Real Life Pharmacology - Pharmacology Education for Health Care Professionals

In this episode of our pharmacology podcast, we take a deep dive into the pharmacology of levomilnacipran (Fetzima), a unique serotonin-norepinephrine reuptake inhibitor (SNRI) approved for the treatment of major depressive disorder (MDD) in adults. Designed for pharmacy students, clinicians, and anyone interested in psychopharmacology, this episode breaks down what makes levomilnacipran different from other antidepressants and how to use it effectively in clinical practice. We explore levomilnacipran's mechanism of action, which features a greater affinity for norepinephrine reuptake inhibition compared to serotonin—an uncommon trait among SNRIs. This pharmacologic profile gives it a distinctive effect on energy, motivation, and physical symptoms of depression. Listeners will also learn about its pharmacokinetics, including once-daily dosing, renal elimination, and metabolism via the CYP3A4 pathway—making drug interactions an important consideration. The episode also covers levomilnacipran side effects, including common adverse reactions like nausea, dry mouth, constipation, and increased heart rate or blood pressure. We'll also highlight rare but serious risks like serotonin syndrome and urinary hesitation. Because levomilnacipran drug interactions can impact safety and efficacy, we review important combinations to avoid, such as CYP3A4 inhibitors (e.g., ketoconazole), serotonergic drugs, and blood pressure-altering agents. For pharmacists and prescribers, this is a key segment to help guide safer medication use and monitoring. Finally, we wrap up with clinical pearls for starting, titrating, and monitoring levomilnacipran therapy—including renal dose adjustments and differences with duloxetine. Whether you're studying for boards or optimizing your patient’s antidepressant regimen, this episode delivers a concise, evidence-based overview of levomilnacipran pharmacology in a digestible, podcast-friendly format.

Transcribed - Published: 31 July 2025

Asenapine is an atypical antipsychotic that acts as an antagonist at multiple receptors, including dopamine D2 and serotonin 5-HT2A, contributing to its antipsychotic and mood-stabilizing effects. Adverse effects of asenapine include somnolence, dizziness, and extrapyramidal symptoms. Because asenapine is significantly metabolized by CYP1A2, inhibitors or inducers of these enzymes can affect its plasma concentrations. Co-administration with other CNS depressants may increase the risk of sedation and impaired cognitive or motor function. Asenapine can prolong the QT interval, so caution is advised when used with other medications that affect cardiac conduction.

Transcribed - Published: 24 July 2025

Loxapine is a first-generation (typical) antipsychotic with dopamine D2 receptor antagonism as its primary mechanism, though it also has affinity for serotonin 5-HT2A receptors, making its pharmacology somewhat atypical. Loxapine is available in multiple formulations, including oral capsules and an inhalation powder, the latter approved specifically for acute agitation in patients with schizophrenia or bipolar I disorder. Sedation and extrapyramidal symptoms (EPS), including dystonia, akathisia, and parkinsonism, are common adverse effects due to its potent dopamine blockade in the nigrostriatal pathway. Orthostatic hypotension can occur with loxapine due to its alpha-1 adrenergic blockade, requiring monitoring in elderly patients or those on antihypertensives.

Transcribed - Published: 17 July 2025

Ketoconazole is an imidazole antifungal that works by inhibiting fungal cytochrome P450 14α-demethylase, an enzyme essential for ergosterol synthesis, which disrupts fungal cell membrane integrity. Common adverse effects of ketoconazole include nausea, vomiting, abdominal pain, and elevated liver enzymes, with hepatotoxicity being a notable concern. Ketoconazole carries a boxed warning for severe hepatotoxicity, including cases of liver failure and death, and should not be used as a first-line treatment for fungal infections when other safer antifungals are available. Another boxed warning highlights ketoconazole’s potential to prolong the QT interval, increasing the risk for life-threatening ventricular arrhythmias such as torsades de pointes. Ketoconazole is a strong inhibitor of CYP3A4 and can cause significant drug interactions by increasing serum concentrations of medications metabolized by this pathway, including statins, certain benzodiazepines, and some antiarrhythmic.

Transcribed - Published: 10 July 2025

NSAIDs can reduce the effectiveness of antihypertensive medications such as ACE inhibitors, ARBs, beta-blockers, and diuretics by promoting sodium and water retention and decreasing renal blood flow. Combining NSAIDs with anticoagulants or antiplatelet agents like warfarin or aspirin significantly increases the risk of gastrointestinal bleeding, due to additive effects on platelet inhibition and mucosal irritation. NSAIDs can elevate lithium levels and increase the risk of toxicity, as they reduce renal clearance of lithium by decreasing renal perfusion. Co-administration of NSAIDs with methotrexate can impair methotrexate elimination, leading to elevated levels and potential toxicity, especially at high methotrexate doses. When NSAIDs are used with corticosteroids, the risk of gastrointestinal ulcers and bleeding is greatly amplified due to synergistic impairment of gastric mucosal protection.

Transcribed - Published: 3 July 2025

Lotrisone is a topical cream that contains a combination of clotrimazole, an antifungal, and betamethasone dipropionate, a corticosteroid. It is used to treat fungal skin infections such as athlete’s foot, jock itch, and ringworm that also involve inflammation or itching. Clotrimazole works by disrupting the fungal cell membrane, while betamethasone reduces redness, swelling, and itching. Lotrisone should not be used on the face, groin, or underarms for extended periods due to the risk of skin thinning and other steroid-related side effects.

