Latest / Real Life Pharmacology - Pharmacology Education for Health Care Professionals / Top 200 Drugs Podcast – Drugs 31-35

Transcript

Top 200 Drugs Podcast – Drugs 31-35 · Real Life Pharmacology - Pharmacology Education for Health Care Professionals

0:00
Hey. Welcome back to the real life pharmacology
0:02
podcast. I'm your host Pharmacist derek at Christians
0:04
and thank you so much for listening today.
0:07
Go check out real life pharmacology
0:09
dot com. Get your free 31 page Pdf
0:12
on the top 200 drugs. Alright great little
0:14
study, grad, great refresher.
0:16
If you've been out in practice for a
0:17
little while. I just highlight some of the
0:20
most important things that you're gonna see in
0:22
clinical practice and some of the most important
0:24
things
0:24
that you're gonna see on
0:26
pharmacology exams throughout school,
0:29
and maybe board exams throughout your career as
0:31
well. So I go check that out. Take
0:33
advantage of that. Simply an email is all
0:35
it's gonna cost you, and we also get
0:36
you updates when we've got other content
0:39
available.
0:41
Alright. So we are continuing on our list
0:44
of the top 200 drugs, and we've got
0:47
numbers 31 through 35
0:49
today.
0:50
The first drug is ethanol est
0:53
and.
0:56
This is an estrogen
1:01
combination oral
1:02
contraceptive.
1:04
Sometimes you'll see the generic
1:07
kind of abbreviation Oc c's for oral contraceptive.
1:10
Sometimes you'll see C
1:12
for,
1:14
more specific, more for combined oral contraceptive,
1:18
so keep those,
1:20
abbreviation in mind there.
1:23
Brand name in this medication, if I didn't
1:25
mention it is Yes.
1:28
Mechanism of action, how
1:31
these combined oral contraceptive work.
1:34
They block
1:35
population by negative feedback on the hypothalamus.
1:40
The hypothalamus,
1:42
then in turn,
1:44
works with the
1:46
pit
1:47
anterior
1:48
anterior
1:49
pit,
1:51
and that reduces
1:53
f h and L h
1:56
secretions. So f h is
1:58
fo stimulating hormone, and L h is lu
2:02
hormone.
2:03
And by reducing that secret accretion of those
2:06
2,
2:07
that
2:08
prevents o population, which is obviously what we're
2:11
trying to do with oral contraceptive,
2:14
and maybe even a more generic term birth
2:16
control.
2:18
Alright. Now what do we have for risks,
2:21
adverse effects with ethanol ester dial under spa
2:24
on combination?
2:26
As with most estrogen
2:29
progressed
2:30
combinations,
2:30
nausea can occur,
2:32
usually, they hire the estrogen dose
2:36
that's tends to cause more nausea. So it's
2:38
definitely a dose dependent type effect.
2:42
If we
2:43
don't have enough estrogen,
2:46
we can sometimes get breakthrough bleeding and spotting.
2:49
So that's kind of the the yang and
2:51
the yang of you know, too much estrogen,
2:53
too little estrogen.
2:54
Also,
2:55
too much estrogen,
2:57
we can increase risks for Dv, pe,
3:01
in are other cardiovascular
3:03
effects, so that can be a downside there
3:04
as well.
3:07
Important to remember
3:09
patients who are
3:11
over the age of 35,
3:13
and their smokers.
3:15
These patients are at risk for
3:18
higher risk for an increased risk of cardiovascular
3:21
events. So,
3:22
there is a boxed warning on this risk.
3:27
Alright. Moving on. Next medication. We've got a
3:29
press.
3:31
That is the brand name, I should say.
3:33
Hydra
3:34
is the generic name.
3:36
And this is classified as an anti
3:40
medication.
3:42
Most commonly, I've seen it used
3:44
for blood pressure reduction,
3:47
on rare occasion, probably the less common now.
