Episoder
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Hi, I’m Tony Guerra, I teach college pharmacology and I created the Free Pharmacology Course Podcast to help you recognize, understand, and memorize pharmacology and drug names on the run. This first seven lecture series provides a basic understanding of how to recognize common drug names, understand the basic classifications, and quickly memorize them for exams. The print, e-book, and audiobooks these lectures are based on, Memorizing Pharmacology: A Relaxed Approach, can be found in the show notes taking you to Audible.com. If you’ve never had a book from Audible, you may be able to get the seven-hour professionally narrated version for free. Please do take the time to subscribe, rate and review these episodes it helps other people find out about them.
Welcome to Episode 7, Endocrine Pharmacology.
https://www.amazon.com/Memorizing-Pharmacology-A-Relaxed-Approach/dp/B01FSR7XZO/
Full Transcript:
Male speaker: Welcome to the Pharmacy Leaders Podcast, with your host, Tony Guerra. The Pharmacy Leaders Podcast is a member of the Pharmacy Podcast Network. With interviews and advice on building your professional network, brand, and a purposeful second income from students, residents, and innovative professionals.
Welcome to Episode 7: Endocrine Pharmacology.
Tony: So, let's start with Chapter 7; Endocrine. This is our last chapter and we're going to start with three OTC medications.
Most people don't know that insulins are over-the-counter because they aren't literally over-the-counter, they're in the refrigerator in the pharmacy, but they don't require a prescription or two of them don't.
Regular insulin, which is humulin R, and NPH insulin, which is humulin N, and alphabetically you say, "Well, why didn't you put the N first, why did you put the R first?" Traditionally insulins when we talk about them and list them, we list them in the order of the speed that they work. So, I'll mention these in the insulin column, but regular insulin works for less time of an NPH insulin. So, that's how we would put it, regular then NPH.
Emergency contraception. So, the stem here is the -gest- that lets you know it's a progestin. So, Levonorgestrel is Plan B One-Step, why is it called one step? Well, it used to be two steps, it used to be two pills, and the Plan B comes from, well Plan A might have been a condom or something like that, that broke, and Plan B was to take this pill for emergency contraception. It used to be by prescription, then it went behind the counter, then recently it's gone over-the-counter and available readily.
So, let's go with the prescription medications now. So, we'll start with the oral anti-diabetics and to remind us that diabetes is an issue of a blood glucose that's elevated. So, what we're trying to do is reduce that blood glucose. The order that I put them in is alphabetically by their class, so that if you have other medications you want to put in you can just put in more biguanides or more DPP-4 inhibitors, but the B proceeds the D proceeds the sulfonylurea.
So, Metformin has the -fromin stem, F-O-R-M-I-N, but you'll usually see some kind of g-l- in these generic names and Metformin is the exception. So, the manufacturer made Glucophage, the gl- is in the gluco for glucose and then phage. To phage something is to eat it, so if you've heard of cell eating as phagocytosis, cell drinking is pinocytosis, so that's kind of where that comes from. The DPP-4 inhibitor sitagliptin. So, some people just call them 'gliptins' because it's just hard to say DPP-4 and that's Januvia.
So, the second-generation sulfonylureas, glipizide and we have the gli- prefix. Its brand name Glucotrol, so you can see glucose control is what I think they were going for with a brand name, and then glyburide the gly- prefix, and Diabeta is the brand name. So, you can see most of the word diabetes is in there or you can think of the beta cells and insulin secretion and what they do there and the islets of Langerhans.
So, those are if you have a patient that has too much blood sugar, however sometimes we have a condition of hypoglycemia and you would use glucagon when the glucose is gone, is the best way I think to think of that, and that brand name is Glucagen. So, we are generating glucose where there isn't any.
So, let's go on to the insulins and another situation where we have too much or too little of a hormone. So, I've put the insulins here in order of how long they work. So, insulin lispro works very quickly, it should be taken with a meal, and because it works so quickly it's by prescription. The brand name is Humalog, which is a combination of human insulin and analog insulin.
The regular insulin and NPH I already talked about, but this is where they would be placed if you were to put the four insulins together in terms of how long they work. So, insulin lispro, regular insulin, NPH insulin, then insulin glargine. I've heard lazy Lantus to remind you that it's very slow acting, it works all day, and then Toujeo is a newer brand name. Those four insulins in that order.
Just as diabetes was an issue with high glucose and sometimes we get hypoglycemic, hypothyroidism is simply adding thyroid, if you want to treat that. So, levothyroxine is the actual hormone and the brand name comes from Synthroid, which is synthetic thyroid, is how they came up with that brand I believe. Then hyperthyroidism, when we have too much thyroid hormone, we would use something like propylthiouracil, which uses the P, the T, and the U from propylthiouracil to make PTU.
Hormone replacement. So, testosterone the -ster- is the stem indicating it's a steroid and then Andro- meaning man and then gel because testosterone is generally regarded as a male hormone.
So, from there let's go on to some birth control and issues with the bladder. So, beginning with the combined oral contraceptives or the pill, as most people would call it. The estr- is an estrogen and then the 'gest' again is a progestin. These get really complicated, but if you want to look at the estrogens you see that in all four of these ethinyl estradiol is the estrogen, so we don't have to change anything there. What we're doing is we're either adding a supplement or we're adding a progestin.
So, the first one is norethindrone ethinyl estradiol and ferrous fumarate, which makes Loestrin 24 and then we use the Fe, the abbreviation from the periodic table of elements for iron. Norgestimate with ethanol estradiol is Tri-Sprintec, the Tri- comes from that it's triphasic. And those are oral contraceptives.
So, if we're trying to remember something again we try to go head to toe and the patch would probably be something you put on the belly and Norelgestromin, the -gest- for the progestin with ethanol estradiol is Ortho Evra. So, that patch you can put on your belly. The ring is a vaginal ring, so we're going further down. Etonogestrel and ethanol estradiol, again we're using those stems and the brand name I think comes from new vaginal ring where they just took the Nu- from and make the sound new, the -va from vaginal and then ring.
While the tablets or the pill we have seven seven seven and then usually off for a week for a 28-day cycle these, the patch and the ring, are used for seven days and then a new one replaces it.
Overactive bladder. So, some of these brand names actually help quite a bit. So, with oxybutynin, the detrusor muscle is an issue with overactive bladder, so Ditropan alludes to the detrusor muscle, and then that -trol- from control you could think of you're in control with Oxytrol OTC.
The -fenacin- in solifenacin is the stem and VESIcare, vesicae actually means bladder in Latin, and somebody must have been a classics major that helped make this brand name, but VESIcare is care for the bladder. Then tolterodine, again detrusor muscle control in the brand-name.
Urinary retention. So, we've talked a little bit about cholinergic versus anticholinergic and a side effect of anticholinergics is that everything is dry. So, there's anhidrosis, stop sweating , there's blurry vision secondary to dry eyes, there's dry mouth, there's urinary retention, there's constipation, and then tachycardia, but that urinary retention is what would normally cause this kind of state.
So, to treat an anticholinergic state what we would do is we would give a cholinergic. So, bethanechol, -chol and that's not actually a stem so I'll erase it, is a cholinergic medication and you can see the part of acetylcholine that's in the brand name, but again that's not a stem, I just wanted to point it out.
Erectile dysfunction. So, these have the -afil stem and I believe there's actually an infix in here because there's a vardenafil and a sildenafil and those have that same -den- in there, but I won't mess with that right now. So, sildenafil is Viagra, it's the first that came out. It's prominently talked about in Love & Other Drugs, a recent movie, and via- means life and gr are the first two words in growth. So, give life, growth, however you want to take that for erectile dysfunction.
Tadalafil is also an erectile dysfunction medication with a much longer half-life, so they call it the weekend pill. This is the one where the couples there with the bath tubs next to each other at sunset. I can't mention the mnemonic really, my students used something to the effect of tada, but I'm not going to get to that.
So, we just have four drugs left. We've done 196 so we're going to go on to the benign prostatic hyperplasia alpha blocker and then benign prostatic hyperplasia 5-alpha reductase inhibitor.
So, I mentioned that alpha blockers are used for hypertension, but they also are helpful for a precondition called benign prostatic hyperplasia or BPH. This is a benign growth of the prostate where there's an issue with urine flow. So, to make the brand name, the manufacturer must have thought of you know the urine flow being slow, so now we're going to get maximum flow to make FloMax.
Then alfuzosin also alludes to this urine with the 'ur-' [in the brand name] and then control 'tral' instead of 'trol'. The -osin at the end of tamsulosin and alfuzosin it's not an actual stem, but some students use it to remind themselves that the BPH drugs are related.
The last two drugs; So, BPH 5 alpha reductase inhibitors, so the dutasteride and finasteride. Avodart is the brand name for dutasteride. Finasteride is interesting that it has two brand names and I should have put Proscar first for prostate care because that really matches up with the Avodart, but interestingly enough as people were taking the finasteride they were growing hair, something called hirsutism, and not to lose an opportunity the manufacturer said, "Okay, well let's create a medication name that's going to indicate that the person is going to grow hair". So, alopecia is the loss of hair, propecia, I guess, would be adding here. So, that's how that name came about.
At the end of movies or in the old black and whites there was always 'fin' for fini or done. So, we have finished our 200 medications.
Male speaker: Support for this episode comes from the audio book, Memorizing Pharmacology: A relaxed approach. With over 9,000 sales in the United States, United Kingdom, and Australia, it’s the go to resource to ease the pharmacology challenge. Available on Audible, iTunes, and Amazon.com in print, eBook, and audio book.
Thank you for listening to the Pharmacy Leaders Podcast, with your host, Tony Guerra. Be sure to share the show with a hashtag, #PharmacyLeaders.
-
Hi, I’m Tony Guerra, I teach college pharmacology and I created the Free Pharmacology Course Podcast to help you recognize, understand, and memorize pharmacology and drug names on the run. This first seven lecture series provides a basic understanding of how to recognize common drug names, understand the basic classifications, and quickly memorize them for exams. The print, e-book, and audiobooks these lectures are based on, Memorizing Pharmacology: A Relaxed Approach, can be found in the show notes taking you to Audible.com. If you’ve never had a book from Audible, you may be able to get the seven-hour professionally narrated version for free. Please do take the time to subscribe, rate and review these episodes it helps other people find out about them.
Welcome to Episode 6, Cardio Pharmacology.
https://www.amazon.com/Memorizing-Pharmacology-A-Relaxed-Approach/dp/B01FSR7XZO/
Full Transcript:
Male speaker:
Welcome to the Pharmacy Leaders Podcast, with your host, Tony Guerra. The Pharmacy Leaders Podcast is a member of the Pharmacy Podcast Network. With interviews and advice on building your professional network, brand, and a purposeful second income from students, residents, and innovative professionals.
Welcome to Episode Six: Cardio Pharmacology.
Tony: Let's go over chapter six, cardiovascular. I'm going to start with just three OTC medications. There really aren't that many.
