Clinical pharmacist Dr. Christina Madison joins WIRED to answer the internet's burning questions about pharmacology and pharmaceuticals. Does a medication “go bad” after its expiration date? How do extended release pills work? What are the pros and cons of GLP-1 weight loss medications like Ozempic (semaglutide?) Is melatonin dependency bad? Why have we never found a cure for the common cold? Dr. Madison answers these questions and many more on this edition of Pharmacology Support.
Director: Justin Wolfson
Director of Photography: Kevin Dynia
Editor: Richard Trammell
Expert: Christina Madison
Line Producer: Joseph Buscemi
Associate Producer: Paul Gulyas
Production Manager: Peter Brunette
Casting Producer: Nicholas Sawyer
Camera Operator: Christopher Eustache
Sound Mixer: Sean Paulsen
Production Assistant: Ryan Coppola
Post Production Supervisor: Christian Olguin
Post Production Coordinator: Rachel Kim
Supervising Editor: Doug Larsen
Additional Editor: Jason Malizia
Assistant Editor: Justin Symonds
Director: Justin Wolfson
Director of Photography: Kevin Dynia
Editor: Richard Trammell
Expert: Christina Madison
Line Producer: Joseph Buscemi
Associate Producer: Paul Gulyas
Production Manager: Peter Brunette
Casting Producer: Nicholas Sawyer
Camera Operator: Christopher Eustache
Sound Mixer: Sean Paulsen
Production Assistant: Ryan Coppola
Post Production Supervisor: Christian Olguin
Post Production Coordinator: Rachel Kim
Supervising Editor: Doug Larsen
Additional Editor: Jason Malizia
Assistant Editor: Justin Symonds
Category
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TechTranscript
00:00I'm Dr. Christina Madison, a clinical pharmacist.
00:03I'm here to answer your questions from the internet.
00:06This is Pharmacology Support.
00:13Persil would like to know, what is it about grapefruit that makes it so dangerous to mix
00:19with so many medications?
00:21Like them.
00:23Grapefruit goes through the liver.
00:25It's part of something called the cytochrome P450 system.
00:29What that means is that it can disrupt the metabolism of medications.
00:34It can alter the absorption of that drug, meaning that more of the drug will remain
00:41in your bloodstream and you'll be more likely to experience the toxicity associated with
00:46that drug and experience side effects.
00:49Tech with Taz asks, expiration dates on medications.
00:54Are they similar to a bust by situation or what?
00:58Really hot takes.
01:00Expiration dates are what we know to be safe and effective.
01:05Your expiration date is a guidepost.
01:07I like the term best by, but ultimately there are some drugs that if you don't use them
01:14by their expiration date, they can become toxic.
01:17An example of this is doxycycline.
01:20Doxycycline starts to break down and the chemical that's left can be very toxic to you if you
01:25ingest it.
01:27Most medications, however, do not become toxic.
01:30They reduce their efficacy.
01:32You may have to take more, which means you possibly could take an inaccurate dose or
01:37have an overdose because you're taking more medication that's needed because it's not
01:42as effective.
01:43The key here is whenever possible, please try not to take any expired medications.
01:48E Shodan would like to know, why is botulism toxin, the most lethal toxin known, purposefully
01:55injected into humans for cosmetic surgeries such as Botox?
01:59Is there nothing else that could be used?
02:02Botulism toxin in the environment, yes, can be very toxic.
02:06However, what we currently use for therapeutic uses like cosmetic purposes or for things
02:12like migraine headaches is a very small dose that's targeted, localized, and causes limited
02:21effects.
02:22Botulism toxin is going to cause localized paralysis, so no more wrinkles, but the toxin
02:26itself is not going to get into my bloodstream and cause me to be sick or ill.
02:30Zarithi asks, how exactly do extended release pills work?
02:35There's a few different things going on here.
02:38Oral medications are unique in the fact that they may undergo something called first pass
02:43metabolism.
02:46Medications are comprised of chemicals transformed through actions of our body.
02:53So one of the ways that that happens is through first pass metabolism, where it gets metabolized
02:59in the liver.
03:00The chemical structure that is left after it goes through that process is called a substrate.
03:07So some of the time what we do in order to make the medication last longer is that we
03:12use a precursor to that substrate, which allows for the main medication or the active
03:20ingredient to get metabolized after first pass metabolism and become the active medication.
