Memorizing Pharmacology Podcast: Prefixes, Suffixes, and Side Effects for Pharmacy and Nursing Pharmacology by Body System

Memorizing DEA Schedule Medications - Memorizing Pharmacy Technician Mnemonics

In this episode, I give you five mnemonics to memorize the DEA Schedule Medications 

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

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If you are interested in seeing the mnemonics book itself, you can find it here 

https://www.audible.com/pd/Memorizing-Pharmacy-Technician-Mnemonics-Audiobook/B09F8HPT5H?source_code=AUDFPWS0223189MWT-BK-ACX0-275680&ref=acx_bty_BK_ACX0_275680_rh_us

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

Auto Generated Transcript:

Hey, welcome to the Memorizing Pharmacology podcast. I’m Tony Guerra. If you ever need to get a hold of me, [email protected]. I’m going to go over a number of mnemonics from the Memorizing Pharmacy Technician Demonic’s book. You can get it in eBook, audiobook or print book on Amazon or Audible.

And what I want to do is make sure that you understand and how to memorize the medications within the five DEA schedules. Let’s start with our first mnemonic C1 drugs and my mnemonic is One Helm H-E-L-M. And with this one, think that you have like one head so One Helm for the C1 medications that will definitely mess with your head. So H is Heroin, E is Ecstasy, L is LSD and M is Marijuana.

If you want to get technical the LSD stands for Lysergic Acid Diethylamide and Marijuana yes it’s legal in some states but the federal classification is still Schedule 1 but there are ways to use it.

Our second group is going to be with Schedule 2 medications and I say it’s Champ Fog. So with this one, I think of a two-time boxing champ and a fog with the medications in DEA Schedule 2. C for Cocaine, I get it Cocaine is illegal but they do use it in some especially Ophthalmic uses. H Hydrocodone and Hydromorphone, A Amphetamine with Emma Barbitol, M Methamphetamine Methadone Methylphenidate, P Pentobarbital and then the Fog part of it Fentanyl Oxycodone and Glutethamide.

So again, it’s Champ Fog Cocaine Hydrocodone Hydromorphone Amphetamine Ammo Barbitol Methamphetamine Methadone Methylphenidate Pentobarbital for the Champ and then Fentanyl Oxycodone Glutethamide for the Fog.

Schedule three medications there aren’t a ton of these I say Three Tax Tests so you’re imagining a test that you’ve got an A on with three tacks in the cork board you can remember Testosterone and the other meds in the C3 DEA drug schedule. So T Testosterone, AC is for Acetaminophen with Codeine 90 milligrams or less per dosage unit, K is Ketamine and S is for the Steroids Anabolic.

So T Testosterone AC Acetaminophen Codeine 90 milligrams or less per dosage unit K for Ketamine and S for Steroids Anabolic.

Now Schedule four drugs have a lot of medications and the majority of them are going to be Benzodiazepines with the Azepam or Azolam ending and that might be one of the easier ways to remember it but let me go through this list and talk about the mnemonic.

So the mnemonic for the C4 drugs for Calm Cats spelled C-A-T-T-T-Z and you think of four cats sleeping but just spelled differently for the DEA Schedule C 4 medications. So C is for Clonazepam some people like to call it Clonazepam that’s brand name Klonopin A is for Alprazolam brands Xanax L is for Lorazepam brand Ativan and M is for Midazolam brand Verset.

And what I would do is I would take the time to just memorize those four to start Cloneazepam Alprazolam Lorazepam Daisolam notice that the two endings of Azepam and Azelam are there from the Benzodiazepine and then move on to the Cat’s half of the mnemonic.

So then you go on to Carissa Protol Bransoma A for Ambien which is the brand name of Zolpidem T Tramadol Ultram T Tamazepam which is Resteril T Triazolam Halcyon and Z Zaloplan which is brand Sonata.

So again, The Four Calm Cats that’s what helps you remember the C4 medications but in general if you have a Benzodiazepine that’s probably on there and if you have a sleeping pill like Ambien which is Opidem or Xalaplan which is Sonata that’s probably going to be on there as well.

Our final group of the mnemonics is C5 drugs Five Paste so you’re pacing around because you’re worried that it’s a scheduled drug P is for Pregabalin which is brand Lyrica AC is for And Cough as in Robitussin AC or Charitas And AC which also could mean And Codeine E for Elixirs 200 milligrams of Codeine in every 100 mls and then D for Diphenoxylate with Atropine that’s brand Lamodal.

And again if you want to get in touch with me [email protected] otherwise I will work to make a couple of more of these slides if you enjoy what you’re hearing just comment below on the YouTube videos and it just under the Tony PharmD channel and you can subscribe there as well as the podcast.

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

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If you want to get half-off a self-paced pharmacology course visit https://residency.teachable.com/p/mobile and use the coupon code HALFOFF this week. In the course there are 10 hours of video, hundreds of mobile ready questions, PowerPoints and handouts so you can get ready for pharmacology class, succeed in it, or practice for your licensing exam. 

Online Pharmacology Class - Summer 2022

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

Guest student registration opens on March 16th, 2022, make sure to enroll as a guest student, the process is very easy and quick.  https://www.dmacc.edu/programs/pdp/pre-pharmacy/Pages/online-pharmacology-class.aspx if you have questions email [email protected]

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

Auto Generated Transcript:

Hey, welcome to the Memorizing Pharmacology podcast. Just want to let you know that the online Pharmacology for summer is going to be opening up here on March 16th for guest students. So, current students will register on March 2nd if they are returning veterans and honor students. March 7th, the returning students have just started registering last yesterday and then new students and guest students can register on March 16th for summer and then the dates for fall are in April.

So most students that are taking the Pharmacology course, if you’re already a DMACC student then you would just add the course as you do other courses but if you are not, the easiest place to get to this is just put in online Pharmacology class DMACC and you can find this page which is the online Pharmacology class. The syllabus is there and there’s actually two sections in summer. This first 25 students is for fall and spring but you can go down here to non-DMACC students and take the class as a guest student.

And then when you click on this button it’s really just for exactly those students who are only looking to take a couple classes. You just apply for free, there’s no application fee or anything like that. And so when you click on the application for admission, you just click okay well I’m going to another college and university and I’m only going to take a couple classes or maybe just one class. So then there are no prerequisites for this class so you don’t have to worry about those kinds of things for this particular course.

And then you’ll get an acceptance letter by email and then you register for classes when guest registration opens which is in about eight days. So again, if you’re interested in taking an online Pharmacology class there’s a lot of information. Just put online Pharmacology class DMACC and then this page will pop up and hope to see you this summer.

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

Whether you need help with dosage calculations and/or pharmacology proper, you can check out pharmacology tutoring here https://residency.teachable.com/ and choose the pharmacology course or if you have questions [email protected] 

Over-the-Counter OTC Medicines Part 4

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

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

An overview of over-the-counter pharmacology Part 4, if you are looking for the book, you can find it here https://www.audible.com/pd/B09JVBHRXK/?source_code=AUDFPWS0223189MWT-BK-ACX0-281667&ref=acx_bty_BK_ACX0_281667_rh_us

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

Auto Generated Transcript:

Hey, welcome to the Memorizing Pharmacology podcast. We are in part four of the Over-the-Counter Pharmacology series of videos. So this is going to be it and if you want to check out the books Memorizing Pharmacology Mnemonics or Memorizing Pharmacology Relaxed Approach either eBook, print book and audiobook welcome here.

We have the last kind of three categories: Neural, Cardio and Endocrine and there’s not a ton over the counter for them but I think the principles are sound and it gives us an opening into the brand name medications which are in the book.

So start with Benzocaine we look at and brand name Ambisol. We start with the Cane stem and if you think of Cocaine which was one of the initial local anesthetics until we found out that they’d had those addictive properties and came up with Benzocaine, Lidocaine some other choices.

So it is an anesthetic and I want to go over there between something that’s an anesthetic and something that’s an analgesic. So an Analgesia can help with pain but an Anesthetic is going to normally numb something but also put somebody to sleep. Obviously this is a topical anesthetic so that’s not going to happen but it works differently it works by blocking axonal conduction.

This is one of the only drug classes that does this all most of the others work by some kind of transmitter neurotransmitter and you know I get into that in the book but so Anesthetic it’s a Dermatologic form Benzocaine you don’t want to inject it because it can cause some allergenicity so there’s a choice of Lidocaine which is a better choice as an injectable but Dermatologically it’s fine.

