Beta Agonists Mnemonic IMACH Isoproterenol Albuterol Salmeterol Terbutaline

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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 forward slash P forward slash moving. Let's get started with the show. Hey, welcome to Memorizing Pharmacology podcast. I'm Tony Guerra. I wanted to give you with the beta agonists a more general way to look at drugs and remember what you're supposed to know about them and I'm going to use a mnemonic eye match but it's actually i-m-a-c-h and I'll explain what I'm talking about here. So the way that I do this or kind of put drugs in my head to make it simple and create a story and I know many of you are like why am I taking English 1 and

English 2 or comp one and comp2 to become a health professional and as an undergraduate English major although I've got my you know doctorate in healthcare and pharmacy my background in English reminds me that you know to remember something you really got to get the story together and the story comes from I am a considerate health professional so that's my I match mnemonic uh I couldn't get the T in there but what we're trying to do is really say you know for indications mechanism of action which many people

Overdue like you can say you know Methotrexate is going to affect certain enzyme but you can just say it's an anti-metabolite. I don't have to get too into it or something is cholinergic or anticholinergic that's the mechanism of action and some of you call that drug class so however you want to do that but we start with indication mechanism of action adverse effects then some people call this contraindications really I think of it as considerations like if the patient is this then we don't want to give this but in this

Exception we might so it's more of a consideration but many times we'll call this a contraindication and we're really being empathetic to what it is that their other conditions are and then health professionals so I am a considerate health professional and the H is really just as a health professional what do I need to do to help the patient and that depends on what you do. I mean are you a pharmacist physician nurse physician assistant you know what what are you what are you and what is your role in helping the

Patient so indication mechanism of action adverse effects consideration slash contraindications and then how can we help the patient better take the medicine and I'll show you how this works with the beta Agonist that we have in this group okay so let's just start with I always like to just do one slide like what's it for so indications when you have something like isoproterinol which is isopril inotrope is in the word and I'll show you how to do that but this is something that's you know for

Shock or you know bradycardia those types of things Albuterol and we can underline the stem the tyrol stem let's just know it's a beta2 Agonist which is pro air brand name tells you what it's for it's a rescue inhaler so it provides air by you know bronchodilating salmeterol some people call it salmeterol. I like that the word meter is in there because it's a metered dose inhaler but that's also a terol and so we had this problem with the beta blockers where wait a minute you've got Albuterol and

Salmeterol and they're they do the same thing but they're different why are they different well albuterol is short acting some meteorol is long-acting and I'll talk a little bit about that mechanism of action in a minute but usually so meteorol has to be added to fluticasone there was a study that showed that salmeterol alone was no bueno so fluticasone has that sewn ending for a steroid and then we add these together to get error so that's what Advair is but this is that what patients would call a controller inhaler

Something they have to take every day sometimes twice a day those types of things and then terbutylene or breaking now that's a subcutaneous there's some other dosage forms but that's even more short acting than albuterol but these are the indications that's what it's for but how do we remember all this okay well the mechanism of action can be really helpful if you know what to look for so isoproterinol or icprow this is that beta1 beta 2 agonists so it's going to affect the heart and the lungs you've heard that mnemonic where you have two lungs so beta two one heart beta one albuterol that's Pro air is just going to be beta 2 and we'll talk a little bit how that isn't always the case so beta 2 if it's used properly but many uh patient cannot afford Advair or doesn't take Advair on a regular basis their controller inhaler they need more and more Albuterol they keep complaining they're well I'm so jittery and just you know got Tremors and all these things that's from coming and using albuterol

Wrong you're not using it as a rescue inhaler you're trying to use it as a controller inhaler that's not what it's meant for uh some meat roll with fluticasone is Advair so we have a beta 2 Agonist to open up the lungs for a long time and a steroid and so the steroid is to help with inflammation the two components of asthma are that bronchospasm and inflammation and then terbutaline that's beta2 okay so this mechanism of action you're going to see these terms so I just want to make them clear short acting selective

Beta 2 Agonist is a mouthful so we just call it a Saba Saba that's Albuterol and terbutylene and then a long-acting selective beta2 Agonist is a laba which is cell meteorol not the fluticasone it just happens to be in there all right so let's start with isoproterinol and the kind of the mnemonic here so if you take the word isoproterinol and you get rid of the so the ER and the L you actually have all the letters for inotrope and that's what it does so if you don't remember what an inotrope is it increases the force of

