pharmacology

# Pharmacology Skill Use this skill when evaluating medications, assessing drug interactions, or making pharmacotherapy recommendations. ## When to Use - Reviewing prescription medications - Assessing drug-drug or drug-disease interactions - Dosing recommendations (renal/hepatic impairment) - Therapeutic drug monitoring - Medication reconciliation - Alternative therapy suggestions ## Medication Review Framework ### 1. Indication Assessment - Is each medication appropriately indicated? - Is there evidence-based support for use? - Are there more effective alternatives? ### 2. Dosing Evaluation - Is the dose appropriate for the patient? - Renal function adjustment (creatinine clearance) - Hepatic function consideration - Weight-based dosing where applicable ### 3. Interaction Analysis Check for: - **Contraindicated**: Never use together - **Major**: Significant clinical impact - **Moderate**: May require monitoring - **Minor**: Minimal clinical significance Categories: - Pharmacodynamic (additive/synergistic/antagonistic) - Pharmacokinetic (absorption, distribution, metabolism, excretion) ### 4. Adverse Effects - Common and serious adverse effects - Monitoring parameters - Preventive measures ### 5. Patient Factors Consider: - Age (geriatric/pediatric) - Renal/hepatic function - Pregnancy/lactation - allergies - Comorbidities ## Output Structure ``` Medication Review: [Medication 1] - Indication: [appropriate?] - Dose: [appropriate?] - adjustments needed? - Interactions: [list with severity] - Monitoring: [recommended parameters] Recommendations: 1. [Continue/Modify/Discontinue] - rationale 2. [Add alternative] - rationale 3. [Monitoring plan] ``` ## Common Interaction Categories ### Cardiovascular - QT prolongation combinations - Anticoagulant interactions - Beta-blocker + CYP interactions ### CNS - Sedative combinations - Serotonergic drugs (SSRI, SNRI, triptans) - Anticholinergic burden ### Metabolic - Statin interactions (CYP3A4) - Sulfonylurea interactions - Metformin contraindications ### Anti-infective - Antibiotic interactions - Antifungal/viral interactions - QT prolongation ## Dosing Resources Reference standard dosing guides: - FDA labeling - Lexicomp/Micromedex - UpToDate - Nejm grug information ## Best Practices - Always verify current guidelines - Consider patient-specific factors - Provide alternatives when issues identified - Include monitoring recommendations - Add appropriate disclaimers