Alpha Agonists Mnemonic POP CAN - Phenylephrine Oxymetazoline Pseudoephedrine Clonidine

In this episode, I go over how you can use the POP CAN mnemonic to remember the alpha agonists and what that means for pharmacology indications and adverse effects.

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Welcome to the Memorizing Pharmacology podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com.

Let's get started with the show. Hey, welcome to the Memorizing Pharmacology podcast. This one is on Alpha Agonist. The mnemonic is 'pop can' and the idea is just to remember a couple of medications that maybe are a little bit different so that we can kind of compare and contrast and do that kind of thing.

So when we look at Alpha One agonists, we think of pseudoephedrine which is Sudafed, oxymetazolin which is Afrin, and phenylephrine which is Neosinephrine. There aren't really stems; the only stem here is pseudoephedrine which has that driven sympathomimetic stem which just means it works like the sympathetic system but specifically it's the alpha one that's the big deal.

We'll look at that mechanism of action specifically on the alpha receptor. So pseudoephedrine or the pseudofed, it's usually an oral tablet that you're going to take. This stimulates Alpha receptors systemically so it's going to go throughout the whole body. The nice thing about oxymetazolin which is Afrin and phenylephrine which is neo-sinephrine, they both stimulate Alpha receptors locally in the nose so you don't get as much of that issue with cardiac contraindications and so forth.

So again anybody that has heart issues they're going to be very wary about using either these medications but all three result in vasoconstriction and decongestion and are adjuncts for allergic rhinitis treatment. So the big kind of take-home thing is if you've got vasoconstriction you've got a little bit increase in blood pressure and that's something you don't want with a cardiac patient.

But when you talk about side effects though really with Pseudoephedrine it's more excitability and nervousness just kind of a jitteriness rarely you're going to see something like tachycardia oxymetazolin Afrin and phenylephrine eosinephrine the big thing here is that rebound congestion and it's possible around three days you might see four or five days whatever but it's called rhinitis medicamentosa so that's the actual name for that rebound congestion.

If something like that does happen you may need to take an oral steroid or you may need to have a steroid in such a way that we go one nostril at a time but that rebound congestion is very real thank you contraindications really it comes down to those cardiac issues so angina coronary artery disease and hypertension because it's CAD coronary artery disease it also just happens to be closed angle glaucoma which is the more more concerning type of glaucoma and either of those would definitely be a contraindication to using these types of medications.

The Alpha 2 you know the can of the pop can mnemonic so when you think pop you think okay well once my nose clears it kind of Pops open but the can part is just to remind you that c and N are in clonidine and clonidine has a couple of brand names that might help you remember what it's for catapress so if you think of catabolizing blood pressure and then catapress TTS was the patch that also helped with blood pressure and then Cafe which is for ADHD or that's how it's marketed.

But the mechanism of action is quite a bit different so it stimulates an alpha 2 receptors that decreases norepinephrine so norepinephrine would normally bind to Alpha One Alpha 2 beta 1 so you get a decrease in blood pressure and that seems a little bit counter-intuitive to say I'm stimulating something but I'm decreasing so that's just the big thing is that it's stimulating Alpha two it's kind of shutting off the norepinephrine faucet and that's why blood pressure decreases okay indications include hypertension ADHD ticks and Tourette Syndrome it can be an adjunct for cancer pain it can also be an adjunct for neonatal opioid withdrawal syndrome but again not the safest drug in the world not something we use a ton anymore but to be complete to have an alpha Agonist and not to go into those super medications that have many many alphas and betas this one is the alpha two prototype then adverse effects which you would expect when you lose epinephrine you would expect a decrease in blood pressure and that decrease in blood pressure tends to result in some dizziness and some light headedness but also quite a bit of fatigue imagine that you're trying to turn on the system to increase your heart rate and blood pressure and all those things only to find out that the faucet for that particular neurotransmitter is not available so anyway just a reminder with all these this is just informational purposes this is not medical advice if you've got a medical problem contact a medical professional foreign thanks for listening to the memorizing pharmacology podcast you can find episodes cheat sheets and more at memorizingfarm.com again you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com. Thanks again for listening.

Like to learn more?

Find my book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd

Here is the Link to my Pharmacy Residency Courses: residency.teachable.com