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

Acid Reducers and Peptic Ulcer Disease Pharmacology Mnemonics

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Peptic Ulcer Disease has several important concepts to remember; in this episode, I touch on some mnemonics to help you remember them. If you're interested in checking out the course online for a refresher you can go here: https://residency.teachable.com/p/mobile or if you need a credit course, here: https://www.dmacc.edu/programs/pdp/pre-pharmacy/Pages/online-pharmacology-class.aspx

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

Auto Generated Transcript:

Hey, welcome to Memorizing Pharmacology Podcasts, Episode 79: GI Medications Pharmacology Mnemonics. So let's just talk a little bit about the ulcer and then we'll get on with it. The big thing is that once you get this ulcer, you can't really fix it as much as you can create an environment for it to heal. So the number of things that you can do to kind of do that include eradicating H. pylori which is found in a greater percentage of the ulcers, smoking cessation, alcohol reduction, stress reduction, spicy food reduction; all those things can help. But again, making it so that the body can heal itself.

So what are some drugs that cause ulcers? Again, alcohol is a drug so ETOH (ethanol), then bisphosphonates like alendronate, ibandranate (again watching for those stems), the NSAIDs ibuprofen, naproxen. Even though Celebrex or celecoxib is supposed to do it less, it still can be a problem. And then steroids like prednisone.

So we start with things that we could maybe not use a medication for to help deal with these kind of GI symptoms and issues and make things better. And so we'll use the mnemonic SAFER: SAFER for Smoking, Alcohol, Food diary, Exercise, Reducing stress and NSAIDs. I didn't really know how to put that in there because we're taking away a drug so is that non-drug? Sort of. So I just had a little breathe image here for smoking, alcohol just kind of reducing that; have your coffee instead. Here's your food diary, then getting some exercise, reducing some stress (yoga whatever it takes) but all the things that would make it so that there's less acidic environment and of course not using the NSAIDs if possible.

Antacids: You are probably familiar with these colorful chalky tasting limestone things and the big thing to know about antacids first is that they're the only drug whose generic name is their chemical name. So calcium carbonate is Tums, aluminum hydroxide is half of Maalox (it's really Amphojel) and then magnesium hydroxide would be Milk of Magnesia.

So when we talk about antacids we're really looking at which ones are constipating which ones cause diarrhea and you kind of have a little guess which is which here. So pick C or D and with calcium carbonate that one is constipating, aluminum hydroxide is constipating (again it's Amphojel is going to be the brand name) but if you mix them together magnesium hydroxide and aluminum hydroxide it makes Maalox and then magnesium hydroxide Milk of Magnesia.

So which cause constipation which cause diarrhea? So the idea is calcium carbonate is constipating, aluminum hydroxide constipating, magnesium hydroxide causes diarrhea. So if we mix constipating drug like aluminum and a diarrhea causing one like magnesium hydroxide then we end up with something that is more comfortable for the patient.

Alright H2 blockers: I've talked about the antihistamines NO MAN where one nose so that you remember the H1 antihistamines are the ones that are in the nose for allergies and the H2 (the buttons by his stomach) those are H2 blockers.

So H2 blockers all end into -dine so famotidine is Pepcid and now Zantac it used to be ranitidine nice addedine is acid and cymetidine is Tagamet and ranitidine and Zantac but again there's a reason I put them in this order and the reason is that it's the ones that we prefer versus the ones that we don't and the reason we don't is because of side effects.

So cymetidine can interact with diazepam lidocaine phenytone propranolol warfarin can cause gynecomastia and then ranitidine; the problem with the NDMA had it pulled off the shelves. Proton pump inhibitors: It's -prizol ending and then you might see Omeprazole with S Omeprazole and Lansoprazole would duck Pantoprazole and wondering those look awfully the same what's different and we're really talking about either changing the rotation of plane polarized light or an enantiomer more of an organic chemistry thing but basically there's a mirror image and the active one is the one that became the new drug but you know just having the active one versus having the mix of the active and inactive doesn't necessarily make it better so a lot of times like Dexilant hasn't really taken over for Prevacid and Nexium maybe to some extent over Prilosec so be careful here because the prizol it's not Azul you go on the internet and you find these drug cars and they say oh if it ends in a Zoll it's a proton pump inhibitor that is false if it ends in prazole it might be a proton pump inhibitor but if it ends in conazole It's actually an antifungal so Fluconazole which is Diflucan, Voriconazole which is Vfend both of those are antifungals so it's not the azol ending then Aripiprazole which is Abilify and Brexpiprazole which is Rexulti uh those are antipsychotics so really rare to see a stem within a stem that the prizole is in piprazole uh the World Health Organization frowns on such thing and it's really rare but just be careful make sure that you know if you're looking at something you know is it de fungal with conazole is it an antipsychotic with piprazole or is it a proton pump inhibitor with prazole so gobs of side effects gobs is our mnemonic or gastroenteritis and you're going to reduce the acidity which is great for that ulcer but it also allows bacteria to have a chance to thrive osteoporosis B for B12 deficiency and S for secretion rebound so once you stop taking that proton pump inhibitor acid can rebound quite a bit so G-O-B-S is our mnemonic uh H pylori therapy there are many therapies I just put a couple examples of triple and quad therapy so triple therapy is going to be two antibiotics and one acid reducer so Amoxicillin, Clarithromycin, and Esomeprazole makes ACE A C E is the first letter of each of those drugs Amoxicillin, Chlor thermice in the antibiotics, Acetomeprazole the acid reducer or Amoxicillin, Metronidazole, and Omeprazole so Amoxicillin, Metronidazole or the antibiotics Omeprazole the acid reducer again we want to reduce resistance so we use lower doses of more drugs now we can make a quad therapy here where we actually use you know three antibiotics and one acid reducer so a Tetracycline like Doxycycline uh that's not the brand name it's a tetracycline so uh it should have really put Tetracycline kind of a Doxycycline and then put the brand names in the parentheses uh that's antibiotic Omeprazole for Prilosec is NASA reducer Metronidazole is Flagyl which is an antibiotic and Bismuth Salicylate when put in this situation has antimicrobial effects so I put TOMB as the mnemonic Tetracyclin T, Omeprazole O, Metronidazole M, B for Bismuth because once this group comes together it's curtains for H pylori so it would be buried in a tomb uh Misoprostol or Cytotec so if you think of it as Miso protect all from NSAIDs it's really what it does and I was just thinking of miso soup delicious uh but that's the thing I could think of but Misoprostol and it prevents NSAID induced ulcers but it also can be used as a medication absorb abortion labor induction cervical ripening it's a prostaglandin analog so we see The Prost in the Misoprostol and it is pregnancy category X if you're not trying to use it for any of the above indications you don't want to risk it with a patient and that's why it's fallen out of favor when you have a Here is the corrected text:

"Medication that could, you know, harm a fetus, you really try to find something different. I'm going to Cisapride or Propulsid. Again, we don't really see the brand names but see the soccer ball being propelled through the goal so gastroparesis is usually what the issue is so that kind of stomach that just will not empty so it empties much faster and it's a prokinetic. So Pro meaning toward and or you know kind of helping out and then kinetic like Kinesiology movement so it is for movement.

The problem is that some of its mechanism is dopamine antagonist so dopamine antagonist can result in extrapyramidal symptoms (EPS) and the problem with that is that if someone has Parkinson's and they have a dopamine deficiency, the last thing you want to do is block the dopamine they do have. So what we want to do is make sure to tell the patient about that EPS and possibilities that come along with it but rarely used medication Sucralfate or Carafate. It sugar coats the crater is how I remember it. It's a GERD add-on so physician might say okay well let's give you, you know, Prilosec for the month and we'll give you a couple weeks of the Sucralfate so that with each meal we're putting that coating down. It coats the ulcers in that kind of sugary coat. It can cause Bezoars which is really kind of like it's just a knotted ball of stuff. It can be broken up or surgically removed and then the big issue is this isn't an absolute contraindication but if you're a diabetic and you're taking four sugar pills a day just have to account for that in however you're reducing the sugar in your bloodstream and then it's four times a day before meals so again getting that sugar may not be the best thing. So if you can think of Sucralfate or Carafate as a kind of candy, you can remember the concerns about diabetes.

This information is provided for you for your informational purposes only and not intended to provide and should not be relied upon for medical or any other advice. I urge readers to consult with a medical professional with any medical condition. Thanks again for listening to the memorizing pharmacology podcast.

Like to learn more?

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College Online Pharmacology Course - Registration is Open Now

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

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

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Here is the link to the summer online course: https://www.dmacc.edu/programs/pdp/pre-pharmacy/Pages/online-pharmacology-class.aspx

and to the audiobook if you want to get a head start:

https://www.audible.com/pd/Memorizing-Pharmacology-Audiobook/B09JVBHRXK?source_code=AUDFPWS0223189MWT-BK-ACX0-281667&ref=acx_bty_BK_ACX0_281667_rh_us

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

Auto Generated Transcript:

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

Okay, welcome. This is a video showing how to register for the online pharmacology class and the books you'll need. Tuition, try to get everything in here, questions that everybody has. So first, if you want to find it just put in DMACC pharmacology or DMACC pharmacology class. DMACC stands for Des Moines Area Community College. It's a 10-week class and it is completely online. It is completely asynchronous so that means that you have deadlines each week.

