when we've got a new releases of the podcast and other content is well. So definitely a no brainer to go grab that resource for free there. As. So today I'M GONNA cover circling brand name of this medication is Zoloft and I've done a couple of Essar is I believe so far and with that. There's subtleties between the assessor is In a wanted to make sure that those are all pointed out because they they are important and there is different reasons for selecting a different assessor is or and or different things to look out for as we use these these medications so. mechanistically. It's not going to be different from any of the essence rise if you've listened to two previous podcasts on drugs like Satele Pram. Those presynaptic cells Neuron neuronal cells. release that Serotonin and they will also re uptake by taking back in that Serotonin out of the synapse and essentially stop that Sarah urging activity. SS is a block or reduce the amount of that reuptake that happened. So more serotonin stays in the synapse and gives you a physiological. Responses and hopefully helps manage a treat indications like depression anxiety disorders PTSD. OCD. in the way the the medication works there. All right. So one thing I really wanted to point out was dosing It's just common sense. The higher. The dose we start with more aggressive we get. The more likely we're going to run into adverse effect. So. Usual dosing starting dosing ranges twenty five to fifty milligrams. In clinical practice, most often I've seen the twenty five milligrams starting dose utilized. In, geriatric specifically I have actually seen twelve and a half milligrams started as well. So what you're gonNA look at you severity of depression. You know how aggressively do we? WanNa get after this. potential you tolerability issues in the past maybe with. s arise that have been tried or other antidepressant medications. possibly genetic variance may be looked at as well. you genomic testing has been done isn't typically done at least at this point for patients that may be have never tried to necessarily. But I think it is going to get more common as we go on there. Certainly. Are At. So thinking about that dosing, we need to think about adverse effects of we get aggressive with the dosing. The side effect, you're most likely to see or at least the one I've seen most often clinical practice is nausea in maybe more specifically diarrhea. So search aline has been nicknamed squirreling. Because it definitely causes. Diarrhea more frequently. Than, some of the other ESA Sarah so that is definitely one big differentiating factor. With circling compared to some of those other agents within the the class there. nausea I mentioned as well. It's important to note. That patients May. Become tolerant. They May Kinda get through the initial period and it may be okay for them to continue that. Obviously, you're going to have to look at that patient clinically. How severe is the nausea? House fears the diarrhea. And what are we going to do about it do just back off on the dose for a period of time. So maybe starting at fifty milligrams, they're having problems. Can we just back off on that dose You know if you start loads, may we can go to every other day for a period of time and then you don't ramp it back up again and and it might be okay that way. So you're GONNA have to work with patients. They're obviously we can switch potentially to another S. SRI is well that may have a lower incidence of those gi adverse effects so. Important, to think about that work with patients clinically assess if they have had any benefit. Which I'll talk about a little bit here as far as how long that generally takes But yeah important to to work with with patients on that and assess the. Severity of symptoms versus the the risk of of continuing there. Of course, all Esser is have that box warning on suicide allergy risks. Suicidal thoughts important to remember that monitor patients closely certainly as were starting in an increasing doses. A CNS. Happen Fatigue Insomnia. Dizziness dry mouth I would say it's not. Incredibly common. It as far as we think about fatigue versus insomnia, I have seen both happen So definitely, you know just just pay attention to what the patients reporting and checking in on them in monitoring them as is certainly important. Sexual. Dysfunction significant problem with s are is in general search aline is no different there. So. That's something that's sometimes forgotten about and not asked about by healthcare professionals and it might be something that patients may be sensitive about reporting as well. So I keep that in mind the important to ask and assess for that as well. Serotonin Syndrome. I'll talk a little bit more about that with drug interactions and in some medications that may add to that. Tremor I have seen on occasion I would say it's not real common, and again for most of these adverse effects, it's going to be a dose dependent. So as you get up to one hundred, fifty milligrams, two hundred milligrams those adverse effects those unique adverse effects may come more into play. QVC prolongation risk. It's not crazy high on my radar. It has been reported in the literature. SA- Tallow Pram is probably going to have much higher risk as far as the assessor is go in relation to to cutie prolongation compared to something like circling. A weight gain is possible search, Elaine again, kind of middle of the road there as far as the hood of causing it. PAROXETINE would generally consider on the high end fluoxetine would be on the low end of of that weight gain problem and searching lies probably somewhere in the middle there. kinetics search lean does have probably a shorter to moderate half life about a day twenty, four, twenty, six hours I think is is reported in the literature there. So what this means is at least what I think about is patients who miss a few doses may have a higher likelihood of having discontinuation syndrome symptoms, and I believe I covered that on a previous podcast. But again, there's the short of the half life the more likely if we miss a few doses that were going to experience that discontinuation syndrome. So certainly. I believe kind in the middle of the road as far as that half life goes flew oxygen is is up on the high end there where it's got a long half life of several days maybe even up to a week in patients who are. Chronically on that medication. with onset of action, very, very important to remind patients. That antidepressants take a while to work and search lean is known different there we've got anticipate that we're probably going to be weeks before we get. Some sort of benefit going with that medication. that's. A downside because we may experience adverse effects immediately within the first few days of starting that medication. So I can be a challenge to navigate that, but it's important. To remind patients of that that it's not an immediate. Cure all fix for depression. or at. So let's take a quick break from our sponsor, and then we will finish up with drug interactions. Fear in the market, for Pharmacists Board certification study material like be CPS Basiji P. B. c. m. t. m. s. or the C.. ACP exam. Definitely go check out met Ed one dot com slash. Store Of Your Pharmacy Student we have nap like study materials available as well, and you can find links there admitted one one dot com slash store as well. If. You're a healthcare professional looking for a good information surrounding medications whether it be Drug Interactions Clinical case studies I've got a lot of Amazon books, audible books as well, and audible still has their offer available. Where you can go get your first audible book for free. So I've got you don't ten our book on Drug Interactions You can get that absolutely for free if you've never listened. To a book on audible and again, all those links admitted one zero one dot com slash store. or at so finishing up on drug interactions in general I would say. Search Elaine's probably at less potential. For Drug interactions through the SIP pathways compared to other agents like flu oxygen or PAROXETINE. So that's a good thing. Certainly I as far as drug interactions go most often think about Serotonin Syndrome, of course. SOLANA'S LID Other SS, Arise S are is. Cycle Benza preen trauma doll manny's T C. as. Trip Tans, all these medications potentially have. Additive Serotonin type of facts. So serotonin syndrome while extremely rare is extremely serious. So as we add more agents that have Sarah urged activity that risk can go up there. bleed risk is a little bit more of a controversial one. indeed patients on anticoagulant anti platelet medications may be at higher risk for having additive bleeding type of facts and is you remember mechanistically. Serotonin reuptake into platelets is a step in platelet aggregation. So if we block that. We. In theory could potentially block platelet aggregation, which could increase the risk of bleeding. In probably not something that's real high on my radar in a patient on search elaine twenty, five milligrams and they're taking baby aspirin. but you know patients on higher doses maybe on you know more and more blood thinners. You've got that patient that's on aspirin plavix in anticoagulant, for example. It might be something more significant to think about their particularly if we're seeing anemia bleeding bruising. it may certainly be something to to think about and monitor their weighing that risk of you know their depression, their anxiety coming back if we reduce doses, change agents or something like that. So it really a clinical judgment thing in that situation. But again, not crazy on my priority list as long as the patients not bleeding and we don't have Many issues with with bruising or anemia lower global and that type of thing. alcohol I did want to mention that often gets oust with regards to antidepressants in general. There's potential that you don't see ns. Like confusion and things like that could worsened when using. Antidepressants like SSI rise in combination with alcohol. So in general, we don't encourage been binge drinking for example, but certainly. The more alcohol you take. The. More likely were probably going to have you know central nervous system impairment in that type of thing when these drugs are used together. So that really needs to be looked on a case by case basis and certainly making patients aware that it could potentially exacerbate the effects from alcohol when we're taking an ESA. Ryan with that. QC PROLONGATION RISK I wanted to mention it has been reported I. Don't worry about it quite as much with search lean as they do with a drug like Satala Pram, but you will see case reports out there and oftentimes it's patients with other risk factors for qt prolongation. So. I think that's going to wrap it up for today. I think you so much for listening if you enjoy the PODCAST. Leave a rating on review on I tunes or wherever you're listening. That's greatly appreciated. Also check out real realized pharmacology DOT COM go snag that Free Thirty One page PDF on the top two, hundred drugs a great little study resource. for you if if you're going through pharmacology classes or if you just want to refresh her once you get out into clinical practice so Go check that out you can track me down One and G MAIL DOT COM or linked in is probably the the best way to track me down there as well. So Eric Christianson. Farm D. H. E., P. B., C. P. S.. All right I'm going to sign off today. Thanks so much for listening and I hope you have a great rest of your day.
