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 Summary:  Prescription drugs are so often approved for what they can do for you, and abused for where they can take you…and so it goes for Ketamine.  Valued for its ability to provide sedation and analgesia while maintaining cardiorespiratory stability, its abuse lies in its dissociative and hallucinogenic actions.  This episode is a brief discussion of the history of ketamine, what it is, how it might work in the brain, possible new indications as a prescription medication, and possible adverse effects of long-term ketamine abuse.  Recent studies indicate these troubling long-term effects may include memory impairment and diminished executive functioning i.e. ability to plan ahead and meet goals, display self-control and stay focused despite distraction.

Topics:

·      Dissociation 01:40

·      K – Hole 02:10

·      Dissociative Anesthetic Hallucinogen 03:00

·      Spravato (eskatamine) 03:55

·      Altered States 04:45

·      Hallucinations – Drugs to Prevent & Drugs to Induce 05:15

·      Balance 06:00

·      Chronic Pain Management, Neuropathy, Migraine, Refractory Depression 06:30

·      Response Time to Meds for Depression 07:00

·      Ketamine Mechanism of Action? 09:30

·      A Spiritual Experience? 11:20

·      Ketamine Side Effects 12:40

·      Close Monitoring 17:00

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Summary:  The medical term is vasomotor symptoms (VMS); the more common term is hot flashes and night sweats; the term used by my wife is Sweaty Betty.  And that’s as nice as she can be about it.  Recently the FDA issued a Priority Review for Veozah, due to its unique non-hormonal action and if approved, the potential significant improvements it might provide for moderate to severe hot flashes, compared to standard applications.  This May it was approved.  In this episode we introduce Veozah as a new option in the treatment of hot flashes, this discussion as always including the Risk-Benefit analysis of the drug. 

Topics:

·      Veozah 01:21

·      FDA Priority Review 01:43

·      Risk-Benefit 02:13

·      VMS (Vasomotor Symptoms) 03:55

·      Hypothalamus 05:27

·      Thermoregulatory Dysfunction 05:41

·      Biofeedback 05:57

·      Hormonal Therapy (Estrogen/Progesterone) 06:39

·      Non-Hormonal Therapy 07:29
      (antidepressants, gabapentin, pregabalin, oxybutynin, clonidine and Veozah)       

·      Mind-Body Options 08:15

·      Veozah Mechanism of Action 09:25

·      Randomized, Placebo-Controlled, Double Blind Study 10:00

·      Placebo Effect 10:41

·      Risk-Benefit Analysis 12:20

·      Risk-Benefit Analysis of Veozah 13:10

·      Veozah Possible Side Effects 14:10

·      Veozah Drug-Drug Interactions 15:40

·      Post Marketing Data 16:30

·      Monitor-Monitor-Monitor 17:15

·      Veozah Cost 18:00

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Summary:  To discover how you got here, you must care enough to ask the question.  This episode is not about peeling away the layers to discover what’s at the mysterious center of your med regimen; rather, it's simply about starting with the drugs which address your most urgent health needs – in this case, your heart.  We will  follow that trail of drugs (one often leads to another), and then move on to other medical conditions i.e., comorbidities.  Ultimately, achieving a balance of the right drugs, doses, and schedules, by monitoring your meds and communicating with your physician and pharmacist, will not only reveal how you got here, but it may result in a better here.

Topics:

·      Meds For Life 01:55

·      Vioxx & Celebrex 02:24

·      Vioxx Voluntary Pull 04:00

·      Celebrex 05:07

·      Acute Coronary Syndrome 06:12

·      Plavix (post first stent) 06:36

·      Nitroglycerin 06:56

·      Brilinta 07:15

·      Metoprolol Tartrate 07:50

·      Nitro-Dur Patch 10:09

·      Nitro Headache 12:00

·      Nitro-Viagra/Cialis Interaction 13:15

·      Monitor Your Meds 14:30

·      Atorvastatin & Fenofibrate 16:35

·      Lopid 18:32

·      Brilinta & Aspirin 19:00

·      CoQ10 20:55

·      Tamsulosin (Flomax) 22:12

·      OTC Drug Interactions 22:30

·      Vitamin D 24:10

·      Shared Decision Making 25:09

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 Summary:  Time to talk about the number one prescribed drug in the United States.  Xanax?  Ozempic?  Adderall?  Nope.  Atorvastatin (Lipitor)!  You fasten your seatbelt to prevent possible harm, and people do the same with the statins, the possible harm being a stroke or heart attack.  It’s all about oil in water.  It’s all about cholesterol and triglycerides (fats) in your blood (92% water).  Why you have cholesterol in your blood, and why you might start, why you might continue, and why you might possibly have to stop Statins.  And should they fall short in lowering your cholesterol, or you cannot tolerate them, the options are discussed as well. 