You do not have to be in a video at any time or any specific time. Rather, you watch the videos, complete the exercises, and then you're graded on your submissions there and the discussions as well. Okay, so we do have a limitation of the number of students that can register for it but you would register here. So again, you put in DMACC pharmacology, it's going to bring you to this page and then you register. If you're not from DMACC, you just register as a guest student. It takes like a day total to get you registered and that just means that you're not planning on getting a degree from here, you're just signing up. And then if you are a DMACC student, you can just normally register for classes through that registration started for non-DMACC students on the 15th of March 2023.

To find out if the syllabus is something that's appropriate for you, you can also find the summer syllabus from last year here and the fall syllabus as well. It'll be the same books, same content this summer as it was last except for those things when I update something as far as maybe a change in a drug that's approved or something new and things like that. Tuition is not non-resident tuition if you are out of state rather it is the online tuition. It's a four credit course and we did that because a lot of schools that are maybe four-year schools want to see an extra credit if it's coming from a community college but again 208 dollars per credit hour seems reasonable. It's 178 in tuition plus thirty dollars in online support fee per credit hour so you can do the math on that times four but again it is a 10-week course.

This was when everybody was able to register for summer so March 15th, you register for summer if you're thinking about spring or fall it's taught every single semester. It's just in summer we have so much demand for it we actually open two sections usually in the summer but that's not always the case hopefully we will again open two sections okay.

The dates start on May 23rd of 2023 and end on August 3rd of 2023. You will get if you are trying to transfer this out a couple of days after that you will be able to transfer it and what you can do is you can just say hold my transcript for final grades and that will allow it to transfer to wherever it is that you need it to transfer to make up for if for example you had a bad spring and weren't able to pass pharmacology some colleges allow this some don't and again it's really up to your college to decide if that's going to be appropriate for them.

For those of you that are in maybe high school or are thinking about medicine or nursing or Pharmacy as a career or maybe and this happens quite a bit if you have pharmacology coming up in fall and you want to take pharmacology now so that when you get into fall with some colleges if you fail pharmacology you would have to repeat the entire year and by doing this with your hardest class it makes sense that okay well I'm just gonna give myself some insurance I've already taken the class learned the pharmacology language so that when I go into the class I'm well prepared for it.

I did this with biochemistry I knew that I would be taking biochemistry in pharmacy school in the first year I knew that was the very hardest class available and so I took it and then ended up actually auditing it for non-credit because that was what I was doing and I didn't really necessarily want to take the tests and all that but I did attend the courses at Maryland and it was super helpful to have already taken it. I've already gone through the Krebs cycle, I've already gone through those things. So whether you're taking it and these are the biggest three reasons people take it: they either take it because they did not pass a pharmacology course and their college does not offer one in the summer or spring or fall or whenever it is. Two, if they're getting into PA school or they are getting into another type of program that requires pharmacology. Three, they are a student that is interested in the Health Professions, has a little bit of an opening in a class that they want that's relevant, that's going to help them in their next phase and this can be nursing or Pharmacy or medicine but many different people you'll have in the pharmacology class. But again, the fact that it's only 10 weeks and that is completely asynchronous is helpful to a lot of people.

So just with the course syllabus, just let you know, the CRNs are not what they are for this time but I'll just kind of go through the big pieces at the end here. These are the things that we're going to go over and again it's in the syllabus that you can download but this is the course schedule and again it's over 10 weeks. We're going to use three books and I'll show you those and give you the rationale for using each of them. These due dates obviously will be updated for 2023.

Okay, the first one is an open educational resource nursing pharmacology. Unfortunately, it was used for a two credit course so not enough of a book to completely cover everything that we need but because so many of our students are nursing, it was important that we use a nursing book as part of it so that these case studies relate to the nursing profession. Then, the pieces you know, the other credits that we need we use Pharmacology Made Simple and I wrote this book for Elsevier because what we wanted was a book that really makes things quite straightforward but the other big deal is that you can rent it for fifteen dollars for the semester usually around there fifteen to twenty dollars. And so, the OER book is free if you get the eBook and don't buy the print book. This one was fifteen dollars to rent.

And then one thing that I find is a real concern is students can't pronounce the names of the medications or if you're taking a course that's online and it's something like this where you really want to know the medication names an audiobook is an option for this one. You can get the paperback, you can get the audiobook and get the Kindle because I'm on my own Amazon you can't see it but the audiobook actually is free if you become a member of Audible. So if you decide to do that you can.

And then I think that was it yeah so again, the way to sign up for the online course is to go to that original page just put in pharmacology DMACC in a Google search, you'll get to this page whether you're a guest student or somebody who's trying to transfer in. It's a reasonable course to take over summer to kind of either get it out of the way to fix something that happened or again to just get that extra step ahead so that when you come in to take pharmacology at your own College, it is so much easier because you are helping other people rather than being lost in the weeds.

So if you've got questions there's my link to my email a-a-g-u-e-r-r-a at dmacc.edu. If you call me and leave a message it will actually email me that message so if that's the way you prefer to contact me as well that's fine but I'm happy to answer any questions about PHR185 Pharmacology completely asynchronous and online course that's 10 weeks this summer at Des Moines Area Community College.

Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes cheat sheets and more at memorizingfarm.com. Again, you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com/P/mobile. Thanks again for listening.

Like to learn more?

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

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

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

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

B Vitamin Pharmacology Mnemonics

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

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

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

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

B vitamins can be hard to remember with skipped numbers and names for each B vitamin. In this video, I go over some ways to help you remember.

Auto Generated Transcript:

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

Alright, today we're going to go over B vitamin mnemonics. So here we go. First thing of course is that we have water-soluble vitamins versus fat-soluble vitamins. B vitamins are water-soluble as are C vitamins. So here are the names and the trick is how do you remember the number with the name? So B1 is thiamin, B2 is riboflavin, B3 is niacin, B5 is pantothenic acid. Notice there's a skip between three and five, there is no four. B6 is pyridoxine, B7 is biotin, B9 is folic acid, and B12 it's cobalamin.

So let's kind of move on to the next and what we'll do is we'll divide this into thirds. First we'll take a look at thiamin, riboflavin, and niacin. So the way we're going to do this is we're going to go from the bottom up. So we're going to say that B1 is thiamin looking at this skeleton's thigh, riboflavin is rib so 'thi' from thigh, 'rib' from riboflavin and then if you pronounce it I thought it was an Australian accent but it actually comes out more of a South African accent if you say 'Nick' rather than 'neck' you can get the 'Nic' that's in niacin.

So again it's the thigh, the rib and the 'Nic'. So by the rib and the neck reminds you the B1, B2 and B3 going from the bottom up are thiamine, riboflavin and niacin.

The next three and we'll get a little crazy with the picture here but we're going to have pantothenic acid so pants uh and I have no idea why there was this skeleton with the jeans but it was available for purchase so I was able to get the picture. Pyridoxine think of a pyramid so upside down pyramid the way the rib cage kind of comes down right you guys are old enough to remember Mork and Mindy yeah that was the kind of symbol on the front of Mork uh and then biotin uh the tin hat uh on top of the skeleton.

So we have B5 is pantothenic acid with pants, B6 is pyridoxine but the pyramid upside down and then biotin is the tin hat okay.

The last two we'll use just a forest and a beautiful blue sky so forest for folic acid that's B9 and then B12 is cobalamin with the cobalt sky. I know this isn't exactly Cobalt it's not exactly that blue it's actually kind of a green but just roll with me here forest and cobalt sky folate and cobalamin are B9 and b12.

So let's dive into what they're good for three at a time so first B1 or thiamin this converts carbs to glucose prevents Wernicke's encephalopathy in alcoholism or liver disease so a little picture of a beer there and some cirrhotic liver.

B2 is riboflavin deficiency due to alcoholism vegan vegetarian lifestyle malabsorption just can't absorb it or lactose intolerance.

And then B3 niacin is great for high triglycerides where we're really trying to stabilize that plaque as an add-on for statins where the statins maybe they get the LDL down but just not the triglycerides where you want to be so you can avoid pancreatitis and you would need maybe to give an aspirin 30 minutes before to avoid that flushing effect okay all right let's move on to the next.

So B5 pantothenic acid it synthesizes coenzyme A for fatty acid metabolism and you can think of the A in acid and the word acid for coenzyme A and fatty acid metabolism.

B6 pyridoxine this is for alcoholism and peripheral neuropathy from isoniazid. Isoniazid is one of those drugs for TB okay so again the ripe mnemonic when you have a TB in duration that's ripe okay so Rifampin isoniazid uh and so forth okay so.