And then recognize the stem is Kane somebody mentioned that if you take the U and the M out of the word NUM you get the N and B in Anbisol so that might also be a good way to remember what Ambisol is for or Benzocaine.

The Lidocaine I have here again it’s that Cane stem and the brand name for this particular product is Solar Cane now after going out in the sun and maybe burning a little bit Solar Cane can be used to help numb all of the pain from that burning.

And if you look at the back of this bottle it says it’s an External Analgesic maybe we can use those words interchangeably if we’re talking about something topical but we understand that we’re just trying to relieve pain and that’s kind of the bottom line.

Lidocaine though if you start talking about an injectable you start talking about something that can treat dysrhythmias or which are rhythms of the heart that are not quite right you can use it there’s a it’s kind of a jelly form that you can put into a compound to help numb the throat if there’s some issues there there’s a patch that you can use.

So Lidocaine is very versatile and what I want to get across is that these over-the-counter ones are over-the-counter and are safe over-the-counter because they’re topical but if you’re talking about using something systemic some kind of injection then Lidocaine would be by prescription and you know maybe Paramedic would use them Physician something like that.

And again back to the stem, The Cane - That’s what connects Benzocaine and Lidocaine is in a similar class and the original Cocaine is how many students remember it because that’s something they’re familiar with movies and things like that.

Meclizine is Dramamine. This is where that IN stem really gets you in trouble. So an Amine is just something with a Nitrogen atom in it and I won’t get into the organic chemistry of it but IN in Meclazine and then EN in a brand name well brand names don’t have stems and The World Health Organization absolutely indicates that you know any kind of a brand name well I think I saw it in World Health Organization maybe it was The British National Formulary one of those two basically said don’t do that okay you’re gonna cause trouble if you use a stem.

So examples of where somebody might have used a stem in a brand name is like Monopril or Facinopril. That Prill ending means that it’s an Angiotensin-Converting Enzyme Inhibitor and that’s not really something you want to do but Meclizine this is actually an Antihistamine but we found that it helps with motion sickness so somebody going on a cruise or something like that can help.

You see the word Antiemetic. So, emesis is nausea and vomiting or vomiting so antiemetic means against that vomiting. I mentioned again the EEN and the brand and amine don’t use EN as a mnemonic and then dizzy and Izzy. Somebody told me that the IZI they just put it because if you squish the C and the L together it looks like a D and then you have a Z and then an I so you can remember that it’s for dizziness. That might help you remember what Mechlazine is for.

In the book, I use this Anti-Insomnic as a segue to the Sedative Hypnotics. So a lot of times pain keeps people up and Acetaminophen helps with that pain as a non-narcotic analgesic and then Diphenhydramine well it was an adverse effect that people got sleepy but you have a safe medication, a relatively safe medication that just happens to make people drowsy so why not put it with a pain reliever and see if it helps people sleep and that’s what Tylenol PM is.

So the non-narcotic analgesic Acetaminophen, Diphenhydramine is the H1 antihistamine, the first generation and then pain plus insomnia what’s the PM stand for? If you really care it means Postmeridium so well actually probably pronounced Meridium but the Mary means mid and then DM means day so after midday but we really use PM for evening.

I’m really talking about that but that’s just like Anti-Meridium would be the AM so Anti means before just like before you play poker they throw out the ante that comes out before any of the cards come out or your Anti Brachium is your forearm what’s in front of the arm.

So those are the four that I would classify under Neuro if you’re talking about over-the-counter most neural drugs are by prescription but these have some effect that can help us understand better the nervous system medications a little bit.

The Cardio drugs really I’ve just got a couple that help with cholesterol and then I’ll talk about Aspirin not as an analgesic but an anti-platelet so Omega-3 Fatty Acids these are an essential fat. What an essential fat means is that you have to get it from your diet. It’s essential well I didn’t mean to use that word but it’s part of the cell. It’s important for cell membranes formation of those and then lowering cholesterol can help reduce heart disease.

So that’s why this is so popular but you’ll find Omega-3 in small letters and you’ll really find Fish Oil as you know the big letters for Omega-3 Fatty Acids. I mentioned earlier the Omega-3 Ethyl Esters in the very beginning and that’s something that is in Lavazza which is a prescription form of these Omega-3s. It’s gone undergone rigorous FDA testing and can be prescribed by a physician.

Niacin or Nicotinic Acid this is really just Vitamin B3. It’s supposed to improve cholesterol increase HDL decrease triglycerides but there’s something called The Niacin Flush and that is some people get very flushed with it. You can take an Aspirin 30 minutes before you take Niacin and doing that will help deal with this flush but Niacin is a very good drug. I mean it’s a vitamin over-the-counter and relatively inexpensive as is Aspirin.

So when you’re comparing especially if you don’t have insurance some of the options that you have for cholesterol lowering this might be a good option if money is a real issue.

Aspirin, I mentioned before as an analgesic at 325 milligrams here we have Echotrine Low Dose so again the brand name Ekatrin is talking about Enteric Coded and then Aspirin and Low Dose means that it’s 81 milligrams. I think I’ve seen it abroad at 75 milligrams but you get the idea we’re at a fraction of that analgesic dose maybe a quarter something like that.

And so it is a non-steroidal anti-inflammatory drug but that’s not what we’re using it for here now what we’re using it for here is it has an effect on platelets and you’ll hear the term sticky so if you have some kind of Atherosclerotic Plaque that is some buildup of this plaque in a coronary artery.

And if you think of your fist as or your heart is a little bit larger than fist and then the little tiny arteries that are on there it doesn’t take much to create a blockage so the idea is to keep those platelets from sticking together keep them from clotting.

And in that very high speed arteriolar artery 365 tablets, That’s an easy way to remember that you know it’s something that you take every day. And really patients that have had prior stroke heart attack things like that the morbidity mortality is much improved with Aspirin.

So, those are just some drugs that have to do with Cardio. It introduces some basic concepts but just not a lot for Cardio over the counter. I’ll finish these slides with three endocrine slides so two insulins and then talk about Plan B.

So, Regular Insulin or Humulin R, Human R is the Eli Lillian company product. It’s Regular Insulin and this is the one thing about over-the-counter medications when somebody goes to look for an over-the-counter medication they’re usually looking for one thing but that’s why I tried to put this whole video series together so that you get a bigger picture of everything and then you kind of understand where it fits in you know whether it is a GI Musculoskeletal Respiratory or in this case Endocrine to understand where Regular Insulin fits in you really want to know Humalog which is the shortest acting you really have to take it with food it happens so quickly then Human R is Regular so it’s kind of in the middle or on the left side N lasts a bit longer but not quite all day and then Lantis you know we’re talking about all day long.

So to understand where Regular Insulin fits in you have to know that Humalog is the shortest acting R comes after that N comes after that Atlantis comes after that to really get perspective. I say it’s over the counter it just means you don’t need a prescription for it but it’s probably going to be kept in a refrigerator back in the pharmacy and here you see a vial that comes from a hospital pharmacy but generally it’s going to be in a white box sealed so that you know no one is tampered with it.

NPH Insulin is just a bit longer acting in Hemel and R and again to understand where it fits in you want to know Hemolog the prescription insulin and his prescription because it’s so dangerous if you really need somebody to give you the instructions make sure that you know that you have to take it with food or very near food.

The R is usually given if you’re going to move the dosages up and down that’s the one you would adjust. The N this is going to last a little bit longer you wouldn’t really mess with that too much throughout the day and then Lantis again that longer acting one OTC again I mentioned that if you’re talking about insulin you’re going to have to actually go to the pharmacy counter ask them for it and then I recommend asking for the needles at the same time you get insulin so that you don’t have that kind of awkwardness where you go in say you know I’d like buy a bottle 100 box of needles when you’re a diabetic and there’s nothing going on there.

Last one, Levonorgestrel it’s Plan B One Step. Why do they call it One Step? Well, it used to be Two Step. It used to be two pills and now there’s only one. And Plan B, well what’s Plan A? Well, Plan A was to use some kind of contraception that something like condom or something like that where you would plan ahead that you’re not trying to have this pregnancy happen but Plan B, uh… It’s just a way of saying okay well Plan A didn’t work so let’s go to Plan B.

