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