The XYZ mnemonic is to take the X and Y from pyridoxine and match it up to Z in ice niazid okay and that peripheral neuropathy is really this picture we have this exclamation point and somebody's really having trouble feeling their fingers uh so fingers and toes That uh, a lot of times for that peripheral neuropathy shows up, it may show up as not being able to button a shirt as well. So it doesn't necessarily show up as pain, it's just can't always just really use your fingers as you'd like to. Biotin that helps enzymes break down carbs, fats and proteins but really skin and hair is where we see it in beauty products especially. So the 'in' from Biotin for skin and then the hair again. I just got a picture of someone who's an athlete, good hair, good skin.

B9 is folate. This is where we want to prevent those neural tube defects and think of the F in folate and F in defects. Deficiency is a reduced hemoglobin level and really B9 is critical for red blood cell production. To be honest, you need B9, iron and B12 and if you think of a nine iron if you know golf a little bit, a nine iron being used on the 12th hole you can put the nine, the iron and the 12 all together. And there's a very famous shot on the 18th hole that where someone just yelled out 'be right' and the B from 'be right' is just you know, be right, be the right shot.

And so here again we're using that B so B9 iron on the B12 hole um hopefully that helps you remember that iron B9 and b12 need to go together to really form those red blood cells properly.

B12 is cobalamin so it's for macrocytic not microcytic and pernicious anemia so the 'ma' in cobalamin for macrocytic, the 'ni' in cobalamin for pernicious anemia and then a lot of the letters from anemia are in cobalamin so if you're somebody that can kind of do those word scrambles I think that's helpful.

A lot of those people that have gastric bypass surgery you think oh my gosh that's so great they you know they don't aren't hungry and things like that but really it does cause a lot of problems in terms of B12 um uh Celiac and Crohn's disease these are two issues that would definitely necessitate adding some B12.

And then deficiency again just like with B9 and folate I will D equal reduced hemoglobin level for red blood cell production so again both of these really work in tandem to help you know those red blood cells properly form.

And then this was supposed to be uh the nine iron and the golf course and all of that but it turned out to be just grass and sky but think of a nine iron on the 12th hole and uh I think it'll be a lot easier to remember.

Again this is for informational purposes only it is not medical advice so if you've got a medical condition consult a medical professional. Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes, cheat sheets, and more at memorizingfarm.com. Again, you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com/P/mobile. Thanks again for listening.

Like to learn more?

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

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

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

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

Poisons and Antidotes Pharmacology Mnemonics

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

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

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

Another kind of niche topic is antidotes and poisons where you are expected to know which matches which. In this video, I give you some ways to better pair them together.

Auto Generated Transcript:

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

Hey, and we're going to okay welcome to Poisons and Antidotes Pharmacology Mnemonics. What I'm really doing here is just um, I kind of always have to find some way to put things in an order and when you talk about poisons and antidotes it's really by definition is just matching. So how do you match things up? So what I did was I put them in alphabetical order first. So I took a number of poisons or drugs that you can overdose on and five of them happen to start with A.

Then a couple started with B, C, D then E then H and then I finished up with O, P, P, S, and W. And so when we talk about these poisons and antidotes it's really about just keeping them straight in your head and then making a small connection uh to try to help you remember which medication or which uh poison ends up with which antidote.

So let's start with the A's. First of all, acetaminophen's antidote is acetylcysteine so you can use the 'acete' in the very beginning of both of those. Alprazolam and diazepam have Flumazenil as their antidote so the A's in Alprazolam the A's and azepam and more generally the stems azolamine azepam for all the benzodiazepines uh flumesonil is the antidote there.

Anthrax you can if you think of a mirror as Anthrax is the poison and ciprofloxacin is the antidote well if you put a mirror in front of this ax turns around x a so just think of this be xing out Anthrax or something like that okay amitriptyline and aspirin have the same antidote it's both sodium bicarb and the nice thing is that both of them start with an A so A for amitriptyline goes with the B and C for bicarb so ABC a and aspirin goes with the B and C for bicarb so ABC again.

So once you get these first five down then you can kind of move on to the next one we're going to use a couple different letters to kind of move along with those so we're going to go B, C, D, E, H it didn't quite work out the way I wanted but again uh you know we're just trying to get some kind of order so that when we look at the um antidotes it works out.

So beta blockers and calcium channel blockers both use glucagon as a way to have an antidote and a couple of things I was thinking about here when you have a beta blocker it masks the signs and symptoms of hypoglycemia that normal increased heart rate and things like that it tends to be gone so glucagon is something that you use when the glucose is gone.

And if you think of beta blockers masking hypoglycemia maybe it'll all kind of stick in your head and then glucagon again especially with non-dihydropyridines that are going to affect the heart much like beta blockers do we try not to use beta blockers and non-dihydropyridine pyridine calcium channel blockers together maybe that helps you as well um digoxin and digibind.

I think that that really helps that you know first three letters are the exact same but digibind or Jackson immune Fab that tends to be one most people can remember ethylene glycol is a poison well it's not it's a poison if you try to ingest it and from episode uh which is an ADH antagonist those are an E and F okay so we're going B, C, D, D, E, F.

And then Heparin and protamine you might not see this but it's kind of a word scramble if you take the e p a r i n from Heparin you can find e p a r i n in protamine so just a way to connect them and hopefully kind of burn these into your brain uh.

The last five I was going to go over are two that also have the same antidote organophosphates which maybe we do or don't think about it as cholinergic and it would be atropine which is the Anticholinergic drug right, if isostigmine which is also cholinergic. Well, it's an acetylcholinesterase inhibitor which keeps that acetylcholine from being broken down so it is in effect cholinergic. Atropine again is anticholinergic, works against it. Potassium, you think about K Plus on the periodic table of elements, what's right next to potassium? Well, it's Buddy calcium CA plus plus and they both have that hard k sound in the beginning to maybe help you put those together. But the calcium or calium that the K represents which is potassium and then the calcium CA gluconate that you would use for that.

Serotonin syndrome and although I heard it called cyproheptadine, you can call it cyproheptadine to make it easier. Serotonin syndrome and ciproheptadine to use an S sound to connect those and then Warfarin and vitamin K. And if you think of killing happening in warfare, that's one way to remember vitamin K goes with Warfarin as an antidote.

So again, this is very much an educational video meant to help you just remember many of the poisons and overdose and antidotes but if something does happen make sure to call your poison control center. As always this is for informational purposes only, it is not medical advice. If you have a medical question contact a medical professional.

Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes, cheat sheets, and more at memorizingfarm.com. Again, you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com/P/mobile. Thanks again for listening.

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Eye and Ear Pharmacology Mnemonics in 5 minutes

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A lot of time, eyes and ears get short shrift, but there are a lot of medications that you can readily remember with a few suffixes in this group.

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

Hey, welcome to the Memorizing Pharmacology podcast. Today we're going to go over eye and ear infection pharmacology and some mnemonics that can help you. Let's get started here with what is maybe better known as swimmer's ear but external ear infection. So when you have an infection on the outer ear then it actually makes sense to just use drops and put something on it. So you can use something that would be an antibiotic that would take care of the infection but also there's going to be some inflammation so we'll use some kind of steroid.

So the medication that we can use is something like Ciprodex which is a combination of ciprofloxacin and the floxacin ending tells us it's a fluoroquinolone antibiotic. The FL is for fluoro and then the oxygen is for quinolone and then the dexamethasone, we've seen that sewn ending before, that's a steroid for inflammation. Now you do it a little bit differently for a child versus an adult. A child, you'll put the head horizontally, pull the earlobe down and then apply the drops. So the word child ends in d and then use that for d for down whereas an adult has a u in it and we go adult up.

So the head will be again horizontal, we pull the earlobe up and we apply the drop. So child down, adult up. When you have a middle ear infection, the drops aren't going to be able to get to that infection so we need an oral medication. And I remember my daughter had the tubes put in and a physician said okay well you know what this is our week meeting we'll give her amoxicillin like well she's already been on amoxicillin for a whole week. It's like oh all right well what that means is that it is a beta lactamase producing bacteria that is resistant to Amoxicillin.

So beta lactamase is an enzyme that the bacteria secretes and it destroys the beta-lactam ring and makes it ineffective in penicillin. So just to be clear, the amoxicillin didn't work for a week, my daughter still had an infection in her ear and it was because the bacteria made an enzyme that basically broke the amoxicillin ring. So we switched to something a little bit different so we cross off amoxicillin and include amoxicillin with something called clavulanate.

So Augmentin is just that something that augments amoxicillin by itself and what clavulanate does is it kind of has the bacteria attack it instead of the amoxicillin allowing the amoxicillin to do its job. You can do some work with cephalosporins again cephalosporins tend to begin with CEF or ceph so cephachlor which is seclor and cephyroxine which is sinus F those are both second generation or you might see suffixine which is suprax that's third generation.

