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

Classroom Lecture Respiratory Pharmacology

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Auto Generated Transcript :

Okay, welcome to respiratory pharmacology. We're going to start by looking at two topics. So the first one includes antihistamines and decongestants, nasal steroids, and antitussives and expectorants. The second section we'll talk about is asthma and anaphylaxis. So let's start with antihistamines and decongestants.

So first about histamine. We want to make sure we understand the tale of two receptors. When does the body release histamine? Well, when allergens attach to mast cells and basophils, it activates histamine-1 receptors which have to do with vasodilation, vascular permeability, and bronchoconstriction. Those are the things you think about when you think about an allergic reaction.

On the other side, we have histamine two receptors, which have to do with gastric acid secretion, which we talked about in the GI section. So let's first clarify which drugs belong to which camp. So on the H-1 receptor antagonists, we have first-generation versus second-generation. The first generation includes diphenhydramine or Benadryl.

This is something that would make someone sleepy. And the improvement from first to the second generation was going to cetirizine or loratadine, which are Zyrtec and Claritin. And these don't cause the same kind of sedation that a first-generation antihistamine does. On the other side with the H-2 receptor antagonists, famotidine brand Pepcid and ranitidine brand Zantac, until ranitidine was pulled from the shelves. Now it's famotidine with two brand names, Pepcid and Zantac.

And notice that the endings are stems are a bit different. So, you have loratadine, which is -atadine and then -tidine which is an H-2 receptor. So they sound very similar when you're talking about sounding it out or making a verbal order. So you need to be very careful that we're not giving someone who's got nasal allergies, something for their stomach and something or the reverse, which is somebody who has stomach acid, not giving them something that's going to help them with their nasal allergies.

So first-generation antihistamine, and we call it antihistamine, although it's an H-1 blocker because it was the first one and they didn't know an H-2 was coming down the line. So, generally when we say antihistamine we mean the allergy kind, diphenhydramine or Benadryl which crosses the blood-brain barrier easily has a high H-1 receptor affinity in the CNS.

And that causes that drowsiness, indications, well, mild allergy symptoms that runny nose or sneezing, watery eyes, itching. Also insomnia, a short-term solution if somebody has trouble sleeping, this can help. Though there is that morning hangover that they just maybe don't feel well rested, although they may have slept longer than they would have without the drug.

Adverse effects, so drowsiness, a reduced reaction time if they're driving, urinary retention, these are what are called anticholinergic effects or antimuscarinic effects and first-generation antihistamines are notorious for them and they make it very uncomfortable to take them. So when the second generation came around, they were a welcome relief cetirizine, brand Zyrtec, and loratadine, brand Claritin.

They don't cross the blood-brain barrier easily and that reduces those CNS side effects or that drowsiness. They also have longer half-lives in the first generation. So just once daily dosing usually does it. What kind of indications do we have? Mild allergy symptoms, runny nose, sneezing, watery eyes, and itching.

Obviously, no insomnia indication because they don't really make someone drowsy, but we did put on the right-hand side. Sometimes you will get some drowsiness with this, but certainly not to the extent that you would with diphenhydramine. Something that gets confused with allergies is sinus congestion, and this is inflamed sinus blood vessels.

They take up excess fluid and they don't always cause a runny nose. The treatment is to reduce the sinus inflammation by locally forcing the fluid out of the vessels through localized vasoconstriction. Pseudoephedrine or brand Sudafed is the most famous of them.

It's a sympathomimetic action. And sympathetic is the sympathetic fight or flight system. And a mime is someone that copies you. So a sympathomimetic is something that copies the sympathetic nervous system. It activates those alpha-1 adrenergic receptors. So it's indicated for allergic rhinitis and nasal and sinus congestion.

Adverse drug reactions, well, CNS excitement, restlessness, insomnia, maybe some anxiety, cardiovascular, hypertension, tachycardia. So those are maybe a concern, especially if someone has cardiovascular disease. While we're not saying that someone who has controlled high blood pressure should never use something that's a decongestant, we're saying that certainly a prescriber will want to look at the case and make sure that it's safe.

Pseudoephedrine is a drug of abuse. You can manufacture methamphetamine with it. And because of the Combat Methamphetamine Act of 2005, it's only available behind the counter. So you can't just get it off the shelf. A pharmacist hands it to you; you don't need a prescription, but you may need to scan your driver's license or something to be put into a database to make sure that you're not going over the maximum of nine grams per month and 3.

6 grams on any one day of medication to any single person on the other side. Some states like Iowa have decided to have a stronger law and it's 7.5 grams instead of the nine grams. So, manufacturers formulated products with phenylephrine, another decongestant that doesn't have any restrictions on purchasing. So it has the same actions as pseudoephedrine and all the same things.

But it doesn't work very well because it has an extensive liver metabolism. And so when you say, "well, I'll just get the PE version over the counter." It's not quite as good. Oxymetazoline brand Afrin is a topical decongestant. We'd give it by nasal spray with minimal side effects.

It works within a couple of minutes, but we can't use it for more than three days because of rebound congestion. That's when you use the medicine. But it actually comes back worse than it was before. So just a few days is what we're okay using oxymetazoline for. It makes sense that with allergy symptoms, one might combine an antihistamine and decongestant.

So loratadine brand Claritin plus D for decongestant is one combination. So second-generation antihistamine, that doesn't make you drowsy with a decongestant or pseudoephedrine. It treats allergic rhinitis with congestion by reducing that sneezing, runny nose, itchiness, and that inflammation and congestion.

When someone has seasonal allergies annually, it's really a lot better to use a nasal steroid. And then we'll also talk about cough, which are the antitussives and expectorants. Triamcinolone or Nasacort 24-hour and it sounds just like it is a nasal corticosteroid. It's dosed once daily up to two to three weeks to be fully effective.

So it's non for PRN use, and that really puts off a lot of people. They are uncomfortable now. They don't want to have to take something every day, but this works a lot better than treating with antihistamines. You've got some mild adverse drug reactions, nose drying of the nose, nosebleeds, burning and itching, sore throat, headache.

But it's really the most effective medicine for the prevention treatment of seasonal allergies. So if you take it as you should, two or three weeks later, it's going to be a completely different story. One antitussive is dextromethorphan, which is the DM in Robitussin DM. It activates opioid receptors in the brain's cough center and it suppresses that cough reflex.

It's derived from codeine, but with minimal side effects at normal doses, adverse drug reactions similar to opioids, but certainly not to the same extent. Some dizziness, somnolence, fatigue, or possible confusion. Guaifenesin is an expectorant that increases the respiratory mucous volume and decreases the viscosity.

It's easier to cough out and it's often in combination with antitussives. So two combinations that we might see are over the counter guaifenesin with dextromethorphan or that Robitussin DM or the prescription-only codeine-based product. which is Cheratussin AC. So let's talk about asthma a little bit and we'll first have a graphic that kind of goes over the big picture and then we'll see how these drugs work in those different pictures.

So it all begins with some kind of allergy and or some kind of trigger. And then histamine, leukotrienes, these are mediating compounds that get released. And now we have the two big components of asthma on the left we have inflammation on the right bronchial hypersensitivity where you have an easily triggered spasm.

Maybe some of the triggers are exercise or cold air or smoke. Either way, we get this limited airflow or bronchoconstriction and then we have bronchospasm. So to summarize this, the two things we're really worried about are the asthma symptoms that result from one chronic inflammation and two bronchoconstriction.

So we're going to treat the symptoms to prevent this bronchospasm by treating those two components. We'll start with leukotrienes, they're released in the presence of allergens and they're responsible for smooth muscle constriction like bronchoconstriction inflammatory responses and recruiting further inflammatory mediators and montelukast or Singulair.

It's meant to help but very rarely it may cause mood changes, but otherwise, it's very similar to placebo. But again, we're seeing these mediator compounds released and we're trying to block that with this leukotriene receptor blocker, a drug that's more for severe allergy issues would be something like omalizumab, brand Xolair.

It's a monoclonal antibody and we see the -mab at the end of the word, but it complexes with the IgE in the blood. It reduces the amount available to the receptors and mast cells. So reducing the mediator compound amount release. It only works for the allergy-related asthma, but it's meant to stop the cascade in its tracks at the mediator.

Step indications, moderate to severe asthma, ages 12 and up. And then adverse drug reactions and injection site reaction or respiratory infection, maybe anaphylaxis. But again, this is not a first-line. This is certainly for someone that's been struggling and has allergy-related condition, oral glucocorticoids, these are oral steroids that through anti-inflammatory actions.

So, for acute asthma exacerbations rather than chronic treatment, prednisone or methylprednisolone you can give a short burst and asthma, it's only available as an oral formulation, whereas methylprednisolone it's a short burst, but you can get it as an oral tablet.

Note that glucocorticoids can raise glucose levels and you can see glucose and glucocorticoid has the same beginning. And that's one way to remember the connection. But once the diabetic patients closely, because if they're on these medications, it's a real concern. There are many different inhaler types as there are many different levels of people that get asthma. So it was from children to adults to the elderly, And a lot of times we're choosing it by how easy or hard it is to use something like a rescue inhaler.

A metered-dose inhaler requires a significant amount of dexterity. So if you have someone that has arthritis or severe arthritis, this can be very difficult for them. With a dry powder, they might need a little bit less, it can be activated by the breath or a Respimat where you've got this pressure. So the nebulizer, it's really kind of in its own class where if you have a patient that's bedridden or something like that, you may have to put it in the nebule, it'll aerosolize it and they might put a mask on or something like that.

So for different inhaler types and ways to get the medicine to the patient. Let's first talk about the inhaled corticosteroids. ICS, they're for long-term use with minimal systemic absorption, which means that basically if you put it directly in the lungs, it's not going to get to the rest of the body.

And the localized anti-inflammatory action in the lungs makes it much safer. Fluticasone or Flovent HFA Budesonide is often combined with other agents. The issue we have is that inhaled corticosteroids can cause oral candidiasis and dysphonia. So oral candidiasis is thrush or that white tongue, and then dysphonia is being hoarse, so prevented by rinsing out after using it each time.

On the side of bronchoconstriction, we've got the beta-2 receptor agonists and they activate these beta-2 receptors in the airways causing bronchodilation and they relieve and prevent bronchospasm. Again, beta-1 you have one heart, that affects the heart. Beta-2, you have two lungs. This generally affects the lungs and we have it as short and long-acting.

So, if you look at the bottom of the words, short-acting beta two agonists that make SABA or long-acting beta two agonist, that's LABA. We could use a beta-2 It's a rescue inhaler really, or albuterol. And then the long-acting are preventative. These are things you're supposed to take each day, but never alone because a trial showed that the outcomes were worse.

If someone took it alone, they're going to be in combination with some kind of steroid anticholinergics or short or long-acting muscarinic antagonists, SAMA or LAMA. These prevent bronchoconstriction by blocking muscarinic, cholinergic receptors in the lungs. And those two words mean the same thing.