Transcribed - Published: 26 June 2025

Fluphenazine is a high-potency typical antipsychotic that primarily acts as a dopamine D2 receptor antagonist in the mesolimbic pathway, reducing positive symptoms of schizophrenia. Extrapyramidal symptoms (EPS), such as dystonia, akathisia, and parkinsonism, are common due to potent D2 blockade in the nigrostriatal pathway. Neuroleptic malignant syndrome (NMS), though rare, is a life-threatening adverse effect characterized by rigidity, hyperthermia, altered mental status, and autonomic instability. CYP2D6 inhibitors (e.g., fluoxetine, paroxetine) can increase fluphenazine plasma concentrations, potentially raising the risk of toxicity and side effects. Concomitant use of fluphenazine with CNS depressants (e.g., alcohol, benzodiazepines) can enhance sedation and respiratory depression.

Transcribed - Published: 19 June 2025

On this podcast episode, I discuss quinapril pharmacology, adverse effects, drug interactions, pharmacokinetics, and much more. Quinapril is a prodrug that is converted in the liver to its active metabolite, quinaprilat, which inhibits ACE, leading to decreased formation of angiotensin II and reduced aldosterone secretion. Hyperkalemia can occur with quinapril use due to decreased aldosterone, leading to potassium retention—especially in patients with renal impairment. Concomitant use of potassium-sparing diuretics or potassium supplements with quinapril increases the risk of hyperkalemia. NSAIDs may reduce the antihypertensive effect of quinapril and increase the risk of nephrotoxicity, especially in patients with preexisting renal dysfunction.

Transcribed - Published: 12 June 2025

Nifedipine is a dihydropyridine calcium channel blocker that selectively inhibits L-type calcium channels in vascular smooth muscle, leading to vasodilation and reduced peripheral vascular resistance. The extended-release formulation of nifedipine provides more stable plasma concentrations and is preferred for chronic management of hypertension and angina. Common adverse effects include headache, flushing, peripheral edema, and dizziness, all related to its vasodilatory action. Nifedipine undergoes extensive first-pass metabolism in the liver, primarily via CYP3A4 enzymes, which significantly influences its bioavailability and potential drug interactions. CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, grapefruit juice) can increase plasma levels of nifedipine, raising the risk of hypotension and adverse effects.

Transcribed - Published: 5 June 2025

On this podcast episode, I discuss Clotrimazole pharmacology, adverse effects, indications, administration, and much more. Clotrimazole is an imidazole antifungal that exerts its pharmacological effect by inhibiting the synthesis of ergosterol, an essential component of fungal cell membranes. This inhibition compromises membrane integrity, leading to leakage of cellular contents and ultimately fungal cell death. Clotrimazole is primarily used topically due to poor systemic absorption when administered via the skin or mucous membranes, which limits systemic side effects. When clotrimazole is used intravaginally or orally in lozenge form, localized concentrations are sufficient to treat mucocutaneous infections without significant systemic exposure. Pay attention when clotrimazole is used frequently to treat Candida infections as corticosteroids, immunosuppression, and antibiotics may increase the risk of this type of infection.

Transcribed - Published: 29 May 2025

Irbesartan is an angiotensin II receptor blocker (ARB) used primarily for the management of hypertension and diabetic nephropathy in type 2 diabetes. It selectively inhibits the binding of angiotensin II to the AT1 receptor found in vascular smooth muscle and the adrenal gland. This blockade results in vasodilation, reduced aldosterone secretion, decreased sodium and water retention, and ultimately lower blood pressure. Irbesartan is administered orally, with a typical starting dose of 150 mg once daily, which may be increased to 300 mg depending on the patient’s clinical response and tolerability. Adverse effects of irbesartan are generally mild but can include hyperkalemia and dizziness. Hypotension may occur, especially in volume-depleted individuals or those on diuretics. Routine monitoring of renal function and serum potassium is recommended, especially in patients with underlying kidney disease or those taking potassium-sparing agents or supplements. Irbesartan is contraindicated in pregnancy due to the risk of fetal toxicity and should be discontinued as soon as pregnancy is detected.

Transcribed - Published: 22 May 2025

On this episode, I discuss benzonatate pharmacology, adverse reactions, and much more. Tessalon Pearls (benzonatate) are a non-narcotic antitussive commonly prescribed to relieve dry, non-productive coughs. Benzonatate acts by numbing stretch receptors in the respiratory tract, lungs, and pleura, which helps suppress the cough reflex at its source. Unlike opioid-based cough suppressants, it doesn’t work in the brain’s cough center. The usual adult dose is 100 to 200 mg taken orally three times a day as needed, with a maximum daily dose of 600 mg. One of the most critical points is that the capsules must be swallowed whole. Chewing, sucking, or crushing them can cause numbness in the mouth and throat, leading to a risk of choking or aspiration. There are no major drug interactions associated with benzonatate.