"Hey welcome back to the real life pharmacology. Podcast I'm your host Air Christianson. Thank you so much for taking the time to listen. Today you can find me at real life. Pharmacology DOT COM also on linked in as well and of course I WANNA remind you go to really pharmacology dot com. I take advantage of that top two study guide thirty one page. Pdf absolutely free to you. I highlight the most important Clinical Pearls from each of those top two hundred drugs so absolutely must have Little resource there. So today I'm GonNa Cover alendronate which the brand name of that medication. It's Fosamax this is from a class of medications. Used in the management of osteoporosis. So being abyss phosphate Mechanistically how this drug works is the drug ultimately blocks the action of OSTEO class. So if you go back to physiology In your member Osteo class and Osteo blasts the easiest way I remember. It is OSTEO blasts build bone and Osteo class. Break them down. Okay so blast build class break them. Down now by inhibiting OSTEO class. Where he essentially inhibiting that breakdown of the bone sometimes called decreasing bone resorption and that's going to ultimately increase bone mineral density which makes your bones stronger obviously and Helps fight off the negative aspects of osteoporosis. That's how the the drug works with administration. This is probably one of the most important patient education points. And this is definitely What I see patients I get tripped up on or forget about most often is how to administer the drug so remember these important points so thirty minutes before food. Water other medications. Everything very very important to remember that because These drugs have very low absorption rate. And if we're doing other things with taking that oral medication that's going to block that. Absorption even further. And you're not gonNA get as much benefit from the Medication Cape. So that's step one with administration very important about that Next Plane Water to administer with plain water again avoiding any type of mineral water juices or anything that you know could potentially have components in it that may block that absorption next thing to remember patients need to remain upright after they take this dose for at least thirty minutes also as well as Until they start to intake food for the first part of their day so don't lay down for at least thirty minutes and an until after you've eaten so they get up they take it and they're sitting standing for an hour two hours whatever. That's that's great before they eat That's that's all well and good but make sure that they Eat if they go lay back down all the likelihood of of patients doing that. Once they're up for the day is probably pretty low but I think it is an important point To certainly remember so hopefully that that made sense in the way I explained it there Be Very careful with medications. That also require or often. It's recommended to have early morning administration time so there's two that come to mind that. I've seen a CO administered with this fascinates like Alendronate many many times so thyroid pill and PPI's so those often are administered early in the morning before meals. That type thing Definitely pay attention to that. If a patient's on that and make sure they have a process in place to avoid co administration there all right so let's move on and talk about adverse effects so the first one. I want to talk about we can tie this in to why a patient needs to remain upright. Alendronate Bosposs. The oral was fascinates The increase the risk significantly for Esophageal irritation Potential FOR ULCERATION. If it's severe enough so very very important to remember that also looking at your patients history Do they have severe Safa Justice? They have esophageal strictures. Do they have a significant gi bleed or ulceration history? A very important to take a look at that and make sure they're a candidate for oral phosphate or it's going to work for them or if we need to maybe consider other injectable fascinates or or whatever else we we might consider for that specific patient so Very very important to remember that adverse effect. And if you teach the patients why we need to remain upright. Taking the dose can help help you remember that that adverse effect There are some electrolyte Changes that can happen on account of Alendronate so lore calcium. It makes sense if we're not taking calcium out of the bone We might have a lower amount of calcium in the bloodstream. So it's important to remember that Also some you know potentially nonsignificant Usually non significant changes in Phosphorus phosphate levels as well Other kind of rare stuff with BIS phosphate an AIDS and Alendronate Atypical Femur fractures can happen so this is a situation. Where if that happens It's probably a point at which you'd Stop and reassess that therapy and see. Are they benefit from this therapy? Do we believe this atypical fractures? Likely on account of The BAS phosphate And and kind of reassess from there with kind of each individual patient in similar Osteo of the job very very controversial extremely extremely rare That's important to remember because patients will Definitely look that up on the Internet in see that that that is a potential adverse fact There are some Risk factors and I won't go through them all but Oral Surgery is one cancer. Also treatment of cancer potentially with certain chemotherapy agents can potentially increase that risk for Osteo necrosis of the job. Now there is one recommendation that I have seen floating around and used out there from different different organizations and that's the recommendation if a patient is at risk or patients having an invasive dental procedures something To potentially hold the BIS phosphate for a couple of months for example I don't I'm not aware of any evidence at least at this point that that actually does help. It may make the providers. Feel better for sure but Again you know there. There may be new evidence that comes out about this but I haven't seen anything yet absolutely helps or lowers the risk And again this is so rare that that it is kind of difficult sometimes to to study that in my mind. It doesn't really make sense that it would work. Because just thinking about the half-life of Alendronate I mean the halfway alendronate is years and years and years and you don't by holding it for a couple of months I don't think you would you know alter significantly the potential Of the drug being totally out of the body so That's just kind of my Logical thought process but Keep in mind you know double check literature. Things change over time But definitely keep that in mind because that is something patients End Providers have asked me before For specific opinions on that Dosing seventy milligrams once a week It's important with weekly dosing to remember those odd intervals And ensure that patients are actually taking the medication k. This is again another medication where it's like. You don't get any noticeable benefit from after taking the medication you know. It's not like a pain relieving medication where you take. The pain goes away So sometimes that's that's a little bit harder for patients to remember to take those because nothing really a prompting them to take it so Without let's take a quick break and we'll cover drug interactions if you're in the market for Pharmacists Board certification study material if you're looking for books on clinical pearls and Kennel leaning into your education on how to manage medications definitely go check out. Med one zero one dot com slash. Store your pharmacy student. We've also got content there If you're preparing for NAP LEX absolutely Go check out the links there To all that content as far as our pharmacists certification study materials. We've got VCD. Ps BCC PBC EMPTY MS NBC GP. As well so Go support the sponsor met at one one dot com and help keep this podcast free and educational for all to enjoy all right. So let's finish up on drug interactions. So there aren't a ton of drug interactions with this fascinates And alendronate specifically the one. That's going to come up. Most often. In why we educate our patients to take it by itself are binding interactions. We don't WanNa take any meds with alendronate because it's going to reduce absorption and essentially make the drug ineffective so I. That's very very important. First and foremost As far as drug. Interaction Sko- That's what you certainly should think of From an adverse effects perspective. I do think about Ajayi rotation so patients at risk for that Maybe they're taking and says or aspirin or something Patients already at risk for that where we can have those additive effects of alendronate adding onto a J or tation from an end set for example. And then lastly I did mention kind of in Ostia necrosis There are certain potential medications that can Increase that risk again very very rare very uncommon But if you're you have a patient that's on Chemotherapy being actively treated for cancer There are certain agents that can Have been associated with an increased risk of Osteo necrosis. So those are a few drug interactions not a ton again with Alendronate in the class of this fascinates in general but I think some important ones to Consider an intake of so with that. I'm going to wrap it up today if you enjoyed. The podcast founded helpful definitely Leave us a rating review on I tunes or wherever you're listening. Go subscribe sign up Get EMAILS WHEN WE GET NEW. Podcasts available and we'll also get you that free Thirty one page. Pdf of important clinical pearls. With the top two hundred drugs you can track me down. Real-life pharmacology DOT COM or Linked in is probably the best social media platform that. I'm most active on Erik Christiansen Farm D. B. C. G. P. P. S. signing off for today. Thanks so much for listening. Take care and great rest of your day.