We start with OTC anti hyperlipidemics, you'll see these called anti-cholesterol drugs, or things like that. I put that they’re over-the-counter, but they're also by prescription, and it's a little bit goofy.
So, the omega-3 acid ethyl esters are actually Lovaza, which is a brand name for the prescription omega-3 acid ethyl esters, and then niacin has a brand name of Niaspan, but you can still find Niacin and fish oil over the counter which have essentially the same thing.
So, what's the what's the advantage of getting the prescription? The FDA has tested those particular medications, the omega-3 and the niacin and to know that it's FDA-approved. To know that it's at that level of purity can be an advantage
The big OTC cardio drug is something that's been around for a long time which is aspirin, but it's used a little bit differently. So, instead of the 325-milligram aspirin as an analgesic or for fever, we’re talking about 81 milligrams and we used to have something called children's aspirin. We now know that aspirin can cause Reye's syndrome spelled capital R-e-y-e-s, but pronounced rise, like I rise in the morning and this aspirin at 81 milligrams does a good job of keeping the platelets from getting sticky, and there's good outcomes with morbidity/mortality in terms of cardiac events like heart attack like stroke.
So, a daily aspirin, the physician tells the patient to take it, but they can just find them over-the-counter, but a very inexpensive way to help the patient. Then just a reminder that this brand name, Ecotrin is an "enteric coated aspirin" to help protect the stomach from this non-steroidal, but again this aspirin is not being used for pain it’s not being used for fever, it's being used because of its ability to thin the platelets.
Well the first prescription group we have is going to be the diuretics and with the diuretics what you want to do is in your mind picture the glomerulus and from the glomerulus we want to go to the proximal convoluted tubule, then to the Loop of Henle, then to the distal convoluted tubule, then to the collecting duct. I say distal convoluted tubule and collecting duct as separate but really, we're talking early distal convoluted tubule, but that doesn't really matter as much as getting the order right.
The reason this order is so important is that diuresis decreases as you get further away from the glomerulus. So, if you think about being on a waterslide at the top of the waterslide there's a lot of water coming out into that slide, but as you get to the bottom there's just a little trickle down at the bottom. The same thing's true here, so the osmotic diuretic Mannitol which is Osmitrol. This is used for brain edema, a very serious event but not used that often.
So, the next group are the loop diuretics. They work in the Loop of Henle, and we have furosemide, and this has a stem the -semide stem. So, there's torsemide, furosemide other diuretics and the brand name comes from the fact that it lasts six hours so, Lasix and this loop diuretic is used more for congestive heart failure or severe edematous states where there's a lot of fluid that needs to be taken off or it might be used if the fluid needs to be taken off quickly.
When you're talking about treating hypertension you could use furosemide, but more likely you'll use a thiazide diuretic like hydrochlorothiazide abbreviated HCTZ, one of the brand names is Microzide, it was the capsule form. These thiazide diuretics are more used for somebody who has hypertension. So, if you look at again the diuresis, the mannitol would be the most furosemide a little bit less Hydrochlorothiazide less than that.
The issue with both furosemide and hydrochlorothiazide is that they decrease potassium and because they decrease potassium we need to in some way get that potassium back. So, we have what's called a potassium sparing diuretic. Triamterene is one, it doesn't cause a significant amount of diuresis because it really works closer to the collecting duct and that triamterene is paired as a combination product with hydrochlorothiazide, again the -thiazide stem, and Triamterene’s brand name was Dyrenium. You take part of the hydrochlorothiazide or the ending to make the brand name Dyazide, so this was Dyrenium or used to be. But we don't really see that brand name on the shelf, ever.
Potassium sparing, so some triamterene alone is potassium sparing, spironolactone is another one. It's known as Aldactone and while there's no stem here know that spironolactone affects aldosterone and that a-l-d that's in the front of Aldactone is really referring to that aldosterone that will retain sodium and water and then by blocking that sodium and water then we'll have some amount of diuresis and we'll hold on to the potassium, so they'll be an exchange.
Electrolyte replenishment, often with loop diuretics just adding a potassium sparing diuretic wouldn't be enough, so you would need to have electrolyte replenishment with potassium chloride and to make the brand name they took the K from Kalium which is the Symbol on the periodic table of elements for potassium and then D-U-R for duration, long duration. So, a potassium supplement that has a long duration.
And again, with diuretics you really want to memorize them in this order. From the glomerulus to the proximal convoluted tubule up the ascending Loop of Henle to the distal convoluted tubule and then to the collecting duct to remember which has the most diuresis, which has the least, where are the potassium sparing all the way on the other side by the collecting duct.
So, from the diuretics we're going to go to the alpha antagonist, the alpha agonist, the beta blockers, talk a little bit about hypertension.
So, the first thing I want to go over is alpha and beta. If you weren't in a Greek letter society you might not know the Greek alphabet, but the first two letters of the Greek alphabet are like our A and B except we call it Beta [Bay-tuh]. If you were to go to the UK they call it Beta [Bee-tuh], which actually makes a little more sense that it sounds like the B and our A and B in the first two letters of the alphabet, but the important thing to know is that if you block the alpha 1 receptor you're going to get vasodilation and then if you activate it you get vasoconstriction.
So, to treat hypertension we want a lower blood pressure. To lower blood pressure we would need to vasodilate, so we would use an alpha 1 antagonist or alpha 1 blocker, and then it looks like a little fish with a 1 if you want to make the little Greek form of the Alpha, but the -azosin is the stem and there's other drugs: terazosin, doxazosin [docks AH zo sin] I've also heard it pronounced doxazosin [docks uh ZO sin] but I've always pronounced it doxazosin [docks AH zo sin] and then Cardura, it alludes a bit to cardiac or some kind of long-duration drug. The alpha-2 agonist clonidine, you can see this as a patch and clonidine it's also used with ADHD treatments, but in this case you want to maybe think about the brand name as "Catabolize blood pressure" or to lower blood pressure in some way or another and again I put up the fish or backwards fish, the alpha-2 is how most people will refer to it just because it's a lot easier than writing out a-l-p-h-a 2.
Beta Blockers fall into three generations. There's the important part of the beta blocker name or the stem is the -o-l-o-l and if you put those l's together o-l-o-l you get two backwards Bs, and you can think beta-blocker. Inderal is the brand name [of propranolol] and the way that you want to think about it is it blocks all of the beta receptors, so first-generation beta blocker it's non-selective it affects beta-1 and beta-2. So that it affects beta-1 is good, it reduces heart rate. That it affects beta-2 is not good because in an asthmatic this can be problematic. If you have a something that blocks beta 2 receptors, then you would cause bronchoconstriction. So just remember we have one heart beta-1, we have two lungs beta-2.
Beta blockers second-generation, so atenolol metoprolol are all very common beta blockers. The difference is that we're only affecting beta one. So, in this way atenolol and metoprolol are similar but what I want to call your attention to are these salts and these aren't stems, these are salts, and if it's a tartrate salt then it is short acting or shorter acting and if it's succinate then it's longer-acting. So, somebody might take one tablet a day versus two tablets a day depending on which salt they have. So, if you just say metoprolol sometimes you're not giving enough information to let us know which one did you mean?
Beta-Blocker third generation, so carvedilol. I see a lot of videos that say the -lol is a stem, it’s not -alol is a stem. -olol is a stem and -dil- is a stem or at least an approved stem. What it looks like they've done with this generic is they've recognized that Coreg affects Beta 1 receptors Beta 2 receptors but also has a vasodilator property to it, so having that d-i-l in there lets you know that it's a vasodilator and that di really took the place of what would have been that first o to make -olol. So, to remember it just think, "Okay, I would have had -olol, but I added this di and then I have the dil to let me know it's a vasodilator, and it has beta blocking activity as well".
Why would this be something that we want to do? Well if you lower heart rate, then your body is naturally going to vasoconstrict to get the blood pressure back up, the bloody doesn't want the blood pressure to be down. So, by vasodilating and lowering heart rate then we're doing two things to maintain that hypertensive patient and a normotensive state. So that's the alphas and betas.
This next group comes from something called the RAAS, so the Renal Angiotensin Aldosterone System. So, Rina is an enzyme that converts angiotensinogen, it's a zymogen. If you want to think of a fire extinguisher with the pin in it that would be a zymogen and if you pull the pin, then you can use the fire extinguisher. So, angiotensinogen becomes angiotensin 1, but you still have to do something before the fire extinguisher will fire. So, you can think of angiotensin converting enzyme as the hand that actually pushes that fire extinguisher making I guess would be carbon dioxide, I'm not sure what gas is in there, make it work. So, by going from Angiotensinogen to angiotensin 1 to angiotensin 2 you now have a postinvaso constrictor, so that's how it works physiologically to raise blood pressure.
What we want to do though is lower blood pressure, so we would block that second enzyme the angiotensin converting enzyme itself and we have an ace inhibitor, so an angiotensin converting enzyme inhibitor and sometimes people call them the prills because they always end in -pril or enalopril lisinopril. So, the renan was that first enzyme, the angiotensin is second the angiotensin one is second, then angiotensin II is third, but then what about this aldosterone? Well aldosterone retains sodium and water as its physiologic purpose, so we're going to want to block that to allow for the secretion of sodium and water and then in secreting the sodium it exchanges from potassium as a potassium sparing medication.
So, understanding the way that the electrolytes work is critical in the raas, and then it all comes together as a system, but what if a patient develops a dry unproductive cough and this can happen with angiotensin converting enzyme because of its effect on Bradykinin. What we do is not treat it. We don't give them codeine, or we don't give them Dextromethorphan. What we do is we switch them to an arb or an angiotensin II receptor blocker. So instead of affecting the enzyme we're going to block the receptor itself and some people call these the sar tans because they all end in [Sar] [tan] or S-A-R-T-A-N and you can see some clues to cardiac in the raas if you look at [Kosar] backwards it would be [ra] az or looks like [raas] and then benicar benefit cardiac. Never came up with anything for diovan, but the van and diovan takes the V in the last two letters of sartan.
So, again understanding that ace inhibitors, we've known them for a long time. They work very well, but you might switch a patient over to an arb if there's some kind of non-productive cough caused by the ace inhibitor.
So, let's go to calcium channel blockers and two very different kinds of calcium channel blocker. One that vasodilates and affects the heart and one that just vasodilates.
The nondihydropyridine CCB's, or calcium channel blockers, are the ones that affect both the heart and cause vasodilation. Why is this important? Well beta blockers can be used as antidysrhythmics, calcium channel blockers can be used as antidysrhythmics if they're in this nondehydropyridine class. So, diltiazem has the -tiesm stem which is cardizem, and you can see cardiac in there and verapamil, which ends in -pamil with the pamil stem and you can see the brand name Kalyan the Ca for calcium or the Cal for calcium and then -an for antagonists or part of channel. There are a number of different ways you can look at it to remember it's a calcium channel blocker.
