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

Asthma Mnemonics Part 2 Theophylline, Cromolyn, Montelukast, Methylpred, Omalizumab

Some oddball additional medications in asthma treatment, including theophylline, montelukast, cromolyn, methylprednisolone, omalizumab

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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 memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com. Let's get started with the show.

Okay, I wanted to go over a couple of 'oddball' asthma medications. It's more that they're just not used as much as that kind of beta 2 Agonist or anticholinergics or inhaled steroids and so we just want to at least touch on them to understand what they do. So again, we're going to go back to what asthma is all about - that episodic bronchoconstriction and inflammation. With these medications, we're really talking about Theophylline.

We're talking about primarily being a bronchodilator so taking care of that opening of the airway but Mata Lucas chromalin homilizumab predn methylpred um all of these are really meant to reduce inflammation. So let's take a look at a couple of them and maybe some details about them.

So Theophylline, there's also aminophilin which is kind of a combination but the big thing to kind of take away is that we're working about the bronchodilation so this is the opening up of that Airway it relaxes the smooth muscles and opens the airway. So if you look at the offaline and aminophilin you see o-p-i-n-o-p-i-n so one way to remind you that it's the bronchodilator side more than the anti-inflammatory side.

I have a little coffee cup here because it's chemically a methazanthine so it is chemically similar to caffeine so if you want to think about what it's like to have too many cups of coffee you have the idea of what it is to have toxicity from Theophylline and I'll get to the um narrow therapeutic window in the next slide.

It does have a lot of drug interactions and this is why it's really fallen out of favor. I still have it, it's just something that we just don't use very often but you do want to check for potential interactions with those other drugs and the blood tests are going to be kind of part of this.

So when we look at a narrow therapeutic window I thought of a castle in how they had those Arrow slits and the narrow therapeutic window is between 10 and 20 micrograms per milliliter and so if you think of the T within this Arrow slit and I intentionally picked the T to combine the T from Theophylline, the T from therapeutic, the T from 10, and the T from 20. So the four T's and this narrow therapeutic window are maybe a good way to remember Theophyllin has this 10 to 20.

Uh Montelukast, I change the colors a little bit because when you think of Singulair it's kind of like that Claritin clear where you've got this picture of blue skies and green grass. This is for asthma and COPD that's refractory to other medications. It's just not - the other medicines are just not doing it.

It's a leukotriene inhibitor but you know what does that mean? Well leukotriene inhibitor is going to come from the mast cells and really it's going to be part of that kind of cascade of the um asthmatic response. And so when we look at adverse effects I put Neuropsychiatric event because this is exactly what's on the documents but really I think that you're going to see something like suicidal ideation or something like that but Neuropsychiatric events is obviously a real concern especially since we're talking about a medication that's often used with children.

Um lfts are probably a consideration with liver and then uh you really don't use this alone um you really use this as something to add to an asthma um treatment regimen but you don't use it alone and it's not called Singulair because you don't use it alone. It's called singular because it's once daily dosing and if you look at zapher look is what I think was the first one that came out - that one was four times a day so when you come out with one that you only take once a day, it's gonna kind of knock the other one off the market and I think that's exactly what happened. But look at the Lucas ending to remind you about the leukotrienes inhibitor as something that's going to improve asthma.

Okay, this is cromelin which is uh Intel um we use this for asthma and COPD and it's what's called a mast cells. This is crumbling and it's again for asthma COPD. It's a mast cell stabilizer. Think about the M for Mast and I've got a couple of pictures of ships here and the idea is that you're kind of going through the storm here until we stabilize the Mast and we get this nice Placid kind of view of a sailboat.

The idea is that to stabilize the mast cell is to stop releasing all of those things that are going to cause the asthmatic and allergic reactions. In terms of adverse effect, you get kind of a dry mouth, real irritation of the throat, and kind of a cough with it. So where you were rinsing your mouth out with inhaled steroids to avoid thrush, in this case, you're maybe gargling or rinsing your mouth out a little bit to avoid the irritation and to avoid that cough.

Uh contraindications really rare rare shortly shortness of breath or something like that um I often use IV steroids so this is not necessarily an oddball as much as it is that it's just much more rare. So something like asthma would benefit from methyl pred if you did have an asthma attack. It is a steroid anti-inflammatory and it's tough to say in terms of side effects because you're talking about using it for a couple of days probably where you know maybe agitation changing mood maybe a little bit of weight gain but again we're talking much shorter term steroid use.

Infections always kind of an issue um you know we suppressing the immune system anytime we're giving a steroid and then this is used in combination so Albuterol and petropium remembering that albuterol is that beta 2 Agonist it's a bronchodilator and ipritropium is the anticholinergic that really relaxes those lungs.

Okay uh omole is umab zolair uh this is kind of a Last Resort for many people who have allergic asthma or chronic hives where you don't know why they have hives and then nasal polyps. It's an ige blocker so it binds that ige antibody on mast cells and basophils and stops kind of the Cascade if you would flu-like symptoms might be one of the adverse effects but the real thing to worry about is that anaphylaxis can occur in the first dose and Beyond.

And this kind of makes sense because of the way that the anaphylaxis Cascade goes but again just recognizing that anaphylaxis could happen and so making sure that the patient is aware that okay we're gonna watch you while we give it to you but we're also going to ask you to watch yourself as you kind of move on.

And then last thing if this is a subcutaneous dosage so a little bit different than all the inhalers we've been talking about again this is for informational purposes only so it is not medical advice if you have medical condition consult a medical professional listening to the memorizing pharmacology podcast.

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

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Asthma COPD Pharmacology Mnemonics in about 10 minutes

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

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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 memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com. Let's get started with the show.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And then so make sure that the patient knows to rinse their math on and I just wanted to be clear about the devices the nebulizer like this is kind of what we had where we got that nebula out and they could either put their mouth on it or just kind of get into the Mist there and then the spacers for those that can't do it themselves. I'm not talking about veterinary medicine but it just kind of makes it you know if you've got a cat something like that it's obviously not going to be able to use an inhaler normally and so what happens is it goes into this chamber and it can just allow the cat to breathe and there's a little flap in here that tells you that the cat is taking breaths. So it's kind of a neat device but nebulizers versus spacers as always this is for informational purposes only it's not medical advice. If you've got a medical problem, consult the medical professional. Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes, cheat sheets and more at memorizingfarm.com. Again, you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile and thanks again for listening. Thank you!

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IV Fluids in 5ish Minutes and the Hypotonic Hippo

A quick rundown on some often confused terms hypotonic, hypertonic, and isotonic as it relates to IV fluids.

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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 memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com. Let's get started with the show.