"Tale welcome back to the real life pharmacology podcast I'm your host pharmacist? Air Christianson thanks so much for listening today. Always WanNA remind you guys definitely go check us out realize pharmacology dot, com. Go sign up for the email list. We let you know when we've got a new podcast and other stuff available go check that out real life, pharmacology dot com, and you'll get a free thirty one page pdf kind of a little study guide on the top two hundred drugs are really a unique resource to kind of have. That highlights really the most important things. You're actually GonNa see in clinical practice and I also tried to tie in. A lot of the things that you're going to see. in quizzes and exams throughout your career in in taking. Exams Board exams in relation to pharmacology so go check that out at real life pharmacology dot com. All right, so let's get into the drug today. Satala. Program is what we're GONNA cover brand name of this medication is select so. If you remember I did more of a generalized overview of SSI. but there's really some unique clinical quirks with Satanic AP- Ram that I wanted to kind of nail down in make sure everyone was aware of their, so a mess mechanistically being an S. S. R. I. Selective Serotonin reuptake inhibitor. Essentially this allows more action and activity. In Laws Serotonin to remain in the synapse in 'cause, more action, and that. Serotonin is well known to be associated with feelings of happiness in things of that nature, so with that we anticipate that providing more serotonin will help. depression is probably the most common indication. Used for. Also. Indications and evidence to support the US in anxiety. OCD post traumatic stress disorder, so there's lots of different things you may see us ital- pram used for. Overwhelmingly I'd say. I see it used for depression and anxiety when I do see it in clinical practice. let's talk about adverse effects little bit. J. Upset Nausea that can certainly happen. with SS or is in general can happen was talent. A drawl is one that that I have seen happen before. Telegram, so some of the assessor is are much more sedating or much more activating. I think of Satala parameters kind of being a little bit more in the middle of the road where you may see patients that have a sedating type response, and you may see patients that get an activating type response. So I can't really give you any specific trend there we just have to monitor patients. Make sure they're tolerating it okay. If I had a patient that really you know struggled with insomnia. Let's say and they were staying up at night. I would definitely look in. Make sure that medication is being a dosed in the day same thing with sedation. If it was being dose early in the morning, and the patient said they felt sedated for several hours in the morning, maybe after taking that medication. That might be a patient to do a trial. To switch, that's a teleprompter to the evening so again you WanNa Kinda Taylor what you're GonNa do depending upon. The patient response there and if they encounter either of those potential adverse effects. behavioral changes can happen with any of the assessor is in telegram included there. Remember, there is a boxed warning in pediatrics and young adults. About an increased risk of. Suicidal behavior case reports potentially supporting that so that's a good education point but also a good thing to pay attention to especially early on as we're figuring out if the patient is going to tolerate this medication or not. sad h syndrome of inappropriate anti heretical hormone. That can lead to a significant hypo nature MIA. And in general. psyttalia prime on its own at least in my experience I. Don't know if I've seen too many situations where it's done it on its own but oftentimes it's patients that maybe. Have a pre existing Hypo Nutri Mia. have other risk factors. Maybe there on on other medications like. Carbamazepine for example so usually. The the significantly low hypo me as that I've seen. have been more associated with patients. With numerous risk factors in reasons for Hypo Nutri me, but it is something to to look out for. Another one sexual dysfunction that's more of a class. Adverse effect with the assessor is I think I talked about that before we can look to other agents. If this is a significant problem again not other s arise were probably going to look at of appropriate or maybe a Murtaza's gene that may have less risk of for that sexual dysfunction adverse effect. All right, so whistle teleprompter dosing is important. So usual dosage range I've seen. is in that ten to forty milligram range. With a couple of caveats, so the first thing I think of and this is speaking to my population that I work with mostly in geriatrics in patients. Over the age of sixty, according to the manufacturer package insert. The Max recommended dose of Talent Prom. Is Twenty milligrams. So as you can imagine, that gets difficult. You're try to figure out what to do. Sometimes if you've got a patient that has well on a dose and now all of a sudden. Sixty sixty, five, seventy. What do we do? Do we leave them on that? Forty milligrams, which may be technically isn't recommended or do. We try to do something else so I guess I want to backtrack a second I. WanNa talk about the risk potentially of higher concentrations of telegram, so the risks, the biggest risk is association with Cutie, prolongation on obviously a cardiac complications from that which could be a potentially severe and life threatening, if bad enough there so. Thinking about that patient that's. Getting older and they're on forty milligrams of tallow. PROUN-. Obviously we can think about a trial reduction in trying to taper down on that dose. Now that may or may not work depending upon the situation but that's probably a good place to start as we think about de Prescribing and making sure patients are at the minimum effective dose. Now when that's not possible or patients may be tried that in the past, and they failed miserably they this. Is the only antidepressant that works for them. wish those situations do happen and you get painted into a tough corner. the major thing I would look at here is risk factors for Cutie prolongation? And looking at an actual ekg to see what that cutie interval is. So that can give you a little bit more sense of You know what's going on with this patient, and are we putting this patient at higher risk by having them on the satellite, Brown. The cute interval wasn't too bad or in more of a normal range where we're doing okay, and we can probably continue on with that medication if we're on the higher risk end if we're approaching five hundred or higher as far as the the tea interval goes there. That's definitely a a riskier situation, so we've got to think about. Patients clinically but again you know trial dose reduction, we can consider and ekg in monitoring for Cutie prolongation risk are probably the two most important strategies that I use in trying to assess We should do about a patient on a long term. Higher dose of Satala Pram. All, right, so that's GonNa wrap up the First Section. Here we're GONNA finish up with drug interactions after a quick break from our sponsor. If, you're in the market for Pharmacists Board certification study materials like MTA, 'em. Geriatrics ambulatory care pharmacotherapy. Were the NAP PLEX exam definitely go check out met Ed one dot com slash store. You'll find links to all sorts of packages as far as question banks review courses. For those various exams, so go check that out. Support the sponsor where you can help keep this content. Free and educational for all to enjoy. I in addition to that, if your healthcare professional just looking to hone your skills, get better at at medication therapy medication management Yan Check Out Med one one dot com slash store We've got Amazon books. WHO got links to audible books? You can get your first audible book for free by the way so You know six ten our book on Clinical Pharmacy You can go check that out and get. Those links admitted one one dot com slash store. All, right, so let's wrap up on drug interactions and there are definitely important ones that I think about with settler. Pram specifically. So first off of SOTELA PRAM is metabolized by a couple of liver enzymes and primarily the first one I. Think about is sip to see nineteen. So if we inhibit CYP to see nineteen, we're potentially going to raise. Those concentrations increased risk for the facts and q prolongation and things of that nature. So think about that enzyme to classic medications I think of. Was Way more common than the other, and that most common medication is Oh map Brazil there. There's a lot of people on a generic Pry Lasek K. and it's got some Drug Interactions Satele Pram is definitely one of those, so it's actually recommended. To Max out the dose of the Teleprompter, twenty milligrams if the patient is taking all members all. So it's important again where you can get put into this clinical judgment situation where you know. Maybe you've got a patient. Thirty milligrams of prammer forty and there are no members. All is well and they're doing. Okay, you know. What do we do well? We can certainly monitor that patient. And again we could consider a trial reduction if they're doing well and things are going okay. so I'm talking about a trial reduction of Talim what we could also do is trial reduction in potentially hopefully taper off of Omegas all a in my geriatric patient population. I see that a lot. The over prescribing of P P is so make sure that we actually need both drugs. Because if we don't or if we can reduce doses, or or whatever the case, maybe we can lower that risk. Four, Cutie prolongation and drug interactions there so. same editing another example of drug that can have some to see nineteen in addition but by far in clinical practice omeprazole Ansa Tallow program is the most common interaction. I probably see there. S is I did go through those a little bit in the. General, SRI, category. We've gotta remember other drugs that can increase the activity of Serotonin So Tournament Syndrome is a risk so. Drug like trauma doll Linda's listed t C. as like a trip to lean Eh Mayo is older drugs not use very often, but these are all drugs that have Sarah energetic activity and could increase that risk of Serotonin Syndrome a particularly in combination with Satala Prim. Bleed risk there. This is always kind of a controversial one in a difficult one for me, Does in has been reported to have. Some anti platelet type activities so maybe some blood thinning effect How clinically significant that is? I would say is probably up for debate. Now if you've got a patient that has significant bleeding histories. Still having issues Yeah, certainly we've. We've got to consider the the SRI as well as any. Anti platelets anti-coagulants. All these medications that can contribute. To bleed risk, so it's something I look out for if somebody's really anemic, or they're having blood, loss or bleeding or bruising but it's generally not crazy high on my radar as far as risks go so again important to keep an eye on it and think about it but how clinically significant it is in many situations. Sometimes it's it's hard to determine, and it's you know really looked at on a case-by-case basis based upon other medications, and what's going on with that patient there? So sip three four in addition to to see nineteen could impact concentrations of tallow pram activity. Pram, So think about some of the classic Cyp, three three or four inhibitors have mentioned before. So those can raise concentrations, and essentially the effects of Taliban. Now inducers can potentially lower the effectiveness of teleprompter. Just one last kind of a drug interaction I wanted to talk about there, and then, of course you know other drugs that prolong the q t interval. I. Think talked about several of them in the antipsychotic podcast, but A, definitely important to take a look at that risk, monitor EKG's if we do have risk factors for cutie prolongation. And I also have an excellent blog post guest blog post that was shared. With me. To find that blog posts go checkout qt prolongation, for Community Pharmacists, quick guide admitted one one dot com slash blog. You should be able to to find it. They're a really really excellent. Kind of breakdown of things we can look out for in things. We can monitors I t prolongation risk and the use of of medications, so a quick plug their on that that blog post which I felt was was really helpful to kind of simplify things and Get US thinking in a more clinical fashion so definitely go Check that out. So I think that's going to wrap it up for today. If you enjoyed the podcast, do me a huge favor and leave a rating and review on itunes or share. This podcast with colleagues friends students. Any healthcare professionals that you feel might benefit from learning a little bit more about medications, so I'm going to sign off for today. You can track me down at Lincoln Air. Christianson Farm D BCP SBC GP. And shoot me a message. There feel free to do that and I'll let you go for today and thank you so much for listening.