What's important, and I'll give you a story, is that my daughter's when they were -- after my cerclage procedure to keep them in she needed a calcium channel blocker to keep the children from coming back out and the calcium channel would would block -- if we used nondihydropyridines then we would suppress heart rate, not only in my wife, but also in the three fetuses, and we wouldn't want to do that. So, the choice was one of these two and amlodipine and nifedipine and we ended up having nifedipine prescribed, but nifedipine only vasodilates and it was a very low dose. So, just used as something off-label, but there is a huge difference between the two and that both groups vasodilate but only the nondihydropyridines affect the heart directly.
Then both of the brand names, Norvasc you can think of vasculature and then Procardia, cardia has to do with the heart. Then this -dipine you can find the in Hydropyridine, you can find the D-I-P-I-N-E and you actually have more choices, but my students looked at it as we see the dipine, but we also think of a dip in blood pressure, so the -dip and then the -in as a way to remember what it's for.
So, moving from those vasodilators to single vasodilator nitroglycerin -nitro is the stem. I didn't see it on the USANC, but I did see it on the World Health Organization and the brand name Nitrostat means certainly we're using nitro, and we're doing it very quickly or stat.
The HMG-Coareductase inhibitors. These are known as the statins because of this ending and this is the stem, statin but you really don't want to use just statin. You want to use this infix -va or the -va statin because there's an antifungal called Nystatin that has this S-T-A-T-I-N at the end as well, and you don't want to confuse those. So, atorvastatin is Lipitor, sounds like the lipid gladiator, and then rosuvastatin is Crestor, and you can think of cholesterol. There's a couple letters from cholesterol in Crestor. The fibric acid derivative, so the fibrate is the stem, and this is Tricor and the reason they named it that way is because these fibric acid derivatives affect the triglycerides or help with triglyceride lowering. So those are some medications again for hypertension, some other uses for cholesterol.
Let's go and finish up with some anticoagulants. Cardiac glycoside and then one anticholinergic. So, the big difference between the anticoagulants is if they're parental or enteral. So, enoxaparin ends with -parin and that's the stem and that's Lovenox. Then heparin, I didn't want to put a brand name because we've been using it so long it doesn't really, it does sort of have one, but I just left it like that. But notice that the parenteral and -parin are sort of alike. This parenteral role isn't parent like someone had a child, it's the word para, meaning outside of, enteral, and we just got rid of the second A. So, something parenteral is outside the GI. Something enteral is taken by mouth or orally?
It looks like I forgot to put one up there which is dabigatran, which is Pradaxa, and -gatran is the stem. Then warfarin and dabigatran are very similar in that they're both oral anticoagulants, but warfarin requires INR measurements to make sure that the patient has the right amount of coagulation to the point where they're going to be bleeding or isn't to the point where they're more likely to get a stroke or something like that. So, you can see the letters. I N and R at the end of warfarin to remind you of that. Another thing my students used warfare, that warfare is bloody as a way to remember that bleeding is a side effect or possible side effect of warfarin.
The antiplatelet, so where the anticoagulants tend to work in the veins, very slow-moving areas where coagulation happens because of stasis or where the blood slows down. Something like clopidogrel, an antiplatelet, which is comparable to aspirin in the way that it works has the -grel stem and it works on platelets, and you can see the -pla from platelets in the word Plavix, so it vexes platelets.
Cardiac glycoside, so there's no stem here but it comes from the plant Digitalis Lanata and it looks like little fuzzy fingers. So, the -dig comes from digitalis and -lan comes from Lanata. So, digoxin and Lanoxin are both, I guess, homages to the flower itself that this came from, foxglove, but digoxin is a cardiac glycoside. So, it's a positive inotrope, increases the strength and force of contraction of the heart, but it also works as an antidysrhythmic. So, it used to be used all the time back in the mid-90s, but then they found that sometimes there's a bit of a danger with it because a patient that has very low potassium and digoxin could go digitoxic.
Anticholinergic. So, the tropes stem lets you know there's a cholinergic component, but the tropine really lets you know that it's a tertiary nitrogen compound versus the [tro] [p.m.], which is a quaternary compound, and this is atropen. What we use an anticholinergic for is anticholinergics would cause tachycardia or increase in heart rate. In some procedures were really worried about bradycardia or very low heart rate. So, by giving atropine we prevent low heart rate by giving a drug that causes high heart rate. It's one of the four drugs in the lean acronym which is L-E-A-N. So, lidocaine epinephrine atropine and Naloxone and then these are the drugs for emergencies for various reasons.
So that's cardiac.
Male speaker: Support for this episode comes from the audio book, Memorizing Pharmacology: A relaxed approach. With over 9,000 sales in the United States, United Kingdom, and
Australia, it’s the go to resource to ease the pharmacology challenge. Available on Audible, iTunes, and Amazon.com in print, eBook, and audio book.
Thank you for listening to the Pharmacy Leaders Podcast, with your host, Tony Guerra. Be sure to share the show with a hashtag, #PharmacyLeaders.
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Hi, I’m Tony Guerra, I teach college pharmacology and I created the Free Pharmacology Course Podcast to help you recognize, understand, and memorize pharmacology and drug names on the run. This first seven lecture series provides a basic understanding of how to recognize common drug names, understand the basic classifications, and quickly memorize them for exams. The print, e-book, and audiobooks these lectures are based on, Memorizing Pharmacology: A Relaxed Approach, can be found in the show notes taking you to Audible.com. If you’ve never had a book from Audible, you may be able to get the seven-hour professionally narrated version for free. Please do take the time to subscribe, rate and review these episodes it helps other people find out about them.
Welcome to Episode 5, Neuro and Psych Pharmacology.
https://www.amazon.com/Memorizing-Pharmacology-A-Relaxed-Approach/dp/B01FSR7XZO/
Full Transcript:
Male speaker: Welcome to the Pharmacy Leaders Podcast, with your host, Tony Guerra. The Pharmacy Leaders Podcast is a member of the Pharmacy Podcast Network. With interviews and advice on building your professional network, brand, and a purposeful second income from students, residents, and innovative professionals.
Welcome to Episode 5: Neuro Pharmacology.
Tony: Okay, let's go over chapter five neuro of our review.
So, let's start with local anesthetics and these are OTC and what a local anesthetic is it's just something that's going to numb a certain area. Anesthetics, when injected, will make a person pass out, but what I want to talk about is the ester vs the amide.
So, benzocaine is an ester, it's a type of organic chemistry molecule, and that tells you that the esters we don't really want to inject because they can become allergenic where a patient might have an allergic reaction. Lidocaine has less of that allergenicity, but they're both related by this -caine stem C-A-I-N-E and that might look like cocaine and that's right because cocaine was one of the original anesthetics and they found or develop some anesthetics that weren't addicting.
If you look at Anbesol, you see two of the letters from the word numb, so that's one way to remember that one, and then Solarcaine. Solarcaine takes the -caine ending, that's still frowned upon by the World Health Organization, but solar meaning sun. So, we're using something to take care of the pain from a sunburn, but lidocaine has many uses, an injectable in an emergency, patch, some other different things that it can be used for.
OTC anti- vertigo, so, meclizine. If I were to do meclizine in small letters like this, m-e-c-l-i-z-i-n-e you could kind of put this C in this L together to make a D and then you see dizzy. So, it's for dizziness, but the brand name's Dramamine that you might know, but there is also a brand name that was a prescription item, Antivert for antivertigo, but that one told the whole story, anti-vertigo.
Another OTC under neuro would be a sedative hypnotic and we see diphenhydramine. You might say, "Well, I remember that one, but that was an antihistamine you told me." and that's what's kind of infuriating about pharmacology is that prescription drugs can be for many different things and all this is OTC, but diphenhydramine as an adverse effect made someone drowsy, but here we're using that side-effect as a good thing.
So, tylenol acetaminophen diphenhydramine, the antihistamine that makes you tired, Tylenol PM, and that PM means post-meridian after literally afternoon, but we just use it at night time. So, Tylenol PM is something used at night time. Sometimes asleep is disturbed because of pain and that's what the acetaminophen is there for.
Benzodiazepine like sedative hypnotics, now we're going to the prescription items. Benzodiazepine-like means it's not a benzodiazepine but it works a little like one. So, eszopiclone with the -clone stem and we see this es- again, so the S isomer, and you can think of Luna or rest in Lunesta. Then zolpidem, -pidem is the stem, P-I-D-E-M and this is Ambien or Ambien CR, Ambien controlled release. So, Ambien works to help somebody fall asleep, but if the person has trouble staying asleep the controlled release, much longer acting version works well.
Melatonin receptor agonist. So, ramelteon the -melteon is the stem and it looks like melatonin for a reason because it is a melatonin receptor agonist. You can think of Rozerem, roz- rhymes with doze, REM for rapid eye movement sleep.
So, a lot of hints in these brand names certainly worth remembering. Those are some OTC neuro drugs, something to help you sleep.
In the next column we're going to go in to antidepressants and how those can help us.
The first thing that throws students off is the classifications as SSRI, SNRI, TCA, MAOI and each one has its own acronym. So, an SSRI is a selective serotonin reuptake inhibitor and that means that serotonin is going to normally be re-uptaken or if you want to think of it as recycling that's maybe a better way, but instead what happens is we inhibit that recycling, it stays in the synapse, and it's supposed to make the patient happier. It's that hypothesis of norepinephrine and serotonin not having enough of it.
There's five of them I'm going to go over; citalopram and escitalopram, we see two drugs with the same root just like we saw esomeprazole and omeprazole. Celexa was the first one that came out, it reminds me of relax. These SSRIs can also be used for anxiety. Then Lexapro, you can think of a professional upgrade from the first one, so it takes part of the ending of Celexa and then just adds pro to make Lexapro, but those are related, and the escitalopram is supposed to be better than the citalopram.
The -traline stem for Zoloft, so it lofts your mood and then the -oxetine. So -oxetine is a little bit tricky. The Adopted Names Council calls -oxetine a fluoxetine-like entity, but fluoxetine and paroxetine are SSRIs, then we're going to see that duloxetine is an SNRI, and later we're going to find a non-stimulant ADHD medication atomoxetine. So, this -oxetine ending you really have to be careful with.
Fluoxetine is interesting it's got two brand names. Prozac was the first brand name that came out, it was antidepressant. Sounds like a strong drug with the P, Z and the C or with a K sound. Then Sarafem. I'm not sure what they were going for, a seraphim it's like the highest angel, so maybe it was the work of angels, but that's for something called premenstrual dysphoric disorder, PMDD. Paroxetine, Paxil and then Paxil controlled release. So, again another medication that works a little bit longer.
Then we have the serotonin norepinephrine reuptake inhibitor and I'll try to do a little better job with my writing here serotonin norepinephrine, and I'll abbreviate it NE, reuptake inhibitor. So, we're just affecting different neurotransmitters where selective serotonin reuptake inhibitor was just serotonin, now we're talking about serotonin and norepinephrine. Again the -oxetine, be careful with that it's supposed to indicate a SSRI Cymbalta. So, my mnemonic was to remember that symbol players would always seem to be happy and alta means above in Spanish, so higher mood maybe.