So what we're really doing with this middle ear infection is it's a resistant infection we're going to give what's quotation figures a stronger antibiotic now why don't you want to give clavulanate why don't you just give that in the first place well you want to reserve it for resistant infections but also it tends to cause a lot of GI upset unlike amoxicillin by itself.

Let's move on to the eyes. There's really three big conjunctivitises that you have to deal with. There's the allergic where we kind of put in an eye drop antihistamine is usually a good way to do it. Something viral, we might have to take an oral medication like oral acyclovir or if it's bacterial, we have lots and lots of eye drop antibiotics. Fluoroquinolones like we talked about with the ear, Amino glycosides Gentamicin Tobramycin, macrolides like erythromycin and then others will see the kind of neomycin type of thing.

Alright, well let's start with the allergy eye drops, the antihistamines. There's just a number of them and there's not really as good a stem as this although if you're familiar with Loratadine which is Claritin, you notice olopatadine which is Pat a day then open which looks a lot like ketoprofen which is a non-steroidal but that's zaditor and then pheneramine. You may remember the chloropheneramine which is color trimeton from a long time ago that was also an antihistamine which is Opticon A or part of afcon A.

So again, if the patient has allergy eyes we're going to try to put an antihistamine drop in there. Usually there's some water, some redness that's how allergic conjunctivitis presents. We talk about bacterial conjunctivitis, you're going to get some crud as it were and you're going to have eye drops and ointments available. You can use the fluoroquinolones again that's the floxacin stem ciprofloxacin levofloxacin, aminoglycosides Tobramycin Gentamicin, the macrolides erythromycin and azithromycin.

So again be careful with that mycin stem, a lot of drugs end in mycin and it just means that the streptomyces bacteria was used to actually make the antibacterial and then the other is like neomycin polymixon B and Bacitracin or polymixon B and trimethoprim. So lots and lots of options when it comes to bacterial conjunctivitis. Viral conjunctivitis actually usually clears up in a week or two maybe three weeks at worst. You'll probably use an oral medication like oral acyclovir if that's something we're going to use.

Well let's talk about actually instilling the drop itself so you want to tilt the head back while looking up that's the first thing and this is kind of a natural thing you kind of look up to the sky you tend not to look down you're going to pull the lower eyelid down and away foreign drops into that pocket then this is kind of the key is that you're going to and you'll probably do this automatically you'll close the eye okay to get those drops in there so kind of four steps here tilt your head back while looking up pull the lower eyelid down and away squeeze the drops into the pocket and then close the eye.

Again this information is informational only if you have a medical condition contact a medical professional. Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes cheat sheets and more at memorizingfarm.com. Again you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com/P/mobile. Thanks again for listening.

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Glaucoma Pharmacology Mnemonics in 10 minutes

Glaucoma is one of those topics that you see a lot of contraindications with, but not necessarily a good explanation of the pathophysiology. I do a 10-minute run down of the most important aspects of glaucoma with a few mnemonics to help out.

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Auto Generated Transcript:

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

Alright, welcome to the Memorizing Pharmacology podcast. Tony Guerra, we're going to do glaucoma pharmacology mnemonics and talk a little bit about the eye. So let's get started here. So the first thing is what are we really doing with these treatments? The first thing we're doing is we're either decreasing aqueous humor out or we are increasing aqueous humor outflow. So we're actually decreasing the amount of the fluid or we're helping it get out of there and the big issue is that usually this drainage canal is going to be blocked and it's just too much fluid in there and that increases pressure. Increased pressure creates damage to the optic nerve.

So let's start with acute angle closure glaucoma. So there's the two types: there's open angle where we see it wide open here just before the cornea and then there's closed angle where it's a bit sharper in the angle here and the real issue is some form of mydriasis so pupillary dilation and that might be that someone put in eye drops so atropine, epinephrine drops which are an anticholinergic or an adrenergic agonist respectively. So atropine is an anticholinergic, epinephrine is an adrenergic agonist that open the eye really wide.

If you go into a dark room what happens to your eye? Well your eye goes really wide so got our anticholinergic Bud cat here with this really wide open eyes and then excitement and stress. So if there's some kind of something that makes your fight or flight open up and your body's epinephrine going then your eyes open up wide there maybe is a crisis. So not only is the crisis causing the excitement and stress but this is an emergency so this acute angle closure glaucoma is something that needs to be treated right away. We'll talk about some treatments in a bit.

So let's talk about or contrast that with open angle glaucoma. So open angle glaucoma is where this angle is still wide open so not an emergency this is going to be something that's a lot slower. So what's happening here is the fluid can't get out okay so it's just this decrease of aqueous humor outflow and because of that outflow is not happening we have an open ankle glaucoma so it's much slower than the acute angle closure.

And causes could be family history, age, ancestry, myopia or you're nearsighted or elevated intraocular pressure so the FAME mnemonic: F for family history, A for age ancestry, M for myopia and then E for elevated intraocular pressure but again a much slower thing.

And when we talk about what happens you know what you would expect I was just thinking of the DC Metro and anyone that's ridden the DC Metro can knows this kind of tunnel that it's just iconic these concrete tunnels and you can't help but look down the line and you can't really see what's going on in the left you can't really see what's going on on the right.

So not only do you have this kind of tunnel vision but it's really a synonym for losing that peripheral vision so if you're a glass half full person you know you have tunnel vision you can still see what's in the middle if you're a glass half empty person you can't see to the sides so just peripheral vision tunnel loss of peripheral vision tunnel vision those are synonyms really.

Well let's use this ABCD and two P's glaucoma stems as a way to memorize which medications work how. So first we could decrease aqueous humor production: You can use an alpha agonist like brimonidine and this works both to decrease aqueous production or increase aqueous outflow beta blockers like timolol also decrease aqueous humor.

Carbonic anhydrase inhibitors so dorzolamide or dorzolamide really acetazolamide this IV dorzolamide is the eye drop and then a diuretic like mannitol it's a little more complicated but it made the ABCD mnemonic work but mannitol as well.

So when you talk about increasing outflow we think of two P's so you've got cholinergic pilocarpine again sludge cat was our cholinergic cat and then prostaglandin and that's what PG is for and then F2 alpha that's the receptor so the pH GF2 Alpha analogs, so Latina Pros, there are some other ones but you can see the Prost ending that helps you with that one. So again, the endings on these really help you distinguish Alpha Agonist versus beta blocker versus Carbonic anhydrase inhibitor versus maybe a prostaglandin analog. Alright, so getting into the much bigger ones and we're really just going to focus on the indication, the mechanism, and the adverse effect. The alpha Agonist promonidine, that's you know it's open angle glaucoma and that's kind of a thing to take home which is some of these are for open angle, some are foreclosed, some are for both. This mechanism is to decrease aqueous humor and increase aqueous humor outflow so it'll do both but you really have to watch for hypertension and then fatigue. What really might help you with this is that clonidine has those issues in clonidine is that one that kind of stopped the faucet of norepinephrine and if you look at the endings, the CL of clonidine and the brim of bromonidine they're really really close together.

Okay, the beta blocker timolol, okay so open angle or acute closed angle glaucoma. Let me get my head out of the way so it's not blocking the slide. It decreases aqueous humor by blocking beta receptors as it sounds and a lot of times you can use the drug class as the mechanism and then bradycardia is really what we're worried about again this stimul can get into the systemic system C so Carbonic anhydrous inhibitor dorsolamid which is the trusop or the IV acetozolomide either of those can help with our open angle glaucoma or acute closed angle glaucoma. It decreases that aqueous humor by inhibiting Carbonic anhydrase and again so many times the mechanism and the drug class are the same but watch out you can get quite a bit of blurry vision.

Our diuretic Mannitol or osmetrol, I don't want to go into kind of the weeds on this one but it it's really an emergency drug. The acute closed angle glaucoma, it decreases aqueous humor through a bit of a complex process and with Mannitol because it is such a potent diuretic so close to the glomerulus where where it works in that proximal convoluted tubule hypovolemia is a real concern.

Okay, the two P's okay so the first p is cholinergic so pilocarpine or pilocar that's closed angle glaucoma and it works by contrasting Contracting so ciliary contraction to increase the outflow of aqueous humor kind of squeezes it out through the canal slim and we want to think about the adverse effects as our sludge cat here so those are supposed to be pinpoint pupils. I know cats don't really have pinpoint pupils the way humans do but think of sludge B so that salivation, bradycardia but pinpoint pupil pilocarpine and I'll say that 10 times fast that might be an easier way. Pinpoint pupil pilocarpine pinpoint pupil pilocarpine easier way to remember this is the one that's going to help with that closed angle glaucoma by really narrowing the pupil and ciliary contraction.

Our second P P2 is a prostaglandin analog so it's going to mimic that effect so latinoprost or xeletan. The indication is open angle glaucoma increases outflow of aqueous humor by mimicking taking the prostaglandin effect is an analog and then it has this weird pigmentation of the iris or lashes but again now we're probably not going to use it unilaterally because that would make one eye a different color than the other one but again maybe just a little image here to help you out.