"Hey welcome back to the real life pharmacology. Podcast I'm your host their Christianson Pharm d and thank you so much for listening and taking the time out of your day. Today I'm going to cover Tanna processed which is an eye drop used in the management of Glaucoma. The brand name of this medication is Xylitol and it is definitely used very frequently in clinical practice for sure so Latina Process the easiest way. I remember the mechanism of action. Because there's lots of eyedrops for Glaucoma is to look at the ending of that. Generic name so the processed in is indicative of a prostate gland in Analog okay so what Those prostate glands do and particularly prostate gland and F. Two helps to lower intraocular pressure and it does this by basically stimulating Floor outflow of the acquiesce humor within the I. Now the humor that simply Simply put as just the fluid within the eye and as that outflow becomes blocked or there's other physiological effects that that prevent movement of that fluid that pressure can build up and ultimately that pressure can lead to damage in the eye which is obviously a a resultant factor and flows into Causing Glaucoma if we're we're causing that damage so by giving that Prostaglandin analogue that's GONNA help kick that fluid out of the I help that flow and ultimately help lower pressures. That's the goal of the medication there. Now there are a couple of really important patient education pearls that I wanNA discuss Some mistakes that I've seen in my clinical practice Without a doubt so first one is storage K. So once the medication is removed from the fridge. It is okay at room temp for six weeks. Guess that's forty two days important to remember that patients Forget that they leave it out on the counter Yeah definitely have run into that. So generally when it's on opened not being used yet Have patients keep it in the fridge? If they're going to put it into use and they're GONNA leave it out. They're going to bring with them. You know wherever they're going Keeping it out of the fridge Six weeks is the maximum recommended Expiration they're so very very important to remember that have also seen that issue. Come up In Medication AIDS Tm as a nurse who are administering these medications to Their patients maybe their caregivers or something like that and Yeah they forget to market when that bottle came out of the fridge and when it's going to expire so very very important to remember that I encourage patients and their caregivers. Obviously to mark the date of when that medication is going to expire. Once you've pulled it from the fridge are at the other important Patient Administration Pearl Patient. Mistake that I've definitely seen is administration of eyedrops Particularly with the timing I've always kind of typically remembered five to ten minutes between different eyedrops. I think that's a good Rule OF THUMB TO ENSURE THAT. We're getting The activity of one drug going and getting that drug in the I Obviously Longer than that. Not going to be an issue but shorter than that where you're giving him thirty seconds apart or a minute apart We definitely run the risk of washing that drug out any sensually making it not effective if we put too much fluid into the eye and duluth that drug so important to remember that with timing generally five to ten minutes apart with a different eyedrops their one other mistake of seeing in patients administering eyedrops in general Avoid that tip touching the I K That can get gross infected. You know what whatever the case may be there so I have seen that mistake with patients as well. So let's talk about side effects a little bit with Tanna prostate. It's an eye drop pretty straight forward. What the majority of side effects are going to be any type of redness irritation pain From the actual I drop within the I By and large is the most common adverse effect I've seen out there in in clinical practice. Now there are a couple of unique ones with Latina prostate and prostate gland. Analogs in general. So I wanna I WANNA mention. We've got to remember Iris Discoloration. So that's really going to bother a patient That could be problematic. So patients with maybe lighter color Irs So maybe a blue or green something like that. The medication over time could start to turn that. I more to a brownish color. Hey so that's very important to remember might be very disturbing to patients It's typically just going to be superficial not gonNA cause any issues with function of the I But for some patients that They really liked their eye. Color that type of thing. That could be very very Bothersome and concerning for him. So it's important to definitely remember that one One other kind of unique adverse effect which In some situations may be a good thing is. Prostaglandins can promote the growth of eyelashes. And so that's kind of a unique one for sure and females particularly Might not like your excuse. Me might like that adverse effect so Yeah a couple of unique ones. Generally both of those Both the Irish discoloration and the kind of extending eyelashes those are going to be longer term. you're not gonNA notice it the next day for example typically so Just keep that in mind. That patient might not see that right away as far as monitoring parameters as a pharmacist. I don't really monitor anything with these medications. They're going to typically be followed by Doctor Monitoring Intraocular pressure and obviously any type of damage worsening vision. That may happen on account of The progression of an Open Angle Glaucoma. So let's take a quick break and then we'll follow up with drug interactions. If you enjoy the podcast definitely go support our sponsor met at one dot com slash store. Sdr Eve we've got a growing list of resources For All different types of healthcare professionals from nurses pharmacists to prescribers like nurse. Practitioners and MED students Definitely go check out those resources. Books on Clinical Pearls Latest Book on Drug Interactions. And Obviously Those Pharmacists Board certification study materials as well so BCP SBC GP Nap LEX MT M Ambulatory Care. Those certification exams definitely go. Check those out Support the sponsor and get some great content along the way so finishing up on drug interactions with a topical agent. That's used in the I. Typically drug interactions aren't going to be too problematic first and foremost I. I want to stress that again. With educating patients. Many patients are on numerous Glaucoma agents. And if they take them too close together. We're GONNA wash that out so in a sense that's kind of a drug interaction but maybe not necessarily do drug But due to the vehicle that the drugs in And then as far as other Drug Interactions. I think about meds that can exacerbate intraocular pressure and or Glaucoma so first one that I think of And probably the most common one that I've seen come up on pharmacology exams and things like that are corticosteroids. So those can increase that. Intraocular pressure Ends heads are another one. I I kind of think of that. Have the potential To RAISE BLOOD PRESSURE. Which could also maybe extend to raising that pressure in Open Angle Glaucoma as well. There now you will see Anti urges come up in Glaucoma and that the increase the risk and that risk generally tends to be a little bit more associated with the closed angle glaucoma which is much more serious acute type situation and then a patient. That's being managed For Open Angle Glaucoma but any drug with anti cholinergic activity could impact More so that risk for closed Angle Glaucoma. If you see an acute situation of that issue so hopefully that gives you some good clinical practice. Pearls definitely go to real life. Pharmacology DOT COM Pickup that free thirty one page. Pdf on the top two hundred drugs a great resource for anybody going through pharmacology I I lay out the most important clinical practice pearls from the top two hundred drugs which also tend to be very highly tested. Pearls on those drugs as well so Go Snag that resource for free. If you enjoyed the podcast today Leave us a rating review on itunes. Or wherever you're listening Those reviews are greatly appreciated allows us to get our educational message Out there even more By sharing those ratings reviews definitely feel free to email a link. Real-life ARMOR ECOLOGY DOT COM to a friend Colleague coworker fellow student And help share in pharmacology education. There's a huge gap. That is absolutely for sure. GonNa Track me down. You can find me at Lincoln. Air Christianson Pharm d be CPS GP You can also find me at rely. Pharmacology DOT COM. Shoot me an email there or one dot com as well and hit the contact button. Those emails should get to me. I do my best to try to respond to everything. So if you haven't heard from me within probably three to five days Definitely don't hesitate to shoot me another email. I might have missed it. Might went to junk Who knows what happened but I. I definitely do try to respond to all the emails that I get. So I'M GONNA sign off for today. Thanks so much for listening Take care have a great rest of your day.
"Hey all welcome back to the real life pharmacology podcast. I'm your host Air Christianson. Thanks so much for listening and making this PODCAST popular Sharon Sharon with your friends I'm greatly overwhelmed by the number of people that care about pharmacology and Really WANNA learn and try to pick up some clinical pearls. So Oh you can reach out to me. real-life pharmacology dot com and with that. Let's get into the drug. We're GONNA talk about today. which is open them? So the brand name for Padam is Ambien and this is a drug that I see on a somewhat regular basis. I think it's lasts nowadays Because of of some of the risks associated with the drug Then it was. You know maybe five ten plus years ago there are so very very important to understand Some things about this medication first. Let's talk about the mechanism of action. Because I think think that's an important One of the the drugs or the class of drugs that I associate 's opem with is the benzodiazepines. Okay so there's definitely a significant amount of overlap between them and Benzodiazepines the difference the primary difference so both drugs class versus OPEM CLASSIC Ben. Today's appearance versus opening. Excuse me They the enhanced the effects of Gabba and Gabba is an inhibitory neurotransmitter. Now there's a couple a couple of different Sites receptor sites that. I need to cover here so there's Benz as a p one receptor site and Ben. Today's Today's opinion two receptor site and the primary difference. Between Adam and the Benzodiazepines is the the activity on those sites so agonised activity on Benzodiazepine site. One will ultimately lead to the additive sleeping hypnotic type adverse effects which benzodiazepines ends open 'em Kerry now is open a little bit more selective for that site Benzodiazepine to site that's more of associated with thing anxiety as well L. as anti-seizure type activity so that's why