Then the -faxine is the stem here in venlafaxine and for Effexor, so that's a way to remember that one. The TCA, so this SNRI and SSRI are both named after neurotransmitters, but amitriptyline is named after or the tricyclic antidepressant is named after the three rings. So, you can see that -t-r-i- in the stem -tripyline and Elavil elevates your mood.
Isocarboxazid didn't have a stem that I saw, but I had a student that said, "I sew car boxes" and it just seemed very sad. So, it's a monoamine oxidase inhibitor. So, mono, M-O-N-O-A-M-I-N-E and oxidase inhibitor. What that monoamine really means is that we're still kind of going back to serotonin, which is a monoamine, and that we're affecting it we're just calling it by a different name.
Smoking cessation. So, bupropion was first an antidepressant, it was Wellbutrin so ideally you would get well or get out of the rut you're in. So, you see the r-u-t and then -i-n in there, but then they found that a lot of these antidepressants stop smoking. So that was great, let's make it an anti-smoking drug, so they renamed it Zyban or repackaged it that way. Varenicline, it's Chantix. So, the new -nicline stem indicates a smoking cessation medication and I had a student that said in a southern accent, "Oh when I take varenicline I'm very inclined to quit or with Chantix, my chant is that I don't need my fix." Anyway, it just stuck in my head.
These are antidepressants all the way down to bupropion, which can also be used for smoking cessation. Then varenicline is specifically a smoking cessation medication.
Next, we're going to go on to some anti-anxiety then ADHD medications and antipsychotics as well. So, the first thing with the benzodiazepines is that on a lot of YouTube channels you'll see -lam and -pam are stems and that's just incorrect. You want to be careful because there's a drug lamotrigine, which is an antiepileptic, and there's verapamil, which is a calcium channel blocker, and that's for high blood pressure. Those are not benzodiazepines, so use the whole stem -azolam or -azepam.
Xanax has part of the word anxiety and it's so easy enough to remember. Versed, I can't remember the verse you just said. Klonopin and clonazepam are very similar and then Ativan, I don't even remember what I use for that one. So, really stick with the generic stems that's what you want to use for the benzodiazepines.
Dexmethylphenidate, methylphenidate I couldn't really find a stem for them, but you can see with the brand names what they're for. So, these are stimulant schedule twos for ADHD. They can help you focus, Focalin, or they can help you concentrate. They just kind of turn the last couple letters around there. Non-stimulant ADHD medication atomoxetine, gain we see this -oxetine stem. This does not mean it's an SSRI, you have to memorize that it's a non-stimulant ADHD medication. Strattera can straighten out your attention. Bipolar is a simple salt. So, lithium and Lithobid, so BID, bis in die, is the Latin for twice daily. So, lithium was taken twice daily in this particular dose.
First generation antipsychotics. So, these would be the typical, t-y-p-i-c-a-l antipsychotics and then when we get to second generations those are atypical, but we don't usually use antipsychotic as a term because to say someone is psychotic is just not a nice way of saying it, so usually we say antischizophrenic. So, chlorpromazine was the first one that came out, its Thorazine, and this is low potency. That's important because the low potency drugs tend to cause sedation and low potency just means that you need a hundred milligrams to get the same thing out of chlorpromazine as two milligrams of haloperidol, which is high potency can do. So, the haloperidol has the -paridol stem and a lot of students think of the halo to remind them or the halo in haloperidol to remind them that this is high potency first-generation antipsychotic, but you can also replace first-generation with typical antischizophrenic.
So, that's first generation some of the drugs for anxiety ADHD bipolar and psychosis.
Let's look at the second-generation antipsychotics and the anti-epileptics.
The second-generation antipsychotics the -peridone in risperidone and the haloperidol and Haldol are very similar. Somebody said that the 'risper' sounds like whispers, so like you're hearing the whispering voices. Quetiapine if you change this T and I and then put the I over one and kind of turn it around you end up with quiet, so quiet the voices, but the stem is -tiapine and that's Seroquel, to quell something is to calm something down.
So, risperidone quetiapine are both second-generation antipsychotics. We would also call these atypical. Why is that important? Atypical antipsychotics have less extrapyramidal symptoms, but would have more dyslipidemia, diabetes, weight gain, things like that, in general. Again, you don't want to generalize too much, there's certainly a variation within the class.
Anti-epileptics we break them down in to traditional versus newer. So, we've got carbamazepine and the -pine just means that we have some kind of, I think it's a tricyclic molecule, but the way to maybe remember it is that you carb or curb the convulsions or you control them. So, you see the T the R the O and the L that could be from the word control, that's one way to look at it. Divalproex is Depakote, second traditional one and then phenytoin has the -toin, t-o-i-n stem and this is Dilantin and you would want to remember it from the -toin stem.
The newer ones, now I only just happen to pick two drugs that happen to have gab in them, gab is a stem . It's for the gamma-aminobutyric acid and gabapentin is Neurontin and you can think of the n-e-u, which is pronounced new, as the newer anti-epileptic, and then Lyrica also is a newer one. If something's lyric its musical, so we're taking this very disordered epilepsy and making it more ordered. so that's one way to think of it.
Parkinson's disease, so dopamine or lack thereof is a real problem. So, levodopa, you can't put dopamine in the brain directly, the blood-brain barrier will block it, but levodopa can as a precursor get into the brain and then be converted to dopamine, but we lose so much as we get there. So, carbidopa is really there as a protectant to protect levodopa, allow more of it to enter the brain. The -giline stem selegiline, that's an MAOB, it's Eldepryl, and so you can see the word elderly in there that Parkinson's affects many elderly people, but certainly it affects younger people as well. That is highlighted in a couple movies and then the actor Michael J Fox certainly. So, that's Parkinson's.
Then let's look at just our last two here Alzheimer's and motion sickness. Alzheimer's, donepezil, the way that I remembered it was my memory is done I can't remember zilch and just put z-i-l-c-h or you can think of perception and Aricept and maybe you lose some degree of perception. Memantine, the m-e-m from memory tends to ring a bell, but then Namenda has the NMDA and that's what kind of receptor it affects.
The last medication is for motion sickness. So, scopolamine is Transderm-Scop, so across - trans, derm - skin, scope and then taking the first four letters of scopolamine. This is usually used for cruise ships and things like that, a person puts on a patch and they don't have to keep taking Dramamine or something like that.
That's neuro in a nutshell.
Male speaker: Support for this episode comes from the audio book, Memorizing Pharmacology: A relaxed approach. With over 9,000 sales in the United States, United Kingdom, and Australia, it’s the go to resource to ease the pharmacology challenge. Available on Audible, iTunes, and Amazon.com in print, eBook, and audio book.
Thank you for listening to the Pharmacy Leaders Podcast, with your host, Tony Guerra. Be sure to share the show with a hashtag, #PharmacyLeaders.
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Hi, I’m Tony Guerra, I teach college pharmacology and I created the Free Pharmacology Course Podcast to help you recognize, understand, and memorize pharmacology and drug names on the run. This first seven lecture series provides a basic understanding of how to recognize common drug names, understand the basic classifications, and quickly memorize them for exams. The print, e-book, and audiobooks these lectures are based on, Memorizing Pharmacology: A Relaxed Approach, can be found in the show notes taking you to Audible.com. If you’ve never had a book from Audible, you may be able to get the seven-hour professionally narrated version for free. Please do take the time to subscribe, rate and review these episodes it helps other people find out about them.
Welcome to Episode 4, Immune and Antibiotic Pharmacology.
https://www.amazon.com/Memorizing-Pharmacology-A-Relaxed-Approach/dp/B01FSR7XZO/
Full Transcript:
Male speaker:
Welcome to the Pharmacy Leaders Podcast, with your host, Tony Guerra. The Pharmacy Leaders Podcast is a member of the Pharmacy Podcast Network. With interviews and advice on building your professional network, brand, and a purposeful second income from students, residents, and innovative professionals.
Welcome to Episode Four: Immune and Antibiotic Pharmacology.
Tony: Welcome to chapter four, immune. There's 40 some medications here, so I just wrote it up. I put one group out of order. My hand cramped from writing all of this, so I'll just tell you which one's out of order, but we'll get to that in a bit.
The first thing I want to do is I want to start with four OTC medications. OTC neomycin polymyxin B and bacitracin. This -mycin stem you may have seen before, it just means that it's from the streptomyces bacteria, but it doesn't necessarily tell you that it's exactly an antibacterial, but neomycin, polymyxin B, bacitracin, this is Neosporin. So, what we're going to do is we're going to go through antibacterials, antifungals, antivirals with these four medications in that order and then through the big list we're also going to go antibacterial, antifungal, antivirals.
So, the antifungal over-the-counter. You might know Lotrimin Ultra, we use for athlete's foot and things like that, it's butenafine. Then influenza vaccine, so again using the prophylactic, something that's trying to prevent infection before we use something acute, docosanol. So, influenza vaccine has one of its brand names as Fluzone and when you see flu in a brand name that means influenza, but if you see -flu- in the generic name, except for obviously the word influenza, like fluoxetine Prozac or another ones escaping me now, but that means a fluorine atom. So, be careful about using flu to mean for the flu or for influenza.
Docosanol, it's Abreva. I had no idea why anybody would pay 20 bucks for this, but it'll make your cold sore go away much faster, but think about docosanol so you can go to the ball or you can go to the prom, that's I guess why you would spend 20 bucks on something like that, but it abbreviates the amount of time that that cold sore lasts, so Abreva.
Let's start with the first antibiotic or antibacterial section. I had a little piece of tape here on the board, so we put penicillin over here, but we have one penicillin antibiotic, but something unusual about it. We start with amoxicillin, which is Amoxil, and this has the -cillin stem and so amoxicillin penicillin methicillin these are all penicillin antibiotics, we see that from the stem, but Amoxil is the brand name. You just took out the -ic- and then the -lin-, but what's this clavulanate?
So sometimes the bacteria can secrete an enzyme which can make the antibiotic ineffective. That beta lactamase enzyme can destroy the amoxicillin, but if you add this clavulanate you can augment, and you see that word augment in Augmentin the brand name, this amoxicillin. The cephalosporins are related to the penicillin’s they work on cell walls as well, so I'm not going to get too much into mechanism of action that's all in the book this is just review. The archaic one was C-E-P-H and I think they got rid of this because ceph- means brain or head if you're talking about medical terminology and its brand name is Keflex, but this is first generation.
What that means is that a first-generation drug has three properties that a third or fourth generation wouldn't or the other way around third and fourth have properties that first wouldn't. So, a third and fourth generation would increase gram-negative coverage would increase the ability to prevent beta lactamase attack, just like the clavulanate does with the amoxicillin, ceftriaxone and cefepime a third generation and fourth generation drug both do the same thing and then these two have better penetration into the cerebral spinal fluid if there's some kind of infection there, but again the stem is cef-, C-E-F.
