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Top 200 Drugs Podcast – Drugs 46-50 · Real Life Pharmacology - Pharmacology Education for Health Care Professionals

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Hey. Welcome back to the real Life pharmacology
0:02
podcast. I'm your host Pharmacist eric Christians. Thank
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With that said, let's get into the
0:49
drugs of the day today. We are continuing
0:51
on with the top 200 lists.
0:53
Gonna pick up on drug number 46,
0:57
and that is Ty.
1:00
Brand name in this medication is X flex.
1:04
This is a skeletal muscle relax.
1:07
Or sometimes referred to as an anti spas
1:11
agent,
1:12
obviously, for, you know, muscle spasms in those
1:15
type of symptoms,
1:17
really a symptomatic
1:19
treatment that I see occasionally used.
1:22
Mechanistic,
1:24
it's what's called a central acting alpha 2
1:27
agonist,
1:29
and that ultimately helps,
1:31
reduce that muscle spas.
1:34
With that said, if you think about this
1:36
medication,
1:38
it has a similar
1:40
mechanism of action to, cl or at least
1:44
overlapping in some ways.
1:47
So what that means as far as a
1:49
side effect profile,
1:50
is if you can remember what some of
1:52
the side effects quantity are, you're probably gonna
1:55
remember
1:56
some potential adverse effects of ty
1:58
as well. So
2:00
it's probably a good guess with any skeletal
2:03
muscle relax that it can be s sedated,
2:06
so that can certainly happen,
2:09
it can increase risk for Cns changes and
2:13
confusion,
2:14
particularly, this is a little higher risk in
2:16
my patient population. The do we get,
2:19
the more and more likely 1 to experience
2:22
that.
2:23
And then if you think about what cl
2:25
is sometimes used for, it's used to bring
2:27
down blood pressure.
2:30
Maybe to a lesser extent. But again, kind
2:32
of a dose dependent adverse fact,
2:35
higher the dose, you know, maybe the more
2:36
likely you're gonna run into some ortho homeostasis
2:39
and some lower blood pressure and fall risk
2:42
issues as well there.
2:45
From a drug interaction standpoint,
2:47
1
2:48
point of emphasis here is
2:50
Sip
2:51
1A2.
2:54
So this drug is broken down
2:57
by Sip 1 82.
2:59
So interactions, with, ci,
3:02
fairly commonly used antibiotic as well as flu,
3:07
which is an Ss r.
3:09
Yeah. Excuse me. Ss r. So So a
3:11
couple drug interactions there, I I wanted to
3:14
specifically,
3:15
point out
3:16
via the Sip enzymes.
3:18
Alright. Next medication is r.
3:21
Brand name is r all.
3:24
This is a second...
3:27
Generation and anti psychotic.
3:29
So it binds s dopamine 2 receptors,
3:33
which
3:34
helps regulate the activity of dopamine
3:37
in the me
3:39
pathway.
3:41
So the easiest way I remember
3:44
dopamine in that interplay in the brain
3:48
too much dopamine,
3:50
and we can induce symptoms of schizophrenia and
3:54
psychosis
3:55
2 little dopamine, and we can create
3:59
movement disorders. K? So that's a really, really
4:02
important
4:03
kinda ying and young,
4:06
homeostasis thing to remember
4:08
with dopamine and the interplay between Parkinson's
4:11
and psychiatric symptoms. It can definitely help you
4:14
out
4:15
on your, you know, board exams, pharmacology
4:17
exams, as well as in clinical practice if
4:20
you just remember that interplay a little bit.
4:23
So as you could expect, thinking about the
4:26
adverse effect, profile,
4:29
extra parameters symptoms, movement disorder symptoms,
4:32
can be an adverse effect of res.
4:35
Now it's generally not as potent or as
4:39
problematic,
4:40
as some of the first generation and anti
4:42
psychotic,
4:43
like hall, for example.
4:46
But again, this is dose dependent as you
4:49
know, a high dose of
4:51
certainly
4:52
will be a lot more likely to to
4:53
cause some of these extra parameters symptoms
4:56
compared to a lower dose. So
4:59
pay attention to that obviously, as we, escalate
5:01
dosages.
5:03
Other adverse effects to think about. So we've
5:06
got s oxidation,
5:08
Q
5:09
prolong risk.