Okay, we're gonna do some IV fluids mnemonics in five minutes or less. You may have heard of the hypotonic hippo. I'll explain what that is but I'm gonna bet that you've probably seen something like this slide before where you see hypotonic and you see this water going into a cell and the cell lysing or exploding. You're going to see isotonic where water is going in water's going out it's about the same and hypertonic where the water is mostly just going out it's causing crenation which is the word for those skinny cells and creating those skinny cells.

So again it's where is the solute the water follows the solute so there is more solute in the cell that's why it goes into the first cell and explodes it's an even amount in both cases so that's why it goes in and out in isotonic and hypertonic it's there's more solute on the outside so the outside is the big one there.

So what I've seen are images for hypotonic you think of a hippo because it also has many of the letters of hypo and we're thinking about the water going into hippo and making it large. The isosceles triangle is one where the sides are equal and so we're thinking inside and outside the cell is equal for isotonic and then you see what I did here that's a skinny cell a lot of people will talk about somebody who's a runner and how they're skinny because they're really hyper but in general as a runner I'm not as much hyper as I'm just very consistent so again skinny cell is what you're going to see.

Last but let me give you something that's a little more tangible than even that when you have just tap water which has very little solutes in it at all that's hypotonic to your body. You are isotonic yourself okay and then we talk about the ocean uh the ocean would be a lot like three percent saline which we'll talk about in a minute that's Ocean City Maryland uh where I used to go for Summers or we'd go for a week in the summer and the Great Salt Lake is below that that has quite a bit more salinity than even the ocean.

And then if you talk about the Dead Sea that's probably about a third sodium chloride you can actually lay in it and you will float on it there's so much salt in there so we're just trying to figure out what the middle is mathematically and I know people don't like percentages and they certainly don't like fractions and you betcha they don't like decimals over fractions so 0.45 percent half normal saline is really 0.45 over 100 point nine percent sodium chloride is 0.9 over 100 and hypertonic saline is three over one hundred.

And you could expand it out to a hundred thousand so you could get whole numbers with 0.225 and all of those but the most important thing to know is that the middle, the 0.9 percent, that's isotonic 0.45 half normal is hypotonic and saline three percent is hypertonic D5W has something very similar where D5W which is which is five percent dextrose and water uh that's in the middle that's isotonic hypotonic is 2.5 dextrose and hypertonic is you know 50 is one example uh d50w.

The important thing is that your middle is D5W just as it was 0.9 for the sodium chloride so here are a couple that we're going to look at there's not a ton here but on the left hypotonic point four five percent sodium chloride and D 2.5 W in the middle isotonic 0.9 percent NaCl D5W lactated ringers we'll talk about it's also Ringer's lactate same thing it's a synonym and then albumin five percent so a colloid.

And then three percent NaCl and d50w as hypertonic we'll talk a little bit about what they're for okay. The first kind of key point is that if we have a hypertonic condition that's when we're going to use a hypotonic solution so 0.45 NaCl half normal we could use in hypertonic extracellular dehydration in D 2.5 W same thing dehydration we don't want to administer though with blood products it will cause hemolysis okay but again a hypotonic solution for a hypertonic condition with an isotonic solution we have an isotonic condition 0.9 saline is you know we could replace isotonic water loss okay D5W same thing but we could also help with hypoglycemia insulin shock you know dehydration certainly but I recommend thinking it of it as g5w or D glucose instead because it's just one of the enantiomers or mirror image of the glucose molecule lactated ringers or ringers lactate this is for nausea and vomiting Burns lactase lactate is a base and buffers Burns metabolic acidosis so it's an excellent choice so think of a firehouse alarm ringing when there is a fire and people get burnt.

Albumin five percent is for hypovolemia hypotension hypoproteinemia to ascites so we expect a loss of volume right that's what we're expecting this drug is for so the Al from albumin for a loss and then the um from volume should help you Al's Barbecue for protein loss so barbecue has protein in it and ALB are the first three letters of Al's Barbecue and finally albumin and ascites both start with an A okay.

Last piece is the hypertonic solution so for a hypo condition three percent saline can be used for hyponatremic encephalopathy traumatic brain injury cerebral edema hypoglycemia certainly faster than D5W for d50w and again g50w or D glucose I recommend you remember it that way and then the hydro was a three-headed monster from mythology and so we have three pathophysiologic head issues the encephalopathy the brain injury and the edema hopefully the Hydra helps you remember it.

Again this is for informational purposes only and should not be relied on for medical advice if you have a medical problem 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 and 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

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Diuretics Pharmacology Mnemonics

From Glomerulus to Collecting Duct, I give you some easy ways to remember and sort the diuretics.

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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 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 Melbourne. Let's get started with the show.

Okay, today we're going to go over diuretic pharmacology mnemonics and where we're going to start actually is just a little brief review of you know what happens with urine formation and there are four words you really need to know. So filtration happens at the glomerulus and glomerulus just means like bundle of string or because it's all kind of convoluted. Reabsorption which happens at the renal tubules so to the paratubular or renal capillary so when you're looking at reabsorption okay what's happening is that you are getting it to come back okay so you're getting that fluid whatever it is to resorb into the capillaries whereas secretion is the opposite so you can kind of see the arrows here where secretion is the peritubular or renal capillaries going into the collecting duct which will eventually result in number four which is excretion from the body.

But this should look weird to you at some point in your anatomy class you learned that an artery went to a little arterial which went to a smaller capillary which went to a little venial which went to veins but Bowman's capsule actually has an efferent an afferent arteriole so it goes arterial capillary arteriole what that does is it creates a really high pressure system much like a garden hose and the way we're going to learn this because that pressure is so high at the one part that means the pressure at the end of that hose is much lower.

So I don't know if you remember from if you're in the United States you learned the United States generally in four regions you learn the west and maybe you broke that up into southwest and west then the Midwest then Southeast and then the Northeast so we're going to do the same thing here because those regions are different when we talk about the Nephron. So our western region is going to be the proximal convoluted tubule so proximal just means close to something so I'm in close proximity to you so proximal to the glomerulus and that really high pressure system that's going to be one. The Carbonic and hydrase Inhibitors like acetazolamide and which is Diamox and two, the osmotic diuretic so Mannitol which is osmetrol.

Then we're going to kind of go to the Midwest where we're going to see the ascending Loop of henle or the ascending limb of the loop of henle and that's our Loop Diuretics now. The big thing here is going to be hypokalemia and we'll talk about how we deal with that in a later slide but this is furosemide which is Lasix torsomide demidex and bumetanide which is bumex.

Then we move on to what would probably be the Northeast which is the distal convoluted tubule and really the early part of the distal convoluted tubule so. The thiazides will also cause hypokalemia so this Midwest and Northeast this kind of middle of the Nephron is causing hypokalemia this is going to be important because later we're going to see the opposite. And this is Hydrochlorothiazide which is diazide if you combine it with triamterene and then chlorthalidone which is thalatone though probably couldn't find the brand name if we wanted to.

