Clinical Pharmacist Answers Pharmacology Questions

I'm Dr. Christina Madison, a clinical pharmacist.

I'm here to answer your questions from the internet.

This is Pharmacology Support.

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purrrcell would like to know, What is it about grapefruit

that makes it so dangerous

to mix with so many medications?

Like damn.

Grapefruit goes through the liver.

It's part of something

called the cytochrome P450 system.

What that means is that it can disrupt

the metabolism of medications,

it can alter the absorption of that drug,

meaning that more of the drug

will remain in your bloodstream

and you'll be more likely to experience the toxicity

associated with that drug and experience side effects.

techwithtaz asks, Expiration dates on medications.

Are they similar to a best by situation or what?

Any hot takes?

Expiration dates are what we know to be safe and effective.

Your expiration date is a guidepost.

I like the term best by,

but ultimately there are some drugs

that if you don't use them by their expiration date,

they can become toxic.

An example of this is doxycycline.

Doxycycline starts to break down,

and the chemical that's left

can be very toxic to you if you ingest it.

Most medications, however, do not become toxic.

They reduce their efficacy.

You may have to take more,

which means you possibly could take an inaccurate dose

or have an overdose

because you're taking more medication that's needed

because it's not as effective.

So the key here is, whenever possible,

please try not to take any expired medications.

eSHODAN would like to know, Why is botulinum toxin,

the most lethal toxin known,

purposefully injected into humans

for cosmetic surgeries, such as Botox?

Is there nothing else that could be used?

Botulinum toxin, in the environment, yes, can be very toxic.

However, what we currently use for therapeutic uses,

like cosmetic purposes

or for things like migraine headaches,

is a very small dose that's targeted,

localized, and causes limited effects.

It's gonna cause localized paralysis, so no more wrinkles,

but the toxin itself is not gonna get into my bloodstream

and cause me to be sick or ill.

Zarithe asks, How exactly do extended release pills work?

So there's a few different things going on here.

Oral medications are unique in the fact

that they may undergo

something called first pass metabolism.

So medications are comprised of chemicals

transformed through actions of our body.

So one of the ways that that happens

is through first pass metabolism

where it gets metabolized in the liver.

The chemical structure that is left

after it goes through that process is called a substrate.

So some of the time what we do

in order to make the medication last longer

is that we use a precursor to that substrate,

which allows for the main medication

or the active ingredient to get metabolized

after first pass metabolism

and become the active medication.

The other thing too that we can do to extend the likelihood

or the length of duration of therapy

is going to be using a different type of container

to hold the medication.

There's tablets, there's capsules,

all different types of coatings that can go over the tablet

that allow for it to be dissolved or metabolized more slowly

once it hits the acid of your stomach.

From OhCoco, I don't think people understand

how dangerous it is taking Tylenol regularly.

Most over-the-counter medications are safe

and effective when used as directed.

However, Tylenol can be toxic, specifically to your liver.

So there is a maximum amount of Tylenol

that you should consume within a 24-hour period.

The max is four grams.

However, for safety, most pharmacists would tell you

you really shouldn't take more than three grams

within a 24-hour period

in order to avoid any injury or toxicity to your liver.

The reason why this is important

is because there's so many different over-the-counter cough

and cold preparations

that contain the active ingredient in Tylenol,

which is called acetaminophen.

So if you've got cough and cold preparation over here

and then you have some regular Tylenol over here,

you have to add the two together and make sure

it doesn't go over that three gram in a day limit.

TheOnlyOneLeft would like to know,

Why do some vaccines require a booster shot

a few weeks later after the first one?

There's a couple of reasons why this may occur.

The first is whether or not the person

has been exposed to the vaccination in the past.

For example, most childhood vaccinations

require lots of booster doses

because it's new to their immune system

and we want them to develop an appropriate response.

Same thing with the influenza vaccine

or the COVID-19 vaccine.

Once you receive it, we're basically priming the pump,

and then we give you a booster

in order for your immune system to be able to recognize it

if it sees it in the environment.

From Ok-Access-3286, How do y'all count your pills?

Easy, by five.

From WinSad5408, Is it beneficial to get HPV vaccine

after you have HPV?

The quick answer is, absolutely.

HPV or human papilloma virus is a type of infection

that can just be transmitted from skin to skin,

and it is the leading cause of cervical cancer,

vulva, vaginal cancer, penile cancer, and anal cancer,

as well as genital warts.

All of those are caused

by different strains of the HPV virus.

6 and 11 have been associated with genital warts.

16 and 18 have been associated with cervical cancers

and other types of cancers,

including anal cancer and penile cancer.

The vaccine that we have now

has multiple strains that it protects against.

So even if you've had HPV,

you've probably only had one, maybe two, of those strains,

and you can be still protected by the other strains

that are included in the current vaccination.