I just wanted to put them both there so you could see them. Muscarine was a mushroom and that's how they first discovered it, but then they realized that acetylcholine was the actual neurotransmitter. So, then we call it cholinergic. Now instead of muscarinic, it's usually used more in COPD than asthma.

Chronic obstructive pulmonary disease, and you have ipratropium which is Atrovent and tiotropium or Spiriva. And it's up to you to remember that the ipratropium much more short-acting. And most of us remember it because we'll see it. Ipratropium with albuterol and knowing albuterol is short-acting ipratropium must be short-acting.

And that combination is very familiar tiotropium, that's long-acting 24 hours as well. So the combined agents are when you take two and you're going to attack both the inflammation and the bronchoconstriction. So which again is for the inflammation, that one that has -sone in it or something like that.

So, fluticasone, budesonide, and then the salmeterol is the one that's for that bronchoconstriction that patients have that combats the narrowing of the airway. On the other side, we could use a SABA and SAMA which is a short-acting beta two agonist and a short-acting muscarinic antagonist. So, albuterol and ipratropium.

Okay, so albuterol on the right-hand side we have a SABA and a SAMA. So albuterol and ipratropium, both affecting bronchoconstriction, call it DuoNeb, because there's two drugs and it goes in nebulized solution. Careful, again, using an inhaled corticosteroid must rinse their mouth after use. Anaphylaxis.

Is an allergen that can cause a very severe allergic reaction. It can happen within minutes affecting beta receptors causing vasodilation. Bronchoconstriction, bronchospasm. They struggle to breathe and usually we use an Epi-pen or epinephrine which acts rapidly on its Alpha and Beta receptors throughout the body.

It's given IM or intramuscularly, and we still want to take the patients to the ED after the epinephrine dose to ensure safety because the body might eliminate the medication before the allergen.

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The Classroom Musculoskeletal Lecture 

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PTCB and NCLEX and TEAS Scholarships (Pharmacy Technician and Nursing Exam Scholarships)

Here are the links for the scholarship applications:

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 https://www.ptk.org/scholarships/other-scholarships/walgreens-pharmacy-technician-certification-scholarship/

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Auto Generated Transcript:

Welcome to the memorizing pharmacology podcast. I just want to talk about a quick scholarship for those taking the pharmacy technician certification exam. Walgreens has 50 scholarships of $250 to cover the exam fees, and it opens up twice a year, so you either apply in the fall or apply in the spring. Here, you don't have to be in a pharmacy technician program; you can be an allied health professional. Maybe you're somebody who's going to nursing school or maybe you're going to be a medical assistant or a CPC coder or something like that. So what I would do is give it a shot and apply for that scholarship. Once you hit the apply now button, it's pretty straightforward—name, all that stuff—and you put that in there. There are some other scholarships too. The one that I found was from Phi Theta Kappa, which is an honorary in the community colleges, but you don't have to be a member of Phi Theta Kappa to get the scholarship. There's also a scholarship for students in nursing programs. So if you're in a nursing degree program and a Phi Theta Kappa member, you can get a scholarship for the review for the NCLEX. This application is due by October 29th. And then there is actually a TEAS prep scholarship as well where you can get a $100 discount to enroll in the TEAS prep courses at StudyBuddy.live for up to 10 weeks. Again, the prep courses are pretty expensive sometimes, and this hopefully can help you. But this one, I believe that you have to be Phi Theta Kappa and enrolled in pre-nursing, nursing, or allied health for any of these scholarships, but the pharmacy tech one you don't have to be Phi Theta Kappa. It's just a portal to get there, and the actual web link is https://www.ptk.org/scholarships/other-scholarships/studybuddy-teas-prep-scholarship/. But you can read it there. All right, good luck.

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Classroom Lecture Video Gastrointestinal

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Auto Generated Transcript:

Welcome to gastrointestinal pharmacology. We'll go over peptic ulcer disease and also constipation, diarrhea, emesis, and GI autoimmune disorders, which we'll just kind of lump together. So let's start with peptic ulcer disease and kind of what it is and what it isn't. And, first the pathology begins with the stomach.

The acidic digestive enzymes have a pH around two, so it's pretty hostile environment. Ulcerations are lining breaks in the stomach or the duodenum, so it goes from the stomach to the duodenum, the small intestine. And then three, the presentation, usually there's burning pain, one to three hours after eating may get worse after lying down over night.

The way to think about it, or one way to think about it is as peptic ulcer disease, invaders and defenders. So our invaders include our knight with his hammer and his shield made up of H Pylori, NSAIDs, gastric acid pepsin, which is an enzyme and smoking. These five invaders are causes of peptic ulcer disease and can damage the stomach or the duodenum, whereas our defenders are our protectors include mucus, bicarbonate, blood flow, and prostaglandins.

So let's talk a little bit more about the invaders or causes. First, Helicobacter Pylori is a Gram negative bacillus. It colonizes in between the epithelium in the mucus layer. And this is the most common cause 60% to 70% of the time. This is the reason for the ulceration. Second are the NSAIDs. So, they block prostaglandin synthesis.

This results in less blood flow, protective mucus production and bicarbonate. We have acid and pepsin when the protective mucous layer is damaged, acid and pepsin can injure the GI system and then smoking. This will delay healing of ulcers and can increase acidity, the peptic ulcer disease defenses with the castle include the mucus layer.

So the GI Mucosa secretes mucus forming a protective barrier to acid and pepsin. Bicarbonate will neutralize the acid from the stomach. Blood flow, slow blood flow can lead to cell injury. So we want normal blood flow and prostaglandin to stimulate the mucus and bicarbonate secretion. And these are the protectors.

So what do we do to treat it? Well, it depends on what kind of severity we have. We can start with antacids just to see if you know, neutralizing the acid will help. So we'll stick with two of them to start calcium carbonate, which is brand Tums. This neutralizes stomach acid to raise the pH.

It's a chewable tablet, but it can be constipating on the other in comparison is magnesium hydroxide or Milk of Magnesia neutralizes the stomach acid to raise the pH, a liquid suspension generally, and it's got a laxative effect. So constipating versus laxative effect. And then just some notes. Now we want to take one to three hours after a meal.

It's no less effective than histamine two receptor antagonists, which we'll talk about in a minute or proton pump inhibitors. But it's more inconvenient to take antacids that many times a day. It's not for preventing dyspepsia, only treating it and both calcium carbonate and magnesium hydroxide can bind to tetracycline and fluoroquinolone antibiotics decreasing their effectiveness.

Peptic ulcer disease treatment, histamine two receptor antagonists. Well, histamine two receptors line the stomach helping secrete gastric acid and the two antagonists we'll talk about are famotidine brand Pepcid and Ranitidine brand Zantac [Note: famotidine is now both brand Pepcid and Zantac]. And you'll notice that their endings are the same.

That's not coincidental. After a certain year, we started keeping the endings the same for the same chemical entities and most of the time the same chemical entity will be in the same therapeutic class. But we'll see as we get to neuro with like oxetine or something like that, you will see that a, it might have different therapeutic indications with the same chemical structures or similar chemical structures.

But focusing on this right now famotidine will block H-2 receptors, prevent acid secretion as will ranitidine, we don't want to use for more than 14 days if we're just taking it over the counter. The physician of course, or prescriber can make it longer. Some notes, we take it an hour before the meal to reduce that acid.

It's best for nighttime GERD, gastroesophageal reflux disease caused more by histamine really. Cimetidine or Tagamet, which is the first one that came out. It's a histamine-2 receptor antagonist causes adverse effects and many drug interactions and long term use can put patients at pneumonia risk. We want to do is just picture that here we have this acidic environment that normally destroys bacteria and then we reduce it.

So, we open the body up to this bacteria and pneumonia, Peptic ulcer disease, Proton pump inhibitors of antacids, H-2 blockers. These are the newest, but they're certainly not new omeprazole and esomeprazole, we see that they both have the -prazole ending and this lets us know that it's a proton pump inhibitor and we'll see that there's a little bit of an issue with something like aripiprazole, with the piprazole ending which lets us know that drug is for schizophrenia. But right now -prazole

is a PPI. Omeprazole is brand Prilosec and it shuts off the stomach. Proton pumps raises the gastric pH where esomeprazole (Nexium) also does the same, but it is the S-isomer of omeprazole. So omeprazole is actually combination of a left and right-handed chemical, whereas esomeprazole is just the S- or the left-handed side.

The S stands for sinister, which in Latin literally was if you were left handed, you were sinister or that's how they thought of you. What it's supposed to be is that well, if there's two sides to it and only one side does anything, well let's just use the one side and that's why esomeprazole came along.

So notes, usually take it 30 minutes before the first meal of the day. There is going to be one exception to this. One of the Proton pump inhibitors doesn't require this, but in general, that's the expectation. You can take up to seven days to work. So, unlike an antacid, which will resolve some of the acid right away, this can take some time.

We want to taper when stopping to avoid rebound hypersecretion. So let's break that down real quick. Rebound meaning, so we've been in a position and now we bounce back. So if we've reduced the acid somewhat and we all of a sudden stop giving these then the body will create a ton of acid because it was trying to compensate for the loss of acid from these drugs.

So hyper meaning above and then secretion. So rebound hypersecretion means there's a significant amount of acid that comes out. Longterm we're concerned about osteoporosis fractures hypomagnesemia but we expect that hopefully, we only have to use in the short term. So treatment steps.

If the ulcer is from H Pylori, we expect to use at least two antibiotics and an anti-secretory agent like a Proton pump inhibitor. So we're going to have three different medications all at once and there are other ways to do it. But this is one of the most common. If however, we have nonsteroidal antiinflammatory drugs, we try to D/C the NSAID if possible because some patients can't.

If you have arthritis in this arthritis is keeping you from functioning, then the patient has to have the NSAID. But we try to stop the offending agent and then we'll use histamine two receptor antagonists or proton pump inhibitors. We want to just create an environment that's best for healing. So I will not, we're not really healing the ulcer.

What we're doing is creating an environment where the ulcer can repair itself. So non drug treatments that we can use, the best of them is to eat five or six small meals daily. If you eat a big meal, a lot of acid goes in the stomach. If you had a little meal, a little acid goes in. So we get less acid naturally avoiding smoking, which can lead to extra secretion of acid, stopping those NSAIDs and aspirin, avoiding alcohol and caffeine and reducing stress as much as possible.

But of these really the five to six small meals daily tends to be the one that's the most effective. Constipation, diarrhea, nausea, vomiting and GI, auto immune disorders. So when we look at constipation in the pathology, the first point is that we have primary constipation. This is caused by slowed or delayed transit.