Transcribed - Published: 15 May 2025

On this episode of the Real Life Pharmacology podcast, I discuss Miralax (polyethylene glycol) pharmacology, adverse effects, and much more. MiraLAX is an osmotic laxative commonly used to treat occasional constipation by retaining water in the stool to increase stool frequency and soften consistency. The standard adult dose of MiraLAX is 17 grams (approximately one heaping tablespoon) dissolved in 4 to 8 ounces of liquid once daily. Electrolyte imbalances are rare but possible with prolonged or excessive use of Miralax, particularly in elderly or renal-impaired patients. Advise patients to maintain adequate hydration while using MiraLAX to support its mechanism and reduce side effects.

Transcribed - Published: 8 May 2025

Today’s sponsor is Freed AI! Freed’s AI medical scribe listens, transcribes, and writes notes for you. Over 15,000 healthcare professionals use Freed and you should too! Learn more here! On this episode of the Real Life Pharmacology Podcast, we cover minoxidil pharmacology, adverse effects, drug interactions, and much more. Minoxidil is a potent arterial vasodilator used in the treatment of hypertension and androgenetic alopecia. The route of administration greatly impacts the drug’s safety profile. Oral minoxidil is typically reserved for refractory hypertension due to its strong systemic effects and associated risks. Topical formulations (2% or 5%) are widely used for hair regrowth, offering local benefits with minimal systemic absorption. Systemic minoxidil can result in fluid retention, tachycardia, and even pericardial effusion, often requiring co-administration with a diuretic and beta-blocker.

Transcribed - Published: 1 May 2025

Today’s sponsor is Freed AI! Freed’s AI medical scribe listens, transcribes, and writes notes for you. Over 15,000 healthcare professionals use Freed and you should too! Learn more here! Prednisone is a commonly used medication for its antiinflammatory and immunosuppressive action. On this episode I discuss prednisone pharmacology, ADRs, and much more. In the episode, I discuss how prednisone affects the HPA system in the body. Cortisol production can be greatly impacted by long term use of prednisone. GI adverse effects can be problematic with oral prednisone which is why we often give this medication with food or milk. Hyperglycemia is a complication from the use of prednisone. I've commonly seen blood sugar spike by 50-100+ mg/dL due to this medication. Osteoporosis is a long term risk with the use of prednisone. Prednisone can also impact the benefits of vaccination. I discuss this in greater depth in the drug interactions portion of the podcast.

Transcribed - Published: 24 April 2025

Today’s sponsor is Freed AI! Freed’s AI medical scribe listens, transcribes, and writes notes for you. Over 15,000 healthcare professionals use Freed and you should too! Learn more here! On this episode of the Real Life Pharmacology Podcast, I cover linagliptin pharmacology, adverse effects, drug interactions, and much more. Linagliptin is a DPP-4 inhibitor used to help control blood sugar levels in adults with type 2 diabetes. It works by increasing the levels of incretin hormones, which stimulate insulin release and decrease glucagon levels in the blood. Linagliptin is usually taken once daily and can be used alone or in combination with other diabetes medications. Unlike some other diabetes drugs, linagliptin does not usually cause weight gain or low blood sugar (hypoglycemia) when used alone. Linagliptin should not be used with GLP-1 agonists as it works on a similar pathway as that medication class.

Transcribed - Published: 17 April 2025

Meclizine is classified as a first-generation antihistamine. I discuss meclizine pharmacology, adverse effects, drug interactions, and much more. Meclizine is included on the Beers list due to its highly anticholinergic activity. Anticholinergic effects include constipation, dry eyes, dry mouth, urinary retention, and confusion. Sedation is an important adverse effect of meclizine. This adverse effect can be increased when used with other sedating medications such as opioids and benzodiazepines. Meclizine is primarily used for vertigo and motion sickness in clinical practice. The usual starting dose ranges between 12.5 to 25 mg. Meclizine is partially broken down by CYP2D6 so medications like bupropion can inhibit the breakdown of meclizine and lead to higher concentrations.

Transcribed - Published: 11 April 2025

In this episode, I discuss amphetamine/dextroamphetamine pharmacology, adverse effects, drug interactions, and much more. Stimulants like Adderall are well known to cause insomnia. This adverse effect can be affected by the timing of the dose. Lack of growth and poor appetite are two important things to monitor in pediatric patients taking Adderall. Changes in the pH of the stomach/gut can alter the absorption of Adderall. I discuss this in greater detail in this podcast episode. Cardiovascular monitoring is essential with the use of stimulants like Adderall. Pulse and heart rate are two important vital signs to assess.

Transcribed - Published: 3 April 2025

Today’s sponsor is Freed AI! Freed’s AI medical scribe listens, transcribes, and writes notes for you. Over 15,000 healthcare professionals use Freed and you should too! Learn more here! Benazepril is an ACE inhibitor used to treat hypertension by blocking the conversion of angiotensin I to angiotensin II, reducing vasoconstriction. Combining benazepril with potassium-sparing diuretics or potassium supplements increases the risk of hyperkalemia due to aldosterone suppression. Common side effects of benazepril include dry cough, hyperkalemia, and hypotension due to its effect on the renin-angiotensin-aldosterone system. Benazepril can be prescribed alone or in combination with other antihypertensive agents, such as diuretics or calcium channel blockers, to enhance blood pressure control. Benazepril has a long duration of action, allowing for once-daily dosing, which improves patient adherence and convenience in hypertension management.