you don't see them used in the management treatment of anxiety or in the management treatment of seizures compared to Benzodiazepines so very very important. I think to to note that difference. And you know why you wouldn't sees open amused in acute seizure situation while there's ivy formulation and I mean there's other reasons for that but That's an important distinction between these drugs. However because they're both active at the Benzodiazepine site one? They have agonised activity there They definitely are going to have similar. Overlapping side effect profiles and often with many drugs. The higher you increase that dose. We sometimes lose that selectivity as well so you could have obviously a blend and blur of some of the adverse effects that are associated with both Zo. Padam Z drugs Compared hard to the benzodiazepines like raise Pam Diana Pam for example. So that's a little bit of a of a deeper dive into the mechanism of action. Action there It's important to remember with these drugs. There is risk for addiction. Dependence there are controlled substance. So I think that's very important to remember and these drugs really were studied in the best evidence has been shown to be the short term relief of Insomnia K.. These drugs aren't typically meant to be used long-term however I have definitely seen Patients that are on these medications on a more long-term basis so Yeah but we really want to try to Have Avenue Exit. Strategy will have a limitation or an expectation with that patient because we really don't want patients to be on these long term If if they don't have to be so very important to think about that. If you're starting initiating these drugs that we don't want this to be an ongoing thing forever however if we can at all help that dosing so immediate release five milligrams immediately ten milligrams. Those are the two most common on dosage forms. You'RE GONNA see in clinical practice. There is an extended release version. Six point two five and twelve point. Five milligrams I I keep in mind. Dose dependent adverse effects are concerning with these drugs as you get to You know the ten milligram dose for immediate it released and twelve and a half milligram dose for extended. Release your more and more likely to run into Excessive sedation confusion may be increased risk for falls also things of that nature as we increase that dose so those are really the primary adverse effects. These drugs are are going to to Be sedating so obviously. That's going to help manage insomnia however with that we can certainly Go over the line so to speak and cause too much sedation. in addition CONFUSION LOSS OF MENTAL CLARITY. A A fall risk especially in our elderly geriatric patients that something I encounter of course Those are issues as well and we need to really wave at dot carefully with the potential benefit. We're GONNA get from the medication they're uniquely. There is a warning with these drugs as as well like like Zo Padam. So unusual sleep behaviors have been reported Sleep walking sleep eating even and Situations cases of sleep driving have been reported. Now obviously that's a huge risk to our patient and potentially others as well so if patients are encountering those issues The the drug just has to be stopped The that's the recommendation there so Definitely inquire about that inquirer Family members spouses If you notice things that are unusual with this medication Definitely got to address that unlikely. Stop the medication there. Another important education point is recognizing saying that those Adverse effects like confusion and sedation loss of of mental clarity. Those can languor into the next day. So if you do bookwork from home or something like that that probably not quite as concerning However if you've got a very a serious job where people's lives on the line Maybe you run machinery. Maybe you're driving to work the next day. You've got to recognize that that drug could have some lingering effects and this is actually more predominant in females based upon the pharmacokinetics a given a a similar dose We've actually seen in studies that females will actually have a higher concentration of the drug given a similar dose compared to males so very very important to remember that females. We want to be a little extra cautious. Obviously another patient population. Relation is the geriatric patient population They may not metabolize the drug as quickly Probably more likely to be on other sedating agents which all all covered covered drug interactions there as well but very very important to to consider that Withdrawal symptoms things like increased anxiety. Things like that. What can result as on account of stopping that drug abruptly and this is going to be more situations where that patients been on that drug drug four weeks months years even Those withdrawal symptoms are going to be more and more likely so as a Geriatric Atra Pharmacists. That's really my specialty area. I work in the most You've got to recognize That we're likely going undrafted taper off this medication if a patient's on you don't moderate to high doses and they've been on it for quite a while so some things is that I think about with the taper How long have they been on it? what dose are they starting out in also. Have they tried it. Come off that medication in the past I see this oftentimes with clinicians that I've worked with where they say. Hey you know. We've tried off this in the past They're they're going to need it it forever. Well how was that that taper done. Did you try to go from you. Don't ten milligrams to nothing in two days and that's what you did or or did you go you know try to reduce to maybe seven point. Five milligrams then maybe five milligrams. Did you do it over. Try to do it over a couple of months because because oftentimes I've seen Clinicians get into this situation where we've tried to taper the drug to aggressively and then what happens while the patient Asian fails the taper and we never try again and they're stuck on that medication forever so very important to to look at that. Try to get context of that. Got And as long as the patients not experiencing over adverse effects Definitely I wouldn't encourage a slow taper to try to prevent eliminate Minimize some of those Withdrawal symptoms that could potentially happen with the drug all right so let's take a quick break from mar sponsor method one one dot com. If you're in the market for board certification study material like NAP LEX pharmacotherapy Board Certified Defied Geriatric Pharmacists Ambulatory. CARE MT M definitely go. CHECK OUT MED. One one dot com slash store. Oh we've got a growing list of resources Packages with over a thousand Question banks in some cases hours and hours of lectures With different disease states. Lots of good information there to help you Pass your specific exams. So go check that out if your healthcare professional nurse practitioner. I've got lots of Clinical Resources Books on Amazon. Go check out those resources really good information for anybody that manages Drug therapy works with drug. Therapy can really help you decipher what's clinically important and what's not clinically. The important my latest book that Recently created was a book on on drug interaction. So you'll definitely find that on metted one one one dot com slash store under the list of Amazon books. So with that let's get into drug interactions and specifically talking talking about SOPA. So the first one I think of is medications that are going to cause or exacerbates sedation. Came so this is really an additive effect type situation and you've got to remember that there are some over the counters that that can do this so I think of Anti Colin Urge Ix diphenhydramine. For example I think of over the counter sleep medications like Melatonin. Patients often try these medications before they even come into a clinic. Come into a pharmacy And ask insomnia because they want to do it on their own and simple as easy. It's cheap To Buy Asleep aid over the counter and they may not recognize that. Hey Hey you know this now. I've got this prescription for his OPEM. This sedative effect can really add on top of what this other medication over the counter medication that I'm currently taking so really enquiring With patients about okay. You know you're coming in your insomnia Omnia. I know you've tried something. What have you tried over the counter so getting to the bottom of? That's really really important. So we don't end up with this drug interaction Kosovar sedation. Maybe increased risk of confusion and falls That that can really add up so Think about some of those over the counters obviously prescription drugs OPIOIDS GABUM pet noise. Like you have a Penton Transit on all sorts of drugs can be sedating so very very important to recognize those additive effects. And if you feel like you need to start 'em still Definitely go slow in patients agents. Who are taking some of these other agents that could have additive effects? Cyp Three a four inhibitors. I can potentially really alter concentrations of Soap Adam so they would raise concentrations of classically your your strongest inhibitors of it. Three four some of your Azel Antifungal Z- CL- Ruth Reminds Sen Some of your HIV medications like Lapenne. avair Retana there. Those they're all drugs that can inhibit CYP three or four in ultimately reduced the breakdown of him and ultimately increased concentrations Other medications indications. That may play a role Cyp One a two inhibitors. So Cipro should reflect sins got some Cyp one a two Activity there that could potentially have some minor alterations in concentrations fluvoxamine an ESA Sarai. That isn't used terribly often a Numerous drug interactions with that one That could also raise concentrations there. So I think that's going to wrap up the podcast for day as always with drug. Interactions interactions a highlight. Some important ones are things that I've seen in clinical practice There is a whole laundry list. If you go look these up online so just wanted to highlight a few important ones there go sign up subscribe rely Pharmacology Dot Com That'll get you emails to when a new podcast is is available in also will get you a free thirty one page. PDF on the top two hundred drugs. Great little resource for started studying pharmacology studying for board exams Definitely go check that out absolutely get it for free simply for following the blog there Met At one one dot com. I blog there twice a week. So if you WANNA go follow over there you can do that as well Definitely go check that out. I'm going to have an interesting case on on Risperidone all in Simba drug interaction Coming up over the next few weeks so by subscribing over there you can stay tuned to that catch some of those stories in case studies also support our sponsor met at one one dot com slash store Leave us a rating review on itunes. And I'm going to sign off for today. Thanks so much for listening take care have a great rest of your day.