And then, last one is the DCT or collecting duct so these are number five which is potassium sparing group okay. So again this is at DCT right at collecting duct so towards end of that distal convoluted tubule and we have hyperkalemia so later on we'll see that we can pair these together. And I've seen a couple mnemonics for this but I like mine better I like use spare for sparing so it's spironolactone we use SP which aldactone amyloride which metamore triamterene we have take R which second letter it's not ideal but again I think spare better mnemonic for dyrenium then eplerenone which Inspira eplerenone spironolactone work same way amyloride trampoline work same way see later.

Alright, I always feel like I'm defending mnemonics against those who say that you're not understanding it, you're just memorizing it, and you want to really want understand it well I'm not saying don't understand it. Think that it's a lot easier to understand things if I have the desk on the right than the desk on the left. So with mnemonics, I'm just trying to make it so that you're not cluttered so that you can kind of clearly understand a concept, move on to the next. So to me, pharmacology without mnemonics is the desk with all that junk on it and pharmacology with mnemonics is the nice clean desk on the right.

So our mnemonic that we use to as we kind of go through these medications and we'll look at some other pieces of it that can help us as well but I am a considerate health professional and that considerate is really for considerations and contraindications but being empathetic to what it is that the patient has right now and you can see what I'm doing there getting our ducks in a row all right we'll put our generic name then brand name first and he stems we'll try to underline those and then again I is for indication M for mechanism of action which again you can just say the drug class so what is the mechanism of action of acetazolamide well you can just say it is a Carbonic anhydrase inhibitor okay that is the mechanism of action now your instructor probably wants it is a Carbonic anhydrous inhibitor that does blank that's probably what they want adverse effects are the A considerations are the C and then how can we help the patient best take their medication is H.

So let's move first to acetozolamide which is Diamox. It is for intracranial hypertension intraocular pressure hopefully those two intras help you remember it and then also altitude sickness so I have a home in Arizona and although it's like bright can't afford Flagstaff now the way that things have gone up but I think of Arizona mind instead of acetazolamide so this is actually a picture of Humphrey's Peak which is the tallest mountain in Arizona and you would get altitude sickness if you went all the way up there so I also changed Arizona mide instead of the amide amide to m-e-y-e-d because of that intraocular pressure and then the M for Mountain so I got it all in there.

The mechanism of action is that it is a Carbonic anhydrase inhibitor which means that we retain carbonic acid since there is a road there would probably be a car on there all right see what I did there all right. And so what we're going to have is this kind of leads to our adverse effect metabolic acidosis because of that carbonic acid that we're retaining. So what are our considerations? Well, we want to watch out for that acid base balance and really renal disease would be a real problem with using acetazolamide and you know how can we help them take it? We want to make sure we have Labs on them and then watching that intraocular pressure as well okay.

Alright, let's go on to our next one again we're still in that West Coast we're still at that proximal convoluted tubule proximal to the glomerulus with Mannitol which is osmotrol. And the nice thing about that and acetazolamide is that it really it's very similar indications intracranial hypertension intraocular pressure it's an osmotic you might recognize Mannitol from sorbitol they look really same there's sugar alcohols they look really similar okay. And the big issue though are going to be those electrolyte imbalances and then because it creates so much diuresis we could become hypovolemic that is too little volume.

So our contraindications anytime we have electrolyte imbalances generally something like congestive heart failure is a real concern and then dehydration certainly if we're going to have too little volume and we're going to use our Labs as our way of making sure that things are on the up and up. So I just have a collision here a man who has head trauma or intracranial issue and so if you want to you can look at NIT in Mannitol mix letters around make I T remind you intra cranial intraocular pressure furosemide or Lasix P furiously because this creates also lot diuresis but certainly not as much as Mannitol but more than Hydrochlorothiazide. And so we've moved from west coast to midwest okay, so the Midwest has a couple of different issues with it. I live in the Midwest but I'm talking about in terms of our mnemonic here. So indications notice that we would use this for CHF as opposed to something like Hydrochlorothiazide which doesn't produce as much diuresis which would be for hypertension a lesser condition. So CHF edema that's certainly why I would use furosemide. It blocks sodium and water resorption in the ascending Loop of henle so again that's kind of our Midwest portion and so because of that we're going to get hyponatremia that is we lose that sodium and also hypokalemia and that is that middle section where both the ascending Loop of Henley drugs and that distal convoluted tubule which we'll talk about in a second both of those guys are hypokalemia. We'll get to the Southeastern section where we will talk about hyperkalemia okay.

So when you take away that much fluid though it's likely you could get orthostatic hypotension now the ototoxicity and nephrotoxicity are part of furosemide but it's a little bit tough it's like how do you remember that those are are part of it and so I I've got a picture of tinnitus here or tinnitus as some people say it and that's that kind of ringing in the ears the buzzing for some people it's a roaring or a clicking or a hissing or a humming but this is that damaged nerve cell that's causing this really uncomfortable ringing in the ears okay.

So ototoxicity that's how it would probably present um and then so you know what considerations we have well we don't want to give something that causes hyponatremia to somebody who is hyponatremic already or hypokalemic already and then certainly with renal disease if we're going to have these kinds of electrolyte imbalances we really want to be careful there. So what do we do well we make sure the labs are again where we want to see them and then be really careful with ototoxic drugs nephrotoxic drugs because we don't want to have an additive effect.

Alright, Hydrochlorothiazide so again the big contrast here as we move from that Midwest to the Northeast here is that we're treating hypertension level issues rather than CHF level. So this is really first thing first line against hypertension and then edema certainly. So the mechanism now we are blocking sodium and water resorption but because we're further away from that efferent and afferent arteriole when we block that sodium and water resorption we're not doing as much or we're not causing as much diuresis because we're further away to the right okay.

And again distal is the opposite of proximal so proximal is close to something distal is distant from it. So the adverse effect is hypokalemia but also hyperuricemia so we're still in that hypokalemia Zone in the middle but the hyperuricemia means I increase uric acid uric acid is bad for what condition yeah gout exactly there's some misunderstanding as to what sulfa allergy really means when you talk about sulfa and it's because many people that are talking about sulf haven't taken organic chemistry and certainly not taught it but sulfa is talking about this group here where you have an R Group.

And so it doesn't really matter what's going on to the left of this s here but these two oxygens bonded to the s in this way or the sulfur in this way also bonded to a nitrogen which also has two R groups which happen to be hydrogens in this case but you notice Hydrochlorothiazide and furosemide both have this sulfa group. And if you were to look at acetazolamide you'd see the same thing. So unfortunately, you can't generally see the chemical formula in this way but if you could, you could very easily say okay that's a sulfa drug right. So the reason I point this out is that you will notice that acetozolamide, furosamide and Hydrochlorothiazide none of them have the word sulfa in it okay like sulfa methoxazole an antibiotic you learn about. So just because it doesn't have sulfa doesn't mean it can't be a sulfa drug. Sulfa is pointing to this moiety which is on the organic chemistry group and then so again it's the labs that we really want to watch out for that hypokalemia hyperuricemia.