Transcribed - Published: 27 March 2025

Today’s sponsor is Freed AI! Freed’s AI medical scribe listens, transcribes, and writes notes for you. Over 15,000 healthcare professionals use Freed and you should too! Learn more here! On this podcast episode, I cover loratadine pharmacology, adverse effects, drug interactions, and much more. Loratatdine is a second generation antihistamine. It has a lower incidence of central nervous system adverse effects compared to first-generation antihistamines like diphenhydramine. Loratadine dosing varies in pediatric patients and those with renal impairment. I get into the details on this podcast episode. Drug interactions aren't common with loratadine but I discuss a few that may be clinically significant.

Transcribed - Published: 20 March 2025

Modafinil (Provigil) is a CNS stimulant medication. I cover modafinil pharmacology, adverse effects, drug interactions, and much more on this podcast episode. You should be aware that modafinil is a Schedule 4 controlled substance so it does carry a risk of dependence and addiction. Modafinil can cause CYP3A4 induction and lead to lowering the concentrations of many medications. This includes antiepileptic agents and oral contraceptives. The most common adverse effects of modafinil include ramping up the body and causing symptoms such as anxiety and insomnia. Cardiovascular changes are a risk with modafinil as this medication can contribute to hypertension and tachycardia.

Transcribed - Published: 13 March 2025

This episode is sponsored by Meded101.com/store - Go check out their resources, books, and review courses! They will help you prepare to pass your pharmacology classes and board exams! Lansoprazole is a PPI that can be used for GERD, ulcers, and other GI conditions. B12 and magnesium deficiency are possible long-term mineral and vitamin effects. Augmentin is a combination medication of amoxicillin and clavulanate. It is an antibiotic for infection. Diarrhea is the most common adverse effect. Lovastatin is a cholesterol-lowering medication. It is often not a preferred statin due to CYP3A4 interaction and it is less potent than other medications. Valacyclovir is a prodrug that gets converted to acyclovir. It is an antiviral medication and can treat herpes zoster and herpes simplex infections. Chlorpromazine is a dopamine antagonist that has anticholinergic activity as well. It is a first-generation antipsychotic medication.

Transcribed - Published: 6 March 2025

Today’s sponsor is Freed AI! Freed’s AI medical scribe listens, transcribes, and writes notes for you. Over 15,000 healthcare professionals use Freed and you should too! Learn more here! Clopidogrel (Plavix) is an antiplatelet medication. You need to understand the pharmacokinetics of clopidogrel and how CYP2C19 affects this medication. Doxycycline is a tetracycline antibiotic. Calcium, iron, and other metal cations can bind doxycycline and reduce the absorption of the medication. Hyzaar is a combination of losartan and hydrochlorothiazide. Losartan is an ARB and hydrochlorothiazide is a thiazide diuretic. Kytril (granisetron) is an antiemetic medication. It is from the same class of medication as the more commonly used ondansetron. Restoril (temazepam) is a benzodiazepine. It is primarily used to treat insomnia as it has a much shorter half-life than many of the other benzodiazepines.

Transcribed - Published: 27 February 2025

Today’s sponsor is Freed AI! Freed’s AI medical scribe listens, transcribes, and writes notes for you. Over 15,000 healthcare professionals use Freed and you should too! Learn more here! On this episode of the Real Life Pharmacology Podcast, we will cover medications 186-190 on the Top 200 Drugs List. The medications included in the podcast episode are Sonata, Zebata, Zovirax, Coumadin, and Luvox. Sonata (ezopiclone) is a Z-drug used for insomnia. It has many similar effects to benzodiazepines and a similar mechanism of action. Zebeta (bisoprolol) is a beta-blocker used for the treatment of hypertension, atrial fibrillation, and heart failure amongst other indication. Zovirax (acyclovir) is an antiviral medication used to treat various viral infection. It needs to be dosed numerous times throughout the day which is a downside to use. Coumadin (warfarin) is an anticoagulant. It is most well known for its need to have INRs drawn to assess drug levels. Luvox (fluvoxamine) is an SSRI antidepressant. It is well known for its ability to cause drug interaction and is often not a first line agent because of this reason.

Transcribed - Published: 20 February 2025

On this Real Life Pharmacology Podcast episode, we cover medications 181-185. Proscar is the brand name for finasteride. This medication can be helpful in shrinking the size of the prostate but it does typically take a while to work (months). Sinemet is a combination of carbidopa and levodopa. Levodopa is converted in the central nervous system to dopamine to help alleviate a shortage of dopamine in the brain. Risedronate is a bisphosphonate medication that can be used in the treatment of osteoporosis. Albuterol (Ventolin) is a short-acting beta-agonist that is used to relieve symptoms of acute respiratory distress most often associated with an asthma exacerbation. Tramadol is classified as an opioid analgesic. It also has activity similar to SNRIs as it has the ability to increase serotonin and norepinephrine in the brain.