So, the importance with putting vancomycin here when it doesn't seem to relate at all is that vancomycin also affects the cell wall. This -mycin stem again isn't really going to help you too much, but vancomycin is a glycopeptide and it works a little bit differently against methicillin-resistant Staph aureus something like that, but these are all grouped together.
This is where I kind of mixed it up. The tetracyclines should be before the macrolides, but you can see tetracyclines doxycycline from the c-y-c-l-i-n-e and minocycline from c-y-c-l-i-n-e. The reason they're called tetracyclines is because they have four rings, so the game Tetris was actually the Tetra for four and tennis. So, the person who invented it just combined those two together. So, we're just naming this class after the four rings in it. Then Doryx for doxycycline is the brand name and then minocycline's brand name is Minocin.
Then we have the macrolides. That macro- comes from just being a big molecule that's why they're named that way. This is an interesting one where we see the -mycin, but we also see something very similar in the middle the T-H-R-O and this might be an infix, I'm not exactly sure, but -thromycin you see that they all have that and that's one way to think that these three are macrolides. Now, do all macrolides have -thromycin? No, but this is a little bit helpful.
So, azithromycin is a z-pack. The way that I order it is that you only take that one once daily. Clarithromycin you take it twice daily so once daily then twice daily so Biaxin, twice daily. Then erythromycin is taken four times daily. So, the way that i put this in was to put it in number of doses a patient would have to take per day, one two and four all.
We're actually continuing on to the next with some other antibiotics Clindamycin which is Cleocin. You see this used a lot topically because it can cause some severe side effects severe diarrhea, so clindamycin a lot of times we'll see used for penicillin allergic patients and dentistry. The oxazolidinone linezolid and you can kind of see the classification in the name, the zolid stem again here puts it in that class, but Zyvox is very solid or 'zolid' against MRSA and vancomycin-resistant enterococci.
Amikacin and gentamicin both have those, the -kasin and -micin stems tell you the -micin doesn't tell you it's an aminoglycoside but these two are related in that way so Amikin and Garamycin. The two dihydrofolate reductase inhibitors. So, sulfa- and -prim are both a prefix sulfa- so let's you know it's a sulpha medication and trimethoprim the -prim lets you know that it's a dihydrofolate reductase inhibitor. What does that mean? Well bacteria need folic acid just like we do but they have to make their own, so if you block them from making their own it would kill the bacteria or hurt the bacteria. Then if you take a couple letters out of the word bacterium you get Bactrum, the brand name.
This fluoroquinolone is interesting because of the -oxacin suffix. So, the -oxacin is the suffix and then this -fl- is an infix and this fluorine atom makes it a fluoroquinolone rather than just a quinolone and then Cipro just got, you just cut off the -floxicin to make Cipro from ciprofloxacin and then Levaquin is like Levaquin except it's a quinolone, so the -quin for that. Antiprotozoal, metronidazole, so -nidazole is the stem and it's an amidazole antibiotic so you could see those letters kind of similar together and this is flagyl. TB, I use R-I-P-E as the acronym or way to remember it. When you think of that raised section that if you would have a positive in duration on a TB test I would think it's ripe like it's a welt or swelling. So, rifampin Rifadin isoniazid INH pyrazinamide PZA and ethambutol which is Myambutol.
There's clues in there that I mention in the book about how to remember what the side effects are for those, but again we're still in the antibacterials and with all these medications and now we're going to move over to the antifungals.
So, three antifungals. A lot of times students will try to be very efficient and they'll just try to remember the generic name, but amphotericin B doesn't really tell you much about what it does, but Fungizone own certainly tells you it's for fungus. Fluconazole the -conazole stem, some people get this wrong and they put that -azole stem in there and -azole- is just a zole, it's just an organic chemistry group. So, you don't want to use -azole because if you do that then you say fluconazole and omeprazole, a proton pump inhibitor in the same class and that's just not true. Nystatin, so this is Mycostatin so if you've had microbiology class you know the myco- means some kind of fungus.
Be careful with this -statin, so the -statin and nystatin, the -statin in Mycostatin there's a class of HMG-CoA reductase inhibitors that are anti-cholesterol medications that have this -statin stem and really the -vastatin is a better way to do that and I'll talk about that when we get to cardio.
Oseltamivir, so the -amivir is the stem here and these brand names are great, they tell you exactly what it's for. Oseltamivir you tame the flu, which is influenza and Zanamivir is Relenza make the influenza relent, so pretty good brand names there. Another antiviral for herpes simplex virus and varicella zoster virus - acyclovir. So, -cyclovir is the stem and this again I didn't mention this -vir stem but it's kind of a sub stem, so -vir is the all-encompassing antiviral stem but -amavir tells you it's for the influenza -cyclvir tells you it's for HSV and we have Zovirax, so zoster virus acts the zoster virus or wreak the virus. So, you can see the val- from Valtrex and val from valcyclovir are similar.
So, some similarities there I go over it all in the book.
Palivizumab, so again we have a monoclonal antibody, m-a-b and this is for respiratory syncytial virus. So, we've had a medication that's a biologic with this kind of naming for asthma for ulcerative colitis and as an antiviral, so this -mab doesn't tell you what it's for, but the -vizu- with the -mab helps you understand how it's working within the body. Then this is Synagis. So, those are the antifungals and then the non-HIV antivirals.
The next thing I’m going to do is go over the HIV antivirals. I haven't mentioned the top 200, there's going to be 200 drugs in this list. The top 200 drugs tend to omit the HIV medications, but I think it's essential that we talk about them and certainly how HIV works in the body. So, let’s go to the HIV medicines.
So, what I did was I put them in an order that makes sense in terms of how the HIV virus attacks the body. The first thing the HIV virus tries to do it tries to fuse, so we've got enfuvirtide and you can see the -fu- from fuse, but the -vir- stem and then the Fuseon, so something that's trying to fuse with the healthy cell. Then you've got miraviroc which is a CCR-5 antagonist, a cellular chemokine receptor antagonist and again we're still outside the cell trying to get in and if you look at the brand you see Selzentry. So, sans entry means no entry, so that's one way you can think of it that we don't want this virus to get in.
Efavirenz is a non-nucleoside reverse transcriptase inhibitor and it's paired here with emtricitabine and tonofovir. Which comes to Atripla so the trip, I have triplet daughters, but this triple makes three drugs in one medication and then the A surround it, so maybe against AIDS or something like that. Efavirenz is a non-nucleoside reverse transcriptase inhibitor, an NNRTI. Emtricitabine and tenofovir are nucleoside nucleotide reverse transcriptase inhibitors or NRTI. So, a mouthful certainly but hopefully a good way of remembering it that we're going from fusion and CCR5 antagonist outside the cell. Now this HIV virus is trying to attack reverse transcriptase and then it's going to try to attack integrase and then protease and so by stopping reverse transcriptase by stopping integrase by stopping protease we can hopefully stop the HIV.
So, we have raltegravir and this is Isentress, so again we see that century as the brand name and then Darunavir which also is Prezista, so we're resisting the HIV virus with a protease inhibitor. You kind of see the -tegrase T-E-G-R-A-V-I-R in raltegravir and darunavir, it's really the brand name with Prezista that you see the protease inhibitor.
But the key is that by memorizing these five brand names and then you certainly got the combination here so it's eight actual medicines but one two three four five six seven, seven actual medicines. Let me do that one again. So, by memorizing HIV medications and we have seven medications but five different types here the key is that we're learning how does HIV go from this to this to that to that and so these orders aren't just about memorizing it but also memorizing the pathophysiology that goes along with understanding HIV.
Male speaker: Support for this episode comes from the audio book, Memorizing Pharmacology: A relaxed approach. With over 9,000 sales in the United States, United Kingdom, and
Australia, it’s the go to resource to ease the pharmacology challenge. Available on Audible, iTunes, and Amazon.com in print, eBook, and audio book.
Thank you for listening to the Pharmacy Leaders Podcast, with your host, Tony Guerra. Be sure to share the show with a hashtag, #PharmacyLeaders.
-
Hi, I’m Tony Guerra, I teach college pharmacology and I created the Free Pharmacology Course Podcast to help you recognize, understand, and memorize pharmacology and drug names on the run. If you’ve never had a book from Audible, you may be able to get the seven-hour professionally narrated version for free. Please do take the time to subscribe, rate and review these episodes it helps other people find out about them.
Welcome to Episode 3, Respiratory Pharmacology.
https://www.amazon.com/Memorizing-Pharmacology-A-Relaxed-Approach/dp/B01FSR7XZO/
Full Transcript:
Male speaker: Welcome to the Pharmacy Leaders Podcast, with your host, Tony Guerra. The Pharmacy Leaders Podcast is a member of the Pharmacy Podcast Network. With interviews and advice on building your professional network, brand, and a purposeful second income from students, residents, and innovative professionals.
Welcome to Episode Three: Respiratory Pharmacology.
Tony: This is chapter three respiratory or respiratory and I'm going to do the same thing just for efficiency's sake I've already written everything up on the board, so that I'm just going to highlight stems. I'm going to highlight drug classes drug classifications and in the order in which I put them.
The first section we're going talk about are antihistamines and you divide antihistamines in first and second generation. There's controversy over whether there's a third-generation drugs like fexofenadine, which is Allegra is one that might be in the third generation. A third-generation drug would be something that's maybe a metabolite or one of the isomers of the racemic mixture. So, I'm not going to go in to a third generation, first and second is enough for just our purposes right now.
So, antihistamines H-1 first generation is diphenhydramine and again we have this non-alphabetical order, so I put an ABC with a slash and then ABC with an arrow here to explain why. We begin with first-generation diphenhydramine. Diphenhydramine is in that generation that was first invented, and these made people very drowsy. You can see B E and D in Benadryl, so you can think of bed, and you can also see the D R Y because it's drying, helps with allergy symptoms. Diphenhydramine, that's first generation that goes through the blood-brain barrier and makes someone drowsy.
Second generation on the other hand, cetirizine and loratadine, so Zyrtec and Claritin. These don't cause the drowsiness because they can't get through the blood-brain barrier or they can't stay through the blood-brain barrier. Loratadine has a stem it's -atadine and I know spelling has been de-emphasized since I was a kid, so I'm a gen X-er. I was clapping erasers and had chalkboards and things like that, but in drug name spelling is incredibly important because you pronounce loratadine the same as you pronounce famotidine and the -tadine and the actual stem is -atadine sounds just like the -tidine in the H-2 blockers, but if you spell it -tidine by accident you've just made this drug instead of for allergies for acid and we don't want to do that. So, paying attention to spelling is very important with these medications.
So, cetirizine, Zyrtec. This -tir- in cetirizine is pronounced "tear" so you can think of tearing from allergy eyes. Loratadine has the -atadine stem and the Claritin Clear commercials have been very clear about what it's for, you see people outside having fun on the picnic you even look at the box it's a blue sky so Claritin Clear for allergies.