And what’s Plan B coming afterwards as an emergency contraceptive to reduce the chance of pregnancy after having unprotected sex. The stem is just that means it’s Progestin so we contrast that to an Estrogen which would be Estr and Progestins alone you’ll see but Estrogens alone for contraceptions is something that you won’t see.

So again, I hope this series was helpful as always if you want to contact me I’m always happy to talk to anybody that has questions about the videos and so forth and you can contact me at aa guerra at dmacc.edu.

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

Over-the-Counter OTC Medicines Part 3

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

An overview of over-the-counter pharmacology Part 3, if you are looking for the book, you can find it here https://www.audible.com/pd/B09JVBHRXK/?source_code=AUDFPWS0223189MWT-BK-ACX0-281667&ref=acx_bty_BK_ACX0_281667_rh_us

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

Auto Generated Transcript:

Hey, welcome to the Memorizing Pharmacology podcast. This is part three of Over-the-Counter Pharmacology. We’re gonna go over the respiratory and immune over-the-counter medications, and then after that, we’ll go on to neuro and endocrine. So this is part three.

So, Diphenhydramine is brand name Benadryl, and this is a first-generation antihistamine. What first-generation means is that something in the second generation has happened to distinguish it from the first. In the book, it talks about antipsychotics and the first generation has significant extrapyramidal symptoms and somnolence associated with some of the drugs where the second-generation antipsychotics don’t really cause that extrapyramidal symptoms in the same degree as that first generation but they have very specific metabolic effects: diabetes, hypercholesterolemia, things like that.

The point I want to make is that this is a first generation; it was one of the first ones that came along. It doesn’t mean it’s worse; we use it all the time. But because of this side effect of drowsiness, we want to recognize that you know we shouldn’t be driving with it or something like that. But it’s also used in a positive way in the PM in Tylenol PM which we’ll get to a little bit later.

It’s an H1 receptor antagonist and I mentioned the H2 receptor antagonists in the GI section: Renitidine, Famotidine. And you really want to be careful with the stems so Diphenhydramine doesn’t actually have a stem but on many of the YouTube videos, many of those guys that kind of create these videos and get you to their website or whatever it is, they talk about EN as being a stem and that you can recognize antihistamines from it.

But if you think about it, that’s just a heuristic cognitive bias. A heuristic is a shortcut and a cognitive bias means that because you’ve only seen maybe Diphenhydramine and Theratidine you think oh everything I’ve seen that ends in EN has always been an antihistamine so it must be so.

But just think about Morphine - well that ends with EEN or INE and there’s many many drugs - 20 percent of all drugs actually end with IN so there is no stem with Diphenhydramine and I’ll show you the stem that goes along with Loratadine or Claritin but you really want to be careful with those stems make sure they’re coming from a credible source.

Here in the states, it’s the United States Adopted Names Council; they’ve got theirs on the American Medical Association website. If you’re in the UK for example there’s the British Approved Names and then there’s the World Health Organization that has their stem book and those stems are there as well but we want to be careful with that.

As far as the brand name and remembering it: well first, the word BED is in there if you take the N A out so you can think of Benadryl as something that can help you get to bed but also there’s the word there’s the beginning of BEN so something like benefit and then DRY because anti-histamines tend to dry up the secretions from allergies and things like that so Benadryl starts us off with the first-generation antihistamine.

Then we’re going to go to a couple of second-generation antihistamines that aren’t supposed to cause this sedation. The first one I put in here - And again I’m sticking with this if you’re in a category or subcategory I’m going to alphabetize it so Satirizing comes first and Loratadine will be next for Claritin.

So Cetirazine is brand name Xertech; this is a second-generation antihistamine. It is an H1 receptor antagonist now be careful some students get that confused maybe under the pressure of the exam Benadryl or Diphenhydramine is first generation H1 receptor antagonist Satirizing Loratadine these are second-generation antihistamine but still an H1 so that one and two sometimes students get the generation versus the receptor mixed up a little bit.

The Satyrizine - It’s spelled T-I-R but you pronounce it T-E-A-R so Satirizing - You can think of the tearing from allergy eyes as a way to remember this one.

Loratadine - This one does have a stem; It’s A T A D I N E and its brand name Claritin. The commercials Claritin Clear tend to help students really remember what this one’s for: clearing up allergies.

But I want to talk about this stem a little bit so TADINE and TADINE are pronounced the same so Famotidine and Rhinitidine those are both H2 blockers for GI. The T-A-D-I-N-E or A-T-A-D-I-N-E in Loratadine has a very similar sound and those can be mixed up when talking so it’s very important to be very clear and there’s this push towards well just talking generic names but just talking in generic names to me is like just talking in first names.

But if you talk in first and last names then you clear something up oh I wanted to talk to Bob. Bob? Well, Bob Smith. Oh okay so that gives you a little bit more information so I know that some of the exams are going towards all generic but patients talking brand names brand names help you remember what the generic is for and sometimes the easiest way to get to remembering the generic name is through the brand name.

As I mentioned Claritin like Xertech is a second-generation antihistamine; it doesn’t cause the drowsiness that we see in Diphenhydramine. It’s an H1 receptor antagonist so again it’s for allergies rather than gastric reduction gastric acid reduction and again just remember that it’s second generation H1.

Try not to get it confused. The antagonist H1 versus the generation and then I mentioned the Adidas stem and then the Claritin Clear. So one confusion patients tend to have is Loratadine versus Pseudoephedrine. When you have a runny nose, that’s something that you would want an antihistamine for. If you have a stuffy nose, that’s something that you want a decongestant for. That is it decongests, removes the congestion from your nose.

Loratadine is the second-generation antihistamine I just talked about. The Pseudoephedrine is the D for decongestant. Now that’s just generic for Sudafed which I’ll get to in the next slide. So we’ve combined a second-generation antihistamine, an H1 receptor antagonist with a sympathomimetic.

Well, what does that word mean? Well, the sympathetic nervous system is one that’s the fight-or-flight system and the mime, mime is to mimic or to do the same thing as. So a sympathomimetic does the same thing as a sympathetic nervous system and in this case, it’s going to decongest because that’s just how it works.

The stems we have Adidene for Loradidine as the second-generation antihistamine and then Dryn D-R-I-N-E is actually a stem for the Pseudoephedrine, the sympathomimetic. The way to remember so again Claritin Clear that tends to help people remember okay clear up my allergies and then one of my students said I’m just fed up with nasal congestion. The Phed in Pseudoephedrine is how they remembered the D in Claritin D and I thought that was pretty good.

Pseudoephedrine and Sudofed so this is a sympathomimetic as I said so it just mimics the sympathetic nervous system but that’s why you get this jitteriness with it is that it does cause that increase in heart rate and things like that so be careful with patients that have uncontrolled hypertension.

Decongestant okay so that’s what it’s for. The stem is Drin and I mentioned the fed up with congestion now the difference between this Claritin D and Sudofed and then just something like Claritin is that you can’t find this over the counter but you’ll have to find it behind the counter.

This might be a little strange to someone that is used to seeing things over the counter and this used to be that way but what we’ve done is because this is a medication that you can make into methamphetamine an illegal drug it’s controlled now so have to show some kind of driver’s license or something like that and then you’re limited to the amount that you can get.

Phenylephrine or Neosinephrine this is the nasal one it also comes in combination with other medications and you’ll see it abbreviated PE so if something has hyphen D it means it’s the decongestant Pseudoephedrine if something has hyphen PE it’s the Phenylephrine and then we went over the DM for Dextromethorphan and then that’s the antitussive or anti-cough and then the PM which is Diphenhydramine which is uh… To help someone sleep.

So like Pseudoephedrine Phenylephrine is also a decongestant but this is a nasal decongestant so it’s a spray but it can also be found in some liquid cold products. It has the F and the Rin so you can see that there’s no official stem here but you can see that there’s certainly some similarities in the words and Neo just means new so you can just think of it as some new decongestant.

We’ve just seen two medications that can be used intra-nasally: The Oxymetazoline, The Afrin and now we get to Triumph Sin alone brand name Nasa Court Allergy 24 Hour. This isn’t for an acute or for acute congestion; this is a medication used prophylactically. That is we want to prevent these allergy symptoms.

So, the brand name reads like exactly what it is: It’s Nasa for the nose; Court - It’s a glucocorticoid which means it’s a type of steroid for inflammation; Allergy - It’s for allergy; And 24 hours - That’s how long it lasts.