"Tale welcome back to the real life pharmacology. Podcast I'm your host Air Christianson. Thank you so much for listening and sharing this podcast with friends and other healthcare professionals at certainly greatly appreciated. I've enjoyed the episode today. Definitely Do us a solid and leave us a rating and review on I tunes or or wherever. You're listening so with that. Let's get into the drug. I WanNa talk about today and that stay site. Claiming the brand name of this medication is mental and in clinical practice. Pretty much. The only thing I've ever seen this medication used for is gi pain. Gi Spasms most often associated with your table Bowel Syndrome. Okay so there may be some off. Label wacky use that that somebody uses it for once in a while but by and large the overwhelming majority of time. He's Times you see this medication. It's going to be for Ibs and Gi cramping and spasms and pain. It is an anti cholinergic agent So we we've talked about anti coroner Jixian in previous episodes Tricyclic antidepressants Sibley diphenhydramine. I've covered So all those anti cholinergic effects are going to come into play with day cyclamate so just a reminder. We're blocking the action of Acetylcholine in the body and pseudo colon is important in stimulating gut motilal eighty And also plays a role in memory. And depending upon the sub type of receptors Maas Greenwich receptors. That bind STU There's all sorts of different actions that it can have on Various types of smooth muscle so with day cyclamen specifically it has been shown That it's mostly ammo one selective so mosque rennick tape one selective however as we escalate doses we have to realize that we sometimes lose that selectivity so At least in one article I saw the they talked about 'em one being specific More so for The GI tract and salivary glands as well as the central nervous system so those CNS adverse effects which all cover a little bit. Further here That that can happen on account of Cyclamen And of course The GI tract. Where we want to have Potentially facts and and Kinda slowing that gut down and maybe easing the pain of some of the the cramping in the spasms that's where the benefit is ultimately going to potentially come from with this medication. let's briefly touch on dosing here. Quick so Manufacturer does say in its package. Insert I believe that you can use it up to a dose of forty milligrams four times per day. I personally don't believe I've ever seen that dose that I recall and as you get up to those higher doses you just run the risk of having Those anti bothersome anti corner drug adverse effects so clinically the dosing that I've seen often is usually twenty milligrams four times a day and most often. I would say I've seen it onny as needed basis if you think about giving a drug That much with that's highly anti corner you could imagine that it's not GonNa make you potentially feel that great In long run and potentially have some Definitely negative adverse effects so. Let's talk about those adverse effects anti cholinergic so good waiter easy way to remember is can't spit. Cpu POOP so Spitting. That's dry mouth in particularly when we talked about that. M One receptor that salivary glands so dry mouth May present at a higher rate for date cyclamen versus maybe some of the other antics urging can't see can exacerbate Glaucoma can cause some. Some dry is a p is urinary retention so that can be problematic and then poop The constipation is what Anti Cholinergic can. Cause they're now. If you've got a patient with your Little Ball Syndrome with predominant diarrhea obviously a constipated type. Perfect maybe a little bit helpful in managing some of those symptoms. Now if you've got. Ibs patients got pain cramping and they've got a lot of constipation. You're really out to be careful with using dislike lemon because is likely going to exacerbate that constipation further so got to pay attention to that. Got To be really careful You know with doses and being aggressive and that type of thing because you certainly could exacerbate constipation make it way worse. other adverse effects sedation and then of course significant Cns penetration with this drug. So confusion you know. Kind of that mental foggy. Nece clarity that that lack of clarity that can happen Certainly with a psych lean. And you know. I think it's one of the reasons why we WANNA try to limit this medication as much as we can in really targeted to only when the patients having pain not using it on a chronic long-term basis If we can help it because of some of those adverse effects so particularly Cns concerns. I've got a big problem in Maija rattray Pysche population with that potentially A patient that's you know. Maybe not necessarily firing also unders. Maybe they already have some underlying confusion adding on day cycle. I mean you know for their gi pain or spasms that's going to Potentially worsen that confusion. So we've we've got to be very very careful In our geriatric patient population Follow that geriatric Mantra you know if you absolutely have to use the drug start logo slow so definitely Pay attention to that. I mean even in younger patients you think about you. Know some of the sleepiness Maybe some of the the mental clouding. If you've got a patient that needs to you know. Be Very focused at work and You know they. They need to be very sharp in there. They're thinking that that can be problematic again. Maybe depends on. The dose. Depends on the patient But definitely something to look at something to Ask Ask and pay attention to quit. Glasses on pharmacokinetics here. So onset of action. is approximately one to two hours four day claiming so what that means you. Can you can absolutely should in certain situations use this on an as needed basis for pain and cramping But I think it's important to recognize for the patient. Hey you might not notice that this is helping right away. You know within the first fifteen minutes and then the first thirty minutes it might take our two for you to really start feeling any benefit so That may help. Educate the patient to watch their symptoms a little bit more closely and if they feel like you know symptoms are maybe starting and they feel like they're gonNA ask wait like it's a pattern for them maybe jumping on that dose right away. Something they can learn just kind of following What their patterns of symptoms are there Half Life as you can expect with a drunk. That's does four times. A day is going to be very very short. So this is a good thing in the Onset of adverse effects. So if you've if patients experiencing adverse effects odds are likely they're not gonNA last you know five days or anything like that typically in most patients because that duration of action Half-life is generally shorter. You know in the Ballpark of two to four hours with this medication. So let's take a quick break from our sponsor mid one one dot com slash store. Go check out the resources there My audible book of Drug interactions in primary care is now available so I'm going to be putting That Lenk On the mid one DOT com slash store page. So you can check that out under the audible books of you've never had an audible book. You can get your first one for free. So that's a pretty cool thing and it is a large book that took me a while to to make and it's over ten hours of clinical content on drug interactions case studies Things you see out in clinical practice. Of course you're pharmacists. Pharmacy student NAP PLEX BE. Cps Geriatrics Ambulatory Care BC. Mt M S study materials as. Well go check that out Also got hard copies e books on Amazon. There's links there as well so med one one dot com slash store Support the sponsor there and help support this. Podcast keep free and educational for all to enjoy so talking about my drug interaction book. Let's get into drug interactions with day. Sake Lemme By far the biggest thing I'm GonNa look at and I'm going to worry about is anti cooler GIC burden so if you've got a patient that you know is taking medications for sleep. Definitely get to the bottom of bottom of it. See WHAT MEDICATIONS. They're taking recognize if it's an anti corner so a diphenhydramine. Doc SCYLLA mean If they say they're taking you know anytime. Any type of coffin cold preparation. That's a nighttime preparation. Odds are likely it's going to have an anti coroner drink medication in it. So that can have additive effects on top of what they say. Clean can do so very very important to keep that in mind. We've also got plenty of prescription drugs with anti cholinergic effects Hydroxy Zine trae. Sick licks of covered. Ingo listen to to that. Podcast oxy Butin. You know. An older medication used for urinary frequency and continents that type of thing So definitely keep tabs on that medication list or ask your Friendly Clinical Pharmacists. If you have one in your practice or wherever you work to help you out. Take a peek at the the medalist. And make sure we're not doubling up on some of those adverse effect profiles there Additive effects. I mentioned Kenneth Sedation. That can happen with cycling. Means any drug that can be sedating That can be Additive in nature Constipation certainly can happen with this medication. Same thing with dry mouth. Think of those out of affects You know drugs like quantity trash zone or a couple of come to mind. That can cause dry mouth. In addition to other antics constipation. So drugs like opioids could add onto the that adverse effect And then I did want to make specific mention of some of the inhaled. Anti Corner Chicks. So certainly we can have some additive effects particularly with Dry Mouth is probably going to be the most common one there. Most of the inhaled anti corner used in. Copd don't have a lot of systemic. Absorption and systemic effects. So we generally don't need to worry about that too much But it is certainly something to to pay attention to if you know patients taking a lot of it petroleum along with frequent day cyclamen Definitely keep an eye out for that and you're probably most likely to run into dry mouth first and foremost Before maybe some of those other adverse effects other anti cholinergic adverse effects so I think that's going to sum it up today go sign up realize pharmacology dot com sent out emails. When we got a new podcast available. Keep tabs on that you also get a free thirty one page. Pdf of the top. Two hundred drugs. And I lay out my most important clinical pearls with those drugs so really unique resource great resource for you know pharmacy. Students Med students nursing students young healthcare professionals in general. Go take advantage of that. And then if you have time like I mentioned earlier in the podcast Lisa rating review on Itunes or wherever listening and of course sheriff's Sent out an email to two classmates to students. That maybe you're precept for example If you enjoy the podcast share it with them help them pick up some clinical pearls Be Better at medication management and ultimately help all of our patients. So I'M GONNA sign offer today. Track me down on a linked in Air Christianson Farm D. B. C. GP CPS. You can also Send me an email at real-life pharmacology dot com hit the contact button and you can track me down there. Thanks for listening. Take care have a great rest of your day.