TobyTheRobot asks,

How does a pharmaceutical company come up with new drugs?

Do they just try various chemicals on animals

until something shows promise?

Pharmaceutical companies take a lot of pride

in their research and development.

It costs millions of dollars

in order for them to develop a new drug.

It can come from natural sources,

it can come from synthetic compounds or chemicals.

Typically it's done from clinical trial work

looking at compounds that have been known

to cause therapeutic effects in other disease states,

and then we try it and see if it works in others.

It's not really this what you're saying

throw it at the wall and see if it sticks.

Next is Funny-Reputation-454,

Favorite animal-derive-drug fact.

One of the things that we know

when we think about drug development and drug discovery

is that a lot of the medications derive from venoms

or toxins that are produced by animals

or biological sources like viruses and bacteria.

One of our popular diabetes medications

comes from the saliva of a Gila monster.

So one of my favorite animal-derived drugs

is from Gila monster spit.

notcornemoji would like to know,

Why does DoorDash need my ID for cold meds?

LOL. What do you think I'm going to do with it?

Cough and cold preparations

may include an active ingredient called pseudoephedrine.

Those medications,

even though they're technically considered over-the-counter,

would be behind-the-counter in the pharmacy.

The reason for this is that we have to document

how much pseudoephedrine you're purchasing on a daily basis.

Seems strange, right?

Why would I need to know how much pseudoephedrine

you're buying in a day?

Before we had this restriction,

pseudo ephedrine was being used

to fuel the methamphetamine processing

in different areas of the country.

We need to keep track of who's purchasing it

in order to hopefully stem the production

of illegal drug production.

So the reason why we have this requirement

is so that we don't have more meth labs.

croyceltic, Alexa, show me how penicillin was discovered.

Dr. Fleming discovered it in 1928.

He's a Scottish biologist

that was working in a hospital in London

and discovered after looking at a Petri dish

that had some mold growing on it

that the staphylococcus that was on that Petri dish

was not growing in the place where the mold was.

Ultimately, we discovered

one of the most powerful antibiotics by mistake.

ZarataroVT would like to know,

Is melatonin dependency bad? Asking for me.

So the first thing is is that melatonin,

you can't really become dependent on melatonin.

However, too much melatonin can be a bad thing.

There was an instance about a year ago

where several children became sick or ill

because of overdoses of melatonin

from the use of melatonin gummies.

It really should not be used on a regular basis.

You should not be using this continuously for a sleep aid.

CindyHendren2 would like to know,

Why hasn't a cure for the common cold been found?

The common cold is often caused by a rhinovirus.

However, there's been 200 separate viruses and organisms

that have been attributed to the causes of the common cold.

That's a lot of different causes.

So it does make a bit of a moving target.

In addition to rhinoviruses,

the common cold can also be caused

by coronaviruses, like COVID-19,

as well as respiratory syncytial virus and RSV.

And the good news is,

is although we may not have a cure for those,

we do have a vaccine for them.

So when in doubt, get your vaccines.

MarketTanker, What do pharmacists actually do though

that require five years training?

Doctors prescribe medicine, and last time I went,

all the pharmacist did was tell me

not to take more than dosage required.

I could have read that easily myself from the leaflet.

I am a pharmacist who went to school for many years,

including a clinical residency,

and I will tell you, we do a lot more

than just stand behind the counter.

We are the medication experts.

Back there behind the counter,

we're gonna be doing a whole bunch of other things

that you probably don't get a chance to see,

like checking for drug interactions,

making sure that the drug that's being prescribed

is actually used for that disease state,

and most importantly, checking it to make sure

that it's appropriate for you, the patient,

and that it's safe for you to take.

bunnytsumu would like to know,

If I drink alcohol whilst on antibiotics, will I die?

Quick answer is no. However, it depends.

First of all, how much alcohol are you drinking?

'Cause alcohol toxicity can be pretty bad.

When we're just looking at alcohol and antibiotics together,

the key here is that there are some agents

that you can get really sick from taking with alcohol.

So one of those is something called metronidazole,

which is an anti-infective,

and it will make you violently ill

if you take it with alcohol.

Another medication, say penicillin,

if you take that with alcohol,

it may make the penicillin less effective

because it's altering your gut.

Rule of thumb, just don't drink until you feel better.

SummerEllenLane would like to know,

What are the pros and cons of Ozempic?

The original use of this medication was to treat diabetes,

and then they realized, in addition to lowering blood sugar,

it also caused people to lose weight,

it improved their cardiac health,

it reduced their cholesterol,

it improved their kidney function,

if they had kidney problems associated with their diabetes,

also, it's being looked at potentially

for Alzheimer's disease,

and it was recently FDA approved to treat sleep apnea.

This drug, for all intensive purposes,

seems like a miracle cure.

However, there are some downsides.