Transcribed - Published: 13 February 2025

Prednisolone is a corticosteroid that is often used in pediatrics. Hyperglycemia, insomnia, and GI upset are relatively common adverse effects. Ibuprofen is a commonly used OTC pain reliever. It is classified as an NSAID and can increase GI bleed risk and exacerbate heart failure. Aceon is the brand name for perindopril. ACE inhibitors are well known to cause drug induced cough and will cause hyperkalemia. Trazodone is classified as an antidepressant but is frequently used to treat insomnia because of its sedative properties. Pioglitazone is an oral anti-diabetes medication that should be avoided in patients with heart failure.

Transcribed - Published: 6 February 2025

Today’s sponsor is Freed AI! Freed’s AI medical scribe listens, transcribes, and writes notes for you. Over 15,000 healthcare professionals use Freed and you should too! Learn more here! On this episode of the Top 200 drugs podcast, we are going to cover these 5 medications: Cyclosporine, insulin glargine, tadalafil, amitriptyline, and gemfibrozil. Cyclosporine is a calcineurin inhibitor that suppresses the immune system. This is useful in patients who have had an organ transplant. Insulin glargine is a long-acting insulin product that can be used in type 1 and type 2 diabetes. I discuss adverse effects, dosing, and much more. Tadalafil is a PDE-5 inhibitor that can be used to treat sexual dysfunction. The nitrate drug interaction is one of the most highly tested drug interactions in school. Amitriptyline is a TCA. It is highly anticholinergic and because of this is not a great medication to utilize in elderly patients. Gemfibrozil is primarily used to lower triglyceride levels. This medication can significantly increase the risk for rhabdomyolysis in patients taking statin medications.

Transcribed - Published: 30 January 2025

Today’s sponsor is Freed AI! Freed’s AI medical scribe listens, transcribes, and writes notes for you. Over 15,000 healthcare professionals use Freed and you should too! Learn more here! On this episode of the Top 200 Drugs podcast from Real Life Pharmacology, we cover Percocet, Epogen, quetiapine, glimepiride, and tirzepatide. These are drugs 166-170. Percocet is a combination analgesic. It contains acetaminophen and oxycodone. Pay attention to acetaminophen intake from all sources when patients are on this medication. Epogen (epoetin alfa) stimulates the production of red blood cells. This medication can be useful in treating anemia. Quetiapine (Seroquel) is an antipsychotic. It is often used in patients with hallucinations and delusions associated with Parkinson's disease because it has a lower potential to block dopamine receptors compared to other antipsychotics. Glimepiride is a sulfonylurea. This medication stimulates the release of insulin which can help lower blood sugars in diabetes. Tirzepatide (Mounjaro) is a combination GIP and GLP-1 receptor agonist that can be used for weight loss and the treatment of diabetes.

Transcribed - Published: 23 January 2025

On this podcast episode of the top 200 drugs, I'm covering liraglutide, folic acid, clotrimazole, empagliflozin, and semaglutide. Liraglutide is a GLP-1 agonist that can be used for weight loss as well as diabetes. The most common adverse effect of this medication is nausea. Folic acid is a commonly used supplement in pregnancy as well as in those patients taking methotrexate. Deficiency of folic acid can lead to anemia. Clotrimazole is an antifungal agent. It is mostly used for topical purposes such as athlete's foot and vaginal yeast infections. Empagliflozin was originally developed as a diabetes medication but can be helpful in patients with heart failure and CKD. I discuss this in greater detail in the podcast. Semaglutide is another GLP-1 agonist that is used for diabetes care as well as weight loss. The formulation used for diabetes is Ozempic while the weight loss product is Wegovy.

Transcribed - Published: 16 January 2025

Welcome back to the Real Life Pharmacology podcast! We are on the home stretch of the top 200 medications. This is meant to be a quicker refresher of some of the most important drugs you'll come across in practice. Please be sure to go search the archives at RealLifePharmacology.com if you are looking for more information on one specific medication. We have over 300 individual episodes on specific drugs! On this episode of the Top 200 medications, we've covered the medications below. Niaspan (niacin) is vitamin B3 and may be used in patients who fail other therapies for triglyceride management. Uroxatral (alfuzosin) is a selective alpha-blocker that can be helpful in relieving urinary retention symptoms in BPH. Biaxin (clarithromycin) is a macrolide antibiotic that is notorious for many drug interactions because it inhibits CYP3A4. Zomig (zolmitriptan) is a "triptan" medication that can be used for the acute relief of migraine headaches. Invokana (canagliflozin) was one of the first SGLT2 inhibitors invented that can be used to lower blood sugar in type 2 diabetes.

Transcribed - Published: 9 January 2025

Today’s sponsor is Freed AI! Freed’s AI medical scribe listens, transcribes, and writes notes for you. Over 15,000 healthcare professionals use Freed and you should too! Learn more here! On this episode of the Top 200 Drugs Podcast, I cover medications 151-155. This podcast includes; cefuroxime, ketoconazole, pregabalin, esomeprazole, and ipratropium/albuterol. Cefuroxime is a 2nd generation cephalosporin that has a very similar bacterial coverage profile to amoxicillin. It has significant gram positive coverage. Ketoconazole is an azole antifungal medication. It is well known for causing hepatotoxicity as well as interactions via CYP3A4. Pregabalin has a lot of similarities with gabapentin. It can be used fo various pain syndromes such as neuropathy and fibromyalgia. Esomeprazole is a PPI and has a similar profile to omeprazole. It inhibits CYP2C19 and has a few notable interactions that I cover in this episode. Ipratropium and albuterol is a combination of a short acting anticholinergic and short acting beta agonist.