5:11
Remember that anti psychotic can cause
5:14
metabolic syndrome, so that's something we may
5:16
monitor for their.
5:19
Hyper
5:20
is definitely
5:22
a risk within psychotic as well.
5:25
Eps symptoms alluded to already far risk
5:28
can happen with that as well as well
5:30
as ortho homeostasis risk.
5:33
Very rarely,
5:35
I can cause neuro mali malignant syndrome,
5:39
which can result in some,
5:42
muscle changes as well as an increase in...
5:44
Body temperature,
5:46
somewhat similar to
5:48
serotonin syndrome in in some of the symptoms
5:51
there.
5:52
And then there is a boxed warning for
5:54
the increased risk of death when we use
5:57
this medication
5:59
to treat,
6:01
dementia related behaviors
6:02
in some of our, elderly patients. So good
6:06
boxed warning there to remember that certainly you
6:08
could be tested on in board exams with
6:11
anti psychotic.
6:14
With
6:16
specifically,
6:17
maybe comparing it to some of the other
6:19
second generation anti psychotic.
6:22
It's probably
6:23
kinda moderate to high on the Eps, those
6:26
movement type adverse effects,
6:29
compared to other second generation and I psychotic,
6:32
and it's also high on the hyper
6:35
risk. It can cause that a little bit
6:37
more. So,
6:39
than some of the other
6:40
second generation and anti psychotic. It's
6:44
monitoring parameters,
6:46
you know, obviously, we're gonna look go for
6:47
some of the side effects, any changes in
6:49
in movements and that type of thing.
6:51
From a lab perspective,
6:53
you may monitor for that metabolic syndrome risk,
6:56
you know, think about lipids,
6:58
a1c, blood glucose, things like that.
7:02
And then 1 last thing, Wanted to mention
7:04
was,
7:05
different dosage forms,
7:07
dolls, got a bunch or
7:09
got a bunch.
7:10
Whether that be oral solution or it's got
7:12
a long acting. It's got some long acting
7:14
injectable
7:15
formulations.
7:16
So we do have a good variety there.
7:19
To kinda meet our patient's needs. And
7:22
in schizophrenia,
7:25
and many mental
7:27
health disorders
7:29
patient adherence is very, very critical, and it's
7:31
very, very difficult.
7:34
As that adherence rates
7:35
aren't that good, particularly,
7:37
in schizophrenia bipolar disorder and things of things
7:40
like that. So definitely a big challenge there
7:44
and some of those dosage forms
7:46
can sometimes allow us to,
7:48
improve that adherence a little bit.
7:51
Alright. Moving on, we've got number 48, and
7:55
that is Rama pro.
7:57
Brand name of this medication is Alt.
8:00
And if you remember your endings
8:03
So we've got Ram PPRIL.
8:07
That ending is going to indicate to you
8:09
that this. Is an ace inhibitor.
8:12
So mechanistic
8:14
it inhibits
8:15
angiotensin converting enzyme,
8:17
which ultimately
8:19
results in less
8:21
angiotensin 2. And if you remember,
8:24
from physiology,
8:26
angiotensin 2 is a potent vas stricter.
8:31
Adverse effect profile, this is definitely going to
8:34
be important If you ever have a patient
8:36
with a dry cough
8:38
be sure to look at their medal list
8:39
and make sure that they're not on an
8:41
ace inhibitor like Rama pro. Definitely can
8:45
cause a kinda dry
8:47
type chronic cough.
8:50
Hyper killing, and we're gonna be monitoring
8:52
potassium levels, and, you know, certainly, this can
8:54
be exacerbated by
8:56
other
8:57
medications, whether it's, you know, potassium spa diuretic,
9:00
potassium supplements,
9:03
even a antibiotic,
9:05
like sulfur, all trim can increase potassium levels,
9:10
so pay attention to that, and that's definitely
9:12
a lab you're gonna wanna be monitoring
9:15
as well as kidney function 2.
9:18
It can cause some
9:20
changes in in renal function and potentially worsen
9:23
than that as well.
9:25
Rare adverse effect I wanted to mention was
9:27
an edema, so kinda swelling of the the
9:30
lips and throat,
9:31
and a can,
9:34
stop or block breathing,
9:36
if that edema is severe enough and swell
9:39
up,
9:41
kinda in the,
9:42
airways coming from the the lungs there. So
9:45
that's an important 1 to to think about.
