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Top 200 Drugs Podcast – Drugs 41-45 · Real Life Pharmacology - Pharmacology Education for Health Care Professionals

0:00
Hey. Welcome back to the real Life pharmacology
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podcast. I'm your host Pharmacist sarah Christians. Thank
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you so much for listening.
0:07
We are continuing on today with the, top
0:11
200 drugs list.
0:13
We're gonna look at, prednisone
0:16
ez that
0:17
fish oil,
0:19
re
0:20
and ph. So hopefully, those drugs will keep
0:23
you interested. I got a lot to cover
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on fe and prednisone
0:28
specifically. Lots of details there, things that could
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come up,
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Alright. So let's get into the drugs today.
1:08
And we've got number 41. Let's start with
1:11
prednisone.
1:12
Brand name in this medication is delta zone,
1:16
and this is a cor steroid.
1:19
You're going to see it used a lot
1:21
in practice. I've seen it used a lot
1:23
in practice.
1:25
And it's mostly used
1:28
shorter term basis
1:29
for inflammatory
1:31
type conditions.
1:33
Also maybe anal
1:35
type conditions as well. So,
1:37
for instance, gout,
1:40
rheumatoid arthritis,
1:42
flares of those disease states where you have
1:44
a high degree of inflammation as well as
1:47
pain that's associated with that inflammation.
1:49
Those are definitely
1:51
common uses of prednisone.
1:54
Other conditions where we've got some inflammation involved
1:57
potentially,
1:59
asthma,
2:00
Copd ex,
2:03
dermatitis, skin reactions, those type of conditions as
2:06
well. So,
2:07
you lots and lots of utilization. For prednisone.
2:10
You're gonna see... It used for lots of
2:12
different,
2:13
inflammatory.
2:15
Disorders. That's just the tip of the iceberg
2:16
and the common
2:18
indications that I I see it used for
2:20
on a somewhat regular basis.
2:22
In addition, I did wanna mention,
2:25
prednisone
2:26
can be used for I suppression
2:29
purposes.
2:30
So an organ
2:31
transplantation, things that nature.
2:33
Yeah it can also be or shown to
2:36
be somewhat helpful in,
2:38
reducing nausea, that cor steroids in in general,
2:41
have been shown to kinda help
2:43
with nausea symptoms as well,
2:45
and things like that.
2:48
Alright. So let's
2:50
discuss adverse effects a little bit. So first
2:52
and foremost,
2:54
I wanna talk a little bit about the
2:56
kinda of short term immediate adverse effects you're
2:58
gonna see good ones to educate the patient
3:01
on,
3:02
Gi upset,
3:04
stomach issues, yeah, it can increase ulcer risk.
3:08
It's admit... It's recommended to administer prednisone,
3:12
with food and or milk,
3:14
and that's gonna help potentially
3:17
reduce the risk or the incidence of some
3:20
of those Gi adverse effects.
3:23
Other kind of acute short term adverse effects,
3:25
they can tender to ramp people up a
3:27
little bit
3:29
so you can definitely have some insomnia, so
3:31
we'd like, you know, if you've got a,
3:33
let's say, 20 milligrams of prednisone for 5
3:37
days.
3:38
We'd like to give that prednisone earlier in
3:41
the day if possible.
3:43
So
3:44
sometimes, you know, patients come into the clinic.
3:46
They get prescribed it at you know, 4
3:49
5PM, They get to the pharmacy, at 6
3:51
or 7,
3:53
you know, depending upon what the situation is
3:55
and how we wanna get that prednisone started.
3:58
You may give it in that situation, but
4:00
obviously,
4:01
we definitely want to
4:04
educate our patients like, this may,
4:07
keep you up a little bit at night.
4:08
So ideally,
4:09
the earlier in the day that we can
4:11
take it with food,
4:13
is generally the the better. So also associated
4:15
with that insomnia,
4:17
some people will get a little bit more
4:19
anxiety.
4:20
So if you have a patient that's really
4:22
prone to that,
4:24
definitely something, to be aware of and and
4:26
pay attention to.
4:29
Couple,
4:30
few disease states I wanted to mention to
4:33
maybe be a little bit careful with at
4:35
least a little extra monitoring or patient education.
4:39
So first and foremost diabetes,
4:41
prednisone,
4:42
can increase blood sugar in all cor
4:45
can, can increase blood sugar cause at hyper.
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And really throw patients out of whack. So
4:54
patients taking insulin,
4:55
for example, I've seen some issues with that.