Topics:

·      What are Statins? 01:30

·      Oil in Water 02:12

·      Atorvastatin (Lipitor) 02:55

·      Fluvastatin, Lovastatin, Pravastatin, Rosuvastatin, Simvastatin 03:30

·      Starting Statins due to Risk Factors 04:35

·      Low Density Lipoproteins (LDL) 05:35

·      Stabilize and Prevent 06:00

·      High Density Lipoproteins (HDL) 06:25

·      Cell Membranes & Hormones 07:00

·      Diet & Exercise  Statins 07:20

·      Statin Side Effects 07:55

·      Liver Function 08:00

·      Type 2 Diabetes 08:37

·      Muscle Pain 09:33

·      Nocebo Effect 10:20

·      Crestor 11:23

·      Memory Loss? 12:00

·      Right Statin at Right Dose at Right Time 14:08

·      Statins and Grapefruit 14:35

·      Maintenance Med 16:00

·      Commit and Monitor Your Therapy 16:35

·      Statin Alternatives 16:55

·      Repatha & Praluent (monoclonal antibodies) 17:05

·      Familial Hypercholesterolemia 17:58

·      Leqvio 18:36

·      Nexletol 19:03

·      Zetia 19:15

·      Cost Risk 19:40

·      Colestipol 20:39

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Summary:  Why Sertraline for me?  Why any drug for you?  Research and development of new drugs doesn’t travel in a straight line.  If luck is where preparation meets opportunity, there’s plenty of luck on that winding trail in the pharmaceutical industry.  This episode traces the development of antidepressants, including new emerging possibilities, ultimately answering a listener’s question:  why sertraline for me?   

 Topics:

·      Gone Fishing 01:05

·      Why Sertraline for me? 02:00

·      MAO Inhibitors (Nardil) 02:27

·      Tri-Cyclic Antidepressants 03:30

·      Serotonin Specific Reuptake Inhibitors (SSRI’s) 04:25

(Prozac, Celexa, Zoloft)

·      Serotonin & Norepinephrine Reuptake Inhibitors (SNRI’s) 05:25
(Cymbalta, Effexor, Pristiq)

·      Wellbutrin (bupropion) 06:00

·      Ketamine 06:36

·      Comorbidities 07:36

·      Sexual Dysfunction 08:30

·      Trazodone 08:54

·      Risk-Benefit & Algorithms 09:38

·      Talk to and with your MD! 11:00

·      When started?  Dose? Intended Effects and Adverse Effects 12:10

·      Cause and Effect 12:50

·      Help @ 988 and SAMHSA 1-800-662-4357 13:14

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Summary:  Alcohol for alcohol addiction?  Nope.  Opioids for opioid addiction?  Yep.  Why?  And for how long?  The addiction to opioids digs in deep and doesn’t want to let go.  Discussed here, to better understand treatment for opioid addiction, is a brief history of how we got here, the principles of how opioids work in the body, and how the opioids for treatment are supposed to work.  Also discussed is the opioid addict’s lifeline:  naloxone.  

Topics:

·      Pain Management 01:41

·      Oxycodone-Morphine Comparison 04:10

·      Heroin 05:07

·      Compassion, Respect and Opioids 05:51

·      Alcohol 06:29

·      Naltrexone 06:36

·      Antabuse 06:50

·      Opioids for Opioid Addiction 07:31

·      How Do It Work? 07:54

·      Opioid Receptors, Endorphins and Dopamine 08:10

·      Receptor Affinity 09:00

·      Intrinsic Activity 09:10

·      Dissociation 09:20

·      Opiates = Naturally Occurring 11:47

·      Opioids = Natural, Semi-synthetic and Synthetic 11:58

·      Methadone Treatment 13:10

·      Methadone Clinics – the Treatment Dose 16:00

·      Suboxone 17:31

·      Suboxone Ceiling Effect 18:31

·      Suboxone Maintenance or Withdrawal? 21:30

·      Chasing the Impossible  23:07

·      Heroin -> Opiate Receptor -> Endorphin Release -> Dopamine Release 23:30

·      Tolerance, Dependence and Addiction 23:52

·      Naloxone 26:05

·      Naloxone Nasal Spray OTC 30:00

·      Reach Out For Help 30:11

988 Suicide and Crisis Lifeline

SAMHSA National Helpline = 1-800-662-HELP (4357)

Local Hospital ED...

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Summary:  A little understanding of the culprit drugs can go a long way in preventing them from becoming gang members and doing harm by causing a fall.  There are usually several factors that contribute to a fall, from a difficult-to-navigate environment (extrinsic cause) to the things going on inside your mind and body (intrinsic cause), including your condition and the effects of drugs.  Here, we hope to change the question from ‘why did he fall?’ to ‘how do we prevent him falling?’    