Maybe the bowel is obstructed or secondary constipation. Maybe it's the diet and lack of fiber. Maybe it's a lifestyle, maybe it's medications, maybe it's underlying conditions. So those are the two different constipations we'll talk about in terms of treatment, what's due, look at a generally. Then we'll look at specific drugs themselves. We can use bulk-forming laxatives.

We can use surfactant osmotic or stimulant. The big difference is some of them just bring water into the bowel to get more of a mush and the others are really propelling things out and it's more of a push. So let's look at some of the names. Okay. Bulk forming.

We have psyllium, which is brand Metamucil, which is very much like fiber that would come in the Diet. Docusate sodium is Colace. Often we see this with opioids, polyethylene glycol too, very different forms. MiraLAX is a powder that comes over the counter that's relatively safe and then Go-Lytely is a bowel prep. So a completely different intention with both of them, but it's the same medication.

And then the stimulant Senna this is something that if things are not going well, you can more push than create this mush. So if you want to think about mush versus push as bulk-forming and surfactants make it easier to go making everything mushier. But stimulants, osmotic push about movement forward, which is a little bit different. So let's start with the laxatives.

Bulk forming mush a, the psyllium or Metamucil, it acts like fiber in the Diet. It swells with water to increase fecal mass and softness. It's the preferred temporary constipation treatment, minimal side effects. Notes: You will want to talk with the patients about dietary fiber. Maybe you can change their diet and they don't have to take this.

You do want to mix well with liquids before taking and it can take up to three days to produce a bowel movement. So often patients are expecting something to happen relatively quickly. Want to make sure to let them know that that's not how it works. Another one is the surfactant, Docusate Sodium or Colace. And this lowers the stool surface tension.

Water enters the feces. And the issue we want to worry about is making sure that they're hydrated. So you take with water to prevent dehydration. As water leaves the body with a stool, it produces a bowel movement in one to three days. So a little bit faster than the psyllium and it should be given to everyone taking an opioid medication.

Okay. Another medication that's on the stimulant side is senna and we use stimulants after fiber and stool softeners fail. But unfortunately these are often used. And abused. Expect a bowel movement within 12 hours or overnight and tablets and suppositories are available. And this is a bit of impatience.

Obviously the patients uncomfortable, they may have waited too long and they want something to happen right away. The osmotic, again, there's two different sides to it. The polyethylene glycol, which is the MiraLAX, it's gentle over the counter. Okay for children versus the bowel prep before colonoscopy. So two very different uses of the same medication.

The polyethylene glycol produces a bowel movement within 72 hours for the MiraLAX, but with the polyethylene glycol, [GoLytely] it happens very quickly. Need to be near a toilet, but make sure the patients are drinking fluids. There is a risk of dehydration. Diarrhea pathology is a change in the normal bowel movements characterized by unusually soft or liquid stools, three or more times in 24 hours and but lasting less than two weeks.

So some of the common causes, maybe it's viral bacterial parasite, maybe it's another drug, maybe it's food allergies, maybe it's GI conditions. Most important to know that a diarrhea issue is not a disease. It's simply a symptom of something else going on. Okay. So loperamide is brand Imodium.

This is a week over the counter opioid. It's for diarrhea, not of infectious origin, and reduces the volume of discharge from ileostomies. Diphenoxylate with atropine, that's Lomotil. It's a controlled substance. The atropine discourages abuse. Someone would be able to crush the diphenoxylate and inject it.

A high dose can bring on a morphine-like response. So, want to be careful not to give too much of this, but again, this is a step up from the loperamide if that's not working. Some kind of, if we had some kind of overdose, we would treat it with naloxone. Bismuth subsalicylate or Pepto-Bismol. So the OTC is available as liquid or chewable tablets.

It causes this harmless black stool and black tongue, but that might surprise the patient if they're not familiar with it. And then children's Pepto is not bismuth. subsalicylate. You can't give a salicylate to a child. So instead it's calcium carbonate, which is basically Tums, but the manufacturer wanted to keep the Pepto name because it's recognizable. So again, avoid in children due the risk of Reye's syndrome because of that salicylate component.

If it's infectious, like E. Coli, t's usually self-limiting, but you may see ciprofloxacin or Cipro. There are new FDA guidelines regarding the usefor minor urinary tract infections and respiratory infections. But this is something you might see.

So again, if there's an infection, then we're going to give some kind of antibiotic Emesis or vomiting. And usually, it's caused by the activation of the vomiting center in the brain. So the indirect activation happens when the chemo receptor trigger zone is first activated. And then this goes on to activate the vomiting center. We're going to talk about three types of emesis.

So the first is anticipatory before the drug is given. So it's triggered by the memory of severe nausea from a previous dose acute, which is minutes after giving it resolves within hours or then delayed and may take more than a day after chemotherapy. The first we'll look at is a dopamine antagonist or an antiemetic.

So it blocks dopamine, two receptors in the CTZ or the chemo receptor trigger zone. It prevents activation and it's useful for emesis caused by surgery or cancer, chemotherapy and toxins. Promethazine or Phenergan is the brand and its contraindicated for children under two, but it is available as a suppository if they're actively vomiting and they can't take something orally, but it can cause extra pyramidal effects because of the lack of dopamine.

Another drug, the 5HT3 serotonin receptor antagonists are ondansetron, which is brand Zofran. This was first approved for chemotherapy and it was really a breakthrough when it came out because we didn't have something for chemotherapy-induced nausea and vomiting or CINV for regular emesis, and CINV and it's available as a tablet orally disintegrating tablet that just dissolves on the tongue.

And then IV, it can cause prolonged QT interval and potentially Torsade de Pointes with V-Tach, but generally the common side effects are just headache, dizziness, a little diarrhea which are much less severe than nausea or vomiting that someone would have.

And then we'll just look at the auto immune disorders, just comparing ulcerative colitis and Crohn's. So this GI, autoimmune pathology or irritable bowel disease, inflammatory bowel disease, can be caused by an exaggerated immune response to the normal bowel flora. So ulcertative colitis, it's an inflammation of the mucosa and submucosa.

The colon and rectum, can cause rectal bleeding and may require hospitalization. Crohn's disease is characterized by transmural inflammation and it usually affects the terminal Ilium, but it can affect all parts of the GI tract. We don't have a cure for it, but we do have some treatments, the five treatments not curative, so only relieve symptoms, the five amino salicylates like sulfasalazine and mesalamine.

Glucocorticoids, steroids, hydrocortisone, dexamethasone, immunosuppressants. So trying to suppress the immune system and the immune response. Azathioprine, cyclosporine and methotrexate, antibiotics like metronidazole or ciprofloxacin and then immunomodulators like infliximab, which affects the immune system. And let's look at that one.

So infliximab or Remicade, this is a monoclonal antibody, and we can see the ending -mab, a designed to neutralize tumor necrosis factor Alpha TNF, a key immuno inflammatory modulator, it's for moderate or severe Crohn's, and it has to be given by IV infusion leading to some infusion reactions. And then we have an increased risk of lymphoma.

And that makes sense. When you're messing with the immune system, you're reducing the immune response. Note, we have to screen patients for tuberculosis and other infections before starting the infusion, because of that immune suppression. And then infusion reactions happen every time. So you can prevent it hopefully after the first infusion.

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Book Memorizing Pharmacy Technician Pharmacology

I review Memorizing Pharmacy Technician Mnemonics, a book that includes a full technician exam that helps you pass the PTCB or ExCPT pharmacy technician exams.  https://www.amazon.com/Memorizing-Pharmacy-Technician-Pharmacology-Calculations-ebook/dp/B09BK3DTVD/

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

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Auto Generated Transcript:

Alright, good morning and welcome to the "Memorizing Pharmacology" podcast. I wanted to talk about a new version of a book that I just put out called "Memorizing Pharmacy Technician Pharmacology." What I'm gonna do is I'm going to make all of these books an offshoot of the "Memorizing Pharmacology" book, which is kind of the foundation. But I want to show you what the difference is and how I'm going to create these books.

The first thing is that when we look at these books, it's going to be the exam that you're studying for. So, in this case, it's the Pharmacy Technician Certification Board Pharmacy Technician Certification Exam, PTCE, that most people call it, the PTCB. And then the ExCPT exam, Exam for the Certification of Pharmacy Technicians. Maybe you're a nurse, maybe you're a PA, maybe you're a pharmacy student, whatever it is, and I'm going to create a version for you. But this version, I just want to talk a little bit about what's different about this and the other ones and then how to use all of the mnemonics.

The new mnemonic that I use, the "Pharm Memorizing Pharmacology" mnemonic is GM RINSE, which stands for Gastrointestinal, Musculoskeletal, Respiratory, Immune, Integumentary, Neuro, Cardio, and Endocrine. And these seven really encompass most of the questions that you're going to have in pharmacology. Now, in this version, I've added dosage calculations, abbreviations, acronyms, and initialisms. And those are like FDA, EPA, yeah, FDA, DEA, EPA, you know, those kinds of things where even NDC, you've got an abbreviation, and you have to know what it is and where it's from. Laws and regulations, supplements, which we're taking apart from these pathophysiologic sections, and then other questions.

What you do is that every time that you take a practice exam, you want to either mentally or in writing, be able to put the question in one of these categories. And that way, you're memorizing and putting all of your material in your brain in this category. So if it's gastrointestinal medication, then you know that goes in GI. If it's an endocrine, it goes in endocrine. If it's some kind of dosage calculations, and these are really easy to see like a dosage calculation question when you see it, you know a law and regulation when you see it. But this is where it gets tricky. The exam is only supposed to have like 40 percent pharmacology. But when you actually look at the dosage calculations, abbreviations, and laws as they relate and have a pharmacology component to them, it's closer to 60-70 percent of the exam. So, it's so important that you're able to memorize these types of things.

As you're kind of going through it, what you want to do is, and I'm going to give you an example of this combination. So a patient brings you a bottle of echinacea to the pharmacy counter. What condition are they trying to treat? And you're saying, "Okay, well, echinacea, maybe I'm not familiar with that." Depression, insomnia, cold symptoms, BPH. But then you start to think, "Alright, let me think of what I do know." I know that if someone is depressed, then they probably go for St. John's Wort. If they can't sleep, it's Valerian root. If it's cold symptoms, oh yeah, that would probably be Echinacea. And then BPH would be Saw Palmetto. So when you expand all of the answers, it makes it a lot easier. Even if you didn't know the Echinacea one, you already knew that, well, depression, St. John's Wort, insomnia, Valerian root, BPH, Saw Palmetto. You could say, "Okay, well, the other one has to be it because it's not those three."