4:59
Where patients have
5:01
adjusted. It's let's say they've got a, you
5:03
know, 05:10 day course of prednisone. They've adjusted
5:06
their insulin dose.
5:08
Because they've seen their blood sugars go higher.
5:11
And then when that prednisone stops,
5:14
then their blood sugars go back down normal
5:16
and they make it hypoglycemia.
5:18
So
5:19
educating patients maybe to monitor,
5:22
those blood sugars a little bit more closely,
5:25
you know, and if you've got some mild
5:27
moderate spikes in blood sugar,
5:29
You know, that's maybe not, you know, a
5:31
huge deal,
5:32
but just keep patients aware that have been
5:35
you know, very well controlled.
5:38
They may see those spikes in those big
5:40
fluctuations.
5:41
Heart failure is another 1 to pay attention
5:43
to can increase
5:45
risk for signs and symptoms of of heart
5:47
failure in those type of patients,
5:49
blood pressure as well. It can bump blood
5:51
pressure up a little bit. So
5:53
pay attention to that too.
5:55
The long term adverse effects of Prednisone,
5:58
more so if you're taking it on a
6:00
chronic basis, which again why we try to
6:02
limit the use if we can.
6:04
So we can
6:06
have, you know, that I suppression risk, the
6:09
longer they're on it, to higher the dose,
6:11
that can increase that
6:13
risk for infection and things like that.
6:15
Hvac suppression, I mean, that's really probably 1
6:17
of the biggest primary reasons why we try
6:19
to limit its used to you know, 1
6:21
week or less than 2 weeks.
6:24
And then osteoporosis as well is a common
6:28
long term adverse effect if you've got patient
6:30
who's taking it chronically.
6:33
Alright. Next medication number 42
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is ez.
6:38
Brand name of this medication is Z.
6:43
It is a cholesterol
6:45
agent, it is primarily focused on reducing
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Ldl.
6:50
Now mechanistic, how does it do that and
6:53
inhibits gut absorption
6:55
of cholesterol by
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impacting
6:58
naming
6:59
Ne pick, c 1 like 1.
7:02
Transport,
7:04
abbreviated NP1L1.
7:07
So Ne pick is kind of the thing
7:10
that I always remember associated with that. And
7:12
and if you're taking
7:14
exams or preparing
7:16
for exams regarding hyper
7:18
board Sam's,
7:19
that's probably the the big thing to remember
7:21
from a mechanism standpoint.
7:23
If you're required to remember that.
7:27
Where do we see this use so it
7:28
lowers Ldl? Like I I mentioned, it's typically
7:32
added on to stat therapy.
7:35
But you may see it used as kind
7:38
of an alternative if you've got a patient
7:40
that's tried numerous statins and they can't tolerate
7:42
them for whatever reason.
7:44
You may see as that I've used as
7:46
mono therapy.
7:49
The probably the biggest downside compared to statins
7:52
is it's just not as potent.
7:54
You know, to is there, it's not not
7:56
bad that way,
7:58
but it's just not
7:59
as near as potent at reducing Ldl
8:03
and
8:04
reducing cardiovascular
8:06
risk
8:07
compared to the proven
8:09
efficacy and benefit that we have with statins.
8:11
So
8:12
just to give you an an idea here,
8:14
it's in the neighborhood of,
8:16
15 to 20 percent reduction
8:18
in Ldl.
8:20
Maybe It can get slightly higher than that,
8:21
but
8:23
versus statins, you can get, you know, above
8:27
50 percent reduction. In Ldl with stat therapy.
8:30
So yet just not quite as potent,
8:33
generally well tolerated. So from an adverse effect,
8:37
standpoint,
8:38
I, you know, I don't typically worry a
8:40
ton
8:42
about side effects with this medication.
8:44
You may see some some Gi adverse effects
8:47
reported. I would say it's pretty low.
8:49
And then,
8:50
have seen,
8:51
reports of neuropathy as well.
8:54
That's probably more likely in patients
8:57
who are taking stat therapy already.
9:01
With 43, we're gonna stick on the
9:04
cholesterol
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theme.
9:06
So we've got fish oil type product.
9:09
Lo being a brand name product there. So
9:11
these are omega 3,
9:13
poly
9:14
fatty acids.
9:16
Mechanism of action isn't totally well understood,
9:20
but ultimately, helps,
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kind of blunt the liver
9:24
the production of triglycerides
9:27
and liver production of of triglyceride rich Ldl.
9:31
V is is what I should say there.
9:35
So ultimately, the use of this is patients
9:38
with hyper,
9:39
so elevated triglycerides.