Topics:

·      Where Most Falls Occur 02:31

·      Intrinsic Causes 02:50

·      Extrinsic Causes 03:00

·      Culprit Drugs 03:31

·      Culprit Drug Actions 04:20

·      Toileting 05:27

·      Culprit Drug Groups 06:20

(neuroleptics, antidepressants, antiepileptics, antiparkinson, narcotic analgesics, sedatives-benzodiazepines, diuretics, antiarrhythmics, vasodilators, cholinesterase inhibitors) 

·      Starting a Med and Monitoring 07:45

·      Polypharmacy 10:03

·      Example Drug Regimen 12:10

·      Lasix 12:45

·      Neurontin (Gabapentin) 13:36

·      Nitroglycerin 14:10

·      Percocet (oxycodone & acetaminophen) 14:30

·      Zoloft (sertraline) 14:52

·      Metoprolol – a Beta Blocker 15:04

·      Orthostatic Hypotension 15:42

·      Interventions 16:00

·      Education 16:23

·      Lower Doses? 16:31

·      Work With Doc for Dosage Adjustments, Med Changes17:11

·      High Risk Meds 17:23

·      Safer Therapeutic Options 18:18

·      Benzodiazepines 18:28

·      Talk With Doc 18:58

·      The Environment – Outside and Inside You 20:17

·      Resource:  CDC Website STEADI 20:53

·      Understanding the Culprit Drug 22:15

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Summary:  Hundreds of OTC products, with nuanced combinations of medications, presented with bold colors and appealing claims, cloud what could be a clear picture of which product would be best for you.  In this podcast, we address the oral over-the-counter options for pain, one ingredient at a time, for indications such as fever, pain, inflammation, and hang-overs.  In the search for OTC pain meds at the grocery or drug store, the question of trade name versus generics presents another question.  Are they the same?     

Topics:

·      Acetaminophen vs NSAIDS 01:45

·      Acetaminophen – Centrlal/Brain 03:33

·      NSAIDS – Peripheral/Body 04:12

·      Children 07:00

·      Sprains and Strains 08:40

·      Naproxen 09:20

·      Hangovers 10:40

·      Vasopressin 11:10

·      Generic vs. Trade Name 14:00

·      New Drug Application 14:34

·      Narrow Therapeutic Index 16:48

·      Phenytoin, Digoxin, Anticonvulsants 17:05

·      Orphan Drugs 18:36

·      Research 19:31

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Summary:  Who - or what - does just what it’s supposed to do?  That’s got to be a small club.  Actively participating in the management of your meds by having an idea of the intended effect, the incidence of possible side effects, and then following up with your pharmacist and doctor goes a long way to dealing with a drug’s unintended effects.  Figuring out golf, on the other hand, is like trying to lasso a cloud.  This episode explains why some side effects occur and how they can be managed, while at the same time acknowledging that some side effects are just wacky. 

Topics:

·      Intended Effects 01:15

·      Lisinopril 01:48

·      Dry Cough 02:22

·      Golf Intended Effects 03:05

·      Golf Unintended Effects 03:21

·      Extension of Pharmacologic Effects 03:42

·      Amlodipine Face Flushing 04:25

·      Calcium Channel Blockers 04:57

·      Amlodipine Mechanism of Action – Intended Effect 05:33

·      Amlodipine Mechanism of Action – Unintended Effect 05:50

·      Wacky Side Effects 06:15

·      Incidence of Side Effects 07:15

·      Doc Talk 09:10

·      Resource: Mayo Clinic Site 09:15

·      Risk-Benefit Discussion 10:40

·      Tracking Meds from the Start 11:15

·      Use the Pharmacist! 12:30

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Summary:  Pharmacists are instructed on how to talk with people about their medications:  communicate verbally, communicate non-verbally, establish trust, listen, ask questions, show empathy and encouragement, remain clinically objective….  But where are the instructions for the patient on how to talk about their medications with the pharmacist or the doctor?  That is what this podcast is about.   

Topics:

·      Laws Mandating Pharmacist Counseling 02:06

·      Being an Active Participant 04:24

·      Shared Decision Making 05:33

·      The Right Drug Question 06:32

·      Risk-Benefit of Not Taking the Meds 07:10

·      Monetary Risk 07:40

·      Best Medical Evidence 08:26

·      Treatment Algorithm 08:48

·      Urgency? 09:32

·      Is the Risk-Benefit Changing 10:15

·      Quality of Life 10:46

·      New Drugs on the Treatment Algorithm 12:51

·      Shared Decision Making – Step Up! 14:06

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