Okay, so again this is for informational purposes only it is not medical advice so if you have a medical condition consult a medical professional. Thanks for listening to the memorizing pharmacology podcast you can find episodes cheat sheets and more at memorizingfarm.com again you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile thanks again for listening thank you.

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

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

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

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

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Antiarrhythmics are usually more of a "can you figure out which class this drug is in" and I give you a number of mnemonics to put the right drug in the right place.

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

Alright, we're going to go into antiarrhythmics or antidysrhythmics is really more correct pharmacology mnemonics and the first step is really to see where these are. You're going to hear class one usually with Roman numerals rather than these kind of numbers but class 1 sodium channel blockers. Class 2 is the beta blocker, class 3 are potassium channel blockers, class 4 calcium channel blockers and class 5 are kind of the unknown or extras. Beta blockers and calcium channel blockers may be familiar from hypertension drugs but these other ones might be a little bit new.

So there's Vaughn Williams which is how we kind of classify these and usually your questions are going to be in some way you have to know what the sodium channel blockers are or which ones are potassium channel blockers. So we're going to do a couple of mnemonics to just kind of get you knowing what's what and then we'll go from there.

So, I made up a little story: NAB money in Kansas City, police are mad. A way to remember that number one is NA which is it's actually for natrium but it's sodium so sodium channel blockers and then the B in NAB and you can put two B's here to make it more clear that it's going to be beta blockers. And then Kansas City represents three and four which are going to be potassium which is calcium or calium that's the K and then CA are the calcium from calcium channel blockers so NAB KC and then mad. The others that are kind of in this fifth group are magnesium, adenosine, and digoxin.

That's kind of one way to do it. Another way is to maybe make a sentence like some block Kings and castles with mad moves. So the sum is for sodium okay and that would be NA plus block would be for beta blockers. K would be for potassium and kings CA from castles would be calcium channel blockers and then mad moves. The Mad represents the Magnesium, adenosine, and digoxin.

I've got a little picture here of a king and a Castle in chess okay so two different ways to remember those but some students have to remember like all of them like a lot of the drugs within the classes so the class ones actually divided up into class one A, one B, and one C.

Traditional way to remember this is Double Quarter Pounder with lettuce tomato mayo and more fries please so class 1A is disopyramide, quinidine, procainamide that's the Double Quarter Pounder. The lettuce tomato Mayo is class 1B lidocaine, mexiletine, tocainide and then class 1C more fries please is moricizine, flecainide, propafenone.

So if you have to remember all of those then hopefully this is helpful and then we kind of add the other ones so a beta blocker. The nice thing is that the endings are the same so it's like bisoprolol, atenolol, metoprolol ending with the OLOL. I just put the three Bam Bam for bisoprolol atenolol metoprolol you can think of Class 2 because they are they are you know have two B's in beta blocker to remind you that's class two.

Class three is potassium blockers: The sad poets so sad is for sotalol amiodarone dofetilide and The Poets is for potassium to remember that one, class four is the calcium channel blockers with four very dill pickles. So it's class four and the Very Dill stands for verapamil and diltiazem. Okay, and then the class five, the Mad group is magnesium, adenosine, and digoxin. So if you have to remember all of them, this is a way to do it. So we can do a little quiz here, make sure that you've got this down. So on the left I have sodium, beta blockers, potassium, calcium channel blockers, and then the unknown. And then adenosine, procainamide, metoprolol, diltiazem and amiodarone are not in the right order.

So how do we get the right order? Well we think about our mnemonics here and our sodium again it's going to be that Double Quarter Pounder so the P from procainamide. The beta blockers end in OLOL so that's group two and again two B's to remind you it's group two. The potassium is going to be that sad poet and the A in sad poet is amiodarone. Then our four very dill pickles are the diltiazem and the verapamil that's four. And then the Mad group is adenosine so that magnesium adenosine digoxin that's in our fifth group.

And so it would look like this if the answers are correct. Okay so let's just take a look at some of the characteristics of some of these. So for example if you've got group 1A procainamide this is the P in the Double Quarter Pounder it's good for atrial fib supraventricular tachycardia vtac it's really chemical cardioversion our mechanism is sodium and hypotension is really the big one here can cause a wide QRS but if we have hypotension as an adverse effect we probably don't want to give it to a hypotensive patient then congestive heart failure second third degree heart block all of these would be contraindications.

And then what are we going to do? Well we'll make sure to watch their labs and then an ECG would also be important as well so that's procainamide. Get to amiodarone now we're talking about ventricular fibrillation rather than atrial fibrillation resistant v-tac you can give it for atrial and ventricular dysrhythmias but that's probably where you would put it potassium is our mechanism again this is group three we kind of skipped over the beta blockers.

And there's a number of things that you're going to have with adverse effects you really want to tell the patient about first the hypotension so just get that blood pressure just kind of dropping blue facial hue I couldn't use the Blue Man Group because those guys are actually a thing so I just found this picture of and I thought it was clever that they're kind of pacing and waiting in line and they've got blue faces and well blue bodies too and then vision changes.

So while it's kind of tough to say well what does vision change look like having this rainbow iris just kind of reminds you that vision changes so hypotension blue facial hue and vision changes bradycardia and shock are really contraindications for this one. And then what do we want to monitor? We want to make sure to put cardiac monitor on and modified valsalva maneuver has just proven to be a bit better.

And then the Valsalva if you aren't familiar with it it's where you kind of plug your nose to pop your ears alright so again this is informational purposes only it's not medical advice if you have a medical condition contact a medical professional.

Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes cheat sheets and more at memorizingpharm.com. Again you can sign up for the email list at memorizingpharm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com/P/mobile. Thanks again for listening.

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ABCD Antihypertensive Mnemonics ACEIs ARBs Beta and Calcium Channel Blockers Diuretics

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Hypertension treatments are really about a few drug classes: ACEIs and ARBs, Beta Blockers, Calcium Channel Blockers, Diuretics, and a few more. This episode has a few mnemonics and a focus on prefixes and suffixes that will help you remember them.

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

Let's get started with the show. I'm going to go over anti-hypertensives in a way that hopefully makes a bit of sense. It's actually easier to compare them side by side with a bunch of these and I'll get into that, but let's start with what the ABCD of hypertension really is. Okay, so it's just talking about the drug classes: ACE, ARBs, the Alpha One blockers, the beta blockers, calcium channel blockers, and diuretics. Let's start with A, B, C, and D and there's going to be some oddball ones that I'll talk about at the end.

The alpha agonists like clonidine, methyl dopa, the dilators that will peripheral vasodilators hydralazine nitropresside and then the direct reading inhibitor Alice Kirin but these are going to be the kind of heart and soul of our anti-hypertensive therapy and what you'll notice is that stems go really well with these. So when I say stems I mean the endings these in these cases they are all suffixes but for Angiotensin converting enzyme Inhibitors it's pril as in lisinopril.

Angiotensin II receptor blockers it's sartan. The Alpha One blocker is as a sin be careful I've seen zosin a lot it's azosin but again that'll get you there too which is a little bit different than tamsulosin we'll talk about the differences in a minute. Beta blockers again be careful first and second Generations have the same stem of olol and that third generation will have something that kind of indicates there is an alpha blocking component uh the alol with labetalol or the dilol for dilation with Carvedilol.

Calcium channel blockers we divide them into dihydropyridines like nifedipine or non-dihydropyridines which are diltiazem and Verapamil. Then the diuretics really furosemide is not for hypertension in general really it's Hydrochlorothiazide that's first line and then the potassium sparing diuretics but Hydrochlorothiazide is definitely preferred.

So when we talk about being able to recognize them that's kind of the first thing you want to be able to do is make sure that as you look at these endings you can recognize all these but what we'll do is we'll kind of cut it down so that makes a little bit easier. I know this seems a little bit busy but soon enough you'll be able to get all of these.

Okay alright well let's just look at what first line is first line are the Angiotensin converting enzyme Inhibitors like lisinopril and the ARBs like losartan. Calcium channel blockers like nifedipine, diltiazem, Verapamil though calcium channel blockers are first line in African Americans because of poor outcomes with ACE inhibitors. Then diuretics Hydrochlorothiazide is certainly first line.

So let's take a look at the renin Angiotensin aldosterone system some people call it renin or the RAS system. The big thing is recognizing what happens here in this pathway and we'll put three of the drugs in here so lisinopril that works here at ACE where Angiotensin one cannot become Angiotensin II if you block this enzyme why does that matter well Angiotensin II is a potent vasoconstrictor and it also acts to release aldosterone which would normally hold on to salt and water so if you block Angiotensin II you vasodilate instead of vasoconstrict and you don't stimulate these release of aldosterone so you're not holding on to salt and water okay increasing blood pressure so the ultimate thing that happens is that you decrease blood pressure okay.

