This Is Why with Dr. Busti

Discover serotonin-norepinephrine reuptake inhibitors (SNRIs)—safe, effective antidepressants for depression, anxiety, and pain syndromes. 

In this episode, you’ll learn:
- How SNRIs work in the brain and differ from SSRIs, TCAs, and MAOIs
- Key medications: venlafaxine, desvenlafaxine, duloxetine, milnacipran, levomilnacipran
- Important side effects, including blood pressure changes and SIADH in older adults
- Tips for safe switching, monitoring, and counseling patients

Companion tables (indications, mechanisms, PK/PD, side-effect grid, and monitoring prompts) are available for download and teaching at https://www.thisiswhy.health/topics/pharmacology-review-snri-antidepressants

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.

Dr. Busti breaks down monoamine oxidase inhibitors (MAOIs)—where they still fit in modern care, how they work, and how to use them safely.

In this episode you’ll learn:

• Why MAOIs remain relevant for treatment-resistant depression
• How irreversible MAO-A/B inhibition elevates serotonin, norepinephrine, and dopamine
• Practical washout rules (why 14 days after MAOI, generally 7 days before starting an MAOI; longer with fluoxetine)
• High-yield differences (e.g., selegiline transdermal for depression vs. oral formulations for Parkinson’s disease)
• Key drug–drug risks (serotonergic agents, certain opioids like tramadol, linezolid/methylene blue)
• Tyramine-containing foods and counseling to prevent hypertensive crisis

Whether you’re prepping for boards or refining clinical practice, this walkthrough turns “what” into the why behind safer, smarter antidepressant selection.

Download the companion tables (indications, interactions, tyramine foods, counseling checklists) to keep handy for boards, precepting, and bedside teaching at https://www.thisiswhy.health/topics/pharmacology-review-maoi-monoamine-oxidase-inhibitors-antidepressants

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.

Dr. Busti explores the atypical antidepressants—bupropion, mirtazapine, trazodone, vilazodone, and vortioxetine. Learn how these agents differ from SSRIs/SNRIs, when to use them, and how their unique side effect profiles can actually guide therapy.

Access tables, visuals, and playlists for this episode at https://www.thisiswhy.health/topics/pharmacology-review-atypical-antidepressants

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.

Dr. Busti reviews Proton Pump Inhibitors (PPIs)—how they work, why they outperformed H2 blockers, key clinical uses, and important risks. From GERD to GI bleeds, learn the why behind PPIs so you can apply them safely in practice.

Access tables, visuals, and playlists for this video at https://www.thisiswhy.health/topics/pharmacology-review-proton-pump-inhibitors-ppi

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.

In this episode of This Is Why, Dr. Busti unpacks the pharmacology and clinical relevance of the potassium-competitive acid blocker (P-CAB) class—featuring vonoprazan, the newest option in acid suppression therapy.

You’ll learn how P-CABs compare to H₂ receptor antagonists and proton pump inhibitors (PPIs) in terms of mechanism, onset, and duration of acid control. Dr. Busti explains the unique pharmacodynamic and pharmacokinetic properties that make vonoprazan a valuable alternative for patients who do not adequately respond to PPIs.

The discussion connects the drug’s molecular action at the parietal cell to the anatomy of the gastrointestinal tract, helping you understand why this mechanism matters in conditions such as GERD, H. pylori infection, peptic ulcer disease, and erosive esophagitis. You’ll also explore the potential side effects, electrolyte disturbances, and drug–drug interactions to watch for in clinical practice.

By grounding pharmacology in pathophysiology and anatomy, this episode helps clinicians and trainees alike integrate new therapies into patient care with confidence and context.

Access tables for this episode at https://www.thisiswhy.health/topics/pharmacology-review-potassium-competitive-acid-blockers-pcab

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.

A practical pharmacology review of inhaled corticosteroids (ICS) in asthma and COPD. Dr. Busti explains why ICS are first-line therapy in asthma, their selective role in COPD, key mechanisms, dosing strategies, side effects, and patient counseling points to improve adherence and outcomes.

Access downloads for this episode at https://www.thisiswhy.health/topics/pharmacology-review-inhaled-corticosteroids-asthma-copd

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.

Levothyroxine is first-line for hypothyroidism, but getting it right requires precision. In this episode, Dr. Busti explains the TSH–T4–T3 feedback loop, why T4 is preferred over T3 or desiccated thyroid, and how half-life and protein binding shape dosing and monitoring. We cover steady-state timing (6–8 weeks), dose step sizes, manufacturer switches, and how food and cation supplements (calcium, iron, magnesium) alter absorption. You’ll also learn how anticonvulsants, rifampin, beta-blockers, steroids, and amiodarone affect levels or peripheral conversion.

Special populations receive focused guidance: immediate dose increases in pregnancy, careful titration in cardiovascular disease, and intentional TSH suppression after thyroidectomy for cancer. Practical counseling points include consistent administration habits, spacing from multivitamins/antacids, pausing biotin before labs, and symptom-based safety checks (palpitations, tremor, heat intolerance, weight change).

If you teach, precept, or practice, this review helps you move beyond memorization to the “why” that improves bedside decisions.

Access bonus materials and downloads at https://www.thisiswhy.health/topics/pharmacology-review-thyroid-hormone-replacement

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.

In this personal reflection, Dr. Busti shares a formative moment of cognitive dissonance that reshaped his approach to evidence-based medicine. When a simple question exposed a knowledge gap, it sparked a lifelong commitment to understanding the “why” behind clinical decisions—and to teaching with honesty and humility.

Access bonus materials and downloads at https://thisiswhy.health

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.

Cognitive dissonance—the moment we realize we don’t know something we should—can either hinder or grow us. In this episode, Dr. Busti explains how understanding and managing dissonance within the Evidence-Based Medicine framework strengthens humility, reflection, and better patient care. Learn to turn uncertainty into growth and develop true cognitive resonance.

Access bonus materials and downloads at https://thisiswhy.health

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.

The final two steps of Evidence-Based Medicine—Apply and Assess—focus on turning knowledge into better patient outcomes. Dr. Busti explains how to apply evidence to real-world practice, integrate patient preferences, and assess the impact of your decisions to continually improve care. Discover how adapting your approach over time creates a more patient-centered, evidence-driven practice.

Access bonus materials and downloads at https://thisiswhy.health

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard in this content.