Alright, so here's the mnemonic for the potassium sparing and I just put these all together. Spironolactone because it does block aldosterone you will see something like gynecomastia but what I really want to kind of take away from this section is that we like to pair these potassium sparing drugs with the hypokalemic drugs. So again those hypokalemic drugs were furosemide okay so spironolactone which blocks aldosterone would pair with furosemide and so what eplerone which also blocks aldosterone and that pairs with furosemide.

How does spironolactone work well oh you just think about what aldosterone does. So aldosterone holds onto salt or sodium chloride or sodium and water to increase our blood pressure when our blood pressure goes too low. So if we're going to block that okay we're going to block it now we're going to lose sodium okay and now we're going to lose water but because we are so far away from that glomerulus that high pressure system the amount of diuresis is very low.

So the actual purpose of these drugs is generally to maintain potassium homeostasis or to make sure that the hypokalemia gets x'd out by this hyperkalemia. So when you talk about what are the side effects of a potassium sparing diuretic well hyperkalemia would be the one that comes to mind. So again the spare mnemonic is SP for spironolactone, A for amyloride, R for trianterine and E for a plurinone. The spironolactone and the plearnone both go with furosemide, the amyloid and triamterene pair so well with Hydrochlorothiazide that there are actually medications that have them paired together.

So amyloride with Hydrochlorothiazide becomes modular edict and triamterene with hydrochlorothiaz becomes diazide. Last point I want to make is about potassium supplementation itself so I just got two pictures here IV bag potassium slow sign on the curve so I remember going up the mountains you know in Colorado as we were kind of going up to Pike's Peak and I assure you it is terrifying if you're the driver and you go very slow.

So potassium supplementation go very slow uh don't even think about doing something like crushing tablets or something like that to make things you know go faster everything must be very slow when you go with potassium supplementation alright as always this information is provided to you for informational purposes only not intended to provide and should not be relied upon for medical or other advice if you've got a medical condition talk to 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 and thanks again for listening.

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Lab Values Mnemonic in 4 Minutes

Just a quick review of some lab values as they relate to the Periodic Table of Elements.

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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 memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.

Let's get started with the show. I'm just going to go through a couple of the lab values and how to remember them in this quick mnemonic. So the first thing is that we're going to go over this L that's in the periodic table. I took out beryllium so hydrogen lithium sodium potassium magnesium and calcium and then these guys are plus one and this is plus two that becomes really important later but knowing that these guys are all in the same column hydrogen lithium sodium potassium that will do well.

Alright so you probably never looked at it this way but hydrogen is the well it's the negative log of the hydronium concentration that's what you actually get with the pH but basically it's how acidic or basic it is your body is a little bit higher than seven which is neutral so 7.35 to 7.45 for the pH but if you look down at sodium if you make that seven into a one kind of straighten it up it turns into a 135 to 145 just like you got 7.35 to 7.45.

And then you can take that 35 from sodium and make the 3.5 from potassium to 0.5 or 2 5 ml equivalents per liter so just a quick way to kind of put the hydrogen the sodium and the potassium together but when we think about these lab values uh really it just comes down to some of the things I've heard in mnemonics I've come across so again hydrogen 7.5 to 7.45 looks a lot like the 135 to 145 mil equivalents per liter in sodium.

I've also seen that you underline the OD and sodium to make odd numbers so the first three odd numbers are one three and five and you just add 10. potassium 3.5 to 5 I've heard three to five bananas in a bunch and they're half off so the 3.525 lithium and serum creatinine you probably never put together before but 0.6 to 1.2 mil equivalents per liter would be lithium.

And if you want you can take that it its atomic number is three multiply by two to get the six and 0.6 and multiply that 0.6 again to get 1.2 uh serum creatinine though is 0.6 to 1.2 milligrams per deciliter magnesium you could have taken the one three from sodium but 1.3 to 2.1 and then calcium and chloride you probably never put together but the nine point zero to ten point five very similar to the ninety-five to one hundred five.

Though I've seen ninety-six to one hundred six for chloride as well but nine-one-one that's the calcium mnemonic so nine to ten point five if you round up and then I've heard ninety-five to one hundred five is a hot tub temperature but be careful the maximum is actually one hundred four.

Uh so Casino cratonin we talked about how that's next to lithium or similar to lithium at zero point six to one point two, the bun though if you put it right under it retains that six gets rid of the decimal and you double the twelve to get twenty-four.

So generally, I see six to twenty-four milligrams per deciliter but I've also seen the mnemonic where you've got bunions on your five toes and you got twenty digits total with your hands and your feet so five to twenty milligrams per deciliter for bun I've seen them both creatinine clearance so the sevens and eights.

So creatinine clearance ninety-seven to one hundred thirty-seven milliliters per minute is the sevens forty is the difference and for women creatinine clearance eighty-eight to one hundred twenty-eight uh milliliters per minute these are the eights they end in eight uh forty is the difference again.

So again, a quick review of some of the lab values that you really do need to know I just thought those mnemonics were really cool as always informations for informational purposes if you've got 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 and thanks again for listening.

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Making Pharmacology Stick and Gaining Peace of Mind

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If you want the peace of mind that comes from knowing you know the material, I have two book recommendations, Make it Stick: The Science of Successful Learning and this Memorizing Pharmacology Mnemonics that came 4 years after they wrote their book 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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It might be free if you've never had an audible book before.

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.

Let's get started with the show. All right, I usually just talk about certain drug names, drug classes but I know that a number of you have emailed me about it being late in the second third week of your pharmacology and things are just a real struggle. So I want to give you a book that is actually not pharmacology but will help you quite a bit with pharmacology, patho and a number of other classes. It's called Make It Stick: The Science of Successful Learning. It's by Peter Brown, Henry Rodiger and Mark McDaniel.

Basically, it teaches you what myths there are about learning and how some of the ways that you might be trying to study don't work. So if you're anyone who has gone through a ton of note cards and still done poorly on a test, this episode is for you. So if there's one book I would recommend for somebody going to school, it's my kids go to college. I would hope they would have this but I couldn't expect them to maybe read an entire book like okay Dad, I'll read the whole book right.

So if you can't read the whole book, I would at least start with chapter eight which is Make It Stick and although they summarize the entire book in the chapter and talk about stories that are in those chapters and it's better to read the chapters before if you only have time for one chapter then that would be it. But if you only have time for one story to convince you that this is the book for you, I would go to chapter eight at the 23-minute mark where they talk about Michael Young, the medical school student.

And how he went from getting barely enough of an MCAT score to get into medical school to being the top of his medical school class and I'm going to give you a couple of kind of pointers that I've used in Pharmacology class that I use but the big problem I have is the discomfort that comes along with some of the recommendations that they make especially the masked practiced one.