And this happens with lisinopril by blocking this enzyme here or with Losartan which is an Angiotensin II receptor blocker I'm actually blocking the enzyme itself okay or The receptors on the enzyme and then Alice Kiran that blocks renin directly right at the beginning but for whatever reason the outcomes were not what we wanted so this is definitely not a first line drug but the first thing is recognize the medications by their stems recognize they have different mechanisms of action within the RAS system and then we'll combine them to look at them side by side so what I do is I take the one that has something more and put it on the left and I have something that has something less and put it on the right.

So, with the ACEs and ARBs, when we go through our eye match mnemonic, we see that I have similar indications: hypertension, congestive heart failure, MI. But when we get to the adverse effects, we see that really the taste, some irritation of the throat, the cough, that's really Angiotensin converting enzyme inhibitors, not really so much Angiotensin II receptor blockers. So when you get there, you're like okay well let me cross that one off on the right and so I'm just remembering one set of things and then one difference. And we'll see that this happens over and over again with our ABCD.

So Angiotensin converting enzyme inhibitors, that's the one that causes that taste, the throat, the cough and it sure it causes angioedema, it causes hyperkalemia. But we switch to an ARB because it doesn't have that issue with taste, the irritation of the throat, the cough and those things. So understanding how those work side by side is critical.

Okay when you look at contraindications which you would think if you have other potassium sparing medications like spironolactone diuretic or pregnancy certainly a contraindication as well that's out. And then really it's just letting the patient know hey you know if you get this dry cough don't try to treat it let us know we can give you something that won't cause that and then maybe talking about the foods and other things that might add to the hyperkalemia.

Alpha blockers we talked about before and we'll just kind of go through the three parts of it where in the beginning we talked about the stem, the azosin stem of prazosin doxazosin terazosin all very similar. And we used the prazosin mnemonic using the word prazosin to remind ourselves of the three indications: prazosin - the pr for prostate or BPH; raz to remind us is for Raynaud's which is when your fingers are really cold or your toes are really cold because just not enough blood getting to them; and then hypertension. And we looked at the last s-i-n for that and it does this by relaxing the bladder neck for prostate and by causing vasodilation for Raynaud's and hypertension.

But the adverse effects come from that vasodilation so I have a picture here of somebody who's kind of a little bit shaky that's getting that maybe first dose effect where first time they took it they didn't realize they were supposed to take it right before bed so they don't fall down. I really feel that reflex tachycardia or orthostatic hypotension or first dose syncope or first dose phenomenon but again big mechanism of action here is that vasodilation.

Okay and then you put them side by side and you see that prazosin is actually second line for hypertension because of that adverse effect that they might just drop so we don't want to give something like that so BPH right now it's hypertension those are certainly indications but when you look over on the other side and take something like tamsulosin or alfuzosin that are really only for BPH it's first line for that condition because it's really not going to cause that kind of first dose syncope phenomenon hypotension all that stuff to the same extent.

So what we do is we take the mechanism and we say okay we're going to have the same Alpha One bladder smooth muscle and vasodilation of blood vessels and maybe we darken out that vasodilation of blood vessels to make clear that we're really being a lot more selective okay in both cases. The elderly is a concern coronary artery disease certainly and then we want our patients to be slow to get from sitting to standing okay.

Beta blocker stems we talked about how the first generation affects beta 1 beta 2 again you have one heart so it affects the heart reduces heart rate but also it affects the lungs it may cause some degree of bronchoconstriction. And so Propranolol is a concern with asthmatic but with the second generation it was beta one specific and we have our bam mnemonic where bisoprolol Atenolol metoprolol these are three of those drugs that are in the second generation.

And then third generation was our Carvedilol and our labetalol which are also non-selective but not in the same way as Propranolol because they also have Alpha One activity so that allows for vasodilation okay because what the body is going to do is as soon as it sees heart rates going down it's gonna try to vasoconstrict because it wants to get heart rate back or blood pressure back up. And so Alpha One blocking takes care of that by causing vasodilation again. The dil or dial is in that stem so when you compare them side by side first versus second you see very similar in terms of what they do.

Hypertension, migraine, and China atrial fibrillation again, beta blockers are an antiarrhythmic. Okay, but again the mechanism is that we block beta 1 and beta 2 receptors so our adverse effect with beta 1 would be bradycardia. Our adverse effect with beta 2 would be bronchoconstriction. Okay, and so we take that bronchoconstriction one and beta 2 away when we get to the second generation. Now again we can cause bradycardia, heart block have are bradycardia, heart block are certainly contraindications but also asthma with first generation not so with second generation. And then they all really do mask those signs and symptoms of hypoglycemia so we want to be careful with our diabetics.

Get to the calcium channel blockers, the C in our ABCD mnemonic here we really need to separate the dihydropyridines from the non-dihydropyridine. So the non-dihydropyridines affect both vasodilation and the heart so diltiazem which is Cardizem and Verapamil which is Calan versus dihydropyridine which is dilation only so the dipine the dilation only the nifedipine or Procardia XL all these D's try to use that to remember that this is just affecting the artery it is not affecting the heart as an antiarrhythmic.

Okay, and so when you put them side by side you would put the non-dihydropyridines here and what you want to do is show that okay hypertension angina they're both good for that but these two are good for atrial fib because it does affect the heart nifedipine is not they both block calcium channels in the smooth muscle but still diltiazem of rap milk are going to have decreased contractility and heart rate both will cause hypotension peripheral edema and constipation but here bradycardia is the issue and here reflex tachycardia is the issue.

So again that vasodilation, the body's not happy with that and it's going to cause the heart sometimes to increase the heart rate which may seem counterintuitive. Again watching out for the elderly and grapefruit juice can be an issue with both of these.

Okay, we talked about diuretics going from left to right uh you know figure out what goes where but with hypertension we're going to take some of them away. We're going to take the PCT ones away because those are for emergency conditions and then we're going to kind of focus on first the thiazides which are first line and then talk a little bit about Loop potassium sparing which are second line.

Okay so first line you just cross everything else off really. The distal convoluted tubule with the thiazides especially Hydrochlorothiazide that's our really first line for hypertension and we'll probably combine this with triamterene as the form of Dyazide.

"So, we have the hypo and hyperkalemia kind of balancing itself out, but that's first line. Then we sure can take a look at maybe the potassium sparing diuretics: spironolactone, amiloride, triamterene, eplerenone. But really those and the loop diuretics (furosemide, torsemide, bumetanide) are definitely not first line for hypertension. Okay, alright. So Hydrochlorothiazide again, not only for hypertension but also edema. It blocks that sodium and water reabsorption in the distal convoluted tubule. We're worried about hypokalemia with Hydrochlorothiazide and also that hyperuricemia if gout is an issue. Watching again for that sulfa allergy and then just making sure that the electrolytes, the labs are all on the up and up for the patient.

Generally, we might pair certain diuretics with other potassium sparing diuretics to make sure that we don't have that hypo or hyperkalemic effect. But note that when you do block aldosterone especially with spironolactone, you do have that issue with gynecomastia. Certainly if you're going to have that maybe you're going to have decreased libido. Those types of things come along with giving something like spironolactone when you're going to block that aldosterone hormone. Okay, but again we're talking about diuretics really that Hydrochlorothiazide is going to be our preferred medication.

There are some oddballs and usually it's just here's a thing or two to remember about each one. The alpha agonist clonidine, we talked about how that really suppresses that norepinephrine outflow so you get that reduction in blood pressure but that can be terribly sedating and causes tremendous fatigue. Methyldopa is one of the ones that we can consider with pregnancy in certain situations.

The peripheral vasodilators so hydralazine again maybe for an emergency or with pregnancy and then Nitroprusside is another dilator but a really strange toxicity to have that cyanide toxicity going along with it.

And then the renin inhibitor aliskiren, that's the one where we're really worried about where we're in the RAS system and it's the area where the ACE inhibitors are and the Angiotensin II receptor blockers. This aliskiren works at the very beginning and just blocking renin altogether but we've just found that that's really just not the way to go in practice.

Again this is just informational purposes only if you've got a medical condition consult a medical professional. Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes, cheat sheets and more at memorizingpharm.com. Again you can sign up for the email list at memorizingpharm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com/P/mobile. Thanks again for listening.

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Statins and More (gemfibrozil, fenofibrate, niacin, ezetimibe, cholestyramine, PCSK9)

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Hyperlipidemia treatments are really about statins and then what to do if that doesn't work. This episode has a few mnemonics that will help you remember them.

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

Okay, today we're going to talk about statins and more. Statin is an HMG COA reductase inhibitor that will be important as we kind of go through here, that's how it works. I'll focus a lot on the statins but I'll also talk about some agile therapy as well or some other choices.

So really what we're talking about here is atherosclerosis and coronary artery disease and you've probably had physiology where you start with that normal artery and you get that fatty streak, you get a plaque and then a complicated plaque. So statins do a good job of lowering LDL and we can use l for lousy cholesterol or bad cholesterol and move cholesterol from the plaque to stabilize it. Now the evidence is a little bit weak in terms of you know making a plaque smaller but again it stops the madness I guess you would say.

