Real Life Pharmacology - Pharmacology Education for Health Care Professionals

Naltrexone is often a first-line medication for AUD. It works as an opioid receptor antagonist, reducing the rewarding effects of alcohol and decreasing cravings. Patients frequently report that alcohol becomes less pleasurable while taking the medication. Oral naltrexone is typically dosed at 50 mg daily, while a long-acting injectable formulation is also available. Avoid use in patients taking opioids and use caution in significant liver dysfunction.

Acamprosate helps maintain abstinence by modulating glutamate and GABA neurotransmission. Chronic alcohol use disrupts the balance between excitatory and inhibitory pathways in the brain, and acamprosate helps restore equilibrium. It is primarily eliminated renally, making it a useful option in patients with liver disease. The most common adverse effect is diarrhea.

Disulfiram works through a completely different mechanism. It inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation when alcohol is consumed. This can lead to flushing, nausea, vomiting, headache, and hypotension. Because of this aversive reaction, patient motivation and adherence are critical for success.

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In this episode, we explore monoamine oxidase inhibitors (MAOIs), one of the oldest yet most effective classes of antidepressants. We discuss how MAOIs such as phenelzine, tranylcypromine, isocarboxazid, and selegiline work by increasing serotonin, norepinephrine, and dopamine levels in the brain. The episode reviews their unique role in treatment-resistant and atypical depression, key adverse effects, important dietary considerations involving tyramine-containing foods, and potentially serious drug interactions. We also highlight practical clinical pearls to help pharmacists and healthcare professionals safely and effectively use these powerful but often underutilized medications.

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I cover the most important insomnia medications. We cover adverse effects, drug monitoring, and much more.

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In this episode, we explore four unique antidepressants that do not fit neatly into the traditional SSRI or SNRI categories: trazodone, nefazodone, vilazodone, and vortioxetine. Trazodone and nefazodone are classified as serotonin antagonist and reuptake inhibitors (SARIs), working primarily through blockade of 5-HT2 receptors while also inhibiting serotonin reuptake. Trazodone’s strong antihistamine and alpha-1 blocking properties make it highly sedating and commonly used off-label for insomnia, whereas nefazodone causes less sedation but is rarely prescribed today because of its association with severe and potentially fatal liver toxicity. Both agents are notable for producing less sexual dysfunction than many traditional SSRIs.

We also discuss two newer multimodal antidepressants: vilazodone (Viibryd) and vortioxetine (Trintellix). Vilazodone combines serotonin reuptake inhibition with partial agonism at the 5-HT1A receptor, a mechanism often compared to combining an SSRI with buspirone. Vortioxetine has an even more complex pharmacology, acting as a serotonin reuptake inhibitor while modulating multiple serotonin receptor subtypes through agonist, partial agonist, and antagonist actions. This multimodal activity may contribute to benefits in cognitive symptoms associated with major depressive disorder. Throughout the episode, we compare receptor pharmacology, clinical applications, adverse effect profiles, and the unique characteristics that distinguish these medications from more commonly prescribed antidepressants.

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In this section, I educate about the most common ICU sedation medications.

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