Okay so first of all, the retrieval practice it feels like you're doing your homework again but no you're trying to remember but it feels like you're failing at something versus Mass practice which makes you feel like you're succeeding. So the example they give is about someone who's going to just hit fastballs and get really good at hitting fastballs. You feel really good about it and then later on a different day you hit curveballs and you try to hit curveballs and feel really good about it. You get good at it but when you try to hit in a game, you don't do very well because in a game they don't tell you what's coming.

The fastball or the curveball and the same thing is true here might not make sense to do your patho home or your patho homework and then your farm homework and then back to your patho homework but that's kind of how your semester goes and then within a class so if you're doing pharmacology and you're talking about respiratory drugs and then you go to diuretics and then back to respiratory drugs that may seem like it doesn't make sense but it'll be a lot easier on the exam when you get those drugs in different orders and so forth.

So the first thing is retrieval practice and I'll show you a little bit what I mean at the end but it's unfortunate they use the word quizzes and don't make clear what quizzing means and I'll show you what I believe quizzing means but I don't think quizzing means multiple choice questions where you can kind of pick up the answer from one of the answer choices. I think it means something a little bit harder so we'll talk about that so first one's retrieval practice next one is elaboration. So when I'm in discussion, I want the student to elaborate on their answer. Okay, they got it right but let's hear your own words. And so if I'm talking about okay, well what's a second-generation antihistamine? They say Loratadine, great they've answered the question okay but now I want them to expand. Alright, well why did they need Loratadine? Well because you don't want an antihistamine making somebody drowsy. Okay well how did they make it from the drowsy antihistamine like diphenhydramine and Benadryl into something that isn't drowsy? Well, they figured out how to make it not go through the blood-brain barrier.

Okay so you don't go through the blood-brain barrier and now that avoids drowsiness. So now that you have kind of a little story that goes with it, you now know diphenhydramine or Benadryl is first generation makes you drowsy and Loratadine which is Claritin is non-drowsy why because it doesn't go through the blood-brain barrier to get to your brain to make you sleepy.

That kind of elaboration helps. The other elaboration is talking about something in your own situation where oh yeah I used to take Claritin and I remember those Claritin clear commercials where you can hear oh Claritin clear clearing your sinuses or clearing your well it's really an antihistamine so clearing your allergies is maybe better.

Again, elaboration that's why the instructor keeps talking even though you've answered the question because if you elaborate you have a story to go with it sticks in your brain then space practice. I think this is the one thing that's the toughest to kind of put together which is studying three times as much they say that you should study three times but no it's studying three times to study less.

So what I mean by that is when you're studying let's say you are going to study total three hours over a whole week if you expend those three hours the night before it's much less useful than if you spent it on Tuesday Thursday and Saturday before maybe a test on Monday right. So that's really hard to do because you say well I'm so behind well you're so behind because you're spending all that time and what you find is that you don't actually need to study three hours each time they find that you only need to study half an hour each time and that you get another hour and a half back to study for another class.

So spaced practice just pick three days they can be together. You know so if you're studying for a Monday test and classes on Friday just okay that's gonna be Friday Saturday Sunday okay or if you have a class on Wednesday then Thursday Friday Saturday something like that but try to space it out at least a day so that you've got this time for your brain to kind of process what was going on.

You come back to it, you're like oh okay I remember and then all of a sudden some I would call Revelations come to you like oh I made this connection or that connection. You literally need to sleep on it to make it work better sharing this is one that often students hate which is when they get called on and it's like well am I doing my homework again? You know why am I sharing this?

Well if you go to the pyramid the learning pyramid, you see that there's at the top it's lecture, you get about five percent retention and at the bottom it's 90 for someone who is teaching it. So when you are sharing and when you are presenting to the class maybe you're just called on, you'll remember that question and you don't really think about it because it maybe happens once or twice or maybe even three times in a class but the more you're sharing the more you're going to remember.

And it feels uncomfortable at the time but it doesn't feel uncomfortable when you do really well in the exam okay all right so let's go on to mnemonics. It's one thing that everybody seems to know me for so Tony farm D the mnemonic guy uh I'm not supposed to memorize I'm supposed to understand right well mnemonics are for building structures for understanding.

So if you're trying to remember Loop Diuretics if you can put a mnemonic in that gets you from the glomerulus to the collecting duct on the right that can put the diuretics in order of mannitol than furosemide then Hydrochlorothiazide than spironolactone well, you understand that there is more diuresis at the beginning with Mannitol and a little bit less at furosemide a little bit less at Hydrochlorothiazide and then certainly less when spironolactone.

So mnemonics aren't just okay I memorized it, it's that you've memorized it in an order that makes sense pathophysiologically or physiologically. So let's take a look at that learning pyramid think it's a little bit misunderstood but the big thing is is that when you are in discussion so maybe you have a recitation where you break out and you talk to your professor and that's when you're learning. Well, the more you're part of the discussion the more you're getting to that 50 retention that you'll remember about half of it okay. However, if they give you an activity like sorting medications into certain drug classes and saying okay well go ahead and on your own go ahead and try to sort the diuretics from glomerulus to the collecting duct okay as you do that that's the practice doing.

And then when you get called on and you show others and tell others what you've learned that's the teaching part. You get 90 so it's almost 100 percent that you are going to remember what you were called on for. So it's almost like if you really want to do well in the test, you want to get called on for every question. Obviously, it's not true but the wanting to get called on with every question but the whole point is that you're teaching others.

So again, the more you participate in the discussion, the more you practice by doing the activities that were assigned and the more you help others and that's why people get paired up or put in threes or fours so that you can show others what you learned. The more you do these guys, the better off you are. The more you sit and listen or just read it's just not going to work anywhere near as well.

So let's see what that looks like here's kind of my half of the pyramid that I care about the discussion, the practice doing and the teaching others. So I did write a book by Rising pharmacology mnemonics and and the point wasn't for you to just absorb it like a lecture. It was okay I learned this cool mnemonic I want to share it with you that's how you learn it.

So I won't belabor that but here's an example of one of those mnemonics and I only took part of it because they're pretty detailed because it's meant for advanced pharmacology really those that are really going into clinical care and those types of things.

So what are four second-generation antihistamines okay easy enough go find them cetirizine Des Loratadine levocetirizine loratadine okay well it's an alphabetical list of them. It's often what you have on the other side of a note card so the question is how can we change this in such a way that it's more valuable to us?

Well, we put a mnemonic together and we say well the order or the prescription called for non-drowsy so C cetirizine a avoid drowsiness l levocetirizine l Loratadine e entering the brain is prohibited is how that happens and then D desclaratidine is Clarinex.