The other thing is when you're doing this, you also want to expand it to if you have generic names, expand to the brand names and their stems. And then I talk about the actual stems in here. So Fluoxetine, the "oxetine" stem, the brand names are Prozac and Sarafem. It's an antidepressant. And some drugs do have those two brand names, the Prozac for depression, the Sarafem for PMDD, Premenstrual Dysphoric Disorder. Fluconazole has the "conazole" stem, which is a brand Diflucan, which is an antifungal. Omeprazole has the "prazol" stem, which is Prilosec, a proton pump inhibitor. And then Aripiprazole has Abilify as the brand name, an antipsychotic. And then in the book, I go over some tricks to recognize these medications, especially the brand names, which is a big component of the pharmacy technician part of it. But Sarafem, for example, Sarafem is the highest angel, so this angel comes and takes care of this Premenstrual Dysphoric Disorder. Prozac is more about the sound, that it's a strong sound. But "pro," like if you're depressed and you can become proactive, that's a good thing. Diflucan has part of Fluconazole in it, "fluc," and you see it in there. Prilosec is protons, low secretion, that's the way to remember that it is for proton pump inhibiting. And then Aripiprazole increases a person's ability, so it's an antipsychotic. And those little tricks, hopefully, will help you. In addition to having the stems for the generic, so not only can you know the drug class of the generic but also the brand name.

And although the top 200 drugs are kind of standard, in this book, we have 300 medications instead. Alright, and then when I kind of go into the rest of it, I'm kind of talking about and I wanted to get into one of these actual mnemonics here at the end of one of the chapters where I go through the actual exam questions, and we can look at something like high-alert medication classes. That's kind of a complicated one. Let's go to something that's a little less complicated. So, let's do this one. One of the tough things to remember is which drugs last a week or more. That can actually be a little bit tough to remember. So what I did was I said, "Okay, well, let's make the mnemonic Methotrexate Weekly Adverbs," and an adverb, ADV-E-R-B-S, is a word that describes a noun. But more importantly, "weekly" is actually an adverb. So, what we're going to do with "weekly" is say, "Okay, well, these are the drugs that are going to be weekly." And then we go into Alendronate, which you can take weekly, Trulicity, vaginal rings, are actually three weeks, Exenatide, it's by Durian, Rosedrinide, is Actin L birth control patches, on and off every week, Semaglutide, Ozempic. And I also go into some of the tricks to remember them. Fosamax is the fossa is part of your bone, Bydurian, something that lasts a long time, has a long duration, so that's Actin L. This one acts on the bone. And so, just little things like that are really going to hopefully help you as you move along. But it does have 100 questions in its own pharmacy technician exam within the book, but it's also telling you how to use practice pharmacy technician exams as you kind of move on. So again, it's what I'm going to be doing is taking "Memorizing Pharmacology," expanding it and narrowing it to the professions. But the first one I did, "Memorizing Pharmacy Technician Pharmacology," because again, I started in teaching pharmacy technicians. Now I teach chemistry, pharmacology, and every once in a while, maybe one of the anatomy and physiology or pathophysiology classes. So, if you need to get a hold of me, [email protected]. But I welcome your questions and suggestions. Thanks for listening.

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Steroid Drug Suffixes Sone and son (Corticosteroid suffix)

The body system we continue to cover is gastrointestinal and omeprazole, esomeprazole, lansoprazole, pantoprazole are all proton pump inhibitors PPIs. 

Find the Memorizing Pharmacology book here: https://adbl.co/3wAZEmN

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Suffixes -sone, -son- (GI)

Because we’re working through the seven major body systems starting with gastrointestinal, I’m going to hold off on talking about steroids for asthma and other respiratory conditions, but there are respiratory and inhaled steroids available such as fluticasone, a component in Advair and budesonide which is a component in Symbicort, both longer acting steroids.

First, let’s talk about the difference between an official stem and a useful drug suffix. An official stem is on the big list I have at memorizingpharm.com/drugsuffix PDF as these 800 or so are the agreed upon stems for medications by the governing bodies that decide such things.

However, there are common endings that are still useful like -sone, s-o-n-e and son, s-o-n. For example, you can see -sone at the end of fluticasone and prednisone. However, budesonide (Enterocort) and ciclesonide (Alvesco) have son, s-o-n, as an infix, in the middle of the word. There are very few infixes in common English. So, look for the letters as an ending or in the middle.

However, if you look on the big drug suffix list, pred, p-r-e-d is on the list. That’s because prednisone is actually the prodrug for prednisolone, p-r-e-d-n-i-s-o-l-o-n-e which has neither sone, s-o-n-e nor son, s-o-n, but we want to show they have a relationship. Officially pred is for prednisone and prednisolone derivatives. Prednisone can be used for a very powerful medicine for an acute flare up, but it’s not one that a patient can use long-term without significant side effects, so we’ll talk about that and budesonide (Enterocort) is a steroid for Crohn's disease and ulcerative colitis. Crohn’s disease can throughout the small or large intestine and rectum. Ulcerative colitis (UC) typically is at the end of the GI tract and the colon. The letter “U” which starts “Ulcerative colitis” is almost at the end of the alphabet to help you remember the difference. Since UC is at the end of the GI tract, that’s a good candidate for rectal formulations.

The reason we use steroids is that they reduce prostaglandin and kinin action, which are important inflammation modulators. Our target therapy length for these conditions might be 4 to 8 weeks.

Side Effects

In the short term, you will see insomnia and stomach upset. That makes sense, the body releases cortisol when you are stressed putting blood glucose in the blood stream, all of that fight or flight action will keep you awake with too much steroid.

That is also an important issue with long term use and the raising of diabetics blood sugar. For example, if there is a diabetic patient with UC we have the problem of needing steroid but raising blood glucose as a side effect. Other notable side effects include increased risk of osteoporosis, affecting the bone strength and immunosuppression. When the immune system is reduced, the chance of infection increases.

The liver breaks down budesonide very quickly which is good for a localized condition, it doesn’t stay in the body as long. However, prednisone, does not break down as quickly which is good for a condition that might affect the whole body like lupus erythematosus.

Interactions

Remember we want to try to put our interactions and drugs on the patient chart in the GMRINCE order, GI, musculoskeletal, respiratory, immune, neuro/psych and endocrine. So, when you look at a CYP3A4 inhibitor chart and see dozens of medicines, try to order and group them. Here are some examples:

Immune - Antibiotics/Antifungals

CYP3A4 inhibition can affect macrolide antibiotics such as azithromycin (Zithromax), clarithromycin (Biaxin), and erythromycin (E-Mycin).  Note their suffix is thromycin, t-h-r-o-m-y-c-i-n vs. just mycin, m-y-c-i-n.

While we call azole antifungals, “azole antifungals,” the actual stem is -conazole, c-o-n-a-z-o-l-e. Remember we talked about differentiating fluconazole (Diflucan), ketoconazole (Nizoral), and itraconazole (Sporanox), with proton pump inhibitors esomeprazole and the -prazole ending and the antipsychotics, -piprazole such as aripiprazole.

Cardio

Verapamil (Calan) is a calcium channel blocker with the pamil, p-a-m-i-l ending.

Endocrine

We discussed the issue of diabetes and increased blood sugar earlier.

Auto Generated Transcript:

Welcome to the "Memorizing Pharmacology" podcast. I wanted to go over our next suffix, and this one's one that isn't really official, but it is very useful and indicates steroids. We can have quite a bit of a talk with it. The suffixes "sone" and "son," we're going to talk in terms of GI because we're working through the seven major body systems starting with gastrointestinal. I'm going to hold off on talking about steroids for asthma and other respiratory conditions, but there are respiratory and inhaled steroids available, such as fluticasone, a component in Advair for asthma, and budesonide, which is a component in Symbicort. Both are longer-acting steroids. You may even know fluticasone from the nasal spray, which is for allergic rhinitis. But we're going to talk a little bit about those and really kind of focus on GI first. Let's talk about the difference between an official stem and a useful drug suffix. An official stem is on the big list I have at memorizingfarm.com/drugsuffix. Again, that's memorizingfarm.com/drugsuffix, all one word, PDF, as these are the 800 or so agreed-upon stems for medications by the governing bodies that decide such things. However, there are common endings that are still useful, like "sone" and "son." For example, you can see "sone" at the end of fluticasone and prednisone. However, budesonide and terracort, and ciclesonide (Alvesco), have "sewn" and "son" as an infix in the middle of the word. There are very few infixes in common English, so look for the letters as an ending or in the middle. However, if you look on the big drug suffix list, "pred" is on the list. That's because prednisone is actually the pro-drug for prednisolone, which neither has "sone" nor "son," but we want to show that they have a relationship. So officially, "pred" is for prednisone and prednisolone derivatives. Prednisone can be used for a very powerful medicine for an acute flare-up, but it's not one that a patient can use long-term without significant side effects. So we'll talk about that and budesonide, branded as "Terracort," and you can see "entero," meaning like the GI. Okay, so "entero" for the GI. And then "cort" for corticosteroids. So it's a steroid for Crohn's disease and ulcerative colitis. Crohn's disease can go throughout the small or large intestine and rectum. Ulcerative colitis is typically at the end of the GI tract and the colon. The letter "U," which starts ulcerative colitis, is almost at the end of the alphabet to help you remember the difference. Since UC is at the end of the GI tract, that's a really good candidate for rectal formulations. The reason we use steroids is that they reduce prostaglandin and cytokine action, which are important inflammation modulators. Our target therapy length for these conditions might be a month or two, four to eight weeks. Side effects in the short term, you will see insomnia and stomach upset. That makes sense. The body releases cortisol when you're stressed, putting blood glucose in the bloodstream. All that fight or flight action will keep you awake with too much steroid. This is also an important issue with long-term use and the raising of diabetics' blood sugar. For example, if there is a diabetic patient with UC (ulcerative colitis), we have the problem of needing steroid but raising blood glucose as a side effect. Other notable side effects include the risk of osteoporosis affecting bone strength and immunosuppression. When the immune system is reduced, the chance of infection increases. The liver breaks down budesonide very quickly, which is good for a localized condition. It doesn't stay in the body as long. However, prednisone does not break down as quickly, which is good for a condition that might affect the whole body, like lupus erythematosus. Interactions: Remember, we want to try to put our interactions and drugs on the patient chart in the GM Rinse order: GI, musculoskeletal, respiratory, immune, neuropsycin, endocrine. So when you look at a SIP 3A4 inhibitor chart and see dozens of medicines, try to order and group them. Here are some examples: immune, antibiotics, antifungals. SIP 3A4 inhibition can affect macrolide antibiotics such as azithromycin (brand Zithromax), clarithromycin (brand Biaxin), and erythromycin (brand E-mycin). Note their suffixes: "thromycin" versus just "mycin." And that's one of those ones that get really confused because all it really is saying is what bacteria this came from. It may sound strange, but bacteria produce antibacterials, and the "mycin," whether it's "mycin," "thromycin," "mycin," that really we'll get into when we get to antibiotics, but that's a big difference. What we call azole antifungals, azole antifungals, the actual stem is "conazole." C-o-n-a-z-o-l-e. So remember we talked about differentiating fluconazole (Diflucan), ketoconazole (Nizoral), and itraconazole (Sporanox). With proton pump inhibitors, esomeprazole, and the "prazole" ending. At the antipsychotics, piprazole, such as aripiprazole (Abilify). So again, we're going through those drugs that have that SIP 3A4 inhibition. Cardio: Verapamil (brand Calan) is a calcium channel blocker with a "pamil" ending. And then endocrine: Well, we kind of discussed the issue of diabetes and increased blood sugar earlier. But that's really how you want to take it as you go drug by drug, and you see that, okay, we're going to add this budesonide (Terracort) for a patient that has this immunosuppressive condition or this autoimmune disorder where the body's attacking itself, and now we need to be very wary of the other medications that come along with it. Again, I hope you enjoyed this kind of quick episode. What I just want to do is go through the endings. And again, today with "sone" and "son," really a little bit more for the GI. But again, we can use them for respiratory, which would be for asthma conditions, and we can also use them for allergic rhinitis in some over-the-counter products as well. If you need to get a hold of me, the best way is [email protected]. Otherwise, check out the website memorizingpharm.com, where you can find everything else.