What I want to talk about also is this loratadine-D. So, what is that D? Well D is for decongestant and that decongestant is pseudoephedrine. Pseudoephedrine is brand name Sudafed and you'll see it as loratadine-D or Claritin-D and what's the rationale for that? Well if you have allergies and nasal congestion, if you just use loratadine or claritin it's not going to help, but if use loratadine with a decongestant then it will take care of the allergy symptoms and the congestion.
This decongestant pseudoephedrine or Sudafed is actually BTC, it's behind the counter you, have to show ID for it. This -rin or -drin, I think, is the stem and because it's behind the counter there's a certain amount that any person can get in a single day a certain amount you can get in a month because the pseudoephedrine can be used to make methamphetamine or meth. One of my students said, "I'm so fed up with being congested and that's how you remember pseudoephedrine or Sudafed".
So, what we're doing to remember these is we start over-the-counter with these antihistamines and this decongestant and what we're going to do is we're going to go in to the nose, so we're physically thinking, "Okay we're in the nose now" and phenylephrine is the PE in many oral liquids and it's very similar to pseudoephedrine except this one is not regulated, and you can get as much of it as you want. The brand name for the nose one is Neo-Synephrine. Another one which can be used in the nose, another decongestant, is oxymetazoline which is Afrin and this nasal spray you should really only use for three days otherwise you might get some kind of rebound congestion.
So, we're staying in the nose and that's how we're just like in the in the GI chapter we went from stomach down to intestines, we're staying in the nose and then we'll go down to the chest. So, we have triamcinolone and this -lone some people use as a way to remember that it's a steroid, it's not a proper stem. The brand name, the '-cort' stands for cortical steroid and nasa- for nose, again it's not a stem, you can't have a stem in a brand name, but these are hints that let you know what it's for. Allergic rhinitis, you have an -itis that means you have an inflammation, so inflammations we can use some kind of steroid.
So, for the first group here we're starting with anti-histamines then we go to the decongestant then allergic rhinitis and we're being very mindful of where we are in the body.
We're going to go from the nose to then cough, which is going to be in the chest. So, just as we've done before we're going to go from an OTC to a prescription and this is where we make our jump, everything before just now is over-the-counter behind the counter.
So, guaifenesin is a mucolytic and some people get that confused because they've seen robitussin for coughs so long, but the guaifenesin is actually just m-u-c-o-l-y-t-i-c a mucolytic is something that breaks up mucus or breaks up chest congestion. The stem is in dextromethorphan, but you may never see that word, you might just see the DM. So, guaifenesin with dextromethorphan is Robitussin DM. There's also Mucinex DM. Either one of those, but the -orphan stem is the one that tells you it's dextromethorphan.
If the cough doesn't subsist and maybe you go to the prescriber and say, "You know, I've had this cough for a week and it's just not going away. It's not productive" they might prescribe something like codeine. Now, in the United States codeine you can't just get it over the counter. You used to be able to get a little bit, but now it's regulated, and that Cheratussin the 'cher' is for cherry and then AC, some people just use anti-cough, but I think, and codeine was probably what it stood for. Then -tussin; an antitussive is something that's for cough.
So, if that cough doesn't go away and you still have that chest congestion, if the prescribers being very aggressive maybe they'll treat the inflammation in the chest and they'll do that with a steroid with either methylprednisolone or prednisone. Again, we're staying with our alphabetical within the class of steroids. Methylprednisolone this is an infix. So, in English we can have something that's a prefix before we can have a suffix which is at the end or we can have an infix and in fixes are extremely rare in English, but they're not rare when it comes to medications. So, the -pred- not the -lone is what tells you it's a prednisone type steroid, but some people still use that -lone or -sone as their cue, but really the stem is that -pred-.
Maybe we go from the chest and we stay in the chest and stay in the lungs and in the lungs, we're going to talk about these asthmatic medications. So, we have budesonide and we pronounce this -son- not as son but as sone and I'm not going to underline it because it's not a proper stem, but some people still use it to recognize this is the steroid part. I put fluticasone, this -sone, underneath it because these two drugs are doing the same thing. They're long-acting steroids that are going to be inhaled, so we have the steroid part of it for asthma and then I put beta-2 here. A beta-2 agonist is a bronchodilator, it's going to open up your lungs and the stem for that is -terol. t-e-r-o-l. t-e-r-o-l.
You're probably most familiar with albuterol, but in these long-acting versions formoterol and budesonide come together to make Symbicort, so they're symbiotic working together with a corticosteroid and then fluticasone is working together with salmeterol to give you air or you're adding them together spelling add ad instead of a DD to get air.
Fluticasone you can find it alone and what I did was where these are combination medicines I just staggered this, I put a hanging indent where the fluticasone is on this side under the steroids and albuterol is on this side just to show you that I'm just separating this out. This is long-acting, but this is a little bit more short acting. So, fluticasone comes as Flonase for the nose, but also, it's Flovent if you're going to use it orally. Then this albuterol is that rescue inhaler that most people are familiar with.
What I did here was I put prophylaxis before acute, so our healthcare system is really treat once something's happened, but ideally you don't get asthma attacks because you take these long-acting medications, but sometimes you might have a breakthrough asthma attack and you would want that rescue inhaler; the beta-2 agonist albuterol. So, I kept with that alignment. So, albuterol the -terol is under here in another combination product, but here we have -tropium and -tropium is an anticholinergic. The -chol c-h-o-l is about acetylcholine and acetylcholine is the neurotransmitter we're talking about.
Ipratropium does a really good job with asthma as well and this comes in the medication DuoNeb, literally two a duo that can be nebulized, and so albuterol works as a bronchodilator ipratropium as well and they work in concert together.
Tiotropium also has this -tropium stem to let you know that it's an anticholinergic, but this one is a little bit more long-acting than this short acting one. Tiotropium is a long-acting anticholinergic and this brand name is Spiriva and if you think of the word respire or respiration you see the s-p-i-r in there, but it's the -tropium stems that lets you know this is an anticholinergic medication.
So, again now we've gone from then just using some of the cognitive tools to go from over-the-counter to Rx. We're going from a cough which is in the chest to the lungs which is in the chest and asthma. Then we're going to go on from these medications to three other medications that can be used in asthma incidents and things like that.
The leukotriene inhibitor, Montelukast the stem -lukast seems an awful lot like leukotriene. It's given once a day and that's where that single comes from in Singular and then if you're asthmatic and it's helping your condition then the air a-i-r is what helps. Anti IgE antibody, so again one of these biologics, omalizumab. So, the -mab tells you it's a monoclonal antibody and then -li and -zu also have meaning, I won't go in to it here, but it's in the book.
It's important to understand with the biologics we're going to have these complex stems telling us where it's from and that's Xolair and that to me that just sounds like extra air. So, again a way to remember that it's for it asthma, but this is an injectable. The one thing with omalizumab is that it can cause anaphylaxis, so you always have to have somebody around when it's being injected, an epinephrine or an EpiPen is what you would use. So, epi means above neph means kidney, so above the kidney. What's above the kidney? The adrenal gland. So, epinephrine is an injectable that does something very similar to the adrenal gland, which is secrete epinephrine.
There's another word it's also called that's very similar and I'll just put it here, it's called adrenaline, and this is the Latin version. So, -ad means above or to towards and then -renal means kidney and then so this is the Roman or the Latin and then the epinephrine is the Greek.
That's the respiratory medications in a nutshell.
Male speaker: Support for this episode comes from the audio book, Memorizing Pharmacology: A relaxed approach. With over 9,000 sales in the United States, United Kingdom, and Australia, it's the go to resource to ease the pharmacology challenge. Available on Audible, iTunes, and Amazon.com in print, eBook, and audio book.
Thank you for listening to the Pharmacy Leaders Podcast, with your host, Tony Guerra. Be sure to share the show with a hashtag, #PharmacyLeaders.
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Hi, I’m Tony Guerra, I teach college pharmacology and I created the Free Pharmacology Course Podcast to help you recognize, understand, and memorize pharmacology and drug names on the run. If you’ve never had a book from Audible, you may be able to get the seven-hour professionally narrated version for free. Please do take the time to subscribe, rate and review these episodes it helps other people find out about them.
Welcome to Episode 2, Musculoskeletal Pharmacology.
https://www.amazon.com/Memorizing-Pharmacology-A-Relaxed-Approach/dp/B01FSR7XZO/
Full Transcript:
Male speaker: Welcome to the Pharmacy Leaders Podcast, with your host, Tony Guerra. The Pharmacy Leaders Podcast is a member of the Pharmacy Podcast Network. With interviews and advice on building your professional network, brand, and a purposeful second income from students, residents, and innovative professionals.
Welcome to Episode Two: Musculoskeletal Pharmacology.
Tony: This is chapter two, we will do musculoskeletal system.
The first thing that we're going to talk about are the first group of drugs and all of this that I'm going to put up there is all in my head, so I'm just going to do this from memory. but you might learn it piece by piece. I'm going to show you the pieces and how they group together and then within those groups we'll have three larger groups, so that you can learn this column then hopefully next column the next column.
The first column I'm going to talk about are the OTC NSAIDS, the non-steroidal anti-inflammatory drugs, and there are three of those. Start with aspirin, ibuprofen which has two brand names, Advil and Motrin and then naproxen. The first thing we want to do is make sure that we check for any stems and a stem is something that indicates what drug class it's in. -profen is a non-steroidal anti-inflammatory stem. -proxen isn't. It looks very similar though, so if you're trying to memorize it that's one good way to do it.
So, we go from the OTC NSAIDs aspirin ibuprofen naproxen to what would be a non-narcotic analgesic also over-the-counter and the one that you're probably most familiar with is acetaminophen tylenol. There's no stem here but what you can see, just like with the aspirin, aspirin is actually acetylsalicylic acid which is abbreviated ASA. We also have an abbreviation that actually comes from acetaminophen which is from N-acetyl-para-aminophenol, which is APAP and we'll use that in just a minute.
So, then we've got those and these take care of most things, most analgesia most pains over-the-counter, but maybe it's some kind of a migraine or something like that, so we're going to combine them. We'll combine the OTC NSAID plus non-narcotic in a medication called Excedrin migraine. It includes aspirin ASA, Tylenol APAP, and also caffeine and the caffeine is a vasoconstrictor, it helps narrow the blood vessels in the brain so that there's less pain.
So, we started with the OTCs and the natural movement or progression is from OTC to Rx, so let's go to the Rx NSAID . The first one we'll look at is meloxicam and this also has a stem -icam and that's mobic. Then we also have another Rx NSAID that's a COX-2 inhibitor. That one's going to be Celebrex or celecoxib and that's Celebrex.
So, the first kind of panel, first group of drugs that we want to look at are these seven and we see that we have nonsteroidals and non-narcotic, we're going to combine the two to help memorize these two groups. Then we're going to have prescription NSAID that works just like ibuprofen and naproxen, meloxicam, and then we have this COX-2 inhibitor which is supposed to protect the stomach. So, again in order, aspirin ibuprofen naproxen acetaminophen aspirin acetaminophen caffeine meloxicam and celecoxib.