And so this is what's in your brain all of these things but I don't tend to put them on the cards because you don't want to muddle the cards so much that your brain can't remember what's what but tear sounds awful lot like tears from allergy tears cetirizine should be second generation before levocetirizine which is third because two comes before three.

The avoid drowsiness is what a second and third-generation antihistamine does Loratadine well that had the Claritin clear commercials so that would be easier to remember. The allergies, you can kind of picture that sunshiny very blue sky day and we would want the third generation Des Loratadine third generation after it Clarin next is the next Claritin right so it's third generation.

And how does it all work? How did diphenhydramine go to Loratadine? Well in entering the brain is prohibited. The mechanism of action of non-drowsy versus drowsy is that somebody figured out that well if I give histamine not go into the brain then it won't make someone drowsy but really we want this kind of nice clean clear type of note card so we're not sitting there muddled with all that other clutter but that's definitely how I would do it.

So again, really if you're really stuck and you just need to hear a story I really recommend chapter eight uh the story about Michael Young. I think it's one that's both inspirational and telling as how someone who barely made it into Medical School ended up at the top of his medical school class and this applies to Pharmacists and nurses and other health professionals. But I know you're maybe discouraged if you're again your second year third week of classes and pharmacology is kicking your butt. Well, the way to kind of turn that around is to really understand what you should be doing and going back to those lessons you know retrieval practice where you ask yourself the question if you can't remember it before the test how are you going to remember it on the test?

So you really want to do that ahead of time and then that spaced practice so important to study on different days rather than try to keep it all for one day because that's not really that short-term memory doesn't work as well as the work that you're going to do to get it into long-term memory.

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 T forward slash mobile. Thanks again for listening.

Like to learn more?

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Cholinergics Video Pharmacology SLUDGE CAT

In this episode, I go over how you can use SLUDGE CAT, to remember the cholinergics and what that means for pharmacology indications and adverse effects in that drug group.

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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 memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com. Let's get started with the show.

Okay, if you ran into this video before you ran into the anticholinergic Bud cat, I recommend that you go to episode 62 and go check that out. But the cholinergic sludge CAD is gonna get us through the opposite effects of antichrominergic anti-anti and we're going to kind of make a U-turn here. So again, we are making a U-turn. We're going from anticholinergic to cholinergic so many of the things that you'll see are somewhat familiar but what we want to do is make sure that we have these clear in our head.

The first thing is to get the vocabulary clear. If something is cholinergic, it is also a muscarinic Agonist. Again, this is our muscarin mushroom and this is where it all began. So people use that as synonyms or use them interchangeably. Oh that's cholinergic oh that's muscarinic they don't say this as much but it also counts it is parasympathomimetic.

Okay, so what were the opposites right? The opposite of cholinergic is anti-cholinergic. The opposite of muscarinic is anti-muscarinic or muscarinic antagonist. The opposite of parasympathomimetic is parasympatholytic.

Okay, so let's kind of look at how we can use these opposites. We learned but the wide-eyed tachycardic cat how that gives us the anticholinergics so let's go to the opposite which is cholinergic Crisis that is we have way too much cholinergic activity too much acetylcholine and what we'll do is we'll kind of take a look at our new cat so our last cat was wide-eyed in the desert very dry our new cat Sledge cat is in the water with pinpoint pupils and is a bit bradycardic.

Okay so the mnemonic itself sludge will get to but the Cat part is that it is a cholinergic starts with C Agonist begins with a ends with t okay all right so here are the Opposites so on the left hand side we have Bud cat from our anticholinergic presentation and blurry vision because of dry eyes urinary retention dry mouth or xerostomia constipation and hydrosis which is a lack of sweat and was tachycardic so again we had to say wide-eyed tachycardic Bud cat because there is a b and a t in the mnemonic and madriasis again is that wide-eyed m-y-d-r-i-a-s-i-s.

Now you've probably seen the sludge mnemonic but what I want to do is show you where it comes from so the opposite of blurry vision because of dry eyes is lacrimation now yours starts with an L now you're still blurry it's just for a different reason before it was because your eyes were so dry now it's because your eyes are so wet urinary retention the opposite is urinary incontinence dry mouth the opposite of salivation constipation obviously the opposite is diarrhea and hydrosis is sweating and then the opposite of tachycardia is bradycardia.

Now to be fair you will have initial tachycardia in the presentation but it'll eventually go to bradycardia and then meiosis the pinpoint pupils are the opposite of madriasis oh so let's put those in the sludge order now and add the other pieces so we saw the salivation the lacrimation urinary incontinence and diarrhea and then we have the GI cramping and emesis so I have this crisis just ahead signpost with a big thunderstorm lots of rain coming to remind you that sludge is sludge because it's so wet where does this come from well cholinergic crisis can come from pesticides and organophosphates.

So I'll put a little chalkboard thing here but the idea is that okay where where's someone gonna get it okay it's going to be the farm okay but we have two competing conditions we have a myosthenic crisis and we have a colon urgent crisis. The issue is that both of them are going to look very similar on presentation but one is because of low acetylcholine stimulation and then the other is because of excess acetylcholine stimulation. So I have a question down at the bottom which explains it better, but we use an antibody test now which can let us know which it is. But why did edrifonium, an acetylcholinesterase inhibitor, result in improvement in myasthenic crisis but worsening of cholinergic crisis?

Well, if hydrophonium is an acetylcholinesterase inhibitor (capital A, capital C, little h, capital E), that means that it stops the breakdown of acetylcholine and there'll be more of it around. So we're basically adding acetylcholine. If we add acetylcholine to myasthenic crisis where we have low acetylcholine, it makes sense that they're going to improve. It's actually the class of drugs we'll give, though this is not the one we'll give because that one only lasted a very short amount of time.

However, if you are in cholinergic crisis and you give them more acetylcholine in addition, well now you're in trouble. Now you're doing the wrong thing. So the reason we don't give it anymore is because well we were adding it and making it a little bit worse and we don't want to make it worse.

So treatments on the myasthenic crisis side where we have too much acetylcholine right too little acetylcholine take it back so myostendic crisis too little acetylcholine we give an acetylcholine State race acetylcholine esterase inhibitor because what we want to do is have them have more acetylcholine so we stop the breakdown. It's also an immune condition so we give immunosuppressants cyclosporin azathioprine steroids to suppress the immune attacking itself or the immune system attacking itself.

On the coal energy crisis side, we treat, we remove the acetylcholinesterase inhibitor and we provide ventilation if they need it and then IV atropine. Why does IV atropine make sense? If you get that then you know you've gotten what I'm throwing down. Well Ivy atropine makes sense because you had a situation where you have too much acetylcholine. Atropine is anti-cholinergic so it goes against that acetylcholine.