Okay, we're always looking for lifestyle changes. I use the mnemonic changer Fates so increase fiber, increase food that's good for you, decrease fat, decrease alcohol or stop Tobacco Stop alcohol exercise gotta increase exercise and then decrease your sodium. So again really the lifestyle changes are the first place that we go but um there are so many good medications for hyperlipidemia that we just go through them now.

Okay so HMG-COA reductase Inhibitors let's start with the suffix it's vastatin be careful you'll probably hear Statin a lot of times and that'll usually get you by but for example if you look the bottom right Nystatin is not for lipids It's actually an anti-fungal so just be careful with that.

We'll talk about this division in a second about how really you can use atorvastatin resuvastatin which are Lipitor and Crestor at higher Doses and then you can use them at lower Doses and that actually means something. And then just like you're going to have to worry about lfts the liver function tests the other drugs are lfps so Lovastatin fluvastatin pravastatin and Simvastatin.

Alright so let's just talk about high intensity versus moderate intensity high intensity are the atorvastatin at greater than 20 milligrams and rosuvastatin is at 40 milligrams because once we start increasing those dosages we're really worried about that myopathy that we're going to get and liver issues and we'll talk about adverse effects in a minute but just know that if the patient is more fragile we would use something moderate intensity if they're less fragile high intensity.

Uh so Lipitor I'm guessing that they were thinking like lipid Gladiator so this is the lipid lion uh that is being slain by the HMG co-a how do we figure out high intensity versus moderate intensity uh we're really looking at the clinical atherosclerotic cardiovascular disease abbreviated As ascvd and we're worried about peripheral artery disease myocardial infarction heart attack or a cerebrovascular accident.

So if the patient is greater than 75 we'll probably go moderate if they're less than 75 we might go high intensity if their LDL is greater than 190 we'd go high intensity if they're diabetic 45 to 70 and their ascvd score is less than 7.5 percent then moderate and then higher than 7.5 high intensity.

And then 45 to 70 we would go greater than 7.5 percent moderate intensity so again it's really just figuring out what their risk is of a coronary event and how these medications can help um you might see a bunch of Statin mnemonics there are a number of things that you kind of want to watch out for with statins uh first s skip the grapefruit juice there is an issue with so the grapefruit juice increases the Here is the corrected version of your text:

"Statin level in your body and um some they say that some statins don't have this effect and some do but you'll be hard-pressed to not find somebody that's going to say just go ahead and skip the grapefruit juice. The big one is toxic to muscles and joints and maybe Rhabdomyolysis is an unfamiliar term but if you work out too much too fast this will happen as well but it can be toxic to the muscles and joints and really it's myopathy that we're going to see first. A for alt AST monitoring so the lfts or liver function tests for liver injury uh and then T tints the eyes yellow uh again kind of going from that liver injury. I how does it work well it for lack of a better term it just inhibits cholesterol production and then n um one of the add-ons that we'll talk about is niacin which is an add-on when the triglycerides are just not getting lowered enough so s skip grapefruit juice T toxic to muscles a a l t a s t t 10 size yellow I inhibits cholesterol production and niacin add-on for triglycerides uh atorvastatin or Lipitor it's this is our big dog uh so hyperlipidemia and cardiovascular risk is the indication and mechanism it is an hmg-coa reductase inhibitor so the big things that we're worried about are this that muscle myopathy that Rhabdomyolysis which is uh you know progression from the myopathy and then the yellowing eyes which comes from a progression from the liver issue so contraindications would be liver disease pregnancy and then the things that you really want to watch for as a healthcare professional you know so looking for that myopathy and I just put the Three L's so you can think about lifting weights so it's really more about the muscles than lifting weights lifestyle and the lfts uh Jim fry Brazil and which is lopid and fenofibrates tri-core these are not statins but they're really important because they're also good for hyperlipidemia and high triglycerides especially and so they can decrease cholesterol production and they can also cause myopathy Rhabdomyolysis and then the liver issues and especially with gemfibrazil we're going to see that myopathy effect is more additive so when you have someone on a Statin engine for Brazil you're going to see that that myopathy more often uh contraindications well liver disease and pregnancy and then again the The Three L's the lifting the lifestyle and the lft is really just a way to remember the muscles are part of all this so the next piece we get to is kind of that combination therapy and we say okay well we haven't decreased their LDL enough so it's a Statin and so maybe it's a Statin and niacin okay so niacin blocks the enzyme for making cholesterol and this would be good if we're you know have those elevated triglycerides but also LDL to some extent uh the big thing with the niacin is that flushing and you can give the aspirin 30 minutes prior and then maybe exacerbation of gout because of its effect on uric acid so adding fluids uh blocking cholesterol absorption so acetamin or zedia against four cholesterol but it's an absorption inhibitor so both acetamine and cholesterolamine those are going to block that cholesterol absorption and you're going to see myopathy but with that blocking of cholesterol absorption you're also going to see fat soluble vitamins D, E, A and K are going to be blocked as well. I always thought of it as a person named Deke, D-E-A-K, that's how I remember the fat soluble vitamins but blocking those vitamins in addition to the cholesterol is a concern. Then cholestyramine which is question, this is not only for cholesterol but also if you have chronic diarrhea this can work as a bile acid sequesterant and again that the Deep vitamins are an issue here because it is blocking um those that cholesterol absorption blocks the enzyme that regulates the number of cholesterol receptors. So the reason I said it that way was because the real name is proprotein convert a subtilicin kexin type 9 which we abbreviate for good reason as PCSK9 Inhibitors so allerocumab which is probably and evolokumab which is repatha both of those are monoclonal antibodies that we would use for a specific type of cholesterol issue they're like Uber expensive like super expensive combination therapy. So if we're now trying to decrease triglycerides rather than LDL we would add the niacin for Brazil again just the way that they work they do a good job with those triglycerides and if we're thinking of decreasing triglycerides and increasing HDL or just increasing HDL again niacin gem for Brazil are our choice there. So um kind of brings us back to this last slide which is a really expensive situation where somebody does need one of those PCSK 9 Inhibitors or they'll go through the Rems to get them if omersin these are for familiar familial hypercholesterolemia so if somebody fails the high high dose statins then the alarokimab and evolution might be something you add on and then nipomeracin requires a Rems because of its liver damage but it works way differently it just binds to the messenger RNA of this really important protein LDL and VLDL and fails to translate so you get less of it but okay so again this is for informational purposes only it's not medical advice if you have a medical question contact a medical professional.

Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes cheat sheets and more at memorizingfarm.com. Again, you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile. Thanks again for listening, sure.

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OTC Cough and Cold

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Cough and Cold treatments really don't have a ton of medications, and this will episode will help you remember them.

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

Alright, welcome to OTC allergy cough and cold. We'll go over antihistamines, decongestants, nasal inhalers, expectorants, cough suppressants, and analgesics but it's an amazingly small number of medications with all of these different lists. So let's start with antihistamines and we need to talk about the antihistamine snowman first to make sure we know what antihistamine we're talking about.

So we're talking about H1 antihistamines versus H2 antihistamines. So an H1 antihistamine and this snowman has one nose our allergy antihistamine it's like diphenhydramine which is Benadryl or Loratadine which is Claritin. So when we say antihistamine we're thinking H1 but technically an H2 antihistamine and that's why we have two buttons at the stomach our H2 blockers so they're also antihistamines but we don't call them that.

And so famotidine which is Pepcid and now zantac's brand name has taken famotidine which has always been Pepcid cymetidine and Tagamet nicetidine and acid for acid reduction. So just to be clear the antihistamines we're talking about are the ones in the nose in this particular video.

So let's talk about the first versus second generation. The first generation is diphenhydramine or Benadryl and if you've ever gotten Tylenol PM that's the PM part of it so Tylenol PM is actually two different drugs chlorpheniramine or Chlor trimeton is one that we don't use a ton anymore uh it only lasted about four hours but it used to be in packages when you had some kind of really bad allergic issue they make you super sleepy so really not a good thing especially if you've got someone driving or somebody does driving for a living.

So the second generation came along and what you'll notice is that each one of these has a pair so the second generation non-drowsy antihistamines were loratadine and then when that went off patent all of a sudden destler adidine showed up which is Clarinex so Claritin declaren X when cetirizine's packet patent went away levocetirizine comes along which is xyzel the owl if you've seen the commercials and then terphenidine was removed from the market because of cardiac issues but Fexofenadine which is the safe metabolite is Allegra.

So those are our five second generation antihistamines that we use. So let's take a look at Benadryl or diphenhydramine and it's again we're going to use the eye match mnemonic so indication mechanism adverse contraindications and what a healthcare professional should do to make it so that's easier to take.

