Jan 7, 2018
This one-day, two hour seven lecture series provides a basic understanding of how to recognize common drug names, understand the basic classifications, and quickly memorize them for exams. The print, e-book, and audiobooks these lectures are based on, Memorizing Pharmacology: A Relaxed Approach, can be found here https://www.amazon.com/Memorizing-Pharmacology-A-Relaxed-Approach/dp/B01FSR7XZO/
Male speaker: Welcome to the Pharmacy Leaders Podcast, with your host, Tony Guerra. The Pharmacy Leaders Podcast is a member of the Pharmacy Podcast Network. With interviews and advice on building your professional network, brand, and a purposeful second income from students, residents, and innovative professionals.
Welcome to Episode Three: Respiratory Pharmacology.
Tony: This is chapter three respiratory or respiratory and I'm going to do the same thing just for efficiency's sake I've already written everything up on the board, so that I'm just going to highlight stems. I'm going to highlight drug classes drug classifications and in the order in which I put them.
The first section we're going talk about are antihistamines and you divide antihistamines in first and second generation. There's controversy over whether there's a third-generation drugs like fexofenadine, which is Allegra is one that might be in the third generation. A third-generation drug would be something that's maybe a metabolite or one of the isomers of the racemic mixture. So, I'm not going to go in to a third generation, first and second is enough for just our purposes right now.
So, antihistamines H-1 first generation is diphenhydramine and again we have this non-alphabetical order, so I put an ABC with a slash and then ABC with an arrow here to explain why. We begin with first-generation diphenhydramine. Diphenhydramine is in that generation that was first invented, and these made people very drowsy. You can see B E and D in Benadryl, so you can think of bed, and you can also see the D R Y because it's drying, helps with allergy symptoms. Diphenhydramine, that's first generation that goes through the blood-brain barrier and makes someone drowsy.
Second generation on the other hand, cetirizine and loratadine, so Zyrtec and Claritin. These don't cause the drowsiness because they can't get through the blood-brain barrier or they can't stay through the blood-brain barrier. Loratadine has a stem it's -atadine and I know spelling has been de-emphasized since I was a kid, so I'm a gen X-er. I was clapping erasers and had chalkboards and things like that, but in drug name spelling is incredibly important because you pronounce loratadine the same as you pronounce famotidine and the -tadine and the actual stem is -atadine sounds just like the -tidine in the H-2 blockers, but if you spell it -tidine by accident you've just made this drug instead of for allergies for acid and we don't want to do that. So, paying attention to spelling is very important with these medications.
So, cetirizine, Zyrtec. This -tir- in cetirizine is pronounced "tear" so you can think of tearing from allergy eyes. Loratadine has the -atadine stem and the Claritin Clear commercials have been very clear about what it's for, you see people outside having fun on the picnic you even look at the box it's a blue sky so Claritin Clear for allergies.
What I want to talk about also is this loratadine-D. So, what is that D? Well D is for decongestant and that decongestant is pseudoephedrine. Pseudoephedrine is brand name Sudafed and you'll see it as loratadine-D or Claritin-D and what's the rationale for that? Well if you have allergies and nasal congestion, if you just use loratadine or claritin it's not going to help, but if use loratadine with a decongestant then it will take care of the allergy symptoms and the congestion.
This decongestant pseudoephedrine or Sudafed is actually BTC, it's behind the counter you, have to show ID for it. This -rin or -drin, I think, is the stem and because it's behind the counter there's a certain amount that any person can get in a single day a certain amount you can get in a month because the pseudoephedrine can be used to make methamphetamine or meth. One of my students said, "I'm so fed up with being congested and that's how you remember pseudoephedrine or Sudafed".
So, what we're doing to remember these is we start over-the-counter with these antihistamines and this decongestant and what we're going to do is we're going to go in to the nose, so we're physically thinking, "Okay we're in the nose now" and phenylephrine is the PE in many oral liquids and it's very similar to pseudoephedrine except this one is not regulated, and you can get as much of it as you want. The brand name for the nose one is Neo-Synephrine. Another one which can be used in the nose, another decongestant, is oxymetazoline which is Afrin and this nasal spray you should really only use for three days otherwise you might get some kind of rebound congestion.