So a lot of students tend to use this alone as a stem; It’s not really a stem. Prednisolone is another medication that can be taken; That’s a steroid. And anytime you see similarities at the end, you just want to be careful that you’re using something that’s an established stem.

So I’d be a little bit careful with that one in Prednisolone; The Pred - The Pred - That’s the actual stem. And then how do you remember it? Well, I think the brand name makes it quite easy. The nasal plus glucocorticoid - The Nasal Cord. So it’s a corticos a glucocorticoid for nasal allergies.

Quite Fenesin with Dextromethorphan Robitussin DM so this is a combination product and some students get mucolytic confused with antitussive. So a mucolytic is something that breaks up mucus so Guy Fenusin you’ll find is Robitussin plane or you’ll find it as Mucinex. You might recognize it from the I don’t know what his name is but there’s this green kind of blob looking thing that’s mis I think it’s Mr. Mucus or something like that and that’s Mucinex that breaks up the mucus.

The Dextromethorphan is meant to stop the cough so if you break up the mucus and stop the cough, the idea is that we can relieve the patient’s symptoms. This Orphan stem I won’t get into it too much because it is technically a derivative of Morphine but it’s over the counter; It’s so far removed from Morphine there’s no addictive potential and things like that as far as scheduling with a drug enforcement agency though Dextromethorphan by itself has been abused.

And then to remember it from Robitussin well Robitussin robs your cough is one way that a student said that they remembered it.

Bacitracin Neomycin Polymix and B if I said those three names you might not recognize it but if I said Neosporin that might be more familiar and Neosporin’s the brand name. So this brings in a couple of good points if you have certain antibiotics and they might have serious side effects if you use them parentally let’s say IV or something like that but if you use them topically they can be very safe to the patient.

Bacitracin, Neomycin, Polymixin - If you put it as take pieces of each word that’s how you get the word Neosporin. So Neo from Neomycin; The Sulfate part of Neomycin Sulfate takes the S; The PO from Polymixin and then the R, the I and the N from Bacitracin.

I want to talk about that Mice and stem though. Mycin just means that it came from Streptomyces bacteria as how this antibiotic was formed so Mycin doesn’t really mean anything; It doesn’t put it into a class of drugs. There’s Erythromycin - That’s a Macrolide; There’s Gentamicin - That’s an Aminoglycoside; Neomycin is also an Aminoglycoside.

So Mycin - It might mean that it’s an antibiotic but I really really would caution is using that as a stem to remember that it’s in a particular class maybe it’s a hint but I don’t think I would use it that way.

Butanophene so that was an antibacterial Neosporin Butanophine is an antifungal Lotum and Ultra and there’s another drug Terbenaphine which is also you can also get this over the counter as a cream and then by prescription as a tablet.

So I didn’t find enough in stem when I looked at the resource but it seems they’re pretty similar and then to understand that Lochman Ultra might not have the exact same thing as Lotumin if it weren’t for all the showiness and the colors and all that stuff patients would really benefit from all of the OTC drugs being turned around that way you know exactly what the active ingredient is in it.

And why I put them up here Bubutenophine is an antifungal so we start with an antibacterial then to an antifungal and the next one I want to go over is an antiviral so Dicosanol is an acute antiviral. That is if you have some kind of cold sore you can apply this.

And I thought who would ever spend 20 bucks or 25 bucks on this little tube for a virus? And then I thought well if I was going to homecoming and it’s the only time I ever get to go to this dance or something like that then I’d probably pay the money for it.

So, I always thought of Decarsonal and going to the ball. So maybe that’ll help you remember it and then the name Abriva to abbreviate the cold sore, how long the cold sore is going to be around, that’s what it does. So hopefully those mnemonics help you a little bit.

So while this one wasn’t for acute infection, let’s talk about Influenza Virus Vaccine Fluzone. This is a prophylactic vaccine so we’re giving this medication hoping to not get the virus in the first place. It’s over the counter sort of. Pharmacists in Iowa certainly can inject this and provide this kind of vaccination but you can’t just find it on the over-the-counter shelf. So maybe without a prescription would be a better description than OTC because it’s literally not over the counter, it’s behind the counter and you have to go through some paperwork to get it but you don’t need a prescription and then depending on the child’s age you might not need a prescription.

What I do want to talk about is this brand name and this confusion that some students have between flu and this is why you kind of have to remember you have to know all the brand names all the generic names and I think that’s very possible. So the book really goes over hey you can learn these 400 words 200 brand 200 generic and here’s a perfect example of why it’s so important to be that literate in the drug names for your patients.

If you have Tamiflu or Fluzone then likely it’s for Influenza okay but if you have Flu Flu in a generic name then it probably means that it’s got a fluorine atom in it, it has nothing to do with the flu. So we’re talking about something like Fluoxetine which is a selective serotonin reuptake inhibitor antidepressant and that Flu is it’s just a fluorine atom that just happens to be in the molecule there’s Flucytacine there’s Fluconazole which is an antifungal so you really have to know not only the brand and generic but which is which and then this is a great example of where Flu comes in and can be a little bit deceiving.

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Over-the-Counter OTC Medicines Part 2

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Auto Generated Transcript:

Hey, welcome to the Memorizing Pharmacology podcast. This is Over-the-Counter Pharmacology Part Two, supporting the Memorizing Pharmacology: A Relaxed Approach series of books, including Memorizing Pharmacology Mnemonics. In this section, we’re going to go over the gastrointestinal and musculoskeletal medications over the counter, and then we’ll get to the other categories: respiratory, immune, neuro, cardio, and endocrine. But here we go.

Okay, let’s start with calcium carbonate or Tums. So we’re going to pair each of these up so that you have a reference point. You really don’t want to try to memorize things by themselves. It’s a lot easier to remember two things together than it is to remember one alone. So what we’ll pair calcium carbonate or Tums up with is magnesium hydroxide milk of magnesia, and that’ll come up in the next slide. Both of them are antacids. They work very quickly; a couple of minutes they should provide some relief, and they’re receptor-less. That just means that they go into your stomach and increase the pH.

Which sounds a little bit strange, but you’re increasing the alkalinity and you’re decreasing the acidity. But these drugs work very quickly because of that. The generic name and chemical name are the same, so calcium carbonate is the generic name; it’s also the chemical name. And magnesium hydroxide is the chemical name; it is the generic name. Calcium is on the periodic table of elements under 20, and then just eight away from it is magnesium. So that means they’re right under each other. So calcium is right under magnesium, and they both have that plus two charge when ionized.

So thinking about how we can remember them: well, Tums - I don’t want to call it chalky but it’s definitely a tablet that kind of breaks apart. They come in fruit flavors; sometimes there’s a mint one. And just like on the periodic table of elements, you’ll find them on the over-the-counter shelf right next to each other or above each other.

So magnesium hydroxide or milk of magnesia as I said is also an antacid. Its generic name and chemical name are the same, and on the periodic table of the elements, magnesium is 12.

What’s important really is that when do we use Tums and when we use milk of magnesia? Well, Tums because of its calcium component can also be used as a calcium supplement. Milk of magnesia if you take enough of it has a bit of a laxative effect. So if you have constipation milk of magnesia would be the right choice; if you want to help with calcium supplementation calcium carbonate would be the choice; and then as an antacid either one would be fine.

But we’re also introducing the idea of solid versus liquid preparations: Famotidine and Ranitidine I’ll put together as the next two. So Famotidine is Pepsid and it’s an H2 blocker.

What that means is that we have antihistamines and technically it’s an antihistamine; there’s a histamine one and a histamine two. And histamine one - that’s the allergies histamine so we don’t say H1 because when we discovered those we didn’t know there would ever be a two.

So antihistamines just talks about allergy antihistamines like Benadryl and Claritin and Zyrtec and Allegra and those types of things. But an H2 blocker - if you block histamine 2 you block the introduction of acid into the stomach.

And we can recognize these by their stem now there’s a lot of misinformation on the internet about stems and suffixes and prefixes and I’m not going to go into it too much into these slides; it’s in the book - the whole book explains it.

But I want you to know that ‘tiding’ is an official stem; it comes from the original Cymetidine and they took the last six letters and said okay if you’re gonna introduce an H2 blocker as a manufacturer of these medications you need to have T-I-D-I-N-E at the end of them.

And this is helpful because this lets you know the four that are out there: Cymetidine Famotidine Nizadine by just knowing those six letters uh… The brand name - I think they did a pretty good job - you’re not allowed to say exactly what it is but peptic means digestive and acid obviously you’re trying to reduce acid so peptic plus acid makes Pepcid AC.

