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Pyrlcasts, brought to you by Pyrls.com! We take a closer look at interesting and relevant clinical topics related to pharmacotherapy. Want to learn more clinical pearls? Boost your clinical confidence? Visit and sign-up for an account at pyrls.com to get over 10 high-quality charts absolutely FREE!

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    #8 - Cocaine & Beta-Blockers: Unopposed Alpha-Adrenergic Stimulation

    Pyrlcasts, brought to you by Pyrls.com! We take a closer look at interesting and relevant clinical topics related to pharmacotherapy. Want to learn more clinical pearls? Boost your clinical confidence? Visit and sign-up for an account at pyrls.com to get over 10 high-quality charts absolutely FREE! Episode References: Center for Behavioral Health Statistics and Quality. (2021). Results from the 2020 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/  COCAINE HYDROCHLORIDE NASAL solution. Lannett Company, Inc. Accessed via DailyMed. Updated August 27, 2020. Zimmerman JL. Cocaine intoxication. Crit Care Clin. 2012;28(4):517-526. doi:10.1016/j.ccc.2012.07.003  Richards JR, Hollander JE, Ramoska EA, et al. β-Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon. J Cardiovasc Pharmacol Ther. 2017;22(3):239-249. doi:10.1177/1074248416681644  Anderson JL, Adams CD, Antman EM, et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines [published correction appears in J Am Coll Cardiol. 2013 Sep 10;62(11):1040-1]. J Am Coll Cardiol. 2013;61(23):e179-e347. doi:10.1016/j.jacc.2013.01.014 Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2014 Dec 23;130(25):e433-4. Dosage error in article text]. Circulation. 2014;130(25):e344-e426. Smith SC Jr, Benjamin EJ, Bonow RO, et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation [published correction appears in Circulation. 2015 Apr 14;131(15):e408]. Circulation. 2011;124(22):2458-2473. doi:10.1161/CIR.0b013e318235eb4d Richards JR, Laurin EG. Cocaine. [Updated 2022 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430769/ Lo KB, Virk HUH, Lakhter V, et al. Clinical Outcomes After Treatment of Cocaine-Induced Chest Pain with Beta-Blockers: A Systematic Review and Meta-Analysis. Am J Med. 2019;132(4):505-509. doi:10.1016/j.amjmed.2018.11.041

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    #7 - Caffeine Pharmacology Pearls

    Pyrlcasts, brought to you by Pyrls.com! We take a closer look at interesting and relevant clinical topics related to pharmacotherapy. Want to learn more clinical pearls? Boost your clinical confidence? Visit and sign-up for an account at pyrls.com to get over 10 high-quality charts absolutely FREE! Episode References: Froestl W, Muhs A, Pfeifer A. Cognitive enhancers (nootropics). Part 1: drugs interacting with receptors. J Alzheimers Dis. 2012;32(4):793-887. doi:10.3233/JAD-2012-121186 Nehlig A, Daval JL, Debry G. Caffeine and the central nervous system: mechanisms of action, biochemical, metabolic and psychostimulant effects. Brain Res Brain Res Rev. 1992;17(2):139-170. doi:10.1016/0165-0173(92)90012-b Institute of Medicine (US) Committee on Military Nutrition Research. Caffeine for the Sustainment of Mental Task Performance: Formulations for Military Operations. Washington (DC): National Academies Press (US); 2001. 2, Pharmacology of Caffeine. Available from: https://www.ncbi.nlm.nih.gov/books/NBK223808/ Hansen PB, Schnermann J. Vasoconstrictor and vasodilator effects of adenosine in the kidney. Am J Physiol Renal Physiol. 2003;285(4):F590-F599. Faudone G, Arifi S, Merk D. The Medicinal Chemistry of Caffeine. J Med Chem. 2021;64(11):7156-7178. doi:10.1021/acs.jmedchem.1c00261oi:10.1152/ajprenal.00051.2003 Gessi S, Merighi S, Fazzi D, Stefanelli A, Varani K, Borea PA. Adenosine receptor targeting in health and disease. Expert Opin Investig Drugs. 2011;20(12):1591-1609. doi:10.1517/13543784.2011.627853 Spilling the Beans: How Much Caffeine is Too Much? United States Food and Drug Administration. Updated Dec 12, 2018. Accessed Aug 4, 2022. https://www.fda.gov/consumers/consumer-updates/spilling-beans-how-much-caffeine-too-much#:~:text=For%20healthy%20adults%2C%20the%20FDA,it%20(break%20it%20down). Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke. Updated July 25, 2022. Accessed Aug 4, 2022. https://www.ninds.nih.gov/health-information/patient-caregiver-education/brain-basics-understanding-sleep