9:42
We're trying to reduce those. Now in most
9:44
patients, we focus on Ldl first.
9:47
But if you got somebody with substantially,
9:51
high triglycerides and there at risk for pan,
9:55
then we might focus on those triglycerides
9:57
first, and
9:59
potentially consider a medication,
10:02
like fish oil.
10:05
Adverse effect profile, usually Gi upsets probably the
10:07
most most common there. Sometimes these pills can
10:10
be larger. So from an inherent standpoint from
10:13
an administration standpoint,
10:15
that may be challenging for some patients.
10:19
We can get some burp and fishy
10:22
type taste
10:23
depending upon
10:25
the product as well a little bit there.
10:28
There is a theoretical risk on platelet function,
10:33
I don't worry about it to a tremendous
10:37
extent,
10:38
but it it is out there in the
10:40
literature a little bit. So I guess it's
10:42
something to consider if you've got a patient
10:44
that's,
10:45
you know, severely an anemic or they're reporting
10:48
bruising and bleeding,
10:50
it might be something to look at and
10:52
consider.
10:52
And reassess kind of that risk versus benefit.
10:56
I did wanna differentiate
10:58
Lo a little bit from vest Vas.
11:03
So Vas is,
11:05
again, kind of a similar type product, but
11:07
it does have evidence
11:09
in lowering
11:11
As d risk
11:14
compared to Lava, which does not have
11:17
that demonstrated benefit, at least from the literature
11:19
I've seen. So kinda 1 differentiating thing there
11:23
with Lo
11:24
compared to
11:25
some of the other fish oil type products.
11:29
Alright. Moving on, we've got to number 44.
11:32
We've got re,
11:34
brand name is Avi vista.
11:37
This is a ser
11:40
type agent, so the SER
11:43
that stands for selective estrogen
11:45
receptor modi.
11:47
So essentially,
11:49
what this does is it stimulates
11:52
specific
11:53
estrogen
11:54
receptors in bone
11:57
and,
11:58
also can act as an estrogen
12:02
antagonist as well.
12:04
So we've certainly got an indication for
12:07
osteoporosis,
12:08
where again, estrogen,
12:10
more estrogen you have, the better it is
12:12
for bone health. This is why post men
12:15
women with less estrogen
12:17
tend to be at greater risk. For
12:19
osteoporosis.
12:21
But then it's, you know, selectivity in what
12:24
it does with estrogen receptors.
12:27
It can act as an antagonist
12:29
at other sites and potentially be useful,
12:34
in certain types of breast cancer as well.
12:38
So kind of a dual indication with this,
12:41
for osteoporosis
12:43
re is not considered a first line agent.
12:46
It's kinda more down along the lines if
12:48
somebody can't tolerate.
12:50
Let's say an oral bi pho, like le,
12:53
for whatever reason, you don't, ro may come
12:56
into play as a potential alternative there.
12:59
And then, obviously, if you've got the 2
13:00
birds of 1 stone, you know, where... It's
13:04
beneficial with for oncology purposes.
13:07
And using it in breast cancer, we can
13:08
have that beneficial effect of osteoporosis management there.
13:12
So if we can do that, that's certainly
13:14
a great thing.
13:17
With that said,
13:19
just kinda
13:21
in the
13:22
osteoporosis realm here,
13:24
reason why it's not utilized first line osteoporosis.
13:29
Is we've got a risk of adverse effects,
13:30
but we've also got lower efficacy.
13:33
Than some of the other agents like bi
13:35
and d, for example.
13:39
Those adverse effects, let's touch on that a
13:41
little bit here.
13:43
1 of the biggest things that I look
13:45
out for is, risk for clot, so,
13:49
Dv and stroke,
13:51
that risk can increase
13:53
with the use of.
13:55
So that's something to look out for if
13:56
you've got patients
13:58
you know, who are taking
14:00
anti regulation and you see that they have
14:02
that clock risk.
14:03
You know, re probably isn't a great medication
14:06
to utilize in that patient population if we
14:09
can avoid it. So
14:10
definitely pay attention to that.
14:13
And then with some of the estrogen
14:15
blocking
14:16
activities,
14:17
you know, it it kinda has again. It's
14:19
kinda selective on which estrogen receptors it's hitting
14:22
and which ones it's not, which ones it's,
14:24
you know,
14:26
agonizing and which ones it's ant agonizing.
14:29
With that said,
14:31
it has been reported that you'll see some
14:33
hot flashes
14:34
with
14:35
re,
14:37
so that can be challenging for some patients
14:39
there as well.
