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Top 200 Drugs Podcast – Drugs 36-40 · Real Life Pharmacology - Pharmacology Education for Health Care Professionals

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Hey. Welcome back to the real Life pharmacology
0:03
podcast. I'm your host, Pharmacist sarah, Christians and
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thank you so much for listening today.
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We're gonna cover drugs 36
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through 40 of the top 200 drugs today.
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Before we do that, go check out the
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top 200 study guide at relay pharmacology dot
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com. It's a 31 page Pdf. Absolutely absolute
0:22
no brainer
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for you to have simply... Email will get
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you access to that, We'll also get you
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updates when we've got new podcast
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episodes available as well as other content. So
0:32
again go check that out, relay pharmacology dot.
0:34
Dot com,
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top 231
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page Pdf study guide.
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Alright. So number 36
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is
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pam. Brand name in this medication is Ada.
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This is classified as a benz,
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kind of a broader class, I guess you
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could consider it an an analytic.
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Primary use is as you could expect,
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use
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short term for anxiety, ideally, short term. I've
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definitely seen patients on it chronically.
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Other
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indications, you know, alcohol withdrawal,
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seizures
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potentially.
1:14
You do see it in hospice patients a
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fair amount for
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you know, agitation and anxiety,
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rare conditions you may see it utilized for
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serotonin syndrome and neuro malignant syndrome.
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Those are
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kinda 2 drug induced states where we could
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have some increase in
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anxiety and agitation there as well. So
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those are some of the the common uses
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or some of the the
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situations where you may see this this medication
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utilized.
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1 nice thing with
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maybe compared to some of the other
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benz
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is it does have a ton of different
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dosage forms.
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So we've got,
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tablet
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formulations. We've got oral liquid
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formulations. We've got injectable
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formulations.
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So that can certainly be
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advantageous depending upon what we're trying to do
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with that medication.
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Adverse drug reactions.
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So if you remember alcohol in a pill,
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that's the easiest way to remember the majority
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of adverse effect. With.
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So it is a depress type medication, so
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it's gonna cause some s edema
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can increase the risk for confusion. This is
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more problematic in our elderly patient population.
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I can increase falls risk, which is obvious
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see a a challenge in our older patient
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population as well.
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Slur speech, another example of an adverse effect.
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That you may see as doses escalate with
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pam.
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As far as drug actions, go, probably the
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biggest thing is other sedative type medications on
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top of using,
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So I think of,
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you know, first generation anti anti,
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t,
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you know, older, skeletal muscle relax and cabo
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pre ga,
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other
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medications and 1 that has a box skeletal
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warning as far as drug interactions go is
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with opioids.
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I can increase the risk for respiratory depression.
3:20
So that's definitely something to monitor for closely
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if you've got somebody on
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in combination
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with an opioid
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medication.
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Last thing I wanted to mention, maybe a
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couple things here. It is a controlled substance,
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so it's a schedule for... Controlled substance, so
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there is the risk of addiction dependence,
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just why we try to minimize its use
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to short term if possible, controlled
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and I also wanted to mention there were
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some new
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draft guidelines out, 20 24 draft guidelines on
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benz
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tapering.
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And I did post about that at med
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01:01. So if Google search,
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med ed 01:01 20 24 Benz,
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tapering,
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you'll see kind of those
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draft guidelines,
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any information on that if you're looking for,
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more detail, there.
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Alright. Moving on. The next
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medication, number 37
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is fin p. It's And brand name of
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this medication is iridium.
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This medication is a urinary anal.
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It helps with painful
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urination.
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Most commonly, I've I've seen it used in
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conjunction for a couple of days.
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Particularly,
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in patients who've maybe then diagnosed with the
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Uti, and they've got significant painful
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urination,
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you may see fin as purity kinda added
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on top of an antibiotic.
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Now I will caution you, be careful with
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patients out in
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the community. So if you're in a community
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pharmacy, for example,
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or if somebody's asking you for you know,
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ambulatory care type
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recommendations saying, hey, I've got some painful urination?
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Is there a medication used to treat this?