Okay, let me give you a visual make me make it a little more clear so here's Myasthenia on the left is the normal neuromuscular Junction and then on the right we have Myasthenia with the antibodies against the receptor and those antibodies are not letting acetylcholine get through so the idea is we need more acetylcholine but we don't do it directly we don't say here you go here's some more acetylcholine just the way that you know when we have certain conditions that in the blood-brain barrier we just can't give dopamine well we have ways around it okay.

So what we do is we treat myasthenia gravis which I call missing acetylcholine Gravely so just play on words to try to remember what the problem is by creating a situation where there will be more acetylcholine because we stop breaking it down okay one of the more telling signs is this ptosis ptosis which is where the upper eyelid droops over the eye okay all right so let's move on to the symptoms.

So myasthenia gravis symptoms: The D's because everything seems to start with D so diplopia double vision drooping of one or both eyelids difficulty swallowing difficulty speaking chewing difficulty using your arms and hands and holding up your head because muscles are weak and so what do we do well if you need acetylcholine we're going to use an acetylcholinesterase inhibitor and just kind of do this again and my autocorrect keeps correcting that Capital C to a lowercase C it's capital a capital c lower h um acetylcholinesterase Inhibitors mechanism of action okay.

We block the enzyme that breaks down acetylcholine called acetylcholine esterase ache, so you have more acetylcholine. If you have more acetylcholine, it enhances cholinergic action. Okay, how do we recognize acetylcholinesterase inhibitors? Well, they're probably going to end with stigmine. Now some of them are for other conditions: isostigmine usually for toxicity and glaucoma, neostigmine from myasthenia gravis, pyridostigmine from myasthenia gravis. Doesn't mean it's the only thing they're for like neostigmine, you can use as a reversal agent for pancuronium which is a neuromuscular blocker.

So again, I haven't gotten into nmbs in here but that's the kind of toxicity we can talk about. Okay, alright well so we've talked a little bit about what cholinergic can do for Myasthenia and how it's kind of the opposite of anticholinergic but let's talk about the bladder control that we talked about with anticholinergic.

So in anticholinergic, we had medications for an overactive bladder. Okay and that made sense. Okay so if the overactive bladder, we want to use the urinary retention that an anticholinergic causes but with bethenticol you're a choline or devoid or two of the brand names we can use the U and the sludge mnemonic that cholinergics cause urinary incontinence.

It's a side effect but for people with atonic bladder or urinary retention it is a therapeutic effect. So again it's a side effect for those that are taking you know cholinergics but if you have a tonic bladder or urinary retention it's actually a therapeutic effect. It's a relief that you can now void or you couldn't okay.

So the mechanism of action itself is to activate those cholinergic receptors and help someone as the brand name said do void so we just spell it d-o-v-o-i-d okay okay all right there are some considerations though with the then a call and and these cholinergic drugs remember a petropium as an anticholinergic that opened up the Airways well if you're gonna give bethen a call and you're going to give a cholinergic then asthma is a concern because it can constrict the Airways okay.

If we think about that bradycardia which is the opposite of the tachycardia in Bud cat right when you decrease heart rate you can decrease blood pressure decrease blood pressure you can end up with orthostasis when you think of cholinergic the opposite of the anticholinergic constipation we would have diarrhea or defecation but if you have these kind of GI issues like a peptic ulcer or intestinal obstruction you could perf or perforate that ulcer which would be terrible or you can worsen the condition of intestinal obstruction.

So imagine someone is impacted for example and you give them a laxative well if that impaction is uh you know some kind of obstruction something's in the way it's just going to make it worse. You're just gonna make it so that you're trying to get through this wall but it's not working okay.

So these would be the things that I really consider or to some extent contraindications asthma orthostasis um that's more kind of a side effect um peptic ulcers and intestinal obstruction disclaimer this information is provided to you for your informational purposes only and is not intended to provide it should not be relied upon for medical or any other advice.

I urge readers and listeners to consult with a medical professional with any medical condition foreign thanks for listening to the memorizing pharmacology podcast. You can find episodes cheat sheets and more at memorizingfarm.com again you can sign up 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 Melbourne thanks again for listening!

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Anticholinergics Video Pharmacology BUD the wide-eyed tachycardic CAT

In this episode, I go over how you can use BUD, the wide-eyed tachycardia CAT (BUDCAT), to remember the anticholinergics and what that means for pharmacology indications and adverse effects in that drug 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 forward slash P forward slash moving. Let's get started with the show. Okay, today we're going to do anticholinergics and our mnemonic will be Bud the wide-eyed tachycardic cat and I'll explain all of this to you as the issue with anticholinergic and cholinergic is not necessarily getting it, it's remembering all seven or more actually of the adverse effects that you have but if you can get those down then you are in good shape. So first let's talk a little bit about Bud the wide-eyed tachycardic cat so b u d and c-a-t are all going to

Stand for something so it's going to stand for blurry vision urinary retention dry mouth constipation and hydrosis which is no sweating and tachycardia. The problem is we have a b and a t in our mnemonic so we have to use tachycardic to remind us that the T is for tachycardia and the B is FLIR from blurry vision because of dry eyes and then we want to say wide-eyed because madriasis is just not going to work in the mnemonic and finally we're going to put this cat in the desert now he's just on some tan

Carpet so we'll say that that's the desert because anticholinergics are all about dry and when we get to cholinergics you're going to see it's all about wet okay to the mechanism of action anticholinergics inhibit acetylcholine capital a Capital C little h a neurotransmitter the issue we have is that it has two synonyms muscarinic antagonists which we sometimes call anti-muscarinics and parasympatholytics so we want to keep those three straight we want to keep those three together because we're going to have the opposite

Three when we get to cholinergics okay all right so what are the adverse effects what does bud cat stand for so again B for blurry vision that's dry eyes U for urinary retention again dry we're not urinating dry mouth you might sear it as xerostomia constipation if we pull water out of the bowel we're going to plug things up and hydrosis is a lack of sweat and again this is our tachycardic cat so tachycardia and finally madriasis m-y-d-r-a-s-i-s for wide-eyed and it's nice it has the word dry in the middle

To remind you that all of this is very dry so why are we starting with adverse effects instead of indications well you're going to hear all the time that oh that drug has anticholinergic properties watch out for that and what they're saying is that maybe in the elderly something like diphenhydramine or Benadryl you don't want to use because it causes sedation but it also has anticholinergic effects causing many of these problems so the reason we start with adverse effects is because we're now going to go to indications

So how do you take a quotation fingers bad thing and make it good well the blurry vision or dry eyes is one of the many things that happens when somebody has cholinergic crisis from an organophosphate so the pesticides and things like that atropine is the antidote we have urinary retention so if we retain urine that becomes an indication if we're trying to treat over active bladder with oxybutynin tolteridine solofenacine if we have dry mouth or xerostomia okay we might want to reduce salivary secretions and we might use

Glycopyrolate constipation is just a placeholder I don't know why you would want to use this exactly for constipation there are other things you can use anhidrosis okay so atropine okay can help with hyperhidrosis or profuse sweating and the big one because it causes tachycardia it can help someone who is very bradycardic so madriasis wide-eyed might want to dilate the pupils although we don't really use atropine we use something called homotropine we get that it's a Madrid edict which is basically "Something that's going to dilate and make those pupils wide just like our cat. So if you were using atropine IV, you know you would use it for that bradycardia, bronchial secretions or in that cholinergic crisis with the organophosphates. So atropine as the antidote okay, but let's look a little bit more at that OAB and some mnemonics that we can use with some of those drugs themselves.

