Real Life Pharmacology - Pharmacology Education for Health Care Professionals

On this episode of the Real Life Pharmacology Podcast, I cover the pharmacology of methotrexate.

Methotrexate has a few different indications. It can be used for treatment of cancer. These doses are typically going to be much higher than standard low doses for other conditions.

Lower dose methotrexate is often used for autoimmune type conditions like rheumatoid arthritis and psoriasis.

Folic acid should be supplemented with use of methotrexate to help reduce the risk of adverse effects.

Liver toxicity and immune system suppression are two important factors to monitor in a patient taking chronic methotrexate.

I also talk about important cumulative drug interactions with methotrexate such as immunosuppressives and other agents that may impact liver function.

Be sure to listen to the end as I talk about the potential impact of methotrexate on some vaccines!

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On this episode, I discuss cyclobenzaprine pharmacology. Cyclobenzaprine is an older skeletal muscle relaxant.

Cyclobenzaprine can have a significant number of anticholinergic side effects.

The anticholinergic side effects of cyclobenzaprine can include sedation, dry eyes, dry mouth, urinary retention, and confusion.

Cyclobenzaprine is not well tolerated in the elderly and cause more problems in that patient population.

Cyclobenzaprine has a similar structure to the Tricyclic antidepressants.

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Lithium is a drug that has a ton of clinical pearls.  On this episode, I talk about the pharmacology, side effects, drug interactions, and critical practice pearls.

Kidney function is very important to monitor in our patients taking lithium.  Lithium can accumulate in renal impairment.

Thyroid function can be altered by lithium.  Be sure to regularly monitor TSH in a patient on chronic lithium.

Over-the-counter NSAID can interact and raise lithium levels.  This is something you need to watch out for as patients can begin taking these medications on their own without supervision.

Be sure to assess lithium levels.  Signs of toxicity can include GI upset, tremor, motor movement issues, sedation, and CNS changes.

Pseudoephedrine is commonly used to help relieve nasal congestion.

There are some adverse effects you need to be aware of with pseudoephedrine. Insomnia, increase in blood pressure, and urinary retention are all possible.

When I assess a patient using pseudoephedrine, I like to investigate blood pressure, history of urinary problems and insomnia history.

Pseudoephedrine can cause the prescribing cascade.  I lay out examples in the podcast.

Pseudoephedrine should not be utilized with MAOI’s if possible – I discuss the reason for this in the podcast.

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On this episode, I discuss fentanyl pharmacology.

I address important considerations that you must remember with fentanyl patches.

Those considerations include how pharmacokinetics can impact our patients.

I also break down common side effects of opioids as well as potential common drug interactions.

Drug diversion and illicit use is an important consideration when using fentanyl.  I also touch on this topic.

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