Esomeprazole actually came after Omeprazole but I’ll explain while this one’s first so Esomeprazole alphabetically though comes before Omeprazole and within a class I’ve tried to alphabetize them so C before M (Calcium before Magnesium), F before R (Famotidine before Rhinitidine), Esomeprazole before Omeprazole and this will help with memorization.

Now in the book I go over the 200 drugs and my expectation is that by the end of the book you can memorize all 200 drugs in order. I’ve done it and I know that you can do it as well. But in here, I’m just keeping those pairings to make it easy to recognize which one should be on the shelf next to each other.

So what is a proton pump inhibitor? Well, going back to our chemistry, proton is something that has to do with acidity and if we stop protons from going into the stomach we reduce that acidity. The stem is ‘prazol’ P-R-A-Z-O-L-E so if something ends in ‘prison’ it should be a proton pump inhibitor.

Now there’s an exception to this with some prescription items antipsychotics that end with ‘piprazole’ P-I-P-R-A-Z-O-L-E this was discouraged by the World Health Organization and you know they still came out I think with the new pip result but for the most part ‘prazol’ you should notice that it’s a proton pump inhibitor.

And then if you think of ‘next’ plus ‘hydronium’ so hydronium is the ionized form of this acid that might be a way to remember it and the ‘next’ means that well Prilosec came first and Nexium came next and they’re the same thing.

We can also look at the colors though and see that they’re very similar so you see a yellow background here with the purple pill and then when we get to the next one you’ll see just a purple background in this purple pill maybe also easy to remember that Omeprazole this came first and this is also a proton pump inhibitor.

The stem is ‘prazol’ and I mentioned that before and if you look at the brand name you can think of ‘protons’ or the PR from protons and then the LO for low and then SEC for the word secretion so protons low secretion to remind you that it’s a proton pump inhibitor and it’s going to help with secretion and hyperacidic conditions.

So we’ve paired two antacids, two H2 blockers, two proton pump inhibitors; next we’re going to pair two anti-diarrheals together: Bismuth Subsalicylate is Pepto-Bismol. Don’t confuse that with Pepto Children’s which is just calcium carbonate or Tums.

So the cell - recognize that as a salicylate - and this is dangerous in children especially if they have some kind of fever or chickenpox or something like that we can have some kind of issue with Rey syndrome. So again this is Pepto-Bismol for adults.

The stem is ‘cell’; I mentioned that already but the salicylate component when we think of salicylates we usually think of analgesia as an aspirin acetyl salicylic acid but in this case we’re really memorizing the cell to remember one of the adverse effects or one of the contraindications that we shouldn’t give it in children.

It’s if you look at the word Pepto-Bismol you can think of peptic which means digestive uh… You can think of bismuth as number 83 on the periodic table; it causes some darkening of the tongue maybe the stool but this effect is harmless.

In this case, it can really dehydrate the patient, so you want to really make sure the patient knows that they should take it with water. If you know, they even get to the pharmacist. Again, this is over the counter; they could just pull it off the shelf and check out without any counseling. And then Colon’s pace - I know it doesn’t exactly work in the colon, but if you think of Colase and slowing the colon’s pace or speeding the colon space, I’m sorry, then maybe that would be a way to remember what Colase does.

Polyethylene glycol or Miralax - so this sort of has a stem. The stem for polyethylene glycol is PEG P-E-G, and you can pull those letters out of the generic name. It’s an osmotic laxative, so it’s very safe; it can be used in children. And when I look at that brand name, I think it’s a miracle laxative or it’s a miracle how well could you feel after you’ve used this laxative something like that. But the word, the letters LAX for laxative are in there.

This is the first of the musculoskeletal drugs: Aspirin and this is the regular analgesic strength aspirin 325 milligrams. Its brand name is Ekatrin. And let me talk about non-steroidal and then I’ll talk about the name. So a non-steroidal anti-inflammatory drug is trying to compare it to maybe like a prednisone that is steroidal and what we’re saying is it’s not that so it’s a non-steroidal anti-inflammatory drug.

And if you take the N, the S, the A, the I and the D, you get NSAID. So it’s pronounced for the first letter N and then we just say the word said. If you really want to get into it, it’s an initialism plus an acronym. The way that you would maybe say like ROTC ROTC ROTC is an initialism; ROTC is an acronym.

But it’s important that you not say Nayset. So a lot of people want to put an A after the N because N and S together - it just doesn’t normally; you don’t say that in English language. So it’s as if it were spelled E-N-S-A-I-D.

ASA and acetylsalicylic acid - so these are different ways that we refer to Aspirin. If you look at acetyl salicylic and acid and you take the A, the S and the A away - that’s where we come up with the initialism ASA.

And then the brand name comes from enteric coated aspirin so something that is enteric is going to go through the enteral system or the GI system something that is paraenteral or parenteral is going to go outside the GI system.

So what this is - this is coated so that it doesn’t hurt the stomach and can pass through to treat some kind of pain fever a couple other things that aspirin is good for.

Ibuprofen or Motrin - this has a stem: The profin stem and there are some brand non-steroidals that also have that profane stem. So again this is also a non-steroidal anti-inflammatory drug; it’s similar to aspirin but because it can be safely used in children, it certainly has its own niche.

Just a reminder if you’re looking in the OTC aisles - you really do want to have a pharmacist with you especially if you’re looking for something for kids because the adult Motrin is in a different place than the children’s Motrin and then children’s and infants tend to be different when we’re talking about these kinds of drugs.

So an infant is someone under two and usually you have to have somebody specifically dosing that and then a child is someone from two to twelve something like that but anytime you’re looking for Motrin for a child - you really should get some help.

So again I mentioned - The stem is profane and then this just goes to visual literacy why is it that Motrin is this bright orange and then Advil is that blue? So if you look on the color wheel those are exactly opposite each other.

And I don’t know who came first - The Motrin or The Advil but somebody said you know I really want this to stand out because if it looks just like it then we’re going to look just like we’re the same thing so to have something stand out the most - You just go opposite on color wheel.

So again this is kind of a tangent but a way to remember that they’re both related is that Motrin orange is opposite Advil blue on color wheel.

Okay Ibuprofen or Advil - so the exact same generic drug Advil is another brand name for over-the-counter medication. And as I mentioned - The colors just a way to remember that those are related in some way same thing stem is profin.

And I always thought of Advil helping with the anvil. So in a lot of cartoons, you’ll see an anvil fall on one of the characters and they get a headache and Advil and anvil are only separated by one letter.

So the way to remember that Advil is for that kind of pain is just think of that anvil falling on the character’s head.

So Aspirin, Ibuprofen - those really need to be taken up to four times a day but the next medication Naproxen only needs to be taken probably like twice a day. And this is also a non-steroidal anti-inflammatory drug. We see the endings are similar now proxin isn’t an official stem but peroxin and profin only are separated by that one letter and maybe that’s a way that you can remember those are related as nonsteroidals.

When I think of the brand name, I think of Aleve and alleviating your pain so that also maybe can help you remember this one.

A drug that’s talked about quite a bit with these non-steroidals is Tylenol and this is Acetaminophen or Paracetamol if you’re coming from the UK and the brand name is Tylenol. So this is a non-narcotic analgesic. Tylenol or Acetaminophen is often paired with narcotics so the brand name of Vicodin - A prescription drug has Hydrocodone which is a narcotic and Acetaminophen which is non-narcotic.

So again we’re trying to define it and we have to define it by what it’s not so just as Aspirin, Ibuprofen, Naproxen are non-steroidals non-steroids Acetaminophen is a non-narcotic okay so it’s a little like defining non-fiction by saying it’s not fiction okay so you’re not really defining it you’re just saying what it’s not.

The name or the short names APAP or Tylenol come from the chemical name N acetyl para Aminophenol. What good is N acetopara Aminophenol? Well if you’re an organic chemist you can draw it from just that description relatively easily but you can see that we take the A from acetyl, the P from para, the A from amino and the P from phenol.

As far as Tylenol - They just took the Tyl from the acetyl and the enol from the phenol to come up with that name. That’s how we used to do it but now once you get a stem then every drug coming after that should be similar.

