Asthma COPD Pharmacology Mnemonics in about 10 minutes

A quick rundown of asthma, COPD, and how to memorize the beta-2 agonists vs. anticholinergics vs. inhaled corticosteroids.

Find the 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 TonyPharmD YouTube Channel here: https://www.youtube.com/c/tonypharmd

Need more help; you can find many of my mnemonics books on Audible that you might be able to get your first for free if you've never had one before. https://www.audible.com/pd/Memorizing-Pharmacology-Mnemonics-Audiobook/B07DLGC8MP?source_code=AUDFPWS0223189MWT-BK-ACX0-118296&ref=acx_bty_BK_ACX0_118296_rh_us

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

Auto Generated Transcript:

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.

Okay, here I wanted to go over a little bit about asthma and COPD and kind of take it from a level where we can kind of get the big picture here. So first thing, asthma this is that episodic bronchoconstriction and inflammation where sometimes the smooth muscle tightens up and you get this inflammation that makes it you know a narrowed Airway and then certainly during an asthma attack that narrowing increases where COPD is more about you're going to hear these two terms chronic bronchitis which is inflammation and excess mucus and then emphysema where the alveolar membranes are breaking down it's down here in the bottom left of the graphic.

Okay, so let's talk about how drugs work on the bronchiole and The receptors and if you keep this kind of tripod together I think it makes it a lot easier. So on the left hand side we have beta 2 agonism these open up the bronchioles okay so you might hear again adrenergic agonism it just means adren which is your adrenal gland that is add on top in Latin Rin of the kidney or renal on the right hand side we have muscarinic which was referring to the mushroom or cholinergic antagonism you might also see these as anticholinergics or anti-muscarinics so these open up the bronchioles.

So just be clear we have two completely different mechanisms we have adrenergic agonism versus the cholinergic antagonism but both of them do the same thing they both open up the bronchiole to relax the bronchioles and then in the middle we kind of have these inhaled corticosteroids ICS which reduce inflammation but that's what asthma is it's these two pieces where you've got bronchi that are constricting and there is inflammation involved.

So here is the acronym Madness a Saba is a short-acting beta-2 Agonist a laba is a long-acting beta-2 Agonist an ultralaba is an ultra long-acting beta-2 Agonist then what basically happened was is that we've got the rescue inhaler which works quickly then you've got the long acting which was working half the day you'd have to use it twice a day and then the ultra long acting are the ones that would last all day.

Then the Sama which is a short-acting muscarinic antagonist it's an anticholinergic the long-acting muscarinic antagonist the llama and then you have ICS the inhaled corticosteroid but this is the picture you want to have in your head when you're talking about treatment as we treat Asthma as it gets worse we start with the inhaled corticosteroid then go to a long-acting bronchodilating or beta 2 Agonist and then maybe a long-acting muscarinic Agonist antagonist.

COPD side we go the other way we go from muscarinic to beta 2 to steroid so if you can keep those two kind of opposite arrows in mind when you're thinking about asthma and COPD I think it'll go a long way. And then all are both conditions we have a Saba so we want to do is we want to convert these acronyms into actual drugs so Savas albuterol level albuterol lava salmeterol for motorol ultralaba indacotroll and volanterol.

Then the Sama epitropium teotropium aclidinium euclidinium and then ICS fluticasone mometasone bechlomethazone there are more but I just didn't want to overwhelm you. So first thing we do is we look at stems and suffixes here so Saba albuterol level Albuterol interroll labas end in Terrell ultralabas end in tyrol well that'll be a problem we'll see but samas lamas end either tropium clydinium but could just look at ium as something that's in common with both them see sewn from fluticasone mometasone becamethasone. So maybe a little bit better to look at it this way where the beta Agonist is the tyrol. Sama is tropium or clinic clydinium and then the ICS is sewn but be careful because it tells you what it is but it doesn't tell you how long acting it is okay. So when we put this into our arrows we can say that okay if I'm going to have a muscarinic antagonist that's going to be the ium, the beta 2 Agonist is the tyrol and the corticosteroid is the Zone. The sabbas are going to be those you know still end with tyrols, the Albuterol and Lev albuterol okay.

And you might have said oh he messed up at the bottom he underlined turol but also albuterol. I was just trying to show you that Lev Albuterol and albuterol are basically the same thing but both would have the Terrell stem. So again if you can put the drugs in here in this way then it makes it a lot easier to figure out okay well what am I dealing with and you've got these kind of the big three which are the muscarinic antagonist, The beta-2 Agonist and the corticosteroid okay.