9:48
There's lots of compelling indications for ace inhibitors,
9:51
in addition to it being an anti,
9:55
you know, can be beneficial in, you know,
9:57
Ck k diabetes, strokes, C,
10:00
heart attack,
10:02
as far as added benefits in some of
10:04
those disease states there.
10:07
With monitoring,
10:08
I wanted to mention
10:11
maybe a little bit, you know, deeper nugget
10:14
here,
10:15
But historically, if you see a 30 percent
10:18
increase in cr, so that's your measure of
10:20
kidney function.
10:22
If you see a 30 percent increase in
10:24
cr levels,
10:26
or more,
10:27
that's likely indicative. That, that ace inhibitor is
10:31
potentially worsening renal function,
10:34
and that it it should be stopped
10:36
potentially. So
10:38
keep tabs on that. And again, that's why
10:40
we monitor,
10:41
renal function with
10:44
with ace inhibitors and with ram here.
10:48
Lastly,
10:49
I think it probably is pretty obvious, but
10:50
all blood pressure lowering medications, can drop it
10:53
too far. So pay attention to ortho homeostasis.
10:57
And fall risk in patients.
11:00
Alright. Moving on to number 49. We've got
11:03
p.
11:04
Brand name is p a call.
11:07
Mechanistic,
11:08
as you could probably guess by the ending,
11:11
p stat.
11:13
It is a stat medication used in the
11:15
management of cholesterol. So mechanistic,
11:18
it inhibits
11:20
HMG
11:22
coa red
11:23
with is ultimately responsible for the rate limiting
11:26
step
11:27
in the
11:28
production of cholesterol,
11:30
which
11:31
adverse effects,
11:33
with all statins, probably the biggest 1 you're
11:35
you're gonna be tested on, need to pay
11:37
attention to in practice is my. So kind
11:39
of all over muscle pain and and ach
11:42
ness.
11:44
Sometimes that can slide
11:46
under the radar. I've I've seen that in
11:49
practice with statins.
11:51
Where, you know,
11:52
gets diagnosed as you kinda generalized osteoarthritis
11:56
or the patient maybe doesn't describe the pain
11:58
that well.
12:00
And
12:00
you know, maybe they've been on a stat
12:02
for years, but maybe we've started a medication
12:04
that increased
12:05
concentrations and caused a drug interaction,
12:07
and increased the risk for,
12:10
there. So,
12:12
pay attention to that, ultimately, in severe situations,
12:16
it can lead to ra my
12:19
there that's going to be
12:21
noted by an elevated,
12:23
C k.
12:25
And,
12:26
ultimately, it can increase the risk
12:29
for acute renal failure. So,
12:32
definitely pay attention if patients are reporting muscle
12:35
pain, muscle sore,
12:37
we've got get at that and figure out
12:39
how severe it is?
12:41
Maybe can we switch statins? Can we reduce
12:44
the dose?
12:45
Do we have to come off it all
12:46
altogether? That's definitely kind of a a clinical
12:48
judgment, something you need to figure out,
12:51
Cp may be checked. To kinda rule that
12:53
out and and figure out how severe of
12:56
a situation this is.
12:58
But I found in my experience if if
13:01
patients get that muscle pain, muscle sore,
13:05
they they generally are very reluctant
13:08
to you know, go on and and try
13:10
another stat. And in some cases, if it's
13:12
not severe, we can certainly try it.
13:16
Obviously, if you've got a patient that's,
13:18
had rh l on a stat.
13:21
You know, there, we've you know, got a
13:23
little higher risk.
13:25
And likely are are probably not going to
13:28
try another stat
13:31
in most cases there. So
13:33
and there are some subtle
13:35
with statins, some are lip filler, somewhere are
13:37
hydrophilic that may or may not
13:39
you don't help.
13:41
In all and reducing
13:43
my type symptoms.
13:45
But again, in general, route life is very
13:47
severe type situation that we need to
13:51
pay attention to
13:52
and not not overlook. But again, very very
13:55
rare as well.
13:57
The advantage, I guess, of p,
14:02
and maybe 1 disadvantage. So
14:05
first, let's start with the disadvantage it doesn't
14:07
get as potent reduction in Ldl
14:10
as some of the high intensity statins, like
14:12
a to and res. So that's kind of
14:15
a downside with it.