Acetaminophen, Aspirin, and Caffeine - Excedrin Migraine. I like this drug because it’s a combination drug and kind of brings together a number of the drugs that we just talked about. So Acetaminophen - A non-narcotic analgesic that helps with the migraine pain. The Aspirin - It helps with pain and inflammation; Acetaminophen doesn’t help with the inflammatory process so it’s nice to have Aspirin helping in that way.

Why wouldn’t you just use Aspirin and just skip the Acetaminophen altogether? There’s a school of thought that if you have two medications and they do something similar then hopefully you can reduce the dosage of both and hopefully you’ll keep below the adverse effect threshold of both.

So the idea is that we don’t have to do full 325 milligrams of Aspirin; we don’t have to do the full 500 milligrams of Acetaminophen or 650 for the extra strength and that way maybe we can reduce uh… The side effects.

The caffeine seems a little bit weird - You want to be wide awake while you’re having your headache? No, the idea is that maybe the headache is an issue of vasodilation so a vessel in the brain opening up. Caffeine tends to constrict or narrow blood vessels so the idea is that it’s going to narrow the blood vessel in the brain and relieve that pain.

So Acetaminophen - The non-narcotic analgesic; The Aspirin - The anti-inflammatory; And Caffeine - A vasoconstrictor altogether working in concert to help get rid of migraine pain.

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An overview of over-the-counter pharmacology Part 1, if you are looking for the book, you can find it here https://www.audible.com/pd/B09JVBHRXK/?source_code=AUDFPWS0223189MWT-BK-ACX0-281667&ref=acx_bty_BK_ACX0_281667_rh_us

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Pharmacology Basics

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An overview of pharmacology concepts. If you are interested in taking a pharmacology course stop by https://www.memorizingpharm.com/

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Auto Generated Transcript:

Hey, welcome to the Memorizing Pharmacology podcast. What I wanted to start with was a pharmacology basics just an overview of many of the concepts that you’ll need to know and it’s set up as a fill in the blank. So starts with an introduction then we’ll talk a little bit about drug regulation and development a little bit about trials and how drug makes it to market about drug names and difference between generic and brand then we’ll go into a little bit of depth of pharmacokinetics which is the four basic principles the absorption.

The distribution the metabolism the excretion then pharmacodynamics how these drugs interact with receptors and things like that then some kind of drug interactions that we can have and then some adverse drug effects and then how individually we react to medicines but again it’s just a 45 minute brief overview of pharmacology I hope you enjoy.

Hello today we’re going to talk about some fundamental concepts of pharmacology we’re going to talk about the history of drug development and drug regulation the different names of drugs. We’ll introduce the concepts of pharmacokinetics and pharmacodynamics we’ll talk about how drugs can interact with each other and the adverse effects they can have and finally the individual responses to medications.

Before we get started I want you to think of these three terms we’ll talk about each of these concepts in more detail as we move along there are three important characteristics of every drug. The first is effectiveness effectiveness is whether or not a drug has its response that it is intended to or how well the drug works it is considered the most important cons characteristic of a drug because if it doesn’t do the job it’s supposed to what is the point in giving it.

The next characteristic is safety whether or not a drug produces harmful adverse effects it’s impossible to eliminate all adverse effects of a drug so drugs are considered in terms of risks and benefits chemotherapy for example always comes with an increased risk of infection when given in high doses and a drug even as safe as aspirin also has its own adverse effects long term it has the risks of gastric bleeding in ulcers.

And finally selectivity selectivity means that a drug only has the effect that it is intended to or it only acts on its target it’s important to remember that all drugs can cause side effects and none are completely selective.

To get started I would like to talk about some history of drug regulation and development in 1906 the first law regarding drug regulation was passed the federal pure food and drug act of 1906 set quality and purity standards. And then in 1938 the food drug and cosmetic act regulated drugs based on their safety diethylene glycol the ingredient in antifreeze was used as a solubility agent in an antibiotic and more than 100 people died so the fda decided that drugs must be deemed safe before they would gain approval from the fda.

Then in 1962 the harris keffer amendment was passed stating that drugs must be proven effective as well as safe. The events leading up to this happened mostly in europe where thalidomide a sedative was being used by many women to treat morning sickness. The drug ended up causing birth defects and fetal deaths. Thalidomide was never approved in the u.s but it did spur the fda to want stricter requirements for drug approval.

In 1970 the controlled substances act created rules for drugs that have a potential for abuse. The next law I’d like to talk about is the 1992 prescription drug user fee act it allowed for accelerated approval of new drugs for aids and cancer. The fda takes a very long time to approve drugs and medications were needed quicker than that process allowed for these serious illnesses.

In 1997, the fda modernization acts act expanded this to cover other serious illnesses and created other rules regarding clinical drug trials. Drug companies test their new medications through randomized control trials. The use of controls help researchers determine how new drugs compare to either existing treatments or no treatment this is done by comparing the new drug to a placebo or to another existing medication randomization prevents allocation or selection bias."

"This keeps researchers from putting sicker people in the placebo group and trying to purposely assign people to make the groups appear the same. Still has challenges due to unknown factors. Randomization controls for both known and unknown factors. This helps ensure members of each group are similar and that the outcome will more likely be the result of the treatment instead of the differences between the groups.

To minimize personal bias, subjects are blinded. By being blinded, the people involved in the trial can’t use their own biases or judgments to determine how they think the treatment affected them. A double-blind experiment is when both the subjects and the researchers do not who know who received the treatment or the placebo. Groups are treated the same and the placebo is usually matched so that it appears identical to the treatment. It’s revealed at the end of the trial who was in each group.

There are different stages to drug testing before new drugs can be tested on humans pre-clinical testing must be done. Pre-clinical testing looks at the potential useful effects, the toxicities in the pharmacokinetics of new medications. Only after pre-clinical testing has been done will the FDA award a drug with an investigational new drug status.

Once a drug enters clinical trials there are different phases that it must go through first in phase one healthy volunteers are used to test the drug’s metabolism pharmacokinetics and potential effects then a drug moves into phase two where the patients who have the condition that is being treated are used to test to determine the best dose and therapeutic uses for the drug.

In phase 3 patients with these conditions are used to test the drug for safety and effectiveness. The drug then is approved and goes to market but it is not done with its testing phase four post marketing research is done to continue to monitor for safety and effectiveness in general population some adverse effects may not be seen in clinical trial populations so post-marketing research continues to monitor drug over time as it is used in a greater larger group of people.

Next I want to talk about different names that drugs can have each drug has a chemical name generic name and trade or brand name. The chemical name tells you about drug’s chemistry for example chemical name for Tylenol is N-acetyl para-aminophenol which is long and complicated.

The trade or brand name is owned by drug manufacturer and is used for marketing sometimes drugs are referred to as their brand names because they are easier to pronounce but best name to use for a drug is its generic name a drug’s generic name often contains a stem to tell you which class it belongs to generic name for Tylenol is Acetaminophen a generic drug for low pressure is Metoprolol and it contains ending olal which gives you clue that it is beta blocker used for hypertension.

In order for a generic to be considered equivalent to brand name, drug and dose must be exactly same however inactive ingredients may differ which can have effect on drug’s absorption for some medications this little difference can have big effect for some medications slight increase in absorption can lead to drug being toxic or not safe and slight decrease in absorption can make it so that drug no longer as effective an example of medication that we should be cautious with when switching between brand and generic or even between two different generic manufacturers is Synthroid or Levothyroxine.

Next I want to talk about pharmacokinetics as you may guess by ending kinetics pharmacokinetics talks about how drugs move throughout body there are four basic principles of pharmacokinetics and they can be remembered by acronym admin A for absorption D for distribution M for metabolism and E for excretion.

Absorption is how a drug moves from site of administration into blood sites of administration could be orally or intravenously or other administration modes which we will talk about later distribution then is how drug moves throughout body how it gets its intended target metabolism is biotransformation of drug or how it is changed excretion is how drug exits body."

"When talking about routes of medication administration, there are two broad categories it can fall into: Enteral or using the gastrointestinal tract or giving medications orally and Parenteral or going outside of the GI tract which usually refers to medications that are given by injection. Parenteral routes of administration include intravenously or IV, intramuscularly or IM, or Sub Q subcutaneously or under the skin.

When a drug is given intravenously or by IV, the absorption is almost instantaneous because if you remember from above absorption refers to how the drug moves from the site of administration into the blood and IV administration injects the medication directly into the vein or into the blood. Because the absorption is 100 percent, IV administration is best for use in emergency situations when drugs have to work quickly. However, IV medications can be expensive and they’re inconvenient for the patient to treat themselves at home because IV medications must be given by trained medical professionals.