Transcribed - Published: 2 January 2025

Today's sponsor is Freed AI! Freed’s AI medical scribe listens, transcribes, and writes notes for you. Over 15,000 healthcare professionals use Freed and you should too! Learn more here! On this episode of the Top 200 Drugs Podcast, I cover medications 146-150. This podcast includes; sevelamer, dalteparin, sertraline, clonazepam, and irbesartan. Sevelamer is a phosphate binder that is used to treat hyperphosphatemia in patients with chronic kidney disease. Dalteparin is a low molecular weight heparin product that is used to prevent and treat blood clots. Sertraline is a commonly used SSRI that can be helpful in managing depression and anxiety. Clonazepam is a benzodiazepine that can be used for acute relief of anxiety. Sedation, confusion, and fall risk are potential adverse effects. Irbesartan is an ARB that can be used for hypertension. Hyperkalemia and angioedema are two adverse effects to be aware of.

Transcribed - Published: 26 December 2024

On this top 200 drugs podcast, we are covering medications 141-145. Raltegravir, ustekinumab, meloxicam, infliximab, and Nighttime Cold and Flu are the medications that are covered on this episode. Raltegravir is an integrase inhibitor that is used to manage HIV infection and may also be used for post-exposure prophylaxis. Ustekinumab is a monoclonal antibody that can help reduce inflammation by binding interleukins. Meloxicam is an NSAID used for pain and anti-inflammatory purposes. GI bleeding risk is a top adverse effect to monitor for. Infliximab is a monoclonal antibody that can be used for autoimmune disorders such as psoriatic arthritis, rheumatoid arthritis, ulcerative colitis, and Crohn's disease. Nighttime Cold and Flu medication is a combination product that often includes acetaminophen, dextromethorphan, and doxylamine.

Transcribed - Published: 19 December 2024

On this episode, I cover cinacalcet, solifenacin, haloperidol, hydrocortisone (focused on topical), and insulin NPH. Cinacalcet is a calcimimetic medication that can be helpful in hyperparathyroidism and useful for managing hypercalcemia. Solifenacin is a urinary antimuscarinic used primarily for overactive bladder. It is an anticholinergic medication that can be problematic in our geriatric patients. Haloperidol is a first generation antipsychotic that has a high incidence of EPS relative to many newer antipsychotics. Hydrocotorisone is one of the most common topical corticosteroids that can be used to reduce inflammation and redness from skin reactions. Insulin NPH is an intermediate acting insulin that is meant to be given on a routine basis. It has fallen out of favor since insulin glargine and other long acting agents allow for few injections and more stable kinetics.

Transcribed - Published: 12 December 2024

On this episode of the Top 200 drugs podcast from Real Life Pharmacology, I cover medications 131-135 which include enoxaparin, methylphenidate, rosuvastatin, denosumab, and dabigatran. Enoxaparin is an injectable anticoagulant that can cause heparin-induced thrombocytopenia. Methylphenidate is a stimulant medication that can be used to treat ADHD. Cardiovascular adverse effects are possible. Rosuvastatin inhibits HMG-CoA Reductase which helps lower LDL in the management of hypercholesterolemia. Denosumab is a monoclonal antibody that is indicated for osteoporosis and may cause hypocalcemia. Dabigatran was one of the first direct oral anticoagulants to be produced. It is dosed twice daily and has warnings about use in patients over the age of 75.

Transcribed - Published: 5 December 2024

In this episode of the Top 200 Drugs Podcast, we cover medications 126-130. Trastuzumab is a monoclonal antibody that can be used for breast cancer that expresses the HER2 protein. Atripla is an HIV medication that contains three separate medications that are beneficial in reducing viral load. Rivaroxaban is an anticoagulant that may be commonly used in the management of stroke and deep vein thrombosis. Fioricet is a combination of three medications. Butalbital, acetaminophen, and caffeine are the three ingredients in this medication. Insulin detemir is a long-acting insulin analog that lowers blood sugar. This medication is used to target fasting blood sugars.

Transcribed - Published: 28 November 2024

On the top 200 drugs podcast, we cover 5 more medications. The medications covered on today's episode include; omalizumab, nitroglycerin, apixaban, gabapentin, and etanercept. Omalizumab is a monoclonal antibody used in moderate to severe asthma. It targets IgE-mediated asthma attacks and reactions. Anaphylaxis is a significant concern with the use of this medication. Sublingual nitroglycerin is frequently used on an as needed basis for angina symptoms. I discuss major drug interactions and much more. Apixaban is an anticoagulant used to prevent stroke in atrial fibrillation. It can also be used in DVT/PE treatment and prevention. Gabapentin is classified as an antiepileptic agent but is most commonly used for neuropathic type pain. Etanercept targets TNF alpha which plays an important role in autoimmune diseases such as rheumatoid arthritis.