That can cause nausea, vomiting, diarrhea, loss of appetite.

Loss of appetite sounds like it could be a good thing,

especially if you're trying to lose weight.

However, the weight comes from everywhere,

and not only do you lose fat, but you lose muscle as well.

Blonde_Icon wants to know,

Why aren't more drugs that aren't very dangerous

or addictive available over the counter,

like antidepressants or weight loss drugs,

like Ozempic or Wegovy?

There are two sets of medications

that we currently have available in the United States,

those that require FDA approval

and those that have been deemed safe and effective

without the direction of a doctor or a medical provider,

and those are over-the-counter medications.

The other thing too is that an over-the-counter medication

also has to have a low risk of being addictive,

habit forming, or dangerous.

Each medication that is considered over-the-counter

must go through a rigorous safety check.

The reason for this is that once you have something

that is over-the-counter, you can take that medication

as directed with no additional consultation by a pharmacist

or another healthcare professional.

Based on that, there are a lot of medications that we have

that are over-the-counter,

but the ones that are prescription that are being looked at

to go over-the-counter,

an example of this would be our allergy medications.

So before the 2000s, things like Claritin, Allegra,

those types of allergy medications,

those were previously prescription medications,

but then were deemed safe enough

to be able to be over-the-counter.

1hyacinthe asks, Why are there so many TV ads

for plaque psoriasis?

Direct to consumer advertising

for prescription medications is only something that occurs

here in the US and New Zealand.

Every other industrialized country

does not allow direct-to-consumer advertising

to the patient.

The reason why it seems like there's so many ads

is because this law changed in the late 1990s,

and it allowed for pharmaceutical companies

to directly market their products to the patient.

This has caused some challenges within the healthcare system

because everyone feels

like they may have that certain condition.

Now, going back to specifically plaque psoriasis,

this is a condition that does not have a lot of medications

that are effective to treat it,

as well as the fact that the medication that are used

are only available as brand name medications.

Now, from the pharmaceutical company standpoint,

it works for them because now they're marketing

a very expensive drug that they're going to now profit from.

So you're gonna keep seeing

more plaque psoriasis commercials

until we come up with the generic

and the profit margins are less.

niifG would like to know,

Pharmacists, what mistakes have you made?

I like to say I'm a work in progress,

but one of the things that I will never forget

was a mistake that I made working as an intern

at a pharmacy when I was still in pharmacy school.

I had an elderly patient who came in

to pick up their prescription for acyclovir,

the medication that can be used for genital herpes.

It's also used to treat shingles.

I did not ask the question,

what did your doctor tell you this medication was for?

So I mistakenly started telling

this very kind elderly gentleman

how this medication would help treat his genital warts.

Unfortunately, he was there to pick it up

to treat his shingles.

I never made that mistake again.

Roxa97 would like to know,

What was considered medicine in the 18th century?

So according to the American Journal of Hospital Pharmacy,

during the Revolutionary War and colonial times,

the 17 and 1800s, most of the drugs that were being used

were to facilitate things like purging, depletion, bleeding,

and things that we used back then would include camphor,

opium, and emetics in order to get people to purge things

that they no longer wanted in their bodies.

bowiesbody would like to know,

As most, I do wonder why there's so many drug shortages.

They're all so random too.

ADHD medications, hydrocortisone, some benzos,

magnesium citrate laxatives,

like, what's happening in big pharma HQ?

The quick answer is, it's complicated.

Number one, quality.

So if there's something wrong with the quality of the batch

of that medication, it will have to be remade.

Number two, if the raw components

of that particular medication are backordered

or not available, this could delay production.

Number three, delay of the product.

Number four, problems with distribution

due to increase in demand.

And last, but not least, number five,

not having profitability.

This often happens with generic medications,

and so the manufacturers will either reduce

or completely stop making the drug

because it's no longer profitable to them.

From api_assassin, What is pharmacology,

and what do you enjoy about its study?

Pharmacology is the study of drugs,

their mechanism of action, how they work on the body,

as well as how the body works on drugs.

Pharmacology is a great thing for us

because modern medicine shows us

that if we didn't have medications,

a lot more of us wouldn't be able to survive.

Most importantly, in something like vaccinations,

which is the single most effective medical intervention

that we've had within our history,

we know that there are thousands and thousands of children

that would not survive if it wasn't for childhood vaccines.

TommyWeb3Cr would like to know,

How can AI assist in drug discovery

and accelerating the development of new medications?

That can help identify new potential drug targets,

can also help us repurpose existing drug targets,

determining what clinical trial participants are appropriate

for a given study, and last, but not least,

it can help us synthesize mass amounts of data,

and this is gonna help us further identify new drugs

that we can use to cure old diseases.

That's it. Hope you learned something new.

Those are all our questions for Pharmacology Support.

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