14:41
Alright. And we are moving on to the
14:43
last
14:44
chin, it is fe.
14:47
Brand name this medication is D lantern.
14:50
Alright. As far as mechanism of action, chin
14:53
it is an anti seizure medication and it's
14:56
thought to do this
14:58
by the inhibition of voltage gated sodium channels.
15:03
Mechanism isn't totally well understood,
15:06
but that's the the proposed most commonly proposed
15:09
mechanism
15:10
with Fe.
15:13
Alright. So utilizing it for seizures,
15:16
what adverse effects are we going to encounter?
15:19
So Gi adverse facts can happen,
15:22
Cns changes, you know, confusion, s evasion,
15:27
a taxi as a good 1 to remember.
15:29
So kind of that difficulty walking or stumbling
15:31
if you notice
15:33
changes in a patient's gate that may indicate
15:36
that they've got some signs and symptoms of
15:37
toxicity.
15:39
It can actually induce the metabolism of vitamin
15:44
d. So it can lower vitamin d levels
15:46
and cause some deficiency there. So
15:49
supplementation may be needed there.
15:52
There has been issues reported with liver function
15:54
changes.
15:55
It's on the rare side, but that definitely
15:57
has has happened there.
16:00
Drug interactions. I definitely want to mention this
16:03
with Fed and there's lots of them.
16:05
And there's is a big challenge
16:07
with Fe. So,
16:09
few examples of
16:12
meds that can increase
16:14
concentration or potentially have some additive adverse effects.
16:17
Flu,
16:19
am,
16:20
alcohols, editing, and flu box. I,
16:24
these are all likely to increase the risk
16:27
of toxicity or symptoms of toxicity there.
16:32
In clinical practice, D is or Is 1
16:35
of those that scares me a little bit.
16:37
And so
16:38
if we have a new medication that's starting
16:41
and I see somebody on Fe.
16:44
That definitely prompts me. That's a good time
16:47
to take a peek at their medication list.
16:48
Maybe run a drug interaction screen. And make
16:51
sure nothing's gonna
16:53
mess with that fe level because
16:56
remember, Fe is a narrow therapeutic window drug.
17:01
So that is a really, really important thing
17:02
to remember.
17:03
Basically, what that means is there's really a
17:06
small...
17:08
Drug concentration, a small window where that drug
17:11
concentration can fall,
17:12
that's therapeutic in preventing seizures
17:17
but not toxic
17:18
in causing adverse effects. So
17:21
that is definitely a a challenge there for
17:24
sure.
17:25
So that usual fe
17:28
level
17:28
is in the 10 to 20 range.
17:32
This can be a little bit misleading if
17:34
patients have low albumin.
17:36
So in those type of situations at free
17:38
level is considered best.
17:40
But you also wanna look back.
17:42
You know, and see
17:44
what patient's previous levels have been where that
17:46
baseline is,
17:47
and, you know, see if there's any any
17:49
trends in, you know, escalation. And then, obviously,
17:52
the associated
17:53
clinical symptoms
17:54
that that may appear as well.
17:57
So
17:58
fe is highly albumin bound
18:01
So if that albumin falls over time,
18:05
probably the most common situation is older patients
18:08
with malnutrition,
18:09
they may have good example of lower albumin
18:12
levels.
18:13
And if that's true, we're gonna have a
18:14
higher free fraction of drug and increase the
18:17
risk
18:18
for toxicity even though, you know, the total
18:20
blood levels may look normal. And so that's
18:23
why
18:24
we consider doing a free level
18:27
in some situations there.
18:30
Those toxicity
18:32
signs and symptoms I kind of alluded to
18:34
it already in the adverse effects, but
18:37
you know, that I attacks you difficulty walking
18:39
confusion, Gi side effects,
18:41
slur speech,
18:42
I didn't wanna mention 1 other 1 that
18:44
I didn't mention in the adverse effects.
18:46
Vertical nice tag. So this is the kinda
18:49
unique moving
18:51
of the eyes,
18:52
kind of this shutter or,
18:55
moving up and down of the, eyes.
18:58
So that is something to pay attention to.
19:01
It's not something I've
19:03
seen in practice,
19:05
and I think from the literature, it takes
19:08
pretty high levels
19:09
to get that adverse effect.
19:12
But if you happen to see that,
19:14
you definitely wanna go a look at that
19:16
patient's medication list and see
19:18
if they're on Ph because it's definitely 1
19:20
of the medications
19:22
that could potentially cause that adverse effect.
19:26
Alright. So that wraps up the next 5,
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