3:50
I have seen it used for
3:52
heart failure, reduced... With reduced ejection fraction,
3:56
and that's in in combination with a a
3:57
nit trait there. Yeah, not something I see
4:00
very often anymore in in in practice. Used
4:03
to be a little bit more common, but
4:04
we've got,
4:05
more and more agents out now for
4:08
heart failure such as
4:10
you know, ent and the ST2
4:12
inhibitors and and other medications there.
4:15
So 1 of the big downsides of hydro,
4:18
is it
4:19
it's dose multiple times per day, so up
4:22
to 3 to 4 times per day. So
4:25
obviously, when it's a a medication that's not
4:27
really relieving any symptoms they were using it
4:30
for blood pressure.
4:31
You know, the patient
4:33
doesn't feel any better after taking it so
4:36
sometimes it's really, really difficult through patients
4:39
to remember to take multiple
4:41
daily doses of a meds. So,
4:44
that is definitely a big challenge with hydra,
4:47
and, definitely 1
4:49
big reason why I don't think you, see
4:52
it
4:53
very often there.
4:56
Classification, it is classified as a direct vas.
4:59
So basically just opens up those vessels or
5:01
causes that
5:04
adverse drug
5:05
reactions,
5:06
probably the most highly test thing that you're
5:10
gonna see with
5:11
hydra,
5:13
is it can cause a lupus like syndrome.
5:17
This tends to be a dose dependent effect?
5:20
If you got a patient specifically that she
5:22
knows on higher dosages,
5:24
they're probably gonna be at greater risk for
5:26
this,
5:28
it can lead to some you know, muscle
5:30
pain, sore, joint pain, swelling,
5:33
and also lead to,
5:35
complications with the heart and liver as well.
5:37
So
5:38
definitely
5:40
can be a significant
5:42
consequence from the use of hydro, and again,
5:45
the higher the dose, the more likely.
5:48
We are to see this risk, but definitely
5:50
a good,
5:52
board exam question, to remember when assessing.
5:55
And I hypertensive agents and hydro
5:59
increasing the risk of a of lupus
6:01
type reaction there.
6:04
Other adverse drug reactions you might see, obviously,
6:08
hypotension and it can drop blood pressure Too
6:10
far increase the risk for falls, dizziness
6:13
flushing,
6:14
edema has been reported and tachycardia as well.
6:18
Next medication, we've got ben str
6:21
brand name of this medication is Cog.
6:25
This is an older
6:27
anti urgent type medication.
6:29
I believe it was originally
6:32
created and shown to be beneficial
6:34
in patients with Parkinson's
6:36
disease in treating those symptoms.
6:39
The challenge with ben and Parkinson's disease is
6:42
the doses that you have to use generally
6:44
tend to be higher.
6:45
And the anti
6:47
adverse effects are really, really
6:50
problematic.
6:51
So,
6:52
where I've seen it used in in practice
6:54
I guess primarily as, drug induced extra p
6:57
symptoms,
7:00
type reactions.
7:02
This, those are are most commonly caused by
7:05
dopamine blocking agents
7:07
such as, you know, first generation and I
7:10
say narcotics.
7:11
Medical c provides another good example there.
7:14
So those are kinda some of the the
7:16
indications you you may see them str
7:19
utilized for.
7:21
So this medication being anti,
7:24
adverse drug reactions,
7:26
you can't spit c or poop.
7:29
That's... Good way to remember that. So dry
7:31
mouth, dry eyes,
7:33
you're in a retention,
7:36
constipation.
7:37
Can also cause some Cns changes and increase
7:40
the risk for
7:41
confusion. It can also increase fall risk.
7:45
Rarely, it can
7:46
contribute to hyper hypothermia, so that's an increase
7:50
in the
7:52
body temperature, basically.
7:54
1 of the mechanisms that it kinda does
7:56
this is it can kind of inhibit sweating,
8:00
and and those type
8:02
of things that help cool the body down.
8:05
So that is something to pay attention to,
8:08
particularly in warmer climates, warmer time of the
8:11
year.
8:12
And then obviously, if if patients are are
8:14
taking other anti
8:17
medications there as well.
