Real Life Pharmacology - Pharmacology Education for Health Care Professionals

Budesonide/formoterol inhalation is sold under the brand name Symbicort.

Budesonide/formoterol is a combination agent that is used in the management of COPD and asthma.

Budesonide/formoterol is a combination of an inhaled corticosteroid and long-acting beta-agonist.

GINA guidelines now allow for the use of budesonide/formoterol in the management of acute asthma exacerbation.

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Benztropine is a highly anticholinergic medication that is primarily used for movement disorders.

Antipsychotics can cause extrapyramidal adverse effects that can help be managed with benztropine.

Because benztropine is highly anticholinergic, it can cause dry eyes, dry mouth, urinary retention, constipation and contribute to falls and confusion, particularly in our elderly population.

While benztropine is classified as an anti-Parkinson’s agent, it is rarely used for that indication as it has a high incidence of anticholinergic adverse effects (particularly at the doses that are required for benefit).

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Budesonide is a corticosteroid that can be given orally or rectally for management of Crohn’s disease or ulcerative colitis.

Because budesonide has a high first pass metabolism, the relative impact of systemic effects may be less than other steroids like prednisone.

Remember that CYP3A4 inhibitors can increase the concentrations of budesonide. I discuss this further on the podcast.

Different dosage forms of budesonide (oral versus rectal) can be used for different reasons. The site of the inflammation in Ulcerative colitis can determine which dosage form is most appropriate.

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Cimetidine blocks histamine 2 receptors which can suppress acid production and reduce symptoms of heartburn.

One of the major downsides to cimetidine is that it has a ton of drug interactions. I discuss many of the common ones in this episode.

Cimetidine is one of a few drugs that has the potential to cause gynecomastia. I discuss the mechanism of this adverse effect in this episode.

Phenytoin concentrations can rise due to the use of cimetidine. I discuss this in the drug interactions section of this episode.

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Clopidogrel is an antiplatelet agent that is often used in combination with aspirin to help reduce the risk of an MI.

The risk of bleed is a high priority with the use of clopidogrel. Patients must be monitored for signs and symptoms of bleeding and bruising.

Clopidogrel is a prodrug that is converted to its active metabolite by CYP2C19.

Fluconazole can inhibit CYP2C19 which may reduce the effectiveness of clopidogrel.

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