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Acid Reducer Drug Suffix PRAZOLE Pharmacology (Proton Pump Inhibitor Suffix)

Find the Memorizing Pharmacology book here: https://adbl.co/3wAZEmN

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The body system we continue to cover is gastrointestinal and omeprazole, esomeprazole, lansoprazole, pantoprazole are all proton pump inhibitors PPIs. 

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

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Suffixes

Omeprazole (Prilosec) with the -prazole suffix, p-r-a-z-o-l-e suffix is a true proton pump inhibitor, abbreviated PPI. We want to watch out for aripiprazole (Abilify) and brexpiprazole (Rexulti) which are antipsychotics, not PPIs but have the -piprazole ending, p-i-p-r-a-z-o-l-e. Also, some drug cards say the ending is -azole, but that is not an actual suffix, that is a chemical group, using that ending might have you confuse antifungals like fluconazole (Diflucan) for PPIs, so again, the PPI suffix is -prazole.

You will notice that omeprazole (Prilosec) and esomeprazole (Nexium) are very similar and it’s that omeprazole contains two molecules, a left and right mirror image and esomeprazole only contains the left-handed image. In Latin, left is sinister, so the “es, e-s” represents that only left-handed side. Why does that matter? That left-handed molecule is the active molecule.

Mechanism of Action (MOA)

PPIs or “prazoles” work by blocking your stomach’s parietal cells which normally release hydrogen ions contributing to the stomachs’ acidity. This, without the proton pump inhibitor, could lead to heartburn or possible GI ulceration. The proton pump inhibitor blocks the hydrogen/potassium ATPase pump preventing protons from going in the stomach. This raises the pH, making it more basic, and removes the excessive acid.

Indications

We then use proton pump inhibitors to manage heartburn, gastroesophageal reflux disease (GERD), peptic ulcer disease, and Barrett's esophagus. Barrett’s esophagus is a condition where the acid reflux damages the esophagus causes it to redden. Many times patients who are on chronic NSAIDs or anticoagulants have a higher GI bleed risk and a proton pump inhibitor is for prophylaxis rather than active treatment.

Dosing

Traditional dosing is to give the PPI 30 to 60 minutes before breakfast. A concern comes when the medication does not seem to work, but it is not the medication, rather, the patient is taking with or even after breakfast. Make sure you know which is which. Also, H2 blockers work a bit more quickly, so the patient might expect a similar timetable with a PPI, let them know that it will take a bit longer.

Clinical Considerations

Acute use for a few weeks, especially with over-the-counter lengths of time, usually 2 weeks, tends to cause few side effects. Long term, however, we have concerns of B-12 deficiency, increased fracture risk, C. Diff, an opportunistic infection. Again, B-12 deficiency comes because the now less acidic stomach does not do as good a job at absorbing B-12.

Before we start this section, here’s a reminder contrasting enzyme inhibition and enzyme induction. A drug that inhibits and enzyme blocks the enzyme somewhat increasing drug levels making the patient toxic. A drug that induces and enzyme, makes the enzyme work better reducing drug levels and making the patient subtherapeutic.

CYP2C19 inhibition can happen with citalopram (Celexa) and escitalopram (Lexapro), so in this case the antidepressant drug levels can go up leading to QTc prolongation. That’s why we have dosing maximums on citalopram of 20 milligrams daily with someone on omeprazole.

CYP2C19 induction with omeprazole and clopidogrel (Plavix) is one class example as clopidogrel is a pro-drug and by inducing the enzyme to break down more clopidogrel, the enzyme lowers clopidogrel levels. A pro-drug is one that is not quite the drug yet, the liver may have to metabolize it into a drug. Clopidogrel itself is an antiplatelet drug, so reducing the effectiveness of an antiplatelet drug while trying to prevent myocardial infarction (heart attacks) and strokes.

Note, prescribers can use cilostazol (Pletal) for intermittent claudication, a problem with blood flow in the legs where they might be in pain for short distances and the drug allows them to walk further is also a concern. Using lansoprazole or a similar PPI might create a favorable effect.

Some drugs need an acidic environment for absorption like iron supplements and lowering the acidity runs counter to the best situation for iron. Adding ascorbic acid, vitamin C can help.

Cefuroxime (Ceftin) is a second-generation cephalosporin antibiotic with good gram-positive coverage, but one might change to another antibiotic if they see omeprazole in the chart.

Mesalamine (Pentasa) for ulcerative colitis and itraconazole (Sporanox) and antifungal both both benefit from an acidic stomach.

Auto Generated Transcript:

Okay, welcome to the Memorizing Pharmacology Podcast. Today, we're going to talk about 'prazole,' P-R-A-Z-O-L-E. I'm Tony Guerra, a pharmacist and pharmacology and chemistry instructor, and I wanted to talk a little bit about why I use this Word document. Many of these names are very difficult to spell and certainly difficult to pronounce, and I want to make sure that it's clear for you. I did have someone ask, 'Could you just zoom in a little bit?' and that's what I've done. So, from now on, you should see me zoom in. As I'm talking, what I'll do is I'll make sure to underline the errors or these red marks are Microsoft Word trying to correct partial pieces. Because what unfortunately happens with this is that it's looking at a stem or a portion and saying, 'Well, that's spelled wrong,' and it's like, 'No, that's exactly what I want.' So, it's not spelled wrong as much as it's just the way that Word works.

Well, let's look at the suffix 'omeprazole' or 'prazole' of 'omeprazole,' which is brand 'Prilosec,' with the 'prazole' suffix. 'P-R-A-Z-O-L-E,' which is a true proton pump inhibitor, abbreviated 'PPI.' We want to watch out for 'aripiprazole,' brand 'Abilify,' and 'brexpiprazole,' brand 'Rexulti,' which are antipsychotics, not PPIs, but have the 'piprazole' ending, 'P-I-P-R-A-Z-O-L-E.' Also, some electronic drug cards say the ending is 'azole,' but that is not an actual suffix; that is a chemical group. So using that ending might confuse antifungals like 'fluconazole,' where 'conazole' is the stem, brand 'Diflucan' for PPIs. So again, the PPI (proton pump inhibitor) suffix is 'prazole.'

You will notice that 'omeprazole' (Prilosec) and 'esomeprazole' (Nexium) are very similar, and it's that 'omeprazole' contains two molecules, a left and right mirror image, and 'esomeprazole' only contains the left-handed image. In Latin, 'left' is 'sinister,' so the 'E' in 'ES' represents that only the left-handed side. Why does that matter in practice? The left-handed molecule is the active molecule; the right-handed molecule is inactive. So in 'omeprazole,' you have this mixture of something inactive and active, and it doesn't hurt anything; it just doesn't have the active part or it doesn't take out the inactive part. But in 'esomeprazole,' it is only the active part.

The mechanism of action will be our next step. The PPIs or 'prazoles' work by blocking parietal cells in the stomach, which release hydrogen ions, contributing to the stomach's acidity. This, in turn, leads to heartburn or possible GI ulceration. The proton pump inhibitor blocks the hydrogen-potassium ATPase pump, preventing protons from going into the stomach. This raises the pH, making it more basic and removes the excessive acid. Now, a lot of what I said is really clear if you had chemistry. If you do not have chemistry, just the kind of takeaways that you need are one, hydrogen, which is the very first 'H' on the periodic table, can form into ions that make the stomach very acidic. The way we measure that acidity is through the pH scale. Now, pH is the negative logarithm of the hydronium concentration, which is probably more than most need to know. But what the pH scale, you do need to know, is that the lower on the pH scale you are (1, 2, and 3, for example), the very acidic, and the higher on the pH scale (which goes to 14, 12, 13, 14), is alkaline or basic. So when you hear 'alkalosis,' then we're talking about something basic, or if you see 'here basicity,' we're talking about the upper end. The middle is 7, which is neutral. So let's give a couple of examples just to clarify this. Seven is neutral; your blood is a little basic at around 7.35, and milk is a little acidic at a pH of like 6. So why do some people give milk if they've got a stomach acid problem or something like that? Well, the stomach acid is around 2, from 1 to 14, so very, very acidic, and milk is at 6. So you're still bringing it up and making it less acidic, and that's really what matters. So in this case, what a proton pump inhibitor would do is, if there are fewer protons, then we would see that pH creeping up from the traditional 2 in the stomach, and

 we'll see that that can kind of cause some problems later. But again, if you haven't had chemistry, the big thing to know is hydrogen ions represent acidity. You might hear them as hydronium, which is H3O+. So you're taking the 'H' and adding it to H2O, which makes H3O+. And again, this is, and again, getting into the weeds, but it's going into the Brønsted-Lowry theory of acid-base if you want to review that in chemistry.

So, what do we use these for? We use proton pump inhibitors to manage heartburn, gastroesophageal reflux disease or GERD, peptic ulcer disease, and Barrett's esophagus, which is where the acid reflux damages the esophagus, causing it to redden. Many times, patients who are on chronic NSAIDs, so again, examples of NSAIDs are like 'ibuprofen' in the U.S., brand 'Advil' and 'Motrin,' or 'naproxen,' which is brand 'Aleve' in the U.S., or anticoagulants, they have a higher GI bleed risk because of those medicines, and 'omeprazole' is for prophylaxis. We're trying to prevent damage to the stomach, and hopefully, that works.

Pharmacokinetics: So standard dosing is to give the PPI 30 to 60 minutes before breakfast. A concern that comes when the medication does not seem to work, but it is not the medication; rather, the patient is taking it with or even after breakfast. And I understand this; I'm busy, I've got three kids, and if I want to remember something, I attach it to something I already do. It's tough to attach something to 30 minutes before breakfast or 60 minutes before breakfast; it's easy to say, 'Oh, I'm eating breakfast; I want to make sure to take my medicine; I'll put those both at the same time.' So that's why it becomes a problem because the patient's just trying to remember it, and their way of remembering it is with meals.