8:19
1 last point with ben str, look out
8:21
for the prescribing cascade. So that's where we,
8:24
add another drug to treat a side effect.
8:27
So good examples here,
8:30
artificial tears for dry eyes, saliva substitute for
8:33
dry mouth.
8:35
Tam
8:36
for symptoms of urinary retention,
8:38
lax agents for that constipation adverse effect.
8:43
Dementia medications. This is something I've seen in
8:45
my practice there as well,
8:48
where we actually start ben str.
8:51
Patients have increased
8:53
confusion.
8:54
We don't recognize that it's from,
8:57
that it's likely an adverse effect, and we
8:59
start
9:00
dimension medications because they were inappropriately diagnosed with
9:03
dementia versus an adverse effect.
9:06
Alright. So moving on, we've got number 34.
9:09
We've got c from
9:11
c
9:13
excuse me. In combination with hydro.
9:16
Brand name of this medication is Ta onyx.
9:19
This is a
9:21
liquid medication that occasionally you will see prescribed
9:24
for patients with chronic cough.
9:27
Or, you know, coughing symptoms associated,
9:30
with with something there.
9:33
1 thing I always look for whenever I
9:35
see a cough medication prescribed for somebody that's
9:38
had a cough for a long time. Obviously,
9:39
take a peek.
9:41
You know, hopefully, the provider
9:43
prescribing the cough medication has looked at the
9:45
medication list or recognize
9:47
if they're on an ace inhibitor, but
9:50
you gotta make sure that they're actually not
9:52
taking an ace inhibitor. Whenever you see, you
9:55
know, cough medicine used
9:58
for kind of a dry hack hack... Or
10:00
excuse me, just a dry cough excuse me.
10:03
Alright. So these
10:05
drugs mechanistic
10:07
their classification, cor is a first generation anti
10:10
histamine.
10:11
It's gonna have plenty of anti
10:13
activity.
10:14
I kind of ran through that with ben,
10:18
and some of the challenges and adverse effects
10:20
you're gonna see
10:21
with an anti
10:24
type medication.
10:26
And then we've got hydro, which is obviously
10:28
an opioid
10:30
medication,
10:31
So adverse effects,
10:33
obviously, as you could imagine, s oxidation,
10:37
constipation and then those anti
10:39
effects as well.
10:41
Now before I move on, I gotta mention
10:43
the boxed warnings
10:45
associated
10:46
with Tess onyx, and there are actually a
10:49
bunch of them.
10:50
I wanna highlight some of the important ones
10:52
here.
10:53
Obviously,
10:55
it is a controlled substance. So risk for
10:57
addiction, abuse dependence
10:59
those are all definitely challenging things there.
11:03
Respiratory depression. So again, we're utilizing an opioid
11:06
in the case,
11:08
situation of,
11:10
inappropriately high dose or overdose,
11:14
that can certainly certainly have and increase the
11:16
risk for,
11:18
coma death,
11:19
things of of that nature.
11:22
With liquids,
11:24
we need to be careful for measurement errors,
11:26
and, particularly when you're talking about a higher
11:29
risk medication,
11:30
that has an opioid in it.
11:33
We need to be very, very careful
11:35
that the dose is appropriate
11:38
and that the patients know and understand how
11:40
to measure out liquids.
11:43
Very, very critical
11:44
to
11:45
not make the assumption that they're gonna know
11:48
exactly what 10 mills is or, you know,
11:50
whatever the dose is.
11:52
For any medication,
11:54
we've gotta make sure
11:56
that they understand and and know how to
11:58
measure out those liquids and what is
12:01
an appropriate,
12:02
dose and measurement there.
12:05
Another box warning, Benz
12:07
use
12:09
alcohol use it can increase the risk for
12:11
respiratory depression, opioid toxicity. Really, really important there.
12:16
And then sip 384 inhibitors. Is also another
12:19
boxed warning. This can increase the effects of
12:22
hydro.
12:23
So again, lots of warnings associated with this.
12:27
I definitely see a lot less use
12:30
of this medication
12:32
than I used to see. 05:10
12:34
plus years ago. So...