"Tayo welcome back to the real life pharmacology podcast i'm your host air christianson pharmacists and you can track me down at real life pharmacology .com shoot me an email there also you can track me down on linked in as well where i am fairly active there as well so today i'm going to cover morphine which is a surprisingly a drug i have not covered specifically yet so i definitely wanted to do that brand names of morphine kadian rocks and all MS contin there are a bunch of different brand names for morphine so if you do see a brand name that you're not sure of definitely a good time to go ahead and look at that look it up and make sure you know what you're talking about there so one of the really unique things about morphine is it's really considered a gold standard opioid as far as dose conversions go and one of the unique reasons why it's like that is because there there are so many dosage forms of morphine so we've got you know oral immediate release we've got extended release we can give morphine IV we've can do epidurals zico administration we've got or liquid formulations a suppository formulations i think you you kind of get the point there there's a ton of different ways morphine can be administered and the geriatric this is definitely a advantageous in our hospice type pop- population where we may not necessarily we always be able to easily give somebody an oral tablet for example so that is definitely one a nice thing about morphine orphan in our hospice type population that may have difficulty swallowing now one real life example sample that i really want to be careful about whether you're a prescriber whether your pharmacist or whether your a nurse administering this medication medication so we've got to remember that this is a high risk medication overdose can lead to respiratory depression and death those are the symptoms of of opioid overdose basically with that said because there are so many different dosage forms arms and because we've had a history of of tight trading doses higher with morphine in the past particularly in hospice patients cancer patients patients there are those numerous dosage forms and if we get goofed up between those dosage forms arms so specifically i'm i'm thinking about oral liquid that's where i've seen errors occur within a geriatric patients if you give ten milligram per five mil morphine if that's what the orders for and you give twenty milligram ram per mille morphine you're looking at a ten fold air potentially if you give a fixed volume they're so very very important recognize that you know concentrated oranmore phoenix twenty milligrams per mille is a lot different than the lower concentration of morphine that can be given which is two milligram per mil so so so critical if you're unsure if if you're unclear if you feel like you're giving a large volume to a patient or doing something that you haven't done before definitely call somebody it double check your math make sure everything is okay with respect to the dosing because once that doses given we do have have narcan that we can potentially reverse in opioid overdose but once it's given you really can't take it back in your putting that patient eh significant risk if an error is made there so i kind of alluded to opioid overdose situation and adverse effects six there ultimately it's going to slow down that respiratory tract and can potentially lead to death it'll just slowly kind of dwindle away patients will fall asleep as the it close to death they will have you know kind of a gurgling breathing noise that they they might make sometimes referred to as a a death rattle so just some important signs is there of opioid taxidermy opioid overdose if you do run into a patient there now other adverse effects prime more commonly finally what you're going to run into particularly if you're starting at at low doses in general at nausea vomiting stomach upset that can happen every once in a while you get a patient that reacts to it you know itching rash and that type of thing constipation is a big one in in generally patients don't develop tolerance to constipation so as long as they're on that opioid they're probably going to have issues concerns with with constipation so make sure that's being assessed in patients who are using opioid therapy and then of course you know sedation especially initially patients might feel a little bit sleepy that type of thing for worried about giving too much you know we think about some all those other symptoms in monitoring respiration and things of that nature but that just gives you a little summary of kind of some of the common adverse suspects that you're going to see with morphine and with opioids in general now i do want to point out we've had some warnings from from the FDA lately regarding opioid withdrawal and avoiding abrupt discontinuation in patients who have been then open on opioids like morphine for a very long time and i have seen this in my practice personally where patients can get very severe withdrawal symptoms it can lead to nausea and vomiting anxiety insomnia sweating wedding and substantial psychological changes in that FDA warning they even mentioned a cases of suicide because his patients feel so terrible with abrupt discontinuation of opioid so very very important to shit to recognize that we get put as healthcare professionals we do get put into really difficult situations where you know maybe maybe unclear whether a patient is diverting medication how much they're using that kind of stuff happens all the time but it is really important to remember that there are substantial ramifications for abruptly discontinuing opioids as well so we've got a you know look at each case individually and do our best to do our best for each patient their metabolism there was one thing i did want to mention that comes up once in a while so morphine is goes through a process called glue purana dacian and with that process it forms metabolites and some of those metabolites do have activity now there's one particularly particularly that you should be aware of morphine six glue cure on it and this metabolite is potentially the associated with some central nervous system toxicity neurotoxicity and patients that are more likely to experience some of those adverse adverse effects from that metabolite our patients with poor kidney function so if you know patients kidney function has been declining and they are on chronic morphine or something keep in mind that that drug ken potentially accumulate in that active metabolite excuse me i i can potentially accumulate and cause some issues there so let's take a quick break from our sponsor met at one one dot com tom if you're in the market for board certification study material geriatrics pharmacotherapy ambulatory care medication therapy management certification we've also got a growing list of resources for nap lex rx dot com so definitely go check out all those resources sources who got links to everything at med ed one one dot com slash store again one one dot com slash store were s. t. o. r. e. if you're a nurse physician other healthcare professional listening we've also got resources at that same link books on clinical clinical pearls and things that actually happen in real life so my book pharmacotherapy is wells thrill the case too great books that can really help you learn some of the real world real life clinical application of medication information pharmacology information so go check out all those resources one dot com slash store so let's finish up on drug interactions with morphine and you'll likely if you've operated a drug interaction program that flags drug interactions you're likely going going to come across something that's going to interact with morphine and the biggest category of meds kind of a generic broad classification is is CNS depressant type effects so when i hear CNS depressants i think of drugs that in general are pretty sedating eating benza is a peens gabba penton pre gabbling maybe some of the anti psychotics older antihistamine gene like diphenhydramine or hydroxy zine skeletal muscle relaxants drugs even like MA wise things of that nature so there's a ton of drugs that really fit under that category of CNS depressants so we've got to be careful and cautious just about starting doses and how quickly we titrate and really assess and it's really really important to monitor these patients closely to make sure they aren't getting to sedated and we aren't greatly increasing their risk of opioid toxicity in opioid overdose to other things i want to mention alcohol marijuana same thing these both can have some sedative type properties opportunities and if you've got a patient that's you know using higher doses or were increasing doses of morphine or potentially i in a situation where the patients are using morphine as an illicit substance abusing that morphine we've we've really got to be careful in caution our patients to the best of our ability that some of these other you know illicit drugs or not considered medications i can have other effects as well additive effects to that morphine at one other quick interaction i did want to mention was the p two y twelve inhibitors so there is some evidence that morphine may kind of block or blunt the effects of these drugs so these are examples here prasad grow pitta girl and in one of my recent podcasts on prasad grell i do talk about this a little bit further so so you may want to head back and listen to that one again if you want a little bit more detail on that or detail on on grill in general so i think that's going to wrap it up for today thanks so much for listening if you enjoy the show leave us a rating review on i tunes greatly appreciated or wherever you're listening also snag your free free PDF real-life pharmacology dot com thirty one page PDF great resource for young healthcare professionals healthcare care professionals that have to take a pharmacology classes or board exams that require you to know pharmacology just a great quick resource that hits the highlights on the top two hundred drugs so it definitely free to you just simply for following the podcast and we'll let you know as as well when we've got a new episodes available which are typically weekly on thursdays thanks so much for listening
"Over Mira Baghran The brand name of this medication is murder trick and it is important to note that this medication at this time hale welcome back to the real life pharmacology podcast I'm your host Pharmacist Air Christianson thank you all so much for listening today I'm going to see Astore Urine so this means that those muscles they aren't constricting they aren't contracting and when you have that constriction and contrast action the patient what they're going to experience likely is that sensation for going to the bathroom so as you could imagine this man vacation is used to manage overactive bladder symptoms urge incontinence type symptoms now I did mention the cost three agonists and you may remember Beta receptors from thinking about betablockers to other Beta agonists and the really important point about Beta receptors is there's multiple sub types of those receptors so the using if you've got a a medication that needs to be dosed multiple times per day the more often you have to dose that medication the pharmacology of the drug actually how the drug works so it's classification it is a Beta significant and you know any patient that's taking this type of medication that always has to be part of our of medications and if they can afford medications so getting into the getting over that little rant there let's get into the not be covered by insurance initially so that's always a big big challenge and I think a lot of healthcare professionals don't understand lacks and when that bladder smooth muscle relax relaxes this allows for a greater capacity greater ability to that Beta three receptor activation or that agonised activity it allows for the bladder smooth muscle let's go are primarily found in the bladder urinary tract system mechanistically how this drug works is a huge huge role in depending upon that patient's insurance how well they're able to afford that medication they may be rationing it they made maybe skipping days on purpose they may be using that in a non approved or inappropriate way that might make that medication as a brand name medication you have to have the expectation that it's going to be very expensive and in our medical system it may or may not in less effective so just have to have to recognize when you're working with patients to ask those questions about the cost whereas brand name medication That cost Ballpark is in the range of three hundred to five hundred dollars a month and so that's substantially assignments so I just wanted to lay out that point because it is so important when it comes to patient adherence to recognize that cost just as being an important factor when it comes to reviewing and assessing patient adherence to medications one other important factor is does the three main subtypes of Beta receptors where we have drug targets are Beta one two and three so one and at least what the cash price for a lot of these medications are so just to give an example of Murga tricky and dosing is pretty easy pretty straightforward so we've got twenty five milligrams or fifty milligrams once day the more likely it is that patients are going to have a difficult time following that regimen now with Mir beg run it isn't extended released product those subtype of receptors are typically found in the heart for example Beta two or on the lungs and Beta three at least as far as drug target ministration so overactive bladder urging continents frequency. This is typically going to be a problem in your geriatric patient population at Max recommended dose there is is twenty five milligrams if we've got patients on dialysis patients with creatine clearance less than fifteen miles per minutes recommended to avoid the use of this medication one important point about that for the most part and it's important to