Also, H2 blockers like 'famotidine' (brand 'Pepcid'), and maybe I should put something like that in there, 'F-O-F-A-M-O-T-I-D-I-N-E,' which is brand 'Pepcid.' These work a bit more quickly, so the patient might expect a similar timetable with the proton pump inhibitor.

Adverse effects: Well, if you use it acutely for a few weeks, especially with over-the-counter protocols of just 14 days, it tends to cause a few side effects, no problem. Well, hopefully long-term, however, we have concerns of B12 deficiency, increased fracture risk, C. diff, which is an opportunistic infection. Where does that come from? Where's the B12 deficiency issue come from? Well, when you lower acidity, it's tougher for the body to absorb B12. And then when you take away that acid, which is a barrier to most bacteria, it's very difficult for bacteria to survive in that kind of environment. Then it also makes it easier for other infections to come in.

Interactions: Before we start this section, let's remember or here's a reminder contrasting enzyme induction and enzyme inhibition. So a drug that induces an enzyme makes the enzyme work better, but that can be a problem because if you make the enzyme work better, it reduces drug levels and makes the patient subtherapeutic. So again, just like a submarine is below the ocean, a subordinate is below a superior. Subtherapeutic means that we are below the therapy where we want to be. So again, an inducer makes the enzyme work better at breaking down the drug, and so our drug levels go down, and then the patient doesn't get as much medicine as they need. A drug that inhibits an enzyme blocks the enzyme and somewhat increases drug levels, making the patient toxic. So again, if we inhibit the enzyme, we block it, and we increase those drug levels. And unfortunately, the patient becomes toxic. Induction: The enzyme works better, but we have less drug. Inhibition: The enzyme doesn't work as well, and we have more drug. In either case, we don't have the right amount of drug. But induction and inhibition are very important terms to remember.

Let's use a good example here where we can talk about the SIP enzymes, and I get it, many of you may not have to have SIP enzymes in the level of pharmacology that you're in, but what I want to do is I want to kind of go into this because there's a great contrast between induction and inhibition. So I'll read this to you and maybe make a couple of comments. So SIP 2C19 induction with 'omeprazole' and 'clopidogrel.' 'Clopidogrel' is brand 'Plavix' if you're not familiar with it, is one class example. 'Clopidogrel' is a prodrug, and by inducing the enzyme to break down more 'clopidogrel,' the enzyme lowers 'clopidogrel' levels. Okay, so a prodrug is one that is not quite the drug yet; the liver may have to metabolize it into a drug. 'Clopidogrel' itself is an antiplatelet drug, so reducing the effectiveness of an antiplatelet drug while trying to prevent myocardial infarction (heart attacks) and strokes, obviously not a very good thing.

If you want to kind of look at the brand name 'Plavix,' you can see 'platelet' or the beginning of the word 'platelet,' and then 'Vix' is very similar to the word 'vex.' So kind of vexing platelets, not making them work quite as well as they should, which prevents that clotting from happening in the first place. But I think that's where that name came from. 'Prilosec,' just to kind of let you know, the name was supposed to be 'Losec,' but it was too much like 'Lasix,' so they had to actually change the name. But you can think of 'Prilosec' as 'protons' and 'low secretion.' So a low secretion of protons is a good way to think of 'Prilosec' as a mnemonic.

So let's look at the other side of it. That's induction; you're making an enzyme work better, and the 'clopidogrel' levels go down quicker than we expect, which is not good for the patient. CYP2C19 inhibition can happen with 'citalopram,' which is 'Celexa,' and 'escitalopram,' which is 'Lexapro.' And this is where we kind of get into the weeds with the stems. 'Pram' is not actually a stem. If we go into the long, long list, it's not in there. But we can take a look and see, wait a minute, I remember seeing 'esomeprazole' and 'omeprazole,' and there's that 'S' he was talking about. And again, what's happening here is that 'citalopram' was the first drug to come out, and what that was was the 'R' and the 'S,'

 and sometimes you might see it represented as a capital 'R' 'S' like that with a hyphen in front of it. So 'RS citalopram.' But that just becomes confusing for a lot of people, so they just put 'citalopram.' But this is just the 'S,' so instead of putting 'S' hyphen or an 'S' in front of it, which makes it like 'sketalopram,' you know, the Skittles of antidepressants, it they put in 'S-citalopram' to let someone know that that's the 'S' or sinister mirror image side of 'Lexapro.' So 'Lexapro' is the left-handed side only, just like 'S-omeprazole' is the left-handed sided only side of that molecule. So in this case, the antidepressant drug levels can go up because if you're going to inhibit the enzyme, it doesn't break down these drugs as well as we like. Then we can have QTC prolongation. So again, QTC prolongation is that real concern with arrhythmias and things like that. So that's why we have dosing maximums on 'citalopram' of 20 milligrams daily with someone on 'omeprazole' or something like that. So why are these interactions so important? Because we have a patient that is with the induction we have a patient who's trying to prevent a heart attack and with the inhibition, where we have a patient on an antidepressant that just happens to have some kind of acidic condition and all of a sudden we're making them toxic because we're trying to treat their GERD. And so that's why so important if somebody's on over-the-counter medicines to let the prescriber know.

No 'Cilostazol,' which is 'Pletal,' that's used occasionally for intermittent claudication, which is a problem with blood flow in the legs where they might be in pain for short distances, and this drug allows them to walk further. So 'Pletal,' so you can see the word kind of 'platelet' in there to kind of remind you of what that's for. And intermittent claudication again, that problem with the blood flow to the legs. You may know something that's called Raynaud's syndrome where you get the really, really cold extremities, especially the fingertips and things like that. This is quite a bit different than that one. Okay, so again, that's the real concern there. So some drugs also require an acidic environment for absorption. And I talked about the B12 above, but 'cefuroxime,' which is brand 'Ceftin,' and this is the first prefix we've looked at. So 'ceph' in the first generation cephalosporin, it's actually 'C-E-P-H.' But 'Cepheuroxime' or 'Cefuroxime' 'Ceftin' is a second-generation cephalosporin antibiotic. It's got great gram-positive coverage. But again, gram-positive is you can divide bacteria into gram-positive and gram-negative. Gram-positive means that it takes the gram stain because it doesn't have that kind of third layer, and gram-negative, where it doesn't take the gram stain. Just a way to separate out bacteria. 'Mesalamine' and here's one that is a little more important when we get to something like 'bismuth subsalicylate,' but that 'cell' is a root meaning an acetyl cell. There's some kind of salicylic component to it. So acetylsalicylic acid, which is aspirin, would have that 'cell' stem. 'Bismuth subsalicylate' is another concern, but 'that cell' is a concern because you're not supposed to give children aspirin or aspirin-like products. And so that's what makes it like aspirin; it's that 'cell.' But 'misalamine,' which is 'Pentasa,' that's good for ulcerative colitis. And you can see the abbreviation in here for 'ASA,' which is 'aspirin' (acetylsalicylic acid) for ulcerative colitis. And then 'iron supplements,' they all need a good acid environment to work well.

So many different ways that we can have drug interactions and concerns with the 'prazoles,' 'omeprazole,' and so forth. But again, knowing that stem is really going to help you identify it at the most basic level, which is, 'What is this?' It's a proton pump inhibitor that reduces acid.

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Free Drug Suffix PDF

In this episode, I review the PDFs you can trust to give you the correct drug prefixes, infixes, and suffixes (endings). You don't know what kind of grades the people who put up those free electronic notecards earned, you can trust this PDF. 

Link for Complete Drug Suffix PDF: https://www.memorizingpharm.com/drugsuffixpdf

Link for Memorizing Pharmacology Drug Suffixes by Body System: https://www.memorizingpharm.com/drug-prefixes-and-suffixes

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

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

Auto Generated Transcript:

Alright, welcome to the Memorizing Pharmacology Podcast. I wanted to talk about getting a drug suffix PDF. I have a free one that I can direct you to, and that's very accurate. That's the real problem. So first of all, I just wanted to kind of address a couple of emails I've received about where people can find the audiobooks. Sometimes it's just easier to search by my name because I have 26 books that I've written, but Tony Guerra, T-O-N-Y G-U-E-R-R-A. Again, I'm a pharmacist who appreciates everyone's support, and I wanted to use this podcast as a way to give back.

Memorizing Pharmacology, the introduction to the top 200 drugs, and Memorizing Pharmacology Mnemonics are the most popular. Strong Residency Interview Questions, Answers, and Rationales is a little bit more for somebody going into residency. How to Pronounce Drug Names If English Isn't Your First Language (it wasn't my first language), so it's just a different way to know how to pronounce things if that's a struggle.

And then Memorizing Pharmacology Questions, Answers, and Rationales Books 1 to 7. Just to let you know, Book 1 is pretty long; it's 18 hours. If you really want to get into the weeds with pharmacology and get quizzed on it, that might be a good choice. But those are the top five. But definitely, Memorizing Pharmacology if you've never had pharmacology before.

So let's talk a little bit about the website. You can go to memorizingpharm.com; you can access all my books, the podcast. If you need an online pharmacology class, I do teach one, and again, it's at a community college, so community college prices. You'll be in class with sometimes pre-nursing students, nursing students, PA students, many students who just want to understand pharmacology, but again, it's that community college price that a lot of people like.

In terms of prefixes and suffixes, what I did was I tried to make it a little bit easier just to find it on its own, and I can put this in the show notes, but it's 'memorizingpharm.com/drug-prefixes-and-suffixes.' Now, I know that's a mouthful: memorizingpharm.com/drug-prefixes-and-suffixes. This list is the one that comes from the books, so all of the drugs that I've put in the Memorizing Pharmacology book and Memorizing Pharmacology Mnemonics book, these I have ordered by body system or drug class. The nice thing is that I do everything always in the same order. As I talk through this podcast, I'll talk about how if you've got a patient on 20 medications or 25 medications, maybe you're working with geriatrics, what you want to definitely do is put that list in this order: G-M-R-I-N-C-E, or 'G-M Rinse': Gastrointestinal, Musculoskeletal, Respiratory, Immune, Neuro, Cardio, Endocrine. That way, when you are studying for something, it's always in the same place. It's kind of like having seven different rooms in your house, and you know exactly where those rooms are and what's in those rooms.

So, let's talk about these. You can obviously read them, but I want to make clear what they are. 'Liximab' is the ending, okay, to a specific GI drug for ulcerative colitis and Crohn's disease. 'Peg' comes from polyethylene glycol, which is an over-the-counter product that's safe for young populations. But there are 'pegylated' compounds, which is a little bit different reason that you're using it. And as I go through the episodes, I'll start linking the episodes to this list. 'Prazol' is the next one I'll be going over, so Episode 5 will be on the 'prazoles' or the proton pump inhibitors and talking a little bit about how 'prazole' can get... If you'll see some of the electronic drug cards that have just 'ozo,' 'azole,' and that's not correct. That'll get it wrong because if you have 'azole' at the end, then it could be 'presele' from GI; it could be 'conazole' from Immune, which is a type of antifungal, and if you're in the Neuropsych section, it could be 'piprazole,' which is an antipsychotic. So what I really cared about was getting a list of drug prefixes and suffixes that you can trust, and this one is the one that goes to the books.