14:18
Some
14:19
clinicians, anecdotally will say that they've noticed a
14:22
little less
14:23
with it.
14:25
And thinking that maybe that's due because it's
14:28
a hydrophilic stat and compared to a lip
14:30
stat,
14:32
You know, the evidence on that is, you
14:34
know, you know, there there might be some
14:35
out there, but
14:37
that's something that,
14:38
clinicians sometimes try.
14:40
If, you know, patient starts to and they
14:43
they couldn't tolerate it, They had some my
14:45
your other adverse effects.
14:47
Sometimes you might, d
14:49
at a at a lower dose utilized and
14:51
tried to to tit trade up and see
14:53
if and and what they might tolerate there.
14:55
So d Again. Always depends upon the severity
14:58
of the in... Of the reaction,
15:00
as well as, you know, what your patients
15:02
are kinda willing to...
15:04
Do and consider after you've educated them on
15:07
the risks.
15:09
P does have a lower number of drug
15:11
interactions
15:13
compared to some of the other
15:14
statins like Ci and a to and, more
15:17
specifically there. So that's definitely,
15:20
a little bit of an advantage there too.
15:23
Alright. Moving on, number 50 last drug I'm
15:26
gonna cover today. We've got.
15:29
So brand name is H,
15:31
and this is a non
15:34
selective alpha blocker.
15:36
K?
15:37
So when we talk about selectivity of alpha
15:39
blockers,
15:41
usually, we're talking about
15:43
the ur neurology system in the urinary system.
15:47
So some of the selective alpha blockers are
15:49
like Tam.
15:51
That's a a great example Commonly used 1.
15:54
Primarily used in a Bp,
15:57
for example.
15:58
Now the non selective alpha blockers have
16:01
many, many years ago, I have
16:03
historically been used for,
16:05
lowering blood pressure and management of of hypertension.
16:10
Probably the only situation I really see these
16:12
agents utilized for,
16:14
like
16:15
T,
16:17
is
16:18
Bp in combination with
16:21
hypertension. K?
16:23
So mechanistic, how does it work? It's an
16:25
app? Alpha blocker,
16:28
so blocking those alpha receptors could cause smooth
16:30
muscle
16:31
relaxation,
16:32
which ultimately leads to vas isolation. That's why
16:35
it's beneficial or can potentially reduce blood pressure,
16:39
as well as opening of the order. It
16:42
which, again, kinda opening up that passageway and
16:44
bp ph. Can you kinda help
16:47
ease the flow of of urine and out
16:48
of the body there,
16:52
they can work quickly
16:54
to help relieve symptoms in in Bp.
16:58
Compared to, let's say, 5 0 for red
17:00
inhibitors,
17:01
that take a long time to actually shrink
17:03
the prostate,
17:06
raise and can help certainly with that.
17:09
So
17:10
why don't we use these
17:12
medications
17:12
for blood pressure management. Why don't we use
17:15
theresa in for blood pressure management. I can
17:18
cause some ortho homeostasis
17:21
so
17:22
significant ortho,
17:24
and that's most apparent usually when starting or
17:27
increasing the dose,
17:29
So, again, that's that, you know, dizziness when
17:32
somebody
17:33
stands up, for example. So,
17:35
really, really important to educate your patience about
17:38
that that they're likely
17:41
to get dizzy when they change positions. They
17:43
go from sitting to standing,
17:45
particularly when starting this medication, k. So definitely
17:48
important to remember that.
17:51
1 other kinda deep deeper nugget here,
17:54
particularly in relation to the eye,
17:58
alpha blockers have been
18:00
shown to increase the risk of floppy iris
18:04
syndrome.
18:05
For those who have who are or have
18:08
got undergone
18:09
eye operations.
18:11
So really important to communicate
18:14
with the,
18:16
you know, opt,
18:17
surgeons ever doing surgery on the eye
18:21
and have them recognize.
18:23
Okay. Yes. This this patient is taking
18:26
an alpha blocker like to raise in. So,
18:29
again, very, very important to
18:32
have that great communication between health professionals,
18:35
and make sure that
18:37
you know, we get them off the medication
18:39
or
18:40
at least that the specialist doing the eye
18:43
procedure,
18:44
is aware that they're taking this medication and
18:46
some of the complications
18:48
that can happen with that.
18:51
Alright. Well, that's gonna wrap up the podcast
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