Alright well let's try one so this is a drug that actually has all three in it you've got Trella geolipta so identify the laba, the lamba and the ICS okay. And so what we do is we underline our endings if we take a Zone, the mclendonium and then volanterol then we can put it into our arrows so the cladinium is over here in the log acting muscarinic antagonist, the volantrol is in the Middle with the long-acting beta 2 Agonist and then the ICS is the inhaled corticosteroid fluticasone okay.

And we still keep our Saba you know, the albuterol level albuterol as our rescue inhaler. So let's look at you know using our eye match mnemonic where we say okay well what's the indication mechanism adverse effects contraindications and some of the considerations. So the short activated to agonists for asthma and COPD that's what the indication is and really as a rescue inhaler okay but it is not meant as a controller and some people that can't afford the controllers may use it in that way and that would lead to some of the you know adverse effects.

The anxiety, insomnia, nausea, tachycardia, Tremors there's more but you got to get the picture that there's a jitteriness that comes from a coronary artery disease certainly a consideration. And then I really want to avoid NSAIDs like ibuprofen and Naproxen make sure that there's a minute between the Puffs don't just puff puff you want to give it a minute with the lungs open up then use the next one. It is a rescue inhaler and these are the ones we would use before the controllers so that we're going to get a little bit more of the controller in the lungs okay.

And you've got lavas so from motorol salmeterol long-acting beta 2 but we're going to see it's very similar same adverse effects same contraindications avoid NSAIDs like ibuprofen we'll use these after the rescue inhaler okay but this is the big thing and they're going to be in combination they're not to be used alone there was a study that showed that when you use these alone, outcomes are actually worse so although you're seeing them alone they're "Actually, in combination, I didn't want to put the combinations in here because there's like 30 of them so it just gets absolutely overwhelming. Okay, ipritropium so here we have again COPD and Asthma anticholinergic anti-muscarinic if you hadn't seen the bud cat video for anticholinergic effects it's blurry vision urinary retention dry mouth constipation anhydrosis and tachycardia for ipritropium when you're talking about something like this you're really talking about that dry mouth the constipation and the tachycardia those three are the ones that you would probably see the most.

Then considerations glaucoma bladder bowel obstruction certainly and then you want to because you don't want to cause constipation when somebody already has an obstructive bowel and you again want to use this before the steroid but it is not a rescue inhaler. I'll tell you a little bit about it when I refer to my daughters as they'd gotten out of the hospital they were preemies okay.

So this Albuterol and iprotropium can be used in combination you'll see them in these nebules that have them both together and you just put them in this little cup and either the child would put this in their mouth or you would put it near them and they would inhale it but a combination sabot lava as a beta-2 Agonist and anticholinergic allows you to get lower doses of both but to get that great bronchial relaxation that they need okay.

So the next piece here are the ICS again we generally we can see these in combination or alone but be careful this fluticasone you might see it over the counter as a nasal inhaler for allergies as Flonase or you might see it behind the counter as a prescription for asthma which is flow vent so vent is for asthma and COPD Nace is for allergic rhinitis then becamethasone also qvar.

So the indications asthma COPD it's these are steroids they reduce inflammation but they do it locally and that's a big deal because now we're getting fewer systemic effects thrush which is candidiasis and then hoarseness which is dysphonia these are common if you don't rinse your mouth out so because we're using a steroid we are locally reducing the or immunosuppressing just like prednisone will be used as an immunosuppressant for transplant we can get this very localized immunosuppression.

And then so make sure that the patient knows to rinse their math on and I just wanted to be clear about the devices the nebulizer like this is kind of what we had where we got that nebula out and they could either put their mouth on it or just kind of get into the Mist there and then the spacers for those that can't do it themselves. I'm not talking about veterinary medicine but it just kind of makes it you know if you've got a cat something like that it's obviously not going to be able to use an inhaler normally and so what happens is it goes into this chamber and it can just allow the cat to breathe and there's a little flap in here that tells you that the cat is taking breaths. So it's kind of a neat device but nebulizers versus spacers as always this is for informational purposes only it's not medical advice. If you've got a medical problem, consult the medical professional. 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 forward slash P forward slash mobile and thanks again for listening. Thank you!

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