Transcribed - Published: 21 November 2024

In this episode of the Top 200 Drugs Podcast, I cover glyburide, citalopram, olmesratan, carvedilol, and tiotropium. Glyburide is a sulfonylurea that is well known to cause hypoglycemia and weight gain because it stimulates the pancreas to increase insulin release. Citalopram is an SSRI most well known for its potential to increase the risk for QTc prolongation. It has a notorious drug interaction with omeprazole Olmesartan is an ARB that can be used for hypertension. Hyperkalemia is an electrolyte imbalance that can be caused by its use. Carvedilol is one of the few beta-blockers with significant alpha-blocking and beta-blocking activity. I discuss what this means in this Top 200 drugs podcast. Tiotropium is an anticholinergic medication that can open the airway. It is most commonly used for COPD.

Transcribed - Published: 14 November 2024

Clindamycin is an antibiotic for infection. It inhibits protein synthesis by binding to the 50s ribosomal subunit and is well known to contribute to C. Diff. risk. Acetaminophen is a common over-the-counter medication that relieves pain and fever. It does not have much benefit in reducing inflammation, however. Ferrous sulfate is a supplement that can be useful in treating anemia. Dark stools and constipation are two common adverse effects. Eletriptan is a medication used to abort migraine headaches. It has serotonin action. I discuss the potential for interactions with other serotonergic medications. Methocarbamol is an older skeletal muscle relaxant that makes an appearance on the Beers list as it can cause sedation, confusion, and increase the risk of falls.

Transcribed - Published: 7 November 2024

Zoledronic acid is a bisphosphonate that can be used to manage hypercalcemia of malignancy and osteoporosis. Glipizide is an anti-diabetes agent that is classified as a sulfonylurea. Weight gain and hypoglycemia and two big concerns with this agent. Lactulose is classified as a laxative but is more commonly used to reduce ammonia levels in hepatic encephalopathy. Rabeprazole is a PPI used to reduce gastric acid secretions and improve conditions such as GERD, peptic ulcer disease, and Barrett's esophagus. Methotrexate is classically grouped with oncology agents but is frequently used in autoimmune conditions like rheumatoid arthritis and Crohn's disease.

Transcribed - Published: 31 October 2024

On this episode of the Real Life Pharmacology podcast, we cover medications 101-105 of the top 200 drugs Atomoxetine is a norepinephrine reuptake inhibitor that is used in the management of attention deficit hyperactivity disorder. Zolpidem is a medication that is used for insomnia. It has a very similar adverse effect profile to benzodiazepines. Advair is a commonly used respiratory medication for asthma. It is a combination of a long-acting beta agonist and inhaled corticosteroid. Levofloxacin is a quinolone antibiotic that has a boxed warning for neuropathy, tendon rupture, and CNS adverse effects. Imipramine is a tricyclic antidepressant that is highly anticholinergic. Dry eyes, dry mouth, constipation, urinary retention, sedation, and memory impairment are potential adverse effects.

Transcribed - Published: 24 October 2024

We have finally reached 100 of the top 200 drugs podcasts! On this episode, we tackle methadone. This is a complex opioid used for opioid use disorder and may also be used for pain. Enalapril is an ACE inhibitor that is used for hypertension. Cough and hyperkalemia are two major adverse effects to remember. Oseltamivir is a neuraminidase inhibitor. In patients with poor renal function, we need to make sure to adjust the dose accordingly. Ropinirole is a dopamine agonist. This medication is primarily used for restless leg syndrome but is also indicated for Parkinson's disease. Penicillin VK is the original penicillin antibiotic. Common indications of this medication are strep throat, skin and soft tissue infections, and syphilis.

Transcribed - Published: 17 October 2024

On this episode of the Real Life Pharmacology Podcast, I cover 5 more medications of the top 200. Fenofibrate is a medication used primarily to reduce triglycerides. This medication differs from statins which tend to focus on LDL management. Doxazosin is an alpha-blocker. The primary indications of doxazosin are hypertension and BPH. Naproxen is an NSAID. Of all the NSAIDs, naproxen is one of the lower-risk agents with regard to cardiovascular risk. Spironolactone is an aldosterone antagonist and also classified as a potassium sparing diuretic. Memantine is an NMDA antagonist that is indicated for the management of Alzheimer's dementia. If you are looking for study materials and our list of popular Amazon books, check out meded101.com/store!

Transcribed - Published: 10 October 2024

On this episode of the Real Life Pharmacology podcast, we cover 5 more medications in the top 200. Metronidazole is an antibiotic for infection. One of the most common complaints from patients involves reporting of a metallic taste in the mouth. Levetiracetam is an anti-seizure medication. Sedation, dizziness, and other adverse effects of the central nervous system are the most common complications. Colchicine is a gout medication. The most memorable side effect associated with this medication is diarrhea. Olanzapine is an antipsychotic. Olanzapine carries a higher risk for metabolic syndrome compared to other antipsychotics. Dutasteride is a 5 alpha-reductase inhibitor that is indicated for the treatment of BPH. If you are looking for all of our study materials and Amazon books, check them out at Meded101.com/store!