03:27The other thing too that we can do to extend the likelihood or the length of duration of
03:33therapy is going to be using a different type of container to hold the medication.
03:40There's tablets, there's capsules, all different types of coatings that can go over the tablet
03:46that allow for it to be dissolved or metabolized more slowly once it hits the acid of your stomach.
03:53From OhCoco, I don't think people understand how dangerous it is taking Tylenol regularly.
04:00Most over-the-counter medications are safe and effective when used as directed.
04:06However, Tylenol can be toxic, specifically to your liver.
04:11So there is a maximum amount of Tylenol that you should consume within a 24-hour period.
04:18The max is 4 grams.
04:20However, for safety, most pharmacists would tell you you really shouldn't take more than
04:263 grams within a 24-hour period in order to avoid any injury or toxicity to your liver.
04:33The reason why this is important is because there's so many different over-the-counter
04:37cough and cold preparations that contain the active ingredient in Tylenol, which is called acetaminophen.
04:44So if you've got cough and cold preparation over here, and then you have some regular
04:48Tylenol over here, you have to add the two together and make sure it doesn't go over
04:53that 3 gram in a day limit.
04:56The only one left would like to know why do some vaccines require a booster shot a few
05:02weeks later after the first one?
05:05There's a couple of reasons why this may occur.
05:07The first is whether or not the person has been exposed to the vaccination in the past.
05:13For example, most childhood vaccinations require lots of booster doses because it's new to
05:18their immune system, and we want them to develop an appropriate response.
05:22Same thing with the influenza vaccine or the COVID-19 vaccine.
05:26Once you receive it, we're basically priming the pump, and then we give you a booster in
05:30order for your immune system to be able to recognize it if it sees it in the environment.
05:35From OKAXIS3286, how do y'all count your pills?
05:43Easy, by five.
05:45From Winsad5408, is it beneficial to get HPV vaccine after you have HPV?
05:54The quick answer is absolutely.
05:56HPV, or human papillomavirus, is a type of infection that can just be transmitted from
06:02skin to skin, and it is the leading cause of cervical cancer, vulvovaginal cancer, penile
06:07cancer, and anal cancer, as well as genital warts.
06:11All of those are caused by different strains of the HPV virus.
06:156 and 11 have been associated with genital warts, 16 and 18 have been associated with
06:21cervical cancers and other types of cancers, including anal cancer and penile cancer.
06:27The vaccine that we have now has multiple strains that it protects against.
06:32So even if you've had HPV, you've probably only had one, maybe two of those strains,
06:38and you can be still protected by the other strains that are included in the current vaccination.
06:44Toby the Robot asks, how does a pharmaceutical company come up with new drugs?
06:49Do they just try various chemicals on animals until something shows promise?
06:54Pharmaceutical companies take a lot of pride in their research and development.
06:58It costs millions of dollars in order for them to develop a new drug.
07:01It can come from natural sources, it can come from synthetic compounds or chemicals.
07:07Typically it's done from clinical trial work, looking at compounds that have been known
07:13to cause therapeutic effects in other disease states, and then we try it and see if it works
07:19in others.
07:20It's not really this, what you're saying, throw it at the wall and see if it sticks.
07:24Next is FunnyReputation454, favorite animal-derived drug fact.
07:31One of the things that we know when we think about drug development and drug discovery
07:34is that a lot of the medications derive from venoms or toxins that are produced by animals
07:41or biological sources like viruses and bacteria.
07:45One of our popular diabetes medications comes from the saliva of a Gila monster.
07:50So one of my favorite animal-derived drugs is from Gila monster spit.
07:57Not Corn Emoji would like to know, why does DoorDash need my ID for cold meds, lol, what
08:04do you think I'm going to do with it?
08:07Cough and cold preparations may include an active ingredient called pseudoephedrine.
08:12Those medications, even though they're technically considered over-the-counter, would be behind
08:17the counter in the pharmacy.
08:19The reason for this is that we have to document how much pseudoephedrine you're purchasing
08:25on a daily basis.
08:27Seems strange, right?
08:28Why would I need to know how much pseudoephedrine you're buying in a day?
08:32Before we had this restriction, pseudoephedrine was being used to fuel the methamphetamine
08:37processing in different areas of the country.
08:41We need to keep track of who's purchasing it in order to hopefully stem the production
08:47of illegal drug production.
08:49So the reason why we have this requirement is so that we don't have more meth labs.
08:55Croy Celtic, Alexa, show me how penicillin was discovered.
