On this podcast episode, I discuss fosinopril (Monopril) pharmacology, adverse effects, drug interactions and much more.

Fosinopril is an ACE inhibitor so it should absolutely NOT be used in pregnancy as it poses fetus risks.

Like other ACE inhibitors, hyperkalemia, cough, angioedema, and acute renal failure represent possible risks in using fosinopril.

Drugs that can raise potassium when used in combo with fosinopril include spironolactone, trimethoprim, calcineurin inhibitors, and heparin.

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On this episode of the Real Life Pharmacology podcast, I discuss haloperidol pharmacology, adverse effects, drug interactions and much more.

Haloperidol comes in multiple dosage forms. Be very careful with the use of injectable haloperidol as there is an immediate and extended release formulation.

Haloperidol is a dopamine antagonist which means that EPS adverse effects are going to be concerning.

In hospice patients, haloperidol is frequently used for its antiemetic properties as well as its potential to help end-of-life restlessness and agitation.

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In this promethazine pharmacology podcast, I discuss its mechanisms of action, side effects, important drug interactions, and much more.

Promethazine has anticholinergic and dopamine-blocking activity which contributes to the adverse effect profile as well as its efficacy.

There is a boxed warning with promethazine to avoid the use of this medication in patients under the age of 2 due to respiratory depression.

Promethazine IV is considered a high-risk route of administration and should be avoided if possible.

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In this episode, I discuss loperamide (Imodium) pharmacology, adverse effects, and drug interactions.

Loperamide has opioid-type activity in the gut but has extremely low oral bioavailability. This allows it to be used for diarrhea but at lower doses won’t cause systemic opioid-like effects.

Loperamide abuse has been reported. Excessive dosages can increase the risk of cardiac arrest and other cardiovascular concerns.

Medication causes of diarrhea should be ruled out prior to starting a medication like loperamide. I discuss numerous medications that can cause diarrhea in this podcast.

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I discuss calcium carbonate pharmacology, adverse effects, drug interactions, and more in this podcast episode.

Calcium tends to have a constipating effect and the higher the dose, the more likely patients are to experience this adverse effect.

Binding interactions are a major problem with oral calcium carbonate. I lay out numerous examples of this on the podcast.

There are a few medications that can increase calcium levels in the blood. Thiazide diuretics are a commonly used antihypertensive that may contribute to hypercalcemia.

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On this episode, I discuss the pharmacology, adverse effects, and drug interactions of ramelteon (Rozerem).

Ramelteon is primarily only helpful for sleep onset and generally is not that helpful in sleep maintenance.

CNS depressant drug interactions will be a common concern to monitor. Opioids, benzodiazepines, and alcohol are common sedatives that can add to the effects of ramelteon.

Some of the CYP enzymes break down Ramelteon. I discuss this in greater length in this podcast episode.

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In this podcast episode, I discuss thiamine pharmacology and its important role in energy production.

In patients with alcohol use disorder, thiamine deficiency can be somewhat common.

Wernicke’s encephalopathy can result from thiamine deficiency in patients with alcohol use disorder.

Common symptoms from Wernicke’s encephalopathy can include confusion, lethargy, and other central nervous system issues. Thiamine replacement can help treat this issue.

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Dutasteride (Avodart) is a 5-alpha-reductase inhibitor. I discuss the pharmacology, adverse effects, and drug interactions on this podcast.

Dutasteride reduces the size of the prostate over time. It takes a significant amount of time to provide symptom relief (usually at least 3-6 months).

Dutasteride is broken down by CYP3A4 to a minor extent which means that strong CYP3A4 inhibitors may increase drug concentrations.

When using dutasteride for BPH, remember to review the medication list for drugs that can cause urinary retention such as anticholintiercs and alpha-agonists.

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On this episode, I discuss prazosin pharmacology, adverse effects, drug interactions and much more.

Prazosin is an alpha-blocker but lacks selectivity. A reduction in blood pressure is expected, but it is notorious for causing orthostatic hypotension.

Prazosin may be used off-label for nightmares, when this is the case, you will likely only see this drug dosed at bedtime.

Alpha agonist medications (such as pseudoephedrine and ADHD stimulants) may counteract the effects of prazosin.

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On this episode I discuss the pharmacology of tirzepatide. I’m appreciative of Derek Borkowski who operates Pyrls for providing a free PDF of the 2023 ADA Diabetes Guidelines when you subscribe for an account at Pyrls.com/rlp – Tirzepatide makes its first appearance in the diabetes guidelines for its ability to promote weight loss.

Tirzepatide is a combination GIP and GLP-1 agonist that is currently indicated for diabetes with reductions of A1C in the range of about 2 points.

Much like GLP-1 agonists, tirzepatide can cause GI upset and other gastrointestinal adverse effects like diarrhea.

Tirzepatide doesn’t have a large number of drug interactions which is nice. Corticosteroids can counteract its blood sugar-lowering effects while sulfonylureas and insulin may significantly increase the risk for hypoglycemia.

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