Transcribed - Published: 3 October 2024

On this episode of the Real Life Pharmacology podcast, I cover medications 81 through 85 on the top 200 drug list. Famotidine is an H2 blocker. H2 blockers are less potent than PPIs but can be used to manage heartburn symptoms. Aspirin is technically an NSAID but is primarily used for cardioprophylaxis purposes. Senna is a stimulant laxative. I often see this medication used with opioids to help manage opioid-induced constipation. Novolog is a rapid acting insulin used to bring down post prandial blood sugars. I discuss sliding scale insulin and other concepts with this medication. Baclofen is a skeletal muscle relaxant. It has central nervous system depressant effects which can be especially problematic in elderly patients. Support the sponsor Meded101.com by going to meded101.com/store - Study materials, books, review courses for pharmacists, pharmacy students, pharmacy technicians, nurses, physicians, prescribers, dietitians, and all others who want to learn pharmacology!

Transcribed - Published: 26 September 2024

Reglan (metoclopramide) is used for gastroparesis and inhibits gastric smooth muscle by blocking dopamine receptors. Relafen (nabumetone) is a non-selective inhibition of COX-1/COX-2 which leads to a reduction of inflammation via reduced prostaglandins. Keflex (cephalexin) is a 1st generation oral cephalosporin that covers common gram positive organisms like Staph and Strep species. Effexor (Venlafaxine) is an SNRI and inhibits both serotonin and norepinephrine reuptake. Primary uses include anxiety and depression. Boniva (ibandronate) inhibits osteoclasts which helps treat osteoporosis. Osteoclasts break down bone to help pull calcium into the bloodstream.

Transcribed - Published: 19 September 2024

This episode is sponsored by Freed – Freed is an amazing time saver for busy healthcare professionals! It listens, transcribes, and writes medical notes for you! Go check them out and support our sponsor! Robitussin (Guaifenesin) is a medication that is used as a cough suppressant. It is often combined with numerous other medications so patients need to pay attention Valium (diazepam) is a benzodiazepine used to treat anxiety or seizures. Falls, dizziness, confusion, and sedation are common adverse effects. Viagra (sildenafil) makes the list at number 73. This medication is a PDE-5 inhibitor that can be used for erectile dysfunction. Bactroban (mupirocin) is a topical antibiotic that can be used for superficial skin infections. Januvia (Sitagliptin) is a DPP4 inhibitor used for treating hyperglycemia in type 2 diabetes. It doesn't reduce A1C quite as much as other diabetes medications like SGLT2 inhibitors and GLP-1 agonists.

Transcribed - Published: 12 September 2024

This episode is sponsored by Freed – Freed is an amazing time saver for busy healthcare professionals! It listens, transcribes, and writes medical notes for you! Go check them out and support our sponsor! Pantoprazole (Protonix) is a PPI that can be used for GERD and peptic ulcer disease. I differentiate why this medication is different from the commonly used omeprazole. Dicyclomine (Bentyl) is an anticholinergic medication that may be used to help reduce pain and spasms associated with irritable bowel syndrome. Sumatriptan (Imitrex) is a selective 5HT1 receptor agonist, which potentially helps with vasoconstriction that contributes to migraine symptoms. Chlorhexidine (Peridex) is an antibiotic oral rinse that can be used for gingivitis. Metoprolol (Lopressor, Toprol XL) is a beta-blocker that may be used for atrial fibrillation, angina prevention, and hypertension. It is not a first-line medication for hypertension.

Transcribed - Published: 5 September 2024

This episode is sponsored by Freed - Freed is an amazing time saver for busy healthcare professionals! It listens, transcribes, and writes medical notes for you! Go check them out and support our sponsor! In this episode, we highlight some of the most important clinical pearls (and highly testable pearls) on the following medications; Suboxone, lisdexamfetamine, nortriptyline, insulin lispro, and valproic acid. Suboxone is a combination of buprenorphine and naloxone used for opioid use disorder. Lisdexamfetamine is a stimulant medication that can be used to manage ADHD. Common side effects include weight loss, insomnia, hypertension, and tachycardia. Nortriptyline is a TCA medication known for its ability to cause anticholinergic side effects like constipation, dry eyes, dry mouth, urinary retention, and confusion. Insulin lispro is a rapid-acting insulin medication that is most often used to bring down post-prandial blood sugar. Valproic acid is an antiepileptic medication that can also be used for migraines.

Transcribed - Published: 29 August 2024

This episode is sponsored by Freed - Freed is an amazing time saver for busy healthcare professionals! It listens, transcribes, and writes medical notes for you! Go check them out and support our sponsor! In this episode, we highlight some of the most important clinical pearls on the following medications; nitrofurantoin, fentanyl patches, isosorbide mononitrate, fluoxetine, and triamcinolone. Nitrofurantoin is an antibiotic used for UTIs. We need to be careful with this medication in patients with CKD. Fentanyl is an opioid. There are many clinical quirks with fentanyl patches. For a full rundown, check out this previous podcast episode. Isosorbide mononitrate is a nitrate medication so we need to be careful with the use of PDE-5 inhibitors. Fluoxetine is an SSRI. It has a longer half-life than most SSRIs. I discuss what that means in this episode. Triamcinolone (topical) is most frequently used for redness, itching, and skin irritation.

Transcribed - Published: 22 August 2024