The route of administration that is most convenient for the patient and usually the least expensive is Enteral or oral or PO. However, some medications can be inactivated by oral administration and oral medications have variable absorption. Enteral medications usually come in tablet or capsule form. There are some preparations that can be made to give the drug different properties.

Enteric coatings are used to allow a drug to pass through the stomach and into the intestines. Enteric coatings have two different intended effects. Enterocodings can be used to protect the drug from the stomach so that it doesn’t dissolve or become inactivated before it reaches the intestine and they can also be used to protect the stomach from the drug as is the case for enteric coated aspirin to help prevent against gastric ulcers.

To allow a drug to achieve more steady levels over time, sustained release preparations are used. Sustained released or extended released preparations have an advantage in that this allows medications that may have needed to be taken many times throughout the day to only be taken once or twice daily with a sustained release preparation.

Once a drug has gotten into the blood it must be able to exit the blood and reach its intended target. Medications need to move through the blood to tissues, exit vasculature and then enter intended cells. Some medications need to get into brain or into CNS system in order to enter CNS system medications must be able to move through blood brain barrier drugs that are lipid soluble can more readily cross blood-brain barrier also drugs that are lipid-soluble are more likely to enter placenta some medications are harmful to growing fetus and this lipid solubility would be a bad factor in regards its ability to cross placenta.

The next two pharmacokinetic principles are metabolism and excretion. The liver is most often responsible for drug metabolism and most excretion is done by kidneys. When drugs are administered orally they are absorbed from gastrointestinal tract and transported to liver some medications are rapidly metabolized by liver and can undergo what is known as first pass effect drugs that are rapidly metabolized can be inactivated and then have no therapeutic effect."

"To bypass the first pass effect, medications are often administered parentally so that they are not transported to the liver. Another way, another example of a medication that avoids the first pass effect is sublingual nitroglycerin. When nitroglycerin is administered sublingually or under the tongue, it is readily absorbed into the bloodstream and carried to the site of action instead of through the gastrointestinal tract and into the kidney in the liver.

Many drugs are metabolized by cytochrome P450 enzymes. Medications can be either SIP or cytochrome P450 substrates, inhibitors or inducers. Drugs that increase the rate of metabolism are called inducers and drugs that slow the rate of metabolism are called inhibitors. If the metabolism of a drug is induced, it means it’ll be broken down quicker and the dose would need to be increased to have the same effect. If the metabolism is inhibited or slowed down that can lead to drug accumulation which can increase toxicity in adverse effects.

Most drugs are excreted or exit the body by the kidneys through urine but there are other ways that drugs can be excreted from the body. A drug can leave the body through sweat, saliva, bile, breast milk and even by exhaling air. These four principles absorption distribution metabolism and excretion all play a part in determining how long a medication will meet will be at its intended target.

It’s nearly impossible to measure the concentration of a medication at the intended target so plasma drug levels are drawn to determine whether or not a medication falls within the therapeutic range. There is a direct correlation between toxicity and effect and plasma concentration. The therapeutic range refers to range of plasma levels that are present when a drug is effective without producing toxic effects.

Most medications are not given in a single dose instead multiple doses are given over time so one important concept that we must look at is half-life. The half-life is time it takes for half or fifty percent of drug concentration to leave body. The half-life is used to determine how frequently a drug is dosed also half-life is important in determining how long it takes medications to reach steady state or plateau in blood.

Drug concentrations will reach steady state after approximately four half-lives. One way to help a drug reach study levels faster is to give loading dose or larger dose of medication. The loading dose does not have different half-life there’s just more of it so when half of original dose is gone concentrations are still higher in blood.

Now that we’ve talked about pharmacokinetics let’s move on to pharmacodynamics. Pharmacokinetics is concept of what body does to drugs whereas pharmacodynamics is what drugs do to body or effects that they have there is dose response relationship that allows us to individualize medications for patients based on desired response.

Two concepts related to dose response relationship are maximal efficacy and relative potency. Maximal efficacy refers to greatest effect a drug can produce for example morphine has greater efficacy in treating pain than acetaminophen that means it can treat more intense pain than acetaminophen can.

Relative potency is measurement of how much of drug is needed to have desired effect one example of this is two different diuretics Bumetanide which is dosed in one or two milligram doses versus Furosamide with normal dose between 20 and 40 milligrams. The important thing to remember with potency means that is drug more potent doesn’t necessarily mean it’s more effective it just means you need less of dose to have same effect."

"I’ve talked a lot about drugs needing to reach their intended target. Oftentimes that target is a receptor. A receptor is a special chemical binding site where a drug acts. Think of receptors and drugs as a lock-in key or puzzle pieces where only certain drugs or substances will have the correct properties or characteristics to bind with certain receptors. Receptors also act with endogenous substances in our body. These are things like neurotransmitters and hormones that are already endogenous or living in our system.

Drugs are selective for certain receptors and if a drug is more selective it will have fewer side effects. Drugs can have one of two different effects at a binding site or a receptor. They can either be an agonist where they mimic the actions of endogenous substances or an antagonist where they block the receptor and prevent their activation. So these antagonists block the action of the endogenous substances in our body like neurotransmitters and hormones.

Agonists have a high affinity for receptors and have intrinsic activity whereas antagonists have no intrinsic activity they are only blocking the activity of other substances. Affinity is the strength of attraction between the receptor and the drug or endogenous substance. Intrinsic activity refers to the drug’s ability to activate the receptor. This is why antagonists have no intrinsic activity.

In addition to being an antagonist or an agonist, drugs can also be partial agonists. This means that they do not have as strong of an effect as a full agonist. Drugs that are partial agonists can also have some agonist and some antagonist activity.

It is also important to note that some medications do not act through receptors but rather produce their effects through physical or chemical properties. One example of this is antacids that work to neutralize stomach acid rather than on certain receptors.

Earlier we talked about the therapeutic range, a similar concept in pharmacodynamics is the therapeutic index during clinical testing the ED50 and the TD50 are determined. The ED50 or effective dosed 50 is the dose where 50 percent of patients achieve the desired or therapeutic effect. The TD 50 or toxic dose 50 is the dose where 50 of the patients had an undesired toxic or side effect.

The therapeutic index is the range in between the ED50 and the TD50 it’s defined by the top, the TD50 over the ED50. The image to right shows two different dose response curves to represent therapeutic index on left you’ll see bell curve where number of patients who achieved therapeutic effect and number of patients who had toxic effects at different doses green line in between represents therapeutic index on right there is another way to look at it where percentage of patients are plotted against dose and you can see ED50 and TD50 where 50 percent of patients achieved either therapeutic response or toxic response.

In row A we see medication that has more wide therapeutic index compared to row B where medication has narrow therapeutic index we can see in row B that therapeutic effects and toxic effects can overlap in drugs that have narrow therapeutic index this is why drugs with narrow therapeutic index are more dangerous and levels need to be monitored more closely.

Let’s take moment to look at hypothetical example to help illustrate therapeutic index let’s imagine that Drug A represents analgesic where ED50 is equal to 200 milligrams and TD50 is equal to 2000 milligrams 2000 divided by 20 would give us therapeutic index of 10.

On other hand let’s imagine that Drug B represents blood thinner where ED50 is 5 milligrams and TD 50 is 20 milligrams 20 divided by 5 would give us therapeutic index of 4. Drug B has more narrow therapeutic index than Drug A up until this point we’ve talked about effects of drugs and how they act individually."

Patients are rarely on only one drug at a time and drug interactions is an important concept that we must talk about. There are three ways drugs can interact with each other. They can intensify the effects of each other, one drug can reduce the effects of another, or the two drugs when taken together can produce a brand new response.

When two medications intensify their effects, this is known as a potentiative interaction. Potentiative interactions can be either good or bad that is beneficial or detrimental. An example of a beneficial potentiative interaction is the use of Clavulonic acid with Amoxicillin in the antibiotic Augmentin. The Clavulonic acid increases the effects of Amoxicillin so this is a beneficial or good potentiative interaction. The two medications work together to intensify their effects.

An example of a detrimental potentiative interaction on the other hand is when a patient takes both Warfarin and Aspirin both of these medications have a risk of bleeding and taking them together increases that risk so it potentiates the risk and since we’re talking about adverse effects this is detrimental.