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You wanna make sure that those patients have
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been assessed,
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whether it be for urinary an tract infection
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or some other medical
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neurological
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condition.
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You definitely wanna
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get those those patients step assess because,
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painful urination definitely isn't
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an incredibly common thing for most patients. So
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usually, there's something else going on with it.
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So again,
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if you see somebody, you know, trying to
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buy this medication, get this medication,
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you definitely might wanna,
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inquire a little bit, ask a few questions.
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And make sure they've been assessed and get
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a, you know, kind of a background on
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their symptoms and what's been going on
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just to see if we need to dig
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a little bit further
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into that diagnoses
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and, have them tested and assessed for other
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things. So,
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important thing, patient education
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thing to remember there with ph.
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Adverse effect
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profile,
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1 unique thing with the medication is it
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can change urine color,
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and that color is a red or orange
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type color.
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That is
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definitely probably 1 of the more common unique
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adverse effects. Typically, it doesn't
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result in anything, but obviously, it can be
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pretty
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unnerving to the patient if they see that.
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Other adverse drug reactions usually they're pretty rare.
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You may see you know, on rare radiation
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skin reaction or maybe some Gi upset.
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Kidney function is important to take a peek
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out.
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If you've got a patient
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whose
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credit clearances is less than 50 emails per
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minute, it's recommended to a void,
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fin,
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there's rare situations, case reports
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associated with acute kidney injury,
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certain types of anemia.
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So definitely some some potential issues there.
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In using ph if patients have poor renal
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function.
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Alright. Moving on, the next drug we've got
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is hydro.
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Quinn. Brand name of this medication is Plaque
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elm.
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This was definitely a,
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hot topic for debate
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as far as whether it was effective for
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Covid or not, several years ago and
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the whole Covid thing was, in full swing.
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But it's a medication that's primarily used for
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rh
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disorders.
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It is classified as a dm, that's a
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disease modifying
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anti
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drug.
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It is also classified
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has an anti malaria drug. It has some
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anti
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malaria
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activity.
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Primary use I and practice on a chronic
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basis. You've rheumatoid arthritis,
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and then,
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Lupus is probably the other 1 that I
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see it
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utilized most often.
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Alright. Adverse drug reactions with hydro.
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So
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1 of the ones that's probably the most
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highly tested on, and definitely 1 that I've
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seen come up and practice quite a bit
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is hydro
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can cause some,
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toxicity.
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More specifically retinopathy.
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And this is a
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concentration dependent adverse effect. So obviously, higher higher
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the dose more frequently, we're giving it.
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The more likely
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this eye adverse effect
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is going to occur. So
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definitely making sure that patients are having
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routine eye exams and monitoring their eyes.
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And definitely should report any issues
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if they exert to experience some,
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unique changes in their vision, for example.
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There are some other rare things associated with
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hydro,
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hem anemia,
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particularly in patients with
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g6 6 pd deficiency.
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Hyper sensitive rack have been reported,
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Q prolong prohibition has been reported as well.
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So again, kinda some unique things with hydro
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when there is a bigger list as well.
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But again, probably the most important thing, if
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you're taking an exam,
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and really unique thing,
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is that risk for retinopathy and eye toxicity.
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Alright. Next
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medication is lid
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and we are specifically focusing on,
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the topical
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patch, so that would be lighted der would
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be the brand name there.
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This is a local an aesthetic.
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So the patch is essentially supposed to be
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placed.
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On the location where the
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pain is.
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Most common type of pain
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that lid patch is going to be beneficial
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for as neuro type pain
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and post
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neurology. Those are probably the 2 most common
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situations
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that I see that lid patch used for.
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An important thing to remember with the administration
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of those
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patches. So, first and foremost, they they act
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locally,
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but you can get absorption over I'm into
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the
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systemic circulation.
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So
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an important patient education point is for my
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patients that it should be
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kept on no longer than 12 hours. And
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that's really to try to reduce
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that accumulate.
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Now when we compare a lighter king patch
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compared to a fentanyl patch, for example,
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fentanyl patches actually have systemic absorption
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and have
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systemic and central nervous system type effects.