So a normal bladder, the detruser muscle is contracting when the bladder is full. However, if an overactive bladder, we have the detruser muscle contracting before the bladder is full right. Well what could we do? We've got medications that have an indication for overactive bladder so oxybutynin is Ditropan or Oxytrol and oxybutynin kind of rhymes with keeping here and in tolteridine is detrol which takes the word letters from detruser and control solofenacin or Vesicare is fencing urine in if you're kind of looking at the stem and then physica is Latin for bladder so literally it is vesica care they kind of just squish that word together and then Darth venison is an ablex where you're again fencing the urine in with that stem but you're enabling an exit from the house because many people with overactive bladder really feel uncomfortable going out they are worried that they're going to have an accident and things like that so the nice thing is when we go back to our adverse effects for these four drugs we see that we have our cat back right you might have some blurry vision urinary retention dry mouth constipation and hydrosis tachycardia madriasis but these drugs are getting more specific for that urinary retention so the idea is that maybe some of these side effects would be quite minimized there are some other indications that we have with anticholinergics for example Scopolamine is called transderm scope and often it's used in motion sickness so you put it on for um maybe a cruise or something like that where maybe it's something that that really bothers you but what would we really expect with side effects we'll get to that in a second and then ifritropium bromide or atrovent this is something that uh bronchodilates but really relaxes the smooth muscle of the lungs and when we go back to adverse effects sure enough who's there well it's bud so we might get blurry vision urinary retention dry mouth constipation and hydrosis and tachycardia so again the thing with anticholinergics is you know getting down that okay here are the medications we've got atropine we've got these glycopyrolate we've got these drugs for overactive bladder Scopolamine for that motion sickness and we've also got the you know generic atrovent or which is a neb um which is ipritropium and the idea is that okay we've got all of those but we already know what they're going to do because we've got the adverse effects down for anticholinergic in the next section we'll go over cholinergics disclaimer as always the information is provided for you for informational purposes only it's not intended to provide should not be relied upon for medical or any other advice consult with a medical professional if you have a medical condition 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.

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Beta Agonists Mnemonic IMACH Isoproterenol Albuterol Salmeterol Terbutaline

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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 memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

Like to learn more?

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Alpha Agonists Mnemonic POP CAN - Phenylephrine Oxymetazoline Pseudoephedrine Clonidine

In this episode, I go over how you can use the POP CAN mnemonic to remember the alpha agonists and what that means for pharmacology indications and adverse effects.

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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.

Let's get started with the show. Hey, welcome to the Memorizing Pharmacology podcast. This one is on Alpha Agonist. The mnemonic is 'pop can' and the idea is just to remember a couple of medications that maybe are a little bit different so that we can kind of compare and contrast and do that kind of thing.

So when we look at Alpha One agonists, we think of pseudoephedrine which is Sudafed, oxymetazolin which is Afrin, and phenylephrine which is Neosinephrine. There aren't really stems; the only stem here is pseudoephedrine which has that driven sympathomimetic stem which just means it works like the sympathetic system but specifically it's the alpha one that's the big deal.

We'll look at that mechanism of action specifically on the alpha receptor. So pseudoephedrine or the pseudofed, it's usually an oral tablet that you're going to take. This stimulates Alpha receptors systemically so it's going to go throughout the whole body. The nice thing about oxymetazolin which is Afrin and phenylephrine which is neo-sinephrine, they both stimulate Alpha receptors locally in the nose so you don't get as much of that issue with cardiac contraindications and so forth.

So again anybody that has heart issues they're going to be very wary about using either these medications but all three result in vasoconstriction and decongestion and are adjuncts for allergic rhinitis treatment. So the big kind of take-home thing is if you've got vasoconstriction you've got a little bit increase in blood pressure and that's something you don't want with a cardiac patient.

But when you talk about side effects though really with Pseudoephedrine it's more excitability and nervousness just kind of a jitteriness rarely you're going to see something like tachycardia oxymetazolin Afrin and phenylephrine eosinephrine the big thing here is that rebound congestion and it's possible around three days you might see four or five days whatever but it's called rhinitis medicamentosa so that's the actual name for that rebound congestion.

If something like that does happen you may need to take an oral steroid or you may need to have a steroid in such a way that we go one nostril at a time but that rebound congestion is very real thank you contraindications really it comes down to those cardiac issues so angina coronary artery disease and hypertension because it's CAD coronary artery disease it also just happens to be closed angle glaucoma which is the more more concerning type of glaucoma and either of those would definitely be a contraindication to using these types of medications.

The Alpha 2 you know the can of the pop can mnemonic so when you think pop you think okay well once my nose clears it kind of Pops open but the can part is just to remind you that c and N are in clonidine and clonidine has a couple of brand names that might help you remember what it's for catapress so if you think of catabolizing blood pressure and then catapress TTS was the patch that also helped with blood pressure and then Cafe which is for ADHD or that's how it's marketed.

But the mechanism of action is quite a bit different so it stimulates an alpha 2 receptors that decreases norepinephrine so norepinephrine would normally bind to Alpha One Alpha 2 beta 1 so you get a decrease in blood pressure and that seems a little bit counter-intuitive to say I'm stimulating something but I'm decreasing so that's just the big thing is that it's stimulating Alpha two it's kind of shutting off the norepinephrine faucet and that's why blood pressure decreases okay indications include hypertension ADHD ticks and Tourette Syndrome it can be an adjunct for cancer pain it can also be an adjunct for neonatal opioid withdrawal syndrome but again not the safest drug in the world not something we use a ton anymore but to be complete to have an alpha Agonist and not to go into those super medications that have many many alphas and betas this one is the alpha two prototype then adverse effects which you would expect when you lose epinephrine you would expect a decrease in blood pressure and that decrease in blood pressure tends to result in some dizziness and some light headedness but also quite a bit of fatigue imagine that you're trying to turn on the system to increase your heart rate and blood pressure and all those things only to find out that the faucet for that particular neurotransmitter is not available so anyway just a reminder with all these this is just informational purposes this is not medical advice if you've got a medical problem contact a medical professional foreign thanks for listening to the memorizing pharmacology podcast you can find episodes cheat sheets and more at memorizingfarm.com again you can sign up 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. Thanks again for listening.

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