So, that's the first group and that's how we would do that. Within the groups though make sure that you want to try to alphabetize it, so A comes before I before N and I'll show you where I'll break that rule a little bit here.
The next group we're going to look at are the opioids and narcotic antagonist. We'll start with the scheduled two. So, again the DEA schedules, one is one that has no medical value, two is the most addicting, three is less addicting than that, four is less addicting than that. and five and so forth. So, we'll go over a two or three and a four.
The first one is morphine, MS Contin and fentanyl has a couple brand names. One is Duragesic an analgesic that lasts for a long duration and Sublimaze, although it's not subcutaneous you can think of it going intramuscularly. Then we have hydrocodone with acetaminophen, that's Vicodin. Then oxycodone with acetaminophen and that's Percocet. So, we've got four C-II opioids and you'll notice that I've got it alphabetically here but not here. Why? Well morphine was the first drug, it's a prototypical drug. If you have something like that you want to take it and put it at the top and then you'll alphabetize the ones that come after it.
But now we're going to go in DEA order from C-II to narcotic C-III and the C-III is going to be Tylenol with codeine, but we call it Acetaminophen with codeine and one of them is Tylenol #3. Then we have a narcotic C-IV. It's a mixed opioid, so I'll just call it a mixed opioid, but it is scheduled four and that's tramadol and we'll just underline -adol and that's the stem there.
So, over here we used the NSAIDs and we did them from OTC to Rx. Over here what we're going to do is we're going to use the number of DEA schedules from two to three to four to help memorize them and then we've got a narcotic antagonist and it's nice to have usually the agonist before the antagonist. It just makes sense intuitively and that's noloxone or Narcan and the stem there is the -nal. So, these are the opioids and how you remember them use them in DEA schedule order. Agonist first antagonist next.
Next, we're going to go actually in the body from head to toe and the first group that we're going to have are the triptans and the triptans are going to be the migraine medications; eletriptan Relpax and you can think of relief and pax means peace in Latin and then sumatriptan, which is Imitrex. There's an IM version, so you can think of the IM in Imitrex, but really, it's these -triptan stems that tell you what kind of medication you have.
Then from there we're going to go to what are called the DMARDs and DMARDs are disease-modifying antirheumatic drugs and I'll show you why I'm going to put this not in alphabetical order. Methotrexate Rheumatrex because it's for rheumatoid arthritis and methotrexate has the -trexate stem and this is a non-biologic.
Then we have two biologics; abatacept and etanercept, so Orencia and Enbrel. I'm going to underline the -cept because that's the stem for these biologics, but also the -ta-, so we'll double underline the -cept and the -ner- and so the -tacept and -nercept means that it's a certain kind of disease modifying antirheumatic drug, but you see we don't have alphabetical order here because we have a non-biologic then we have two biologics in alphabetical order.
So, after the DMARDs the way I remember it is we start with the head then we go to the joint and then from the joint we're going to go to the bone. So, we have two bisphosphonates; alendronate Ibandronate Fosamax , students like to think of fossil, Boniva has the word bone in it, to remember those. These aren't for osteoarthritis like the NSAIDs would be, these are for osteoporosis, so some degradation of the bone.
From there we have the muscle relaxants and then the -dronate stem that tells you that these are bisphosphonates. Then we have the muscle relaxers and the muscle relaxers include cyclobenzaprine, which is Flexeril, and diazepam which is Valium and the -azepam is a stem . So, cyclobenzaprine you can see the word -benz- and it's like you're bending and then flex for Flexeril. Diazepam it's a benzodiazepine, we'll see benzodiazepines in the neuro section, but these are also used for muscle relaxation, so I put one here.
We actually have one more set of drugs, but I want you to notice where we've gone. We started with the head, so triptans for headache. Then we went into the joint and then from the joint we went to the bone and then out to the muscle, so you're thinking inside out and I'll put it over here.
Anti-gout. So, I'm going to have two anti-gout medications; allopurinol which is Zylorpim and Febuxostat which is Uloric and the -zostat is the stem. Now these anti gout medications are for chronic gout, so what we're doing is we're preventing uric acid from forming and you can kind of see the uric from uric acid in here and then the lo for lower, so you lower uric acid. Both of these prevent having too much uric acid, if you have less uric acid you'll have less gout, but again alphabetize them within the group and here we are gout 50% of the time is in the toe so a good place to memorize them.
So, those are the 25 musculoskeletal drugs in a nutshell.
Male speaker: Support for this episode comes from the audio book, Memorizing Pharmacology: A relaxed approach. With over 9,000 sales in the United States, United Kingdom, and Australia, it’s the go to resource to ease the pharmacology challenge. Available on Audible, iTunes, and Amazon.com in print, eBook, and audio book.
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Hi, I’m Tony Guerra, I teach college pharmacology and I created the Free Pharmacology Course Podcast to help you recognize, understand, and memorize pharmacology and drug names on the run. This first seven lecture series provides a basic understanding of how to recognize common drug names, understand the basic classifications, and quickly memorize them for exams. The print, e-book, and audiobooks these lectures are based on, Memorizing Pharmacology: A Relaxed Approach, can be found in the show notes taking you to Audible.com. If you’ve never had a book from Audible, you may be able to get the seven-hour professionally narrated version for free. Please do take the time to subscribe, rate and review these episodes it helps other people find out about them.
Welcome to Episode 1, Gastrointestinal Pharmacology.
Audiobook: https://www.amazon.com/Memorizing-Pharmacology-A-Relaxed-Approach/dp/B01FSR7XZO/
Full Transcript:
Male speaker: Welcome to the Pharmacy Leaders Podcast, with your host, Tony Guerra. The Pharmacy Leaders Podcast is a member of the Pharmacy Podcast Network. With interviews and advice on building your professional network, brand, and a purposeful second income from students, residents, and innovative professionals.
Tony: Welcome to the Pharmacy Leaders Podcast. The semester for me starts tomorrow. Monday the 8th and I need to get up the top 200 in audio form on this forum as well. So, I just wanted to let you know that today, Sunday January 7th, I'm going to put up the top 200 drugs in two hours and it's just seven audio podcasts. We'll get back to Brandon Dyson from TLDR Pharmacy on Monday morning where we will talk about residency interviews and we'll do a number of mock interview questions.
So, for now please enjoy the top 200 drugs in two hours.
Welcome to Episode One: Gastrointestinal Pharmacology.
What I want to do is I want to go through the seven chapters and I'm going to go through them on the board from memory. As we get to the later chapters I might just do them ahead of time just to make the clips shorter, but these first two clips at least I'm going to do it from memory just to show you that hopefully after you've read the book you've got it to the point where you're at the instructor's level. As an instructor with those 200 drugs I see them all as seven pictures. I don't need two hundred note cards, I can just do it from memory, and that's where I want you to get to.
So, we'll start with chapter one gastrointestinal and we'll talk about thirteen medications and while I talk about the thirteen medications I'll also talk about grouping them, and grouping them when you're first learning these top 200 drugs, when you group them students are good at grouping them as these are analgesics and these are maybe for some kind of stomach upset and then these are for pain, but this is another level where we're connecting all 200 drugs in one order.
So, let's start with two drugs that you're probably very familiar with, two antacids. Then from the antacids we're going to go to the H2 blockers and these are better known as histamine-2 receptor antagonists. So, there is a histamine-1, that's the antihistamine you think of when you think of Claritin and things like that. The receptor just means that the drug is going to affect the receptor and an antagonist means it blocks it. So, histamine two must release gastric acid if we're using a drug to block it and then proton pump inhibitors.
So, within each of these categories, I'm going to alphabetize them because it makes it easier to remember.
Although magnesium is above calcium on the periodic table, we're going to put calcium carbonate first. So, calcium carbonate is Tums, but I also want you to know that it's something called Children's Pepto. This is important because regular Pepto has a salicylate component that's a lot like aspirin and that can be very dangerous in children, especially if a child has some kind of chickenpox or fever and things like that and get Reye's syndrome, spelled r-e-y-e apostrophe "s". There's Magnesium hydroxide and that's Milk of Magnesia.
So, these antacids they work very quickly and because they work quickly what we're going to do for the way that we're going to remember them is these work in a couple minutes, maybe five minutes. These work in about 30 minutes, the H2 blockers, and then these work in about a day.
But antacids are probably the first thing you'll reach for because they work so quickly. Then if it persists you might go to an H2 blocker and we have two that we're going to use, famotidine and ranitidine. I'm not going to put the brand names yet because I want you to notice that there's a -tidine ending t-i-d-i-n-e. The first thing I want you to know is that the [een] ine is not the ending. A lot of the videos on YouTube show that as the ending just because 20% of all drugs end in -ine. So, you don't want to classify it by that.
The -tidine has been set by a couple of organizations, the World Health Organization the United States Adopted Names Council and they're the ones that make this into a group so that it's a -tidine makes it a cimetidine like H2 blocker and cimetidine was the first H2 blocker that came out.
So, let's put the brand names in there, Pepcid, which combines peptic and acid. Zantac, you can kind of see the word antagonist in there for acid, and then two proton pump inhibitors and we're going to see similar ending or that they're going to have similar endings and then I'm going to introduce something new as well there. So, esomeprazole there's (brand) Nexium (generic) omeprazole (brand) Prilosec. So, the -prazole ending is what lets us know it's a proton pump inhibitor, but you'll notice we have omeprazole and omeprazole. What's the es- what's this doing? If you look in and Wiki is a good place to look because it has good pictures of molecules, this omeprazole is actually an R- plus S-, Where this omeprazole is just an S- what does that mean?
There's a right-handed rectus and left-handed sinister omeprazole, so it's mixed. There's two sides to the molecule and only the S- does anything. So, Prilosec came first "protons low secretion" is how you remember the brand name and then esomeprazole or Nexium came next and you can remember that from Nexium, but just notice that these have the same root, but they still have this ending -prazole. Be careful some of those YouTube videos call it -azole and those are maybe people that haven't had organic chemistry, an -azole is just an organic chemistry compound, but -prazole is an actual stem by the United States Adopted Names Council.
So, let's look at our first six drugs in order. We start with antacids calcium carbonate and magnesium hydroxide alphabetized, although on the periodic table I know magnesium comes first, it's 12, calcium carbonate is 20. H2 blockers alphabetize them, famotidine Ranitidine. Notice the -tidine stem, the -tidine, and then the proton pump inhibitors esomeprazole omeprazole. Although omeprazole came first esomeprazole should be alphabetized before omeprazole, and this es- means that it's the S- isomer and that's supposed to work a little bit better.