Contraction of the heart it's also a chronotrope which increases heart rate but again inotrope is really when we're talking about what it does that's what it's going to be so if we use our eye match mnemonic here and I get it you you probably get big lists of all these things like well it's not that I don't get what the adverse effect is is I don't get which of the 10 adverse effects are in there or which of the 10 contraindications are in there and what I like to do is just say well let me

Just start with the ones that I understand based on the mechanism of action so I can make a story okay so I put the different types of shock in here we're not going to go into that I mean you know you can you know obstructive distributive cardiogenic hypovolemic and then you can get into the three types of distributive with septic and anaphylactic and neurogenic shock that's going way down the rabbit hole what we want to do is just say all right well what is shock well shock is a decrease in blood pressure you know

We're going to have a decrease in cardiac output well what's cardiac output made up of it you learn that cardiac output is heart rate type stroke volume well if we increase this heart rate we can increase the cardiac output we can increase the blood pressure which does the opposite of what shock is which is lowering it and then increasing heart rate obviously is the opposite of bradycardia so when we look at the indications of shock and bradycardia having an inotrope that's going to increase heart rate increase blood

Pressure cardiac output it's a good thing. The mechanism of action can affect beta 1 and beta 2. So we're going to affect that heart, affect the lungs. Adverse effects, so when you're thinking about beta 1 especially really think about the CNS and how it just really kind of makes you jittery increasing that heart rate. So if we're increasing heart rate, what would be a contraindication or consideration? Well, if somebody's got hypertension, we're trying to lower their you know heart rate blood pressure All that probably not the best medication for that and then in terms of how can we help the patient well when we get to you know you can kind of go in the weeds with shock but and losing that systemic vascular resistance but the big thing is that you know we we need to have that volume uh to make this all work so we want to definitely avoid dehydration okay okay with the albuterol um again this is for asthma COPD but this is the rescue inhaler so this is that short acting bronchodilating agent so it's beta2 it opens up the two lungs

And then again the CNS adverse effects you're like well wasn't that beta one well you can lose selectivity if you take this too much and that's when we would kind of get that jitteriness the tremors and then you say well how can hypertension be it it's beta 2 Agonist again if you lose selectivity then hypertension can be an issue then how can we help the patient well you know you want to open up the lungs before you take that next inhaler breath I know some people like to just squirt the inhaler a couple times right away get it

Done with but really let's wait a minute between Puffs to to help open up those bronchi especially if we're going to use it before the controller inhaler so better to open up the lungs so more controller inhaler gets to the lungs and then kind of a you know bfo blinding flash of the obvious if you're using a beta Agonist you probably don't want to have beta antagonists on board especially something like Propranolol which specifically goes after those beta-2s uh so salmeterol and fluticasone or Advair same thing it's an asthma COPD

But the contrast is to that albuterol this is the controller inhaler the one that long acting beta 2 Agonist and the mechanism of action we're opposing both sides of that asthma now with this controller inhaler the beta 2 Agonist open up the lungs deal with that bronchospasm and then the steroid for the as an anti-inflammatory okay got the little muscled lungs here as an image and then CNS when you lose selectivity again you get that kind of jitteriness that comes along with it but when we think about a steroid one of the things

That it does and we use it for is an immunosuppressant but if your immunosuppressing locally like in the mouth you're gonna get thrush so that's why the washing the mouth out with water you know after each use makes so much sense and then pneumonia because again we're immunosuppressing a little bit here hypertension so again that beta one you know if we lose that selectivity and diabetics you know that especially with when you add some kind of steroid you're going to get that hyperglycemia because you know when

Your body needs is when your body feels steroid it's like okay well something's gonna happen I'm going to need sugar for whatever events happening so it makes you hyperglycemic but obviously if you're a diabetic that's an issue and so again we've got that beta antagonist we want to watch out for and here we want to wash out the mouth with water and not swallow but expectorate and get that out of our mouth so we don't get the thrush okay terbutylene don't really see this as much but this again bronchosmith

Bronchospasm and asthma exacerbation it's a beta-2 Agonist it's even shorter acting than albuterol it's like super short acting and you know we can again get those CNS effects when you lose selectivity but there is a laundry list of adverse effects that can come along with terbutylene uh and then hypertension again we want to watch out for that and diabetic so it's kind of the same as the other ones and of course we want to watch out for beta antagonists but I put a little image here of subcutaneous versus IM injection Although they did bring I am back during covid to avoid using a nebulizer um but really Sub-Q is where you go with tributaline as always uh disclaimer the information is provided for informational purposes only not intended to provide should not be relied for medical or other advice I urge readers to consult with a medical professional if you have a medical condition 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

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