When two medications interact to reduce the effects of one or another medication this is an inhibitory interaction like potentiative interactions inhibitory interactions can be either beneficial or detrimental. An example of a detrimental inhibitory interaction is when a patient who has asthma and is taking Albuterol starts taking Propranolol. Propranolol is a beta blocker and it can interact with receptors in lungs which is where Albuterol works so Propranolol inhibits effects of Albuterol.

On other hand a beneficial inhibitory interaction could be when Naloxone is used to reverse respiratory depression in an opioid overdose. The Naloxone is used to inhibit opioid and stop overdose symptoms.

An example of an interaction that produces new response is when Metronidazole an antibiotic is taken with Disulfiram. Disulfiram or Antabuse is used to treat alcohol abuse when patient drinks alcohol while taking Disulfiram they become violently sick. A patient who is taking Metronidazole who drinks alcohol would have that same Disulfiram like effect.

While those two medications typically would not produce that response on their own when alcohol is taken with Metronidazole they will become violently ill. Another way that some medications can interact with each other is through chelation some medications like Ciprofloxacin can bind to metal irons such as iron calcium and magnesium when Ciprofloxacin binds to these heavy metals that is called chelation and that is why some antibiotics should not be given within few hours of multivitamins or antacids especially those that contain magnesium calcium or aluminum.

Drugs not only interact with other drugs but they can also interact with food so does food increase or decrease drug absorption the answer is either it depends some medications are best taken on empty stomach for example Alendronate a drug used for osteoporosis is almost completely non-absorbed when taken with food.

"Other medications such as Metoprolol are best taken with food to increase drug absorption. An important drug food interaction is grapefruit juice. Grapefruit juice is an inhibitor of SIP 3A4 and can slow down the metabolism of many drugs including Simvastatin and Amlodipine. Because metabolism is inhibited, the peak effects of these drugs will increase which could lead to increased adverse effects.

Now we will move on to adverse drug reactions and medication errors. An adverse drug reaction is an unintended undesired effect when a drug is given at normal doses. We’re going to define some terms related to adverse drug reactions. First, we’ll start with the most commonly known, the side effect. A side effect is a virtually unavoidable effect at intended doses.

An allergic reaction is an immune response that occurs after the body has been re-exposed to a drug. Toxicity is the harmful physiological effects at excessive doses. An example of toxicity is when a patient has life-threatening hypoglycemia or low blood sugar after an overdose on insulin.

Iatrogenic disease may be a new term for you. Iatrogenic disease is a disease caused by drugs or medical treatment. An example of this is patients who are taking antipsychotic medications may develop Parkinson’s disease like symptoms due to the medications that they have been taking.

Side effects are usually predictable but an idiosyncratic effect is unpredictable. An idiosyncratic effect is an uncommon uncommon reaction that is due to a person’s genetics.

Two very specific types of effects are carcinogenic effects and teratogenic effects. Carcinogenic effects are cancer-causing effects of drugs or chemicals. Teratogenic effects refer to birth defects caused by medications.

Lastly, a paradoxical effect is a response that is opposite of what is intended or expected. An example of this is when Benadryl Diphenhydramine is given to young children. Diphenhydramine typically has a side effect of causing drowsiness but when it’s given to young children it’ll have a paradoxical effect of causing excitement or hyperactivity.

Adverse drug reactions can also be organ specific. One important organ due to its relationship with drug metabolism is the liver so we should be aware of medications that can cause hepatotoxicity or liver toxicity.

Another important adverse drug reaction that we need to discuss is QT prolongation. The QT interval on an electrocardiogram measures the time it takes for the ventricle of the heart to repolarize after each contraction. QT prolongation can cause fatal dysrhythmias specifically Torsades to point.

The FDA requires that all new drugs be tested to see if they cause QT prolongation. Currently over 100 drugs are known to cause QT prolongation. When two medications that can both cause QT prolongation are given together this needs to be addressed.

An example of this is when Levoquin or Levofloxacin is given to a patient who is on a Cytalopram, an SSRI used to treat depression. In this case, we would discuss with the patient’s doctor about changing the antibiotic to one that is not known to cause QT prolongation. We would not want to change the patient’s antidepressant therapy and the antibiotic is only given for a short time so that is the medication that we would want to have changed.

Medication errors are a major cause of patient injury and cost billions of dollars each year. Medication error is defined as any preventable event that may cause or lead to inappropriate medication use or patient harm.

Anyone involved at any step of patient care can potentially make a medication error. The Institute of Medicine has identified three main categories as causing 90 percent of all medication errors these are human error, communication mistakes and drug name confusion.

All health care providers must be aware of types of medication errors that can occur in events that lead up to them so that everyone can be vigilant in preventing medication errors.

It’s important for all hospitals and other institutions to adopt a culture of safety other measures that have been taken to reduce medication errors include using bar coding systems to scan patients and medications also replacing handwritten medication orders with computerized order entry.

Another measure that has been taken to reduce medication errors and prevent adverse reactions is medication reconciliation. Medication reconciliation is done at transitions of care where nurse pharmacist or other provider compares list of medications that patient was taking prior to admission or discharge to list of current medications that they are taking while in hospital or when they leave.

Even when we know pharmacokinetics and pharmacodynamic properties of medications and how these drugs can interact with each other, medications can still have individual drug response that can vary from individual to individual.

Factors that can have an effect on drug response in individuals include weight, age, gender, race and genetics. Some medications need to be adjusted for body weight in order to have intended effect some medications are even dosed based on body surface area because body fat percentage can change way drugs are distributed in tissues.

One example of type of medication that’s commonly dosed based on body surface area is chemotherapy for cancer. Age affects way that drugs can respond in individuals. Patients who are very young and very old can have increased toxicity with certain medications. Those who are very young have immature organs and those who are very old their organs are starting to wear out and so they do not metabolize drugs as effectively as before.

An example of how drugs can affect gender differently is alcohol. Females metabolize alcohol slower than males and therefore get intoxicated facts faster. Race is another factor that can alter individual dose response."

"One example of how race can affect drug response is with ACE inhibitors like Lysinophil used to treat hypertension. Studies have found that ACE inhibitors are not as effective in African Americans. Also, people with Asian ancestry may have a gene for HLA BE 150. Individuals with this gene have been found to have a serious adverse skin reaction when they take Carbamazepine, a drug used for epilepsy.

We are learning through pharmacogenomics that genetics can play a big role in how individuals are affected by different medications. One example of this is with the drug Trastuzamab which is used for breast cancer. Trastuzamab is only effective in treating breast cancer that is positive for the HER2 gene, HER2.

This is only one example of how genetics can affect individual drug response. Comorbid conditions are another factor that can affect individual drug response. For example, patients with liver disease and kidney disease can have different effects on drug accumulation because of these organs roles in metabolism and excretion.

Therefore, patients with liver or kidney impairment will need doses of their medications reduced to avoid toxicity. In addition to liver and kidney disease, acid-base imbalance or your body’s pH and electrolyte imbalance are two other ways that patients can be affected by individual drugs.

Digoxin is an example of how electrolyte imbalance can affect drug response. You should monitor potassium levels in patients receiving Digoxin to reduce the risk of dysrhythmia.

Individuals can also develop tolerance to medications that is they have a decreased response or require increased doses to have the same response. There are different types of tolerance. Pharmacodynamic tolerance develops over long-term use higher doses of a medication are required to have the same desired response.

Metabolic tolerance on the other hand is due to rapid metabolism of medications meaning higher doses of a medication are required to maintain consistent plasma levels to keep the medication within the therapeutic range.

Tachyphylaxis is a phenomenon where your body’s defenses build up quickly and stop responding to a medication so when de repeated doses of a medication are given in a short time frame the body reduces its response.

Another term that isn’t exactly related to tolerance is the placebo effect. The placebo effect is a psychological response to a drug independent of the biochemical actions of the drug. The placebo effect is neither a good or a bad thing. It’s been found that nearly all drugs have at least some degree of a placebo effect.

What this means is that attitude is everything. Sometimes just because a patient thinks a medication is working, it actually is. On the other hand, if you take a medication and think it’s not going to work, it may not have its intended response.

Even if a patient is only taking a medication for a placebo effect, it shouldn’t necessarily be discontinued because if they think the medication is going to help, it can speed recovery.

I hope this review has given you a better understanding of the fundamental principles of pharmacology. Thank you for listening.

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