08:59Dr. Fleming discovered it in 1928.
09:03He's a Scottish biologist that was working in a hospital in London and discovered, after
09:09looking at a petri dish that had some mold growing on it, that the staphylococcus that
09:14was on that petri dish was not growing in the place where the mold was.
09:19Ultimately, we discovered one of the most powerful antibiotics by mistake.
09:24Zara Toro VT would like to know, is melatonin dependency bad?
09:29Asking for me.
09:30So the first thing is that melatonin, you can't really become dependent on melatonin.
09:36However, too much melatonin can be a bad thing.
09:39There was an instance about a year ago where several children became sick or ill because
09:46of overdoses of melatonin from the use of melatonin gummies.
09:50It really should not be used on a regular basis.
09:53You should not be using this continuously for a sleep aid.
09:57Cindy Hindren 2 would like to know, why hasn't a cure for the common cold been found?
10:03The common cold is often caused by a rhinovirus.
10:06However, there's been 200 separate viruses and organisms that have been attributed to
10:14the causes of the common cold.
10:16That's a lot of different causes.
10:18So it does make a bit of a moving target.
10:20In addition to rhinoviruses, the common cold can also be caused by coronaviruses like COVID-19,
10:27as well as respiratory syncytial virus, an RSV.
10:31And the good news is, although we may not have a cure for those, we do have a vaccine
10:35for them.
10:36So when in doubt, get your vaccine.
10:39Market Tanker
10:40What do pharmacists actually do, though, that require five years training?
10:45Doctors prescribe medicine, and last time I went, all the pharmacists did was tell me
10:49not to take more than dosage required.
10:52I could have read that easily myself from the leaflet.
10:55I am a pharmacist who went to school for many years, including a clinical residency.
11:02And I will tell you, we do a lot more than just stand behind the counter.
11:05We are the medication experts.
11:07Back there behind the counter, we're going to be doing a whole bunch of other things
11:11that you probably don't get a chance to see, like checking for drug interactions, making
11:15sure that the drug that's being prescribed is actually used for that disease state, and
11:20most importantly, checking it to make sure that it's appropriate for you, the patient,
11:24and that it's safe for you to take.
11:26Bunny Sumo would like to know, if I drink alcohol whilst on antibiotics, will I die?
11:33Quick answer is no.
11:35However, it depends.
11:37First of all, how much alcohol are you drinking?
11:39Because alcohol toxicity can be pretty bad.
11:41When we're just looking at alcohol and antibiotics together, the key here is that there are some
11:47agents that you can get really sick from taking with alcohol.
11:52So one of those is something called metronidazole, which is an anti-infective, and it will make
11:57you violently ill if you take it with alcohol.
12:01Another medication, say penicillin, if you take that with alcohol, it may make the penicillin
12:07less effective because it's altering your gut.
12:10Rule of thumb, just don't drink until you feel better.
12:13Summer Ellen Lane would like to know, what are the pros and cons of Ozempic?
12:19The original use of this medication was to treat diabetes, and then they realized in
12:24addition to lowering blood sugar, it also caused people to lose weight.
12:29It improved their cardiac health.
12:31It reduced their cholesterol.
12:33It improved their kidney function, if they had kidney problems associated with their
12:38diabetes.
12:39Also, it's being looked at potentially for Alzheimer's disease, and it was recently FDA-approved
12:46to treat sleep apnea.
12:48This drug, for all intents and purposes, seems like a miracle cure.
12:52However, there are some downsides.
12:54It can cause nausea, vomiting, diarrhea, loss of appetite.
13:00Loss of appetite sounds like it could be a good thing, especially if you're trying to
13:03lose weight.
13:04However, the weight comes from everywhere, and not only do you lose fat, but you lose
13:09muscle as well.
13:10Blonde Icon wants to know, why aren't more drugs that aren't very dangerous or addictive
13:16available over-the-counter, like antidepressants or weight-loss drugs, like Ozempic or Wegovy?
13:22There are two sets of medications that we currently have available in the United States.
13:27Those that require FDA approval, and those that have been deemed safe and effective without
13:33the direction of a doctor or a medical provider, and those are over-the-counter medications.
13:39The other thing, too, is that an over-the-counter medication also has to have a low risk of
13:45being addictive, habit-forming, or dangerous.
13:50Each medication that is considered over-the-counter must go through a rigorous safety check.