But I do have a complete, free PDF that you can use, and the link is a lot easier. So memorizingpharm.com/drug-suffix-pdf. So, 'drug-suffix,' 'pdf,' all together, no slashes, no anything like that. And what it is, is a complete 60-page list of drug prefixes and suffixes. What I will do is I'll keep updating this PDF as I add the episodes, so that not only do you have the list, but you have the link to the podcast episode if you want to learn a little bit more about it. But that is a 60-page-long drug suffix list, and so it's what I did was I set it up so this PDF, in particular, if you are on your mobile device, it's really easy to use the 'Find' feature to find what you need or to find the drug that you need or the ending that you need. And then, if you find that you don't find the ending, then you know that maybe it was one that was incorrect or if you find the ending is different than what you expected.

So, let me give you examples of both of those. If you try 'in,' 'ine,' you will find hundreds of drugs, and the reason for that is that 'in' is not a stem, it's not an ending, it's just something that happens to be at the end of many drugs. It's incomplete, so antihistamines end with 'een,' antidepressants end with 'in,' morphine, which is a narcotic analgesic, ends with 'enord,' so too many drugs end with 'en' that's not a useful stem. Another one that I just saw on a test prep website, which is really bad, that the NCLEX test prep website has something like this, but they had just 'fil' rather than 'upfield,' and they had 'usin' instead of 'zosin,' and so they were incomplete and incorrect. So this 60-page drug suffix list is accurate, it's correct, and it's very easily searchable.

But if you are on mobile, it's going to be... You might be like, 'Okay, where is it?' You just have to scroll down past the Memorizing Farm image, past the Memorizing Pharmacology Mnemonics image, and then here you can see the free complete

 60-page-long drug suffix list as a PDF. Just click on it, and it'll pop up for you. And then, like I said, I'll start updating those links as we go. But this is what it looks like, and I'll just kind of talk a little bit about how you can use it. So when you are looking at this suffix, and you see something like 'abean,' and you see 'well, go look for 'arabin cytobean,'' what this is letting you know is, 'Hey, sometimes people think that's the ending, but it isn't.' What you want to do is go to this complete ending, something like 'ack,' 'ac' for 'diclofenac,' for example, which is one that we commonly use or 'voltaren.' This is an anti-inflammatory agent, acetic acid derivative, it's a non-steroidal anti-inflammatory drug. And what I'll do is, as I'm kind of going through these, I'll also turn them into plain English, which is a little bit of a concern, as some of this is more chemistry language and we need to translate that into plain English. But most of them do have that kind of therapeutic sense to it. So we'll use 'adol,' for example, so 'tramadol' is a mixed opiate receptor agonist and antagonist. So, 'tramadol' would be the one that we're thinking about there. Again, this is the full 60-page one, it's readily searchable, and you're welcome to use it anytime. And that's again at memorizingpharm.com/drug-suffix-pdf.

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

In this episode, I provide an explanation about why Nursing Pharmacology is so darn hard and why it's not your fault. Here is the link to my book Memorizing Pharmacology Mnemonics which you can find 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

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

Auto Generated Transcript:

Hey, welcome to episode three of the Memorizing Pharmacology Podcast. The next topic I wanted to cover is how to study for next semester's pharmacology class, whether it's in nursing, pharmacology technician, pharmacist, medicine, or whatever. But with nursing, it's especially difficult because not all nursing schools require the same prerequisites. Some nursing schools require chemistry, some don't require any chemistry, and some require up to organic chemistry, especially if you're going to become a nurse practitioner.

So, what I wanted to do was make sure that I clarify why pharmacology is so hard and what you can do about it if you are a nursing student. Let's get on with the show on how to study nursing pharmacology. I wanted to make a video because I've seen a couple of videos with this title, but no one ever explained why it was hard in this way. They'll talk about memorization, they'll talk about time management, but there are some things that you need to know about nursing pharmacology and why it's specifically harder than other pharmacologies.

So first, I'll talk about why nursing pharmacology is hard. In the nursing curriculum, you have anatomy and physiology, usually eight credits of lab, very comparable to a pharmacist or physician's curriculum. Then you have chemistry, maybe zero to three credits usually, and then pathophysiology, followed by pharmacology, and all of this happens very quickly. Whereas pharmacists and physicians take anatomy and physiology just like nurses or nursing students, but then inorganic chemistry, eight credits, organic chemistry, eight to 10 credits, and biochemistry, three credits. Then that's all happening in undergrad. After that, they go to professional school where they take pathophysiology and then pharmacology, maybe in their M1, M2 year or P1, P2 year. So, not only are these nursing student rock stars trying to take pharmacology way earlier, which is impressive, but they're also taking it with up to 18 credits less of chemistry. Let me make it clear, I'm not saying we need to add organic chemistry to the nursing curriculum. I'm saying there's a workaround and a solution to this. If you talk to pharmacy students and medical students and you ask them what they remember from organic chemistry, they'd be hard-pressed to tell you a lot. And if you ask them what they remember from biochem, they might say they remember Krebs cycle and glycolysis, but they might not be able to draw it. What they did learn was the language of pharmacology, and that makes all the difference. Because now, when they're looking at a textbook, it's much easier for them to understand the words that are in there.

What's the curse of knowledge? Well, instructors, pharmacology instructors, are usually nurses, physicians, pharmacists, or maybe Ph.D.s. They might have a Ph.D. in pharmacology and be research scientists or even physician assistants. The curse of knowledge says that as you teach for a long time, your brain will change and make it much more efficient. As I showed in the videos, I did everything from memory. I know the top 200 drugs from memory, not because I'm a great memorizer, but because I created a way to use serial memory, as well as some mnemonics, to help me remember them. Another thing is that I was experienced clinically. I've seen hundreds of thousands, maybe millions of prescriptions. So, I have lots of examples to pull from, and that makes it easier. As a nurse, you'll also have this curse of knowledge, and that'll be when you talk to a patient, you'll explain something, and what you think is really clear, the patient will look at you, and they'll say, 'I have no idea what you're talking about.' That's because you'll have many, many patients that you've helped, and they've seen what's happened with them, and they don't have that confidence that you know the last hundred times everything just worked out fine.

The curse of knowledge is the first thing. The second thing is that you may be getting an instructor that has a physical science background, someone who has a lot of chemistry and is very comfortable with pharmacology. So, the inorganic and the organic, that I talked about, that's a very different thing to study than anatomy and physiology. So, the two things that might get in the way are the curse of knowledge, that they've internalized it and it's just so easy for them because of their experience in teaching, and that they may come from a different background that is, you know, they're not from around here.

So, what are the solutions? The first solution might be books. Additional books can provide what I would call a translation, but you have to learn the textbook and the translation. You may not have time for a print book. With my 'Memorizing Pharmacology' book, many follow along with the videos, but most actually follow along with the audiobook. The audiobook has this great Scottish narrator, and he's just got a much better voice than I do, but also, he puts so much emotion into it. It's really pleasant to listen to over and over again, which in some ways you may have to for some parts of pharmacology, depending on your background.

The other one was a little bit of a surprise because I just wanted something to better explain how to pronounce drug names. What I was finding was that some nurses were using it with their patients, and a patient would come in and say, 'You know, I really don't understand the medicines,' and they would start sitting down with them, talking one-on-one with them, and making it part of patient education. You can see some other videos, but I translate the medication names into regular English words. So, acetaminophen becomes 'the A' from 'coma,' 'the C' from 'ceiling,' 'the TA' from 'data,' 'the MIN' from 'mint,' 'the NUH' from 'cannon,' and then 'the FIN' from 'hyphen.' Those are all English words that you can use to help them understand the medication name, how to pronounce it, and how to spell it. That's really important because if you have the patient on board with their self-care, then they might catch something, maybe a medication error or something like that, that maybe wouldn't have been caught otherwise.

The second thing are the videos. These videos are really people translating the language of pharmacology from physical science to plain English or to something that's understandable with mnemonics and things like that. But you have to be really careful here, kind of buyer beware because you don't know them really. So, watch the comments. If you see in as a shortcut or lamb or pam. So, 'in' is they're saying it's an ending, and all things that end with 'een' are antihistamines, and that's just not true. Loratadine, which is generic for Claritin, and cetirizine both end with 'en,' which is generic for Zyrtec, and they're

 both antihistamines. But they didn't go on to think, 'Wait a minute, fluoxetine is Prozac. That's not an antihistamine. That's an antidepressant. Morphine, that's not an antihistamine either. That's for pain.' So, that shortcut doesn't work. There are shortcuts that do work, and I'll go over them in the next slide. But let me tell you right now, there is a list, and it's not on. It's a list on the United States Adopted Names Council list. It's on the American Medical Association website. The list and then the World Health Organization also has a list, but these lists are very long. I've shortened it in the book. I want to say it's about 800 or 900 endings.

Misspelled drugs. If you see misspelled drugs, that means they're not paying attention to detail, and you want to be really, really careful. I'm going to give you the Skittle story, and I don't know if this is true or not, but I heard that certain rock bands would put a clause in their contract that says, 'We want this many Skittles, and we want no green ones,' or something like that. The reason they're doing it is not to be jerks, but to make sure that the person's reading the contract so that their stage doesn't collapse, so that their sound is going to be good, and all these things. If you see misspelled drugs, that's someone who's not paying attention to the very important details.

Now, why do so many people put, like, 500,000 views or a million views on something like that, where it might even be wrong? Well, students give ethos to pathos rather than attending to logos, and I'll translate that. So, students believe an instructor is credible, that is, they have ethos, because they are smiling and excited, that's pathos, even if a person says they're a beginner. Studies have shown that if you've got an expert and you've got someone who's not an expert, but the expert is boring, and the other person is really excited and smiling, you'll believe the other person, and that's what's happening. So always be careful, buyer beware. Watch for incorrect shortcuts like 'lamb' or 'pam,' or not the endings for benzodiazepines. It's 'azepam' and 'azolam.' It's not 'en.' For loratadine, it's 'adidene,' and then I go over those in my video, so I won't belabor those here. But you may not have time to watch videos; you may have time to listen to it. But the video might be made for someone who's watching it, and that might not be the best solution either.