So allergy and insomnia that's the indication. The mechanism well it's an H1 antihistamine so it's first generation though so it's also going to have anticholinergic effects that's going to be important for adverse effects. So as we've kind of gone into really a lot of depth anticholinergic was our Bud cat so the drowsiness dry mouth confusion and there's a paradoxical effect where in young children a lot of times it'll actually make them hyper instead of tired so confusion is a little bit of an addition to the mnemonic I've used before.

So uh angle closure glaucoma that's one of the contraindications and then on the beers list so we want to avoid it in the elderly because of that drowsiness and confusion and we don't want to have Falls and things like that. So A couple mnemonics some people call it better drill because you're so tired and then no dryfin hydramine so no driving hydramine reminds you not to drive on this one.

Claritin and alivert levocetirizine which is xyzel Fexofenadine which is Allegra these tend to be the popular ones now. The ones that have kind of Taken hold. So in terms of indication it's all the same thing it's all an allergy they're all H1 blockers they're all second generation not sedating and they really in terms of adverse effects and contraindications we really don't have a ton there but you really do want to tell them to prophylax before allergy season not wait until allergy season and say okay we'll take your antihistamines if you know allergy.

Season is coming, go ahead and get on that regimen right away. So Loratadine has the adidine ending, be careful that's a little bit close to t-i-d-i-n-e which is the H2 blocker so it's famotidine and so forth. Uh levocetirizine or even cetirizine if you take that TIR make it a tear to remind you that it's allergy eyes, it's the saddest owl I could ever find. And then Allegra if you put the r here it makes a-l-l-e-r-g change the a to a y and you have allergy. So I got paid a million dollars to figure that out, I want to be that guy.

Alright let's go to the next one Alpha One Agonist and vasoconstriction like what's going on? I thought we were just doing OTC stuff. Well an alpha one Agonist you'll probably know pseudoephedrine which is Sudafed, oxymetazolin or oxymetazoline sometimes I hear is Afrin and then phenylephrine which is neo-sinephrine. The big difference is pseudoephedrine is something you take every day or you can take daily, it's a tablet whereas oxymetazolin and phenylephrine are both inhaled or nasal inhalers and that's going to make a really big difference when it comes to some side effects in terms of those.

And I always use the pop mnemonic so just like your ears pop on the plane nasal congestion just think of a big pop once that nasal congestion goes away. So pseudoephedrine starts with a P, oxymetazoline with an O, phenylephrine with a p going on the pseudoephedrine um.

So let's start with what it's for sinus congestion and it can be used as an adjunct in allergic rhinitis. It does have that alpha-1 vasoconstriction but the problem is it's systemic versus that nasal which is a little bit more local so we're going to get that anxiety and insomnia just kind of a restlessness that comes along with it.

So the contraindications and I've got this little hand holding a heart so it's angina coronary artery disease closed angle glaucoma hypertension all these things are really things you don't want to have if you're going to be taking pseudoephedrine. And the way that I think about all the adverse effects I just think of energy drinks if you have one too many energy drinks anxiety insomnia restlessness that's pseudoephedrine.

And then the next ones we'll see in a second so watch out for any other stimulants that might interact with Sudafed. Okay oops next one here is oxymetazoline which is Afrin and phenylephrine neosinephrine we're going to see it's the exact same thing as sudafed or Pseudoephedrine with the i the M the a except we have something called rebound congestion.

So around three to five days you might get rhinitis medicamentosa rhinitis medicamentosa is where and I've got this picture here of somebody who has congestion, the word breathe because now they can breathe they've taken their medication the phenylephrine and oxymetazolin and now they've got it again. So the rebound congestion that's something that is really inherent to these and nasal inhalers contrasting the Sudafed or the pseudoephedrine tablets.

Fluticasone mometasone we see that sewn ending so common with many of the steroids these are nasal versions of it so with those oral versions we're always washing our mouth out to make sure that we don't get candidiasis we don't get dysphonia which is that hoarseness or difficulty speaking.

So looking at the names, the brand names kind of give it away Flonase and Nasonex but they're both for allergic rhinitis they're both anti-inflammatory steroids. The adverse effect tends to be a dry nose and nosebleeds infections like TB and varicella are something that we really want to avoid reducing the immune response.

And then you really want to use this daily as soon as that allergy season starts so it takes about three to four days to see that optimal effect and we do want to watch growth rate because it is a steroid after all. So they've got a guy here looking at his clock like I don't understand when I took the oxymetazolin, the Afrin my nose was cleared in a couple minutes well it's going to take a couple days with these guys.

Alright dextromethorphan so this is the D and M so the dextro makes the D, the methorphan makes the m in Robitussin DM or Mucinex DM, they both have the same ingredients, the dextromethorphan part. Okay, we'll get to the guaifenesin in a minute, that's the cough suppressant for a non-productive cough. Okay, it works in the medullary cough Center and it can get that CNS toxicity, dizziness or something called robocopping that if you use it illicitly. Hepatitis is a contraindication and really what you want to try to do is stop that cough from happening in the first place, a cool humidifier can sometimes do that. You might call it instead of dextromethorphan, you might call it dry cough methorphan because that's really what you want is if that's a dry cough it's not really producing anything uh dextromethorphan is your man.

Okay guaifenesin so this is Robitussin or Mucinex with or without the DM so without the DM it is just guaifenesin with the DM it's guaifenescent and dextromethorphan. So I want to make clear this is an expectorant we'll talk about a mucolytic in a minute so this is an expectorant for mucose secretion that loosens and thins the phlegm makes it easier to expectorate. Adverse effects are just less common same with contraindications and really it's just if you have that cough for a week maybe you should see a physician or a provider and I've just got a picture of kind of some slime here and exit for expectorant uh and I've heard it sometimes called Green flemisin instead of guaifenesin just kind of an easier way to remember what this thing does.

Okay acetylcysteine now this is a mucolytic now this is not over the counter but what I wanted to do was contrast it because sometimes you'll see that they say guaifenesin is a mucolytic, it's an expectorant. So acetylcysteine though the actual utility in cystic fibrosis is somewhat unclear cystic fibrosis acetaminophen overdose those are two uses we would have for acetylcysteine or muco Mist. It is mucolytic and it loosens those bronchial secretions if you inhale it and then it replenishes the glutathione in the liver from the acetaminophen metabolites so if you're doing those kinds of chemistry in your particular pharmacology class that's really how it protects it against an acetaminophen overdose.

Nausea and vomiting are adverse effect as well as you know you just want to be careful with asthma maybe a GI bleed or something like that and then there's a poor taste when it's inhaled. So the way to remember acetylcysteine is for Cystic Fibrosis is we have this cyst in cystic fibrosis and then when you look at acetyl you take the acetyl group and you think about n acetyl paraaminophenol what is an acetyl peraminophenol well that is acet amino fin okay so that's the whole chemical name or APAP if you've had it abbreviated before okay uh so this is just a bigger picture of it if you want to see kind of how the cystic fibrosis compares to a healthy lung.

Alright ibuprofen so Advil and Motrin and then the naproxen is the Aleve pain fever and inflammation this is important because we're going to contrast it with acetaminophen in a minute mechanism. It's a non-steroidal anti-inflammatory drug and NSAID so non-steroidal is just a way of saying it's not prednisone but it's an anti-inflammatory, it's cycloxygenase inhibitor and we're not going to get into the weeds with that right now. If you want to talk about Celebrex and celecoxib, you can kind of get into the weeds when you start putting in prescription drugs but GI distress, ulceration certainly adverse effects especially if you used a long term. If you have any kind of an allergy to aspirin or stomach ulcer, heart failure, liver disease this really tends to hold on to fluid and those are conditions where you really don't want to hold on to fluid.

And then always mentioning take it with food, it does tend to upset the stomach. So one contrast is well when do I take Ibuprofen when do I take them peroxin well ibuprofen you have to generally take like four times a day where an approxen maybe two times a day or three times a day so that tends to be it. And then I had a pretty decent graphic about peptic ulcers and then here is a larger version if you wanted to look at that uh just kind of explaining what's going on we didn't talk about helicobacter pylori which is really the causative factor in many ulcers but that's getting into prescriptions and triple and quad therapy which we will not.

Alright last one here is going to be acetaminophen or Tylenol. You'll notice that in the indications it has pain and fever just like ibuprofen but the inflammation is missing so that's the one question you get over and over again. It's a non-narcotic analgesic and it's just really liver damage, liver conditions that's really one place we really want to be careful.

And then watch for overdose with RX meds and what I mean by that is maybe somebody's on something called Vicodin and there is acetaminophen in it and then they're taking Tylenol over the counter or they're maybe taking some combination cold product that has acetaminophen in it. Really you don't want to go over 3 000 milligrams in a day, you know the upper end is 4 000 but you really want to be careful there.

So n acetyl peroaminophenol that's how we made acetaminophen or APAP and then here are the stages of liver damage and I just wanted to have it up here so that if that's something you wanted to kind of go through you could. And then a larger version of the same graphic okay all right again this is for informational purposes only it is not medical advice if you have a medical condition consult a medical professional.

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