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Fentanyl is an an opioid of course there.
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So that's definitely different.
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A fentanyl patch is not meant to be
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used in a local area and placed on
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a local location.
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If your pain is on your elbow, you
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aren't supposed to put a fentanyl patch on
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your elbow,
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that's not the way it works. It requires
11:15
systemic absorption and getting adequate concentrations into the
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bloodstream. Versus lid patch, that's definitely more of
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a localized type effect. So if you've got,
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you know, low back pain, that type of
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thing,
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you'll see that lid
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patch
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placed on the side of action. So good
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little
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differentiator there
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with that lid patch.
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Now, I mentioned the 12 hours on maximum
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in a 24 hour period.
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When and if
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lid can accumulates in the bloodstream.
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There is risk for
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cardiac effects and changing
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the way the heart heart works and can
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cause arrhythmias and things of of that nature.
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And I think
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if you've got any experience with, you know,
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acute care or emergency room care, that type
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of thing.
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You'll know that we use or can use
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lid.
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In the Ac
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algorithm as
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medication used to treat certain types of arrhythmias.
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So
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that's the deal. That's the issue with
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accumulation of lid. So
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good 1 to remember there potentially.
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Alright. And our last
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medication of the day, number 40
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is going to be d.
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Brand name in this medication is cat.
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I'm focusing more so here on the oral
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formulation of this medication.
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It is an nsa. That's a non steroid
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anti inflammatory drug.
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Obviously, good at reducing pain and inflammation.
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But we've got plenty of adverse drug reactions
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with Nsa, in general,
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this is
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worsened as we get older, some of those
13:04
adverse effects,
13:06
can occur at a higher frequency or be
13:08
more severe?
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So first 1 I wanna mention, of course,
13:12
with Nsa,
13:14
is Gi bleed.
13:16
So it can increase the risk for Gi
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bleed, gi,
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and that is definitely a a big issue,
13:23
with Nsa in general there.
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There is a boxed warning for Gi bleed
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as well, So I did wanna mention that
13:30
as well.
13:31
Edema, swelling can happen,
13:33
so an increased risk for heart failure ex
13:37
exaggeration, for example,
13:40
the
13:41
medication can cause some
13:43
potential sodium and and fluid retention, so that
13:45
can be a a problematic thing.
13:48
Renal impairment. The way
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nsa work on the kidney.
13:53
They can
13:54
potentially,
13:55
kinda impair the function of the kidney
13:58
and, increase the risk acute renal failure. This
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is typically exacerbated
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in patients who are older,
14:06
at, you know, obviously, at risk for renal
14:08
impairment for and on other medications that may
14:12
increase that risk for renal impairment.
14:14
I think of, you know, diuretics, for example,
14:17
can increase that risk.
14:19
Ace inhibitors and Ar can increase that risk,
14:23
as well as, you know, Iv medications like
14:27
I amino,
14:28
you know, gen mice, and to mice. They
14:30
can increase the risk for renal problems as
14:33
well.
14:35
And then last, I did wanna mention
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there is warnings on cardiovascular
14:40
risks with
14:42
Nsa, and
14:44
d cloth act being nsa falls certainly in
14:46
that category.
14:47
So that boxed warning is for an increased
14:50
risk of t product events.
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And then lastly, finishing up on drug interactions,
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so we've gotta think about
15:00
medications that can increase the risk
15:04
for Gi bleed. So cor,
15:06
they can kinda have an additive effect.
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So if we take prednisone own you know,
15:11
with d,
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that can increase the risk for Gi bleed,
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And then, of course, any medications that thin
15:18
the b. So any type of anti coa
15:22
medication, you know, picks a band
15:24
war, for example,
15:26
any type of anti platelet medication.
15:28
Cl,
15:29
p,
15:31
Aspirin. These are all medications that are gonna
15:33
increase that risk of Gi bleed when used
15:37
in combination with d.
15:40
Alright Well, I think that's gonna wrap up
15:42
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Farm D b
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Take care, and I hope you have a
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