My thought for the best solution is audiobooks, and I have to confess, I'm totally addicted to audiobooks. I've almost listened to 200 since, I want to say, 2014, just on Audible. Nursing students are busy. My sister-in-law is a nurse; my mother-in-law's a nurse; my grandmother was a nurse. They're busy with families, their jobs, and school, and audiobooks, I think, are the best way to fit learning the language of pharmacology into these small windows of time. Because you're doing something on top of the textbook that's supposed to make the class easier. I always recommend listening to it on the semester or even a couple of weeks before you take the pharmacology class. In my book, I say it explicitly, to learn pharmacology, you have to have taken pharmacology. This is a very approachable pharmacology because as soon as someone talks about proton pump inhibitors, which are in GI, and that might be the first module, they also have to talk about drug interactions, and one drug interaction is clopidogrel, which is in cardiology. But you haven't taken cardiology, so what is clopidogrel? You've never heard that before. And that's what makes it so hard. So to succeed in pharmacology, you almost have to have already taken pharmacology.

So, the first book teaches classifications, which is a real struggle a lot of times, through stems, prefixes, infixes, and suffixes. I assure you, these are right. These are the ones that come from the United States Adopted Names Council and the World Health Organization, things like 'alol' for beta-blockers and 'cillin' for penicillin. But also, some ones that maybe you don't know as well, which is like 'omalizumab,' which has two infixes and then the monoclonal antibody suffix. But that's all in the videos; I'm not going to go into that. And then the other book, I was a little surprised because people picked it up to help patients with their self-care. I had made it so that I had difficulty explaining to students how to pronounce something without just saying, 'Well, here's how I say it, you say it back.' And so, I talk about something called 'back building,' which is where you say the last syllable, like with acetaminophen, it would be 'phen,' 'nothing,' 'menifen,' 'tamina,' 'fin,' 'cetominophin,' 'acetaminophen.'

And the audiobook's coming out in a week or two at most, and that'll be out soon, which will do that for 400 drugs. So, I'm so excited to help health practitioners avoid embarrassment and help patients with their self-care. So, why is nursing pharmacology hard? Because, in many ways, there's just not a lot of chemistry, but there's a way around that curse of knowledge. They've internalized it; it's tough to talk to someone that doesn't know or is a novice. And then, solutions: books, videos, and audiobooks.

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

Antacids Mnemonics and Pharmacology

In this episode, I provide a video version of a mnemonic in my book Memorizing Pharmacology Mnemonics which you can find 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

Auto Generated Transcript:

Hey, welcome to Episode 2 of the Memorizing Pharmacology Podcast! Just as we went over H2 blockers in the first episode and talked about suffixes and prefixes, some students want something a little more advanced. What I did was create a video that represents what's in *Memorizing Pharmacology Mnemonics*.

In terms of the order, *Memorizing Pharmacology: A Relaxed Approach* is really a top 200 drug book. It's a little over seven hours long, but it can definitely be done in a weekend if you need to prepare for a pharmacology class or catch up with it. If you want a little more advanced book, then *Memorizing Pharmacology Mnemonics* is a great choice as well because this one is really going to help you. The video will be about 10 minutes long, going over antacids, not only how to remember a number of the popular antacids, which don't have stems, prefixes, or suffixes because the generic name and chemical name are the same (we've got sodiums and calciums and aluminums and so forth). But again, check this out and enjoy the show.

*Memorizing Pharmacology Mnemonics #1: Antacids*

Hey, I just wanted to tell you about a new book I wrote. What I wanted to do was create a review for my students that will allow them to prepare for their final exam, but I'm doing that in a quite different way. I'm not just saying, "Here are the questions you need to know the answers to," or even giving necessarily just a plain review. What I'm doing is I'm really helping you get past the just understanding part. So often, professors are very good at helping a student understand, but they don't always give them the tools that they need to memorize something for an exam. Because in the exams or on the NCLEX, NAPLEX, USMLE, when we're getting to those big exams, that's when we really have to have our memory down so that we can do the higher-level understanding and work through. But let me show you how it works.

So the book is called *Memorizing Pharmacology Mnemonics*, and I changed the title a bunch of times. I think this is what I'm going to stick with: *Memorizing Pharmacology Mnemonics: Pharmacology Questions and Answers for the Future Nurse, Doctor, Physician Assistant, and Pharmacist (Chemist) - Kindle Edition*. I put all of those different professions in there. I'm not trying to exclude anybody else who wants to read it, but I put them all in there because we're inter-professional now. We're working on outcomes, not necessarily worried while we are worried about our individual exams. I think pharmacology crosses across those. And the courses I have include pre-meds, pre-pharmacy, pre-nursing or nursing, pre-physician assistant, pre-dental, physical therapy, and I have all these different groups. When I just talk about one group, then I exclude the others. So I wanted to make sure to include everybody in this interprofessional book.

You can read it two ways: you can just skim the 131 mnemonics in there, and you'll see what they look like and just look at the slide and say, "Oh, okay, I'm getting antacids. I just want to put that in my head. Then H2 blockers, then proton pump inhibitors," and you know from my past books that everything is in a memorizable order, so you can memorize the entire book and the entire bank of slides as well. Or you can read it slowly, and you can go through each drug class.

But what I've done is I've created a question and answer format, so it's not just here are 131 mnemonics. The big mistake people make is that a mnemonic is an answer. So if you're just reading a book with mnemonics, you're just reading a book with answers; you don't have the questions, right? So the mnemonic that you know maybe has "morphine" as the word, and all the side effects of morphine never bothers to ask you and engage your brain and say, "What are the side effects of morphine?" So I've kind of fixed that part. And as you go through the book, I've used page breaks so that it goes question, and that's all you see on the page. And then you can flip to the answer and then go back to the question if you didn't quite remember it, back and forth, and then move on to the next one. So again, it can be read fast, or it can be read slow.

I get this inspiration from when I take piano every once in a while, and there's always a fast and a slow version of each of those. And you can get it here. Obviously, you can't link from the picture, but I'll put the link in the video bottom. So let's get started.

**Question 1: Name four antacids and four side effects or interactions that concern you.**

Here's the first question: Name four antacids and four side effects or interactions that concern you about antacids. And so what you might do is start thinking, "Um, well, Tums is an antacid, and let's see, I heard that it might cause constipation." And you have this very roundabout way of learning it, and what I wanted to do is, no, here, this is the order that you can learn it in such a way that you can memorize it quickly and be done with it. So this is all about efficiency. This is all about getting it done quickly and keeping it in your brain quickly. We're not going to have any of this, "Oh, I just read a whole chapter, and I don't remember anything." No, no, we're doing quite the opposite.

Okay, so here's the answer: "It's acidic meals," and that's going to be our mnemonic that we're going to work with. And I'm going to show you how we go through each of the letters, and we don't always use all of the letters, and you'll see that here. But we will use a majority of them, and you'll see how that fits into something that you can memorize. So we begin with aluminum hydroxide, which is branded as Amphojel. And then we say, "Okay, well, that's good. That's one." Number two, calcium carbonate, which comes as Tums and Pepto Children's. So if you're just kind of burning through this, you say, "Okay, I'm just trying to remember what they are." But in the book, I talk about how Tums and Pepto Children's both have that calcium carbonate, but that's not Pepto-Bismol. Pepto-Bismol is bismuth salicylate, which you can't use in a child because it has an aspirin-like component. It can cause Reye's syndrome, a terrible, terrible disorder. So there are many more details in the actual book. But if we're just kind of burning through it, trying to remember, "Hey, what are four ant

acids, and what are four side effects that concern me about antacids?" That's what I need to know. So we're going to keep going. So those are two of the antacids, and we attach them to "A" and then the "C" of "acidic." Because although you don't really—it's not really the acidic meal; it's the acidity that comes from the meal. It just kind of stuck, is a good way of remembering it. So the first side effect or the first issue that we have is decreased phosphate with aluminum hydroxide and calcium carbonate. I intentionally put the chemical names here because sometimes you'll see them that way, or sometimes you'll see them spelled out in this way. But again, aluminum plus three—that means that we have three hydroxyls or three OH groups with negatives, and then we're going to have three of those to attach the plus three. Calcium is plus two, CO3 two minus. So that goes together as calcium carbonate. But this decreased phosphate can also help someone that has hyperphosphatemia.

Then we go on to the ions and the concern about chelation. So chelation with fluoroquinolones and tetracyclines—you can think about some of the fluoroquinolones that are out there: ciprofloxacin, levofloxacin. So the "C" and the "L" from chelation, and then the "T" from tetracycline to remember the tetracyclines are also an issue. Chelation is a binding that makes it inactive or makes the fluoroquinolone or tetracycline antibiotic inactive. So we want to separate these antacids from those two drug classes by a certain number of hours. And then the next one is constipation from aluminum hydroxide and calcium carbonate. Both of these are constipating antacids. So what we've done very quickly is said, "Okay, I've got two of the antacids: aluminum hydroxide, calcium carbonate, and then I've got three of the side effects: decreased phosphate with aluminum hydroxide and calcium carbonate, the deal with chelation with fluoroquinolones and tetracycline, and constipation from aluminum hydroxide and calcium carbonate." So instead of just this kind of random jumble of, "Okay, this is what I've got to remember. Please stay in my brain for the test," we've said, "Okay, this is exactly how I'm going to do it. This is the order I want my brain to hold on to this information." Now, I said we're going to need four and four, so we're going to take "meals" and take apart that "act on" mnemonic as well. So magnesium hydroxide, which is the brand Milk of Magnesia, another antacid, magnesium hydroxide causes a laxative effect. So we want to make sure to put that as well to contrast that calcium carbonate and aluminum hydroxide cause constipation. So an antacid doesn't always cause the same side effect; it depends on which one. And then sodium bicarbonate, it's in Alka-Seltzer. You would consider this also an antacid. So for this next one, we have "meals," M-E-A-L-S, to remember two more antacids and one more side effect. So now we have four antacids and four side effects in our brain. And we can say, "Okay, what are the four antacids? Aluminum hydroxide, calcium carbonate, magnesium hydroxide, sodium bicarb. What are the four side effects? Decreased phosphate with aluminum hydroxide and calcium carbonate, the deal with chelation with fluoroquinolones and tetracycline, and constipation from aluminum hydroxide and calcium carbonate." So instead of just this kind of random jumble of, "Okay, this is what I've got to remember. Please stay in my brain for the test," we've said, "Okay, this is exactly how I'm going to do it. This is the order I want my brain to hold on to this information." And I know it looks a little bit jumbled here, but your brain has no problem with that. You can just go back to it, and all your brain wants is order and organization. So you just hear the "A-C-I-D-I-C" for acidic, and you know two of the antacids, three of the side effects. And then you've got "meals," M-E-A-L-S, two antacids, one side effect, for a total of four antacids and four side effects in a very memorizable order. And you can come back to this. You can practice this. But this is just one of the 131 mnemonics that I put in there. Let me know in the comments if this method would be helpful. Again, I try to innovate, but that doesn't mean that I know if it works or not. So I'm curious to see if this is something that's helpful for 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