Let's move on to the next group. So, after you have a stomachache sometimes you get diarrhea. So, let's look at some drugs for that. We're going to do again two anti diarrheals and then what we want to do is we want to do the opposite, so we'll do two laxatives and so the anti diarrheals we'll start with and again alphabetical order bismuth subsalicylate, Pepto-Bismol, and loperamide, that's Imodium. So, the -sal- is the stem s-a-l and the way to remember this is bismuth subsalicylate, it's this big pink bottle many people know about it, but just recognize that bismuth subsalicylate Pepto-Bismol is different than Pepto Children's. Loperamide you see low for slow and per for peristalsis, so slowing peristalsis or making Imodium looks a little like immobilized, so we're slowing things down if a patient has diarrhea.
Now again, we don't use those drugs if the patient has some kind of infection. We'll treat that with antibiotics, but let's go to the opposite, let's go to the laxatives on what we can use. Start with Docusate and you can see as docusate or docusate sodium, that's Colace and then we'll also see polyethylene glycol that's MiraLax. So, Polyethylene Glycol, sort of has a stem. The p the e and the g tells you that it's pegylated, but Docusate sodium I know I have an under laxative it's really a stool softener, but think of the word docusate and penetrate as rhyming and then polyethylene glycol, this is the miracle laxative is a way you can remember it, but also Colace allowing the colon to race now giving a laxative.
So, we've gone from the stomach now to the intestines and these have all been over-the-counter, so let me put that in front of these OTC OTC and what we want to do is we again want to have a logical order of the things. So, we're going to go from OTC to Rx and the Rx drugs, we'll look at are the antiemetics.
Antiemetics are those drugs that help with nausea and vomiting and a very important drug that came out, it's called ondansetron. Ondansetron is Zofran and it has the -setron stem, you'll see another couple of medications that have the -setron stem, and then we use promethazine, which is Phenergan. I'm also going to put something here next to the Zofran and ODT. Zofran comes as an orally disintegrating tablet because sometimes if somebody's vomiting even just taking a little bit of water would make them vomit again, so the orally disintegrating tablet allows it to just dissolve. The Phenergan comes as a rectal suppository, again because the patient is vomiting they would lose the medication if they took it as a pill. It's another form.
So, what we've done is we've gone from the stomach down to the intestines back up to the mouth, if you want to put it that way, and then we're going to go back to the intestines. There's two ways that I look at it You're already there if you're thinking of the rectal suppository promethazine and so the last one we're going to do is something for ulcerative colitis. This drug is infliximab and that's Remicade "Remission Aide". So, sometimes ulcerative colitis can go into remission, and that's how you remember it. This has one of the most complex stems. It's a monoclonal antibody, so m-a-b for monoclonal antibody. The -li- and -xi- both have meaning, and I go over into detail in the book, but just since we're just reviewing, but the -liximab is actually the stem and the monoclonal antibody doesn't tell you anything really about what it does it just tells you it's a monoclonal antibody. The -li- and the -xi- are much more useful because we're going to see in later chapters things like Xolair and Etanercept and other biologics that have these complicated stems.
But again, if you're going to try to memorize it you really want to memorize the GI drugs where they're working? So, we went to the intestines down to the rectum with this promethazine and then ulcerative colitis, we would give some kind of injection of Remicade, but that's the ulcers and the inflammation are there in the intestines.
Male speaker: Support for this episode comes from the audio book, Memorizing Pharmacology: A relaxed approach. With over 9,000 sales in the United States, United Kingdom, and Australia, it's the go to resource to ease the pharmacology challenge. Available on Audible, iTunes, and Amazon.com in print, eBook, and audio book.
And I'm going to go through them on the board from memory as we get to the later chapters
I might just do them ahead of time just to make the clips shorter
But these first two clips at least I'm going to do it from memory just to show you that
Hopefully after you've read the book you've got it to the point where
You're at the instructor's level as an instructor
with those 200 drugs I
See them all as seven pictures. [I] don't need two hundred note cards
I can just do it from memory, and that's where I want you to get to so we'll start with chapter one
gastrointestinal
And we'll talk about thirteen medications and while I talk about the thirteen medications also [talked] about grouping them and grouping them
When you're first learning these top 200 drugs when you group them
Students are good at grouping them as okay these are four analgesics and these are
Maybe for some kind of stomach upset and then these are for pain
But [this] is another level where we're connecting all 200 drugs in one
Order so let's start with two drugs that you're probably very familiar with two antacids
And then from the antacids we're going to go to the H2 blockers
and
These are better known as histamine
Two
Receptor
Antagonists
So there is a histamine [1] that's the end of histamine you think of when you think of Claritin and things like that
[the] Receptor just means that the drug is going to affect the receptor and an
Antagonist means it blocks it so histamine
[two] must release gastric acid if we're using a drug to block it and then proton pump inhibitors
So within each of these categories, I'm going to alphabetize them
Because it makes it easier [to] remember
Although magnesium is above calcium on the periodic table. We're going to put calcium carbonate first
So calcium carbonate is Tums
But I also want you to know that it's something called Children's
Pepto
This is important because regular Pepto has a salicylate component. That's a lot like aspirin and
that can be very dangerous in children, especially if a child has
Some kind of Chickenpox or fever and things like that and get Reye's syndrome
spelled Reye
apostrophe "s"
There's Magnesium hydroxide
And that's Milk of Magnesia
So these antacids they work very quickly
And because they work quickly what we're going to do for the way that we're going to remember them is
These work in a couple minutes. Maybe five minutes
These work in about 30 minutes the H2 blockers, and then these work in about a day
But antacids are probably the first thing you'll reach for because they work so quickly
then if it persists you might go to an H2 blocker and
We have two that we're going to use famotidine
ranitidine
I'm not going to put the brand names yet because I want [you] to notice that there's a -tidine ending
t-i-d-i-n-e
The first thing I want you to know is that the [een] ine is not the ending
a lot of the videos on YouTube show that as the ending just because
[20%] of all drugs end in -ine
So you don't want to classify it by that. The -tidine has been set by a couple of [organizations] the World Health Organization
the United States Adopted Names Council
and they're the ones that make this into a group so that it's a -tidine makes it a
cimetidine like H2 blocker and cimetidine was the H2 blocker that came out first and
So let's put the brand names in there Pepcid
Which combines peptic and acid
Zantac
You can kind of see the word antagonist in there for acid okay, and then to proton pump inhibitors
And we're going to see similar ending or that they're going to have similar endings
And then I'm going to introduce something new as well there so esomeprazole
There's (brand) Nexium (generic) omeprazole
(brand) Prilosec, okay
so the
-prazole ending is what lets us know it's a proton pump inhibitor, but you'll notice we have omeprazole and omeprazole
What's the es- what's this doing if you look in and
Wiki is a good place to look because it has good pictures of molecules this omeprazole is actually an R- plus S-
Where this omeprazole is just an S- what does that mean? There's a left-handed
Right or there's a right-handed rectus and left-handed sinister omeprazole, so it's a mixed
there's two sides to the molecule and
only the S- does anything so Prilosec came first
"protons low secretion" is how you remember the brand name and
Then esomeprazole or Nexium came next and you can remember that from Nexium
But just notice that these have the same root, okay?
but they still have this ending -prazole Be careful some of those YouTube videos call it -azole and
Those are maybe people that haven't had organic chemistry an -azole is just an organic chemistry compound
But -prazole is an actual stem by the
United States Adopted Names Council, so let's look at our first six drugs in order we start with antacids
Calcium carbonate and Magnesium hydroxide alphabetized although on the periodic table. I know magnesium comes first
It's 12 calcium carbonate is 20
H2 Blockers alphabetize them famotidine
Ranitidine notice the -tidine stem the -tidine and then the proton pump inhibitors
esomeprazole omeprazole
Although omeprazole came first
esomeprazole should be alphabetized before omeprazole, and this es- means that it's the S- isomer and
That's supposed to work a little bit better
[alright], let's move on to the next group. So after you have a stomachache sometimes you get diarrhea
So let's look at some drugs for that
Okay, so the we're going to do again two anti diarrheals
And then what we want to do is we want to do the opposite so we'll do
two laxatives and
[so] the anti diarrheal we'll start with and again alphabetical order bismuth
subsalicylate
That's [p]
Pepto-bismol, okay and loperamide
That's Imodium
okay, so the -sal- is the stem s-a-l and
The way to remember this is bismuth subsalicylate. It's this big pink bottle many people know about it, but just recognize that bismuth subsalicylate
Pepto-bismol is different than Pepto Children's
Loperamide you see low
for slow and per for peristalsis
so slowing peristalsis or
Making Imodium looks a little like immobilized, so we're slowing things down
If a patient has diarrhea now again, we don't use those drugs if the patient has some kind of infection
We'll treat that with antibiotics, but let's go to the opposite. Let's go to the laxatives on what we can use
start with Docusate
And you can see [as] docusate or docusate sodium
That's Colace and then we'll also see polyethylene glycol
That's MiraLax. Okay, so
Polyethylene Glycol, sort of has a stem. The p the e and the g tells you that it's pegylated
but
Docusate sodium I know I have an under laxative
It's really a stool softener, but think of the word docusate and penetrate as rhyming and then polyethylene glycol
[this] is the miracle laxative is a way you can remember it, [but] also
Colace
Allowing the colon to race now giving a laxative
so we've gone from the stomach now to the intestines and
These have all been over-the-counter, so let me put that in front of these
OTC
OTC and
What we want to do is we again want to have a logical order of the things so we're going to go from
OTC to Rx and
The Rx drugs, we'll look at are the antiemetics
Antiemetics are those drugs that help with nausea and vomiting and a very important drug that came out. It's called ondansetron
Ondansetron is Zofran and
It has the -setron
stem you'll see another couple of medications [that] have the -setron stem and then
We use promethazine
Which is Phenergan
I'm also going to put something here next to the Zofran and ODT
Zofran comes as an orally disintegrating tablet because
Sometimes if somebody's vomiting even just taking a little bit of water would make them vomit again
So the orally disintegrating tablet allows it to just dissolve
The Phenergan comes as a rectal suppository again
Because the patient is vomiting they would lose the medication if they took it as a pill. It's another form
Okay, [so] [what] we've done is we've gone from the stomach down to the intestines back up to the mouth if you want to put
It that way and then we're going to go back to the intestines. There's two ways that I look at it
You're already there if you're thinking of the rectal suppository promethazine and so the last one we're [going] to do is something for ulcerative colitis
And this drug is infliximab
and
That's Remicade
"Remission Aide" so sometimes ulcerative colitis can go into remission, and that's how you remember it This says one of the most complex stems
It's a monoclonal antibody so m-a-b
for monoclonal antibody the -li- and -xi- both have meaning and I go over into detail in the book
But just since we're just reviewing but the -liximab is actually the stem
And the monoclonal antibody doesn't tell you anything really about what it does it just tells you it's a monoclonal antibody
The -li- and the -xi- are much more [useful] because we're going to see in later chapters
things like Xolair and
Etanercept and other biologics that have these complicated stems
But again if you're going to try to memorize it you really want to memorize the GI drugs where they're working [ok]?
So we went to the intestines
Down to the rectum with this promethazine and [then] ulcerative colitis
we would give some kind of injection of Remicade, but that's
The ulcers and the inflammation are there in the intestines