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    #6 - Don't Hold Your Breath: Ticagrelor & Dyspnea

    Pyrlcasts, brought to you by Pyrls.com! We take a closer look at interesting and relevant clinical topics related to pharmacotherapy. Want to learn more clinical pearls? Boost your clinical confidence? Visit and sign-up for an account at pyrls.com to get over 10 high-quality charts absolutely FREE! Episode References: Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery [published correction appears in Circulation. 2016 Sep 6;134(10):e192-4]. Circulation. Cattaneo M, Faioni EM. Why does ticagrelor induce dyspnea?. Thromb Haemost. 2012;108(6):1031-1036. doi:10.1160/TH12-08-05472016;134(10):e123-e155. doi:10.1161/CIR.0000000000000404 Krakowiak A, Kuleta J, Plech I, et al. Ticagrelor-Related Severe Dyspnoea: Mechanisms, Characteristic Features, Differential Diagnosis and Treatment. Clin Med Insights Case Rep. 2020;13:1179547620956634. Published 2020 Oct 8. doi:10.1177/1179547620956634 Undem BJ, Kollarik M. The role of vagal afferent nerves in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2005;2(4):355-372. doi:10.1513/pats.200504-033SR PLAVIX- clopidogrel tablet, film coated. Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. Accessed via DailyMed. Updated March 5, 2021. BRILINTA- ticagrelor tablet. AstraZeneca Pharmaceuticals LP. Accessed via DailyMed. Updated May 9, 2022. PRASUGREL tablet, film coated. Accord Healthcare Inc. Accessed via DailyMed. Updated May 21, 2021.

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    #5 - Mechanisms that Don't Mix: GLP-1 RAs & DPP-4 Inhibitors

    Pyrlcasts, brought to you by Pyrls.com! We take a closer look at interesting and relevant clinical topics related to pharmacotherapy. Want to learn more clinical pearls? Boost your clinical confidence? Visit and sign-up for an account at pyrls.com to get over 10 high-quality charts absolutely FREE!

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    #4 - Sips & CYPS: Assessing Grapefruit Juice & CYP3A4

    Pyrlcasts, brought to you by Pyrls.com! We take a closer look at interesting and relevant clinical topics related to pharmacotherapy. Want to learn more clinical pearls? Boost your clinical confidence? Visit and sign-up for an account at pyrls.com to get over 10 high-quality charts absolutely FREE!

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    #3 - Assessing Statins and Diabetes Risk

    Pyrlcasts, brought to you by Pyrls.com! We take a closer look at interesting and relevant clinical topics related to pharmacotherapy. Want to learn more clinical pearls? Boost your clinical confidence? Visit and sign-up for an account at pyrls.com to get over 10 high-quality charts absolutely FREE!

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    #2 - Tramadol & Serotonin Syndrome: A Review of Receptor Affinity

    Pyrlcasts, brought to you by Pyrls.com! We take a closer look at interesting and relevant clinical topics related to pharmacotherapy. Want to learn more clinical pearls? Boost your clinical confidence? Visit and sign-up for an account at pyrls.com to get over 10 high-quality charts absolutely FREE!

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    #1 - Metronidazole & Alcohol: A Review of Common Counseling

    Pyrlcasts, brought to you by Pyrls.com! We take a closer look at interesting and relevant clinical topics related to pharmacotherapy. Want to learn more clinical pearls? Boost your clinical confidence?  Visit and sign-up for an account at pyrls.com to get over 10 high-quality charts absolutely FREE! Episode References: Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021). Sexually transmitted infections treatment guidelines, 2021. MMWR. Recommendations and Reports: Morbidity and Mortality Weekly Report. Recommendations and Reports, 70(4), 1–187. https://doi.org/10.15585/mmwr.rr7004a1 Katzung BG, ed. Basic and Clinical Pharmacology. 13th ed. New York: McGraw-Hill Education; 2015. Antabuse (disulfuram) tablet package insert. Pomona, NY: Duramed Pharmaceuticals, Inc.; 2010 Feb.

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Pyrlcasts, brought to you by Pyrls.com! We take a closer look at interesting and relevant clinical topics related to pharmacotherapy. Want to learn more clinical pearls? Boost your clinical confidence? Visit and sign-up for an account at pyrls.com to get over 10 high-quality charts absolutely FREE!

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