13:55The reason for this is that once you have something that is over-the-counter, you can
13:59take that medication as directed with no additional consultation by a pharmacist or another healthcare
14:06professional.
14:07Based on that, there are a lot of medications that we have that are over-the-counter, but
14:12the ones that are prescription that are being looked at to go over-the-counter, an example
14:16of this would be our allergy medications.
14:19So before the 2000s, things like Claritin, Allegra, those types of allergy medications,
14:27those were previously prescription medications, but then were deemed safe enough to be able
14:31to be over-the-counter.
14:33One Hyacinth asks, why are there so many TV ads for Plaque psoriasis?
14:40Direct-to-consumer advertising for prescription medications is only something that occurs
14:45here in the U.S. and New Zealand.
14:48Every other industrialized country does not allow direct-to-consumer advertising to the
14:53patient.
14:54The reason why it seems like there are so many ads is because this law changed in the
14:59late 1990s and it allowed for pharmaceutical companies to directly market their products
15:05to the patient.
15:07This has caused some challenges within the healthcare system because everyone feels
15:10like they may have that certain condition.
15:13Now going back to specifically Plaque psoriasis, this is a condition that does not have a lot
15:19of medications that are effective to treat it, as well as the fact that the medication
15:25that are used are only available as brand name medications.
15:29Now from the pharmaceutical company standpoint, it works for them because now they're marketing
15:34a very expensive drug that they're going to now profit from.
15:38So you're going to keep seeing more Plaque psoriasis commercials until we come up with
15:43the generic and the profit margins are less.
15:46Nif G would like to know, pharmacists, what mistakes have you made?
15:51I like to say I'm a work in progress, but one of the things that I will never forget
15:55was a mistake that I made working as an intern at a pharmacy when I was still in pharmacy
16:01school.
16:02It was an elderly patient who came in to pick up their prescription for acyclovir, the medication
16:08that can be used for genital herpes.
16:12It's also used to treat shingles.
16:14I did not ask the question, what did your doctor tell you this medication was for?
16:20So I mistakenly started telling this very kind elderly gentleman how this medication
16:27would help treat his genital warts.
16:29Unfortunately, he was there to pick it up to treat his shingles.
16:32I never made that mistake again.
16:34Roxa 97 would like to know, what was considered medicine in the 18th century?
16:40So according to the American Journal of Hospital Pharmacy, during the Revolutionary War and
16:45colonial times, the 17 and 1800s, most of the drugs that were being used were to facilitate
16:51things like purging, depletion, bleeding.
16:56And things that we used back then would include camphor, opium, and emetics in order to get
17:02people to purge things that they no longer wanted in their bodies.
17:07Bowie's Body would like to know, as most, I do wonder why there's so many drug shortages.
17:14They're all so random too.
17:16ADHD medications, hydrocortisone, some benzos, magnesium citrate laxatives.
17:23What's happening in Big Pharma HQ?
17:26The quick answer is, it's complicated.
17:28Number one, quality.
17:30So if there's something wrong with the quality of the batch of that medication, it will have
17:35to be remade.
17:36Number two, if the raw components of that particular medication are backordered or not
17:43available, this can delay production.
17:45Number three, delay of the product.
17:48Number four, problems with distribution due to increase in demand.
17:53And last but not least, number five, not having profitability.
17:57This often happens with generic medications, and so the manufacturers will either reduce
18:03or completely stop making the drug because it's no longer profitable to them.
18:06From API Assassin, what is pharmacology and what do you enjoy about its study?
18:13Pharmacology is the study of drugs, their mechanism of action, how they work on the
18:19body, as well as how the body works on drugs.
18:22Pharmacology is a great thing for us because modern medicine shows us that if we didn't
18:27have medications, a lot more of us wouldn't be able to survive.
18:30Most importantly, in something like vaccinations, which is the single most effective medical
18:36intervention that we've had within our history, we know that there are thousands and thousands
18:42of children that would not survive if it wasn't for childhood vaccines.
18:47TommyWeb3CR would like to know, how can AI assist in drug discovery and accelerating
18:55the development of new medications?
18:57It can help identify new potential drug targets, can also help us repurpose existing drug targets,
19:04determining what clinical trial participants are appropriate for a given study, and last
19:10but not least, it can help us synthesize mass amounts of data.
19:15And this is going to help us further identify new drugs that we can use to cure old diseases.
19:22That's it.
19:23Hope you learned something new.
19:25Those are all our questions for pharmacology support.