12:37
But if you do see it, definitely a
12:38
few important things to remember there.
12:41
Alright. Then our last 1 of the day,
12:43
we've got number 35, and that is par.
12:46
Brand name is Pax.
12:48
This is an Ss r. So ultimately, it's
12:51
gonna increase
12:53
serotonin
12:54
in the synapses of the brain.
12:57
Utilized to treat a bunch of,
12:59
different psychiatric
13:01
disorders, depression,
13:03
anxiety, Ptsd,
13:05
a few others as well.
13:07
Keep in mind, it it can be used
13:10
to help manage possible symptoms.
13:13
You do see that occasionally in practice where
13:16
it's...
13:18
We're using a non estrogen type product to
13:20
help
13:21
maybe help with, some of the
13:24
vas motor symptoms associated
13:26
with menopause.
13:29
There is a boxed warning, of course, with
13:31
all virtually all antidepressants, increased risk for
13:35
suicidal thoughts and behaviors, particularly in young patients.
13:39
So that's important to note.
13:41
Adverse drug reactions can have some
13:44
Gi issues
13:46
you know, constipation, stomach upset occasionally.
13:50
Sexual impairment
13:51
is an important 1 to remember with all
13:53
Ss i's and pro is
13:55
included in that.
13:58
Pro is not the best Ss I to
14:00
use in the elderly for sure. It's got
14:03
some,
14:04
you know, higher anti
14:05
activity
14:06
compared to
14:08
the other Ss or i's within its class,
14:12
another challenge
14:13
with per,
14:15
can be tapering off and reducing,
14:18
per, it does have a shorter half life.
14:21
So disco,
14:23
that medication can be a challenge as well
14:25
and
14:27
kinda of that Ss disco
14:29
syndrome, maybe a little bit more likely to
14:31
to have with per than compared to,
14:34
let's say, flu, which has generally a much
14:37
longer half life.
14:40
Then for drug interactions,
14:42
there are some drug interactions through Sip 2D6,
14:46
I'm not gonna go into detail on that.
14:49
Definitely go back to the archives. At relay
14:51
pharmacology dot com. If you're looking for more
14:53
specifics.
14:54
On any of these drugs.
14:57
I've done
14:58
over 300 podcasts of individual medications, you could
15:01
find them all at relay
15:03
dot com. Just search a specific drug you're
15:05
looking for.
15:06
If you can't find the specific drug you're
15:09
looking for. I certainly take
15:11
request periodically as well. So a Feel free
15:13
to reach out to me at med education
15:15
ones you're 1 at gmail dot com.
15:18
As always, if you enjoyed this podcast, found
15:20
and helpful, please support the sponsor. Or med
15:22
01:01 dot com slash store.
15:24
Any purchase there goes directly
15:27
to support this podcast,
15:29
help keep it free of charge
15:31
for all to benefit from. So
15:33
please do that if you're able at admitted
15:35
1 1 dot com slash door. Lots of
15:38
items for anything from pharmacy
15:41
technicians, pharmacists, pharmacy students,
15:44
board certification study materials,
15:47
case studies,
15:48
drug interactions, primary care information. So if you're
15:52
a nurse,
15:53
you know, Pa, nurse practitioner, med student, all
15:57
the way up to physician.
15:59
Lots of different things available,
16:01
that can definitely help you in your practice
16:03
and learning and applying pharmacology so go take
16:07
advantage of that, and obviously, help this podcast
16:10
too. So Again, med 1 1 dot com
16:12
slash store. Again, if you wanna reach out
16:15
to me, comments, questions, suggestions, med education 01:01
16:18
at gmail dot com. If you wanna connect
16:20
with me. You can do that on Linkedin
16:21
as well.
16:22
Eric Christians Farm, Bc,
16:24
bc gp,
16:26
and
16:27
take advantage of your free 31 page Pdf
16:30
as well at relay life pharmacology
16:32
dot com. Thanks so much for listening.
16:34
Take care, and I hope you have a
16:35
great rest of your day.