remember that as we age we may not be able to swim the one major exception is there is an adjustment in patients with chronic clearance fifteen to thirty mils per minute follow medications quite as well as we used to that may be an issue I I've definitely run into to patients that are you know crushing medications in mixing it that can act on Beta receptors we've always got this potential for working on as far as adverse effect profile goes think more of the the Beta one activation so Beta one agonised activity very very important to remember that and when we go from that twenty five milligrams up to fifty milligrams it's definitely going to be more likely to happen. woah uphill whole for example adverse effect profile so when I think about a drug three receptors and what blockade does versus agonised activity there another thing to keep in mind the potential ramifications from that are increase in blood pressure in increase in pulse so it's important to recognize that and some of those other Beta receptors so in the setting where a patient is maybe on the higher dose for example in stuff they're chewing up their pills actually in in their mouth and it's important to to make sure we're assessing that nations so be sure to assess that with patients that you might think have a borderline capacity or -bility to be able to swap or for whatever reason that Beta three agonists is activating some of those Beta one and Beta two receptors specifically block that bladder outlet or potentially at least inhibit reduce the potential for Bladder out mirror beg run as a dose dependent factor may increase blood pressure in May increase a heart rate case if we kinda relaxed that that bladder smooth muscle sometimes these medications or or mere Baghran's used income as well because something like mayor Beran this is a medication that you're you're not supposed to split chew crush because it is an extended release formula and symptoms of urinary retention so let's take a quick break from our sponsor here and I'll finish up on drug interactions if you're in the market for Pharmacists Certification Study Material We've got BC MT M S we've got be CPS BCC pe- as well as folks if you've never had an audio book from Audible Dot Com they have a special promotion where you can absolutely get your first one for free so I've got links there rene retention so they have frequent stones for example it's probably more rare case more commonly if they have something like bph that's going to a lot of potential for drug interactions particularly drugs that are impacted by alterations in the function of core resources for Nurse Practitioners Med students PA students In all all different types of healthcare professionals who there is well admitted one one dot com slash store we also have books on Amazon NAP plex study material a whole host of Clinton that are actually activated by Cyp Two d six so if you use Mir beggar on if that's up to thirty six so Cyp Tutti six it's an enzyme that breaks down certain drugs and or converts them into active metabolites now have to understand what medications can do and holiday can impact patient so you can go check out those resources help support the hello and the Drug Mayor Beg Ron In combination with Anti Corner Jackson's well could potentially worsen that and worse the nation with Other Urinary Anti Colon urge ix so keep an eye out for patients who may have urinary retention or be at risk for a- At that higher dose so very important to recognize the pharmacology behind that to understand the differences between Beta one two and to happen now we also have numerous drugs that are active that are broken down and turned into we've got a couple anti depressants for example flew Occitania
"Hey, all thanks for listening. Welcome back to the real life, pharmacology podcast. I'm your host air christianson, pharmacists, and we have got a heavy hitter for a drug today drug called carbamazepine, and there is a ton of clinical pearls with this medication. So we'll just get right into at brand. Name of this medication is tech Raton, and its mechanism isn't totally well understood, and there's multiple possible mechanisms I would say the one that's most commonly associated with the Houston, this drug as binds, sodium channels and alters sodium transfer across cell membranes, which can ultimately slowdown prevent action potentials from happening and synapses and things like that. So kind of a little bit more of a challenging medication as far as the mechanism goes because there is kind of so much ambiguity. And it works in the brain, which makes. Things more difficult to research and understand. But that sodium channel aspect does seem to be important. Other things that, that can potentially cause can stimulate the release of age. So we'll talk about that a little bit adverse effect profile mildly anti corner GIC as well. I would say, in the grand scheme of things that probably isn't a huge, huge deal. But because there are so many different side effects and boxed warnings with this medication now getting into the uses in my clinical practice, probably the three most common, I've seen Tegel tall or carbamazepine used for is seizures BI polar disorder and tread. Jemele neuralgia and it's, it's really a, a messy messy drug as far as lots of drug interactions, which will cover. So that's really why you don't see a lot of provide. Offers using this medication. Because there's so much a monitoring in potential for hazards along the way with this medication. But obviously in a situation like seizures bipolar disorder or trigeminal neuralgia or you know, maybe we're limited options and or it's very serious condition. You may potentially see it. I did want to mention target concentrations, usual. Target concentrations, are four to twelve micrograms per mille. Now with that said in something like epilepsy. This is much more important to find kind of target goal level of, of where we want a patient to be in something like a tragic neuralgia where, you know, you're treating pain and you're treating symptoms. Obviously, it's probably not that big deal to find a target concentrations. Now, if you're recognizing some symptoms of toxic maybe some CNS problems, some GI upset things of that nature. After that might be a situation where you actually check a level. But, you know, in, in try jemele neuralgia for example, ongoing routine monitoring of levels is going to be much, much less important than when you're treating seizures with as medication one thing that always comes up or frequently comes up on exams is carbamazepine is an enzyme inducer, and it can actually auto induce its own metabolism. So kind of stimulates itself stimulates the breakdown of itself until it reaches a steady state, but this auto induction can take weeks maybe in the period of two to five weeks for this auto induction Kana to come to a steady state. So if you've got a patient, that's maybe very stable after, you know, a few days or week or something like that. It. There is potential that those concentrations could come down as kind of this auto induction ramps up a little bit. So what that means if a patient is starting on this medication, and we're doing drug levels and monitoring for efficacy, whether it's reducing seizures, or, you know, mood control by polar disorder we need to have that close monitoring within those, you know, maybe I one to two months that type of thing. Now, adverse affects we've got a boxed warnings with carbamazepine. And so the first one's actually genetic variation. So patients with the. Lille. H L, A B fifteen to, and I have seen that come up on test questions as well. These patients are at risk for severe skin reaction called Steven Johnson syndrome. So that's a good one to remember also warnings on a plastic anemia also a granular Saito, so lots of things to kind of unpack, and you could definitely understand how you don't monitoring certain labs, CBC and things of that nature would be important with this medication. Now talk city at did wanna talk about a little bit. So obviously these box warning things can happen. But in the realm of tax. Cecily due to do to too high of concentrations. I think you can think of it very similarly to, you know, alcohol Fenton, those kind of toxins where you're really gonna have, you know, that CNN's depression, maybe dizziness, maybe a taxi difficulty walking, you know, maybe nausea vomiting, some GI upset confusion things of that nature is what you're going to see if those drug levels get elevated now couple other adverse effects again. I said, this is very dirty drug. I always think about highpoint trivia, I absolutely have seen cases of SIA, D, H and hype. Nate tree Mia from carbamazepine that risk tends to go up as we're on more agents that can also cause highpoint trivia, he think about, you know, loop diuretics or diuretics in general. Also think about SS arise and medications of that nature as well. So definitely important to keep tabs on sodium with this medication liver. Toxicity is possible LSAT's are in with that CBC monitoring as well as sodium monitoring an important aspect that you're gonna wanna follow in a long, you know, with the L F teas that, I mentioned, you got to think about other agents that might be damaging to the liver as well. Obviously in combination with another agent like carbamazepine that can cause some liver problems. That's something to certainly be aware of as you're looking at that patients, maybe poly pharmacy medication list. So with that. Let's take a quick break from our sponsor admitted one one dot com slash stores. Proud sponsor, the real-life pharmacology podcasts, just love the podcast. Enjoy the free material go support met at one one dot com slash store. Tons of resource. You can even get a couple of free ones. If you've never had an audible book, so definitely go, check out those links take advantage of that. If you're pharmacists, or pharmacy student looking for board certification materials. Absolutely. That is a good place to go. Check out what we've got at mid one, one dot com slash store drug interactions. So probably the biggest thing I think of with carbamazepine is it is an inducer and you always gotta remember what an inducer is versus what an inhibitor is. So a sip three four inducer is going to stimulate these enzymes in the liver to clear the body of drug or metabolize drugs. More quickly. So if a drug not carbamazepine is metabolized by CYP three a four and we use carbamazepine. That drug is going to basically be chewed up faster, and it's a facts aren't going to last as long in a patient, who is not on carbamazepine. So it's kind of a simple as simple as I can make explanation to try to understand what happens to these drugs that go through CYP three four and here's some examples, so a picks Aban river rock. Som also warfronts anticoagulant. So if those concentrations fall because we're using carbamazepine that's a pretty big concern. You know, depending upon what you're using it for you're looking at increased risk of DVD p potentially a risk of a stroke. If we don't have adequate anticoagulant, concentrations to help prevent those strokes. So definitely a big deal there, again, gray. Good example, why we try to steer clear from using carbamazepine, if we can avoid it era. Pip Zola lands opinion, a couple of anti psychotics I think of there's anti-hiv drugs. So I think of the protease inhibitors, as well as some, some other oddballs that can be reduced concentrations, and reduce the effectiveness there, alternately, dill, tie them Rapa. Mel again couple of medications you may see amused for hypertension. May see him used for maybe migraine prevention. Maybe atrial fibrillation. A few different uses you can use that type of class for gin, those concentrations could be reduced by adding carbamazepine some of the as all antifungal, you gotta think about contraception. So estrogen contraception could be chewed up a little bit quicker. And that might leave a pair. At more risk for becoming pregnant when maybe they don't necessarily want to be, so that's an important one there as well. Also, some other oddballs hydro Koto and that's got some CYP. Three four metabolic breakdown today. Phil, another example, with the fast food restaurants. Five inhibitors there drug for rectal dysfunction. So very, very important to think about other drugs, whenever carbamazepine I think that's the, the bluntest most simple point. I can can tell you, and I would encourage you, if you see this drug being used to run an interactions check look it up and see what we're going to be affecting. 'cause if you've got a patient on three or four or five, plus medications, and carbamazepine odds are probably pretty favorable that one of might be affected. So very, very important. There. Couple of things I did want to mention, so a grapefruit juice. So that is known to be a sip three or four inhibitor. So this can actually raise concentrations of carbamazepine, so grapefruit, juice with carbamazepine may put a patient at risk for carbonates being toxicity, how important to remember that one. I do wanna I kinda hinted at the teas, you know, thinking about drugs that, that may cause liver function problems, and you add on remains a PM could be potentially an additive effect type of thing. And then I also think of the SAD h which I think I mentioned, a couple of examples there of other drugs that could 'cause that adverse effect, and that low sodium, as well. So that's going to wrap it up for today. Thanks for listening. If you love the podcast, fodder helpful leave us a rating review on I tunes greatly greatly appreciated or wherever else. You're listening there. Get your free. Top two hundred study guides thirty one page PDF, real-life arm college dot com. That's simply I subscribing, you'll get that in you'll basically get Email a blast as to when we have a new educational podcast is what that list is for their so sport, our sponsor minute when one dot com slash store, and I am going to sign off for day for today. Thanks for listening and have good rest your day.