So, we're staying in the nose and that's how we're just like in the in the GI chapter we went from stomach down to intestines, we're staying in the nose and then we'll go down to the chest. So, we have triamcinolone and this -lone some people use as a way to remember that it's a steroid, it's not a proper stem. The brand name, the '-cort' stands for cortical steroid and nasa- for nose, again it's not a stem, you can't have a stem in a brand name, but these are hints that let you know what it's for. Allergic rhinitis, you have an -itis that means you have an inflammation, so inflammations we can use some kind of steroid.
So, for the first group here we're starting with anti-histamines then we go to the decongestant then allergic rhinitis and we're being very mindful of where we are in the body.
We're going to go from the nose to then cough, which is going to be in the chest. So, just as we've done before we're going to go from an OTC to a prescription and this is where we make our jump, everything before just now is over-the-counter behind the counter.
So, guaifenesin is a mucolytic and some people get that confused because they've seen robitussin for coughs so long, but the guaifenesin is actually just m-u-c-o-l-y-t-i-c a mucolytic is something that breaks up mucus or breaks up chest congestion. The stem is in dextromethorphan, but you may never see that word, you might just see the DM. So, guaifenesin with dextromethorphan is Robitussin DM. There's also Mucinex DM. Either one of those, but the -orphan stem is the one that tells you it's dextromethorphan.
If the cough doesn't subsist and maybe you go to the prescriber and say, "You know, I've had this cough for a week and it's just not going away. It's not productive" they might prescribe something like codeine. Now, in the United States codeine you can't just get it over the counter. You used to be able to get a little bit, but now it's regulated, and that Cheratussin the 'cher' is for cherry and then AC, some people just use anti-cough, but I think, and codeine was probably what it stood for. Then -tussin; an antitussive is something that's for cough.
So, if that cough doesn't go away and you still have that chest congestion, if the prescribers being very aggressive maybe they'll treat the inflammation in the chest and they'll do that with a steroid with either methylprednisolone or prednisone. Again, we're staying with our alphabetical within the class of steroids. Methylprednisolone this is an infix. So, in English we can have something that's a prefix before we can have a suffix which is at the end or we can have an infix and in fixes are extremely rare in English, but they're not rare when it comes to medications. So, the -pred- not the -lone is what tells you it's a prednisone type steroid, but some people still use that -lone or -sone as their cue, but really the stem is that -pred-.
Maybe we go from the chest and we stay in the chest and stay in the lungs and in the lungs, we're going to talk about these asthmatic medications. So, we have budesonide and we pronounce this -son- not as son but as sone and I'm not going to underline it because it's not a proper stem, but some people still use it to recognize this is the steroid part. I put fluticasone, this -sone, underneath it because these two drugs are doing the same thing. They're long-acting steroids that are going to be inhaled, so we have the steroid part of it for asthma and then I put beta-2 here. A beta-2 agonist is a bronchodilator, it's going to open up your lungs and the stem for that is -terol. t-e-r-o-l. t-e-r-o-l.
You're probably most familiar with albuterol, but in these long-acting versions formoterol and budesonide come together to make Symbicort, so they're symbiotic working together with a corticosteroid and then fluticasone is working together with salmeterol to give you air or you're adding them together spelling add ad instead of a DD to get air.
Fluticasone you can find it alone and what I did was where these are combination medicines I just staggered this, I put a hanging indent where the fluticasone is on this side under the steroids and albuterol is on this side just to show you that I'm just separating this out. This is long-acting, but this is a little bit more short acting. So, fluticasone comes as Flonase for the nose, but also, it's Flovent if you're going to use it orally. Then this albuterol is that rescue inhaler that most people are familiar with.
What I did here was I put prophylaxis before acute, so our healthcare system is really treat once something's happened, but ideally you don't get asthma attacks because you take these long-acting medications, but sometimes you might have a breakthrough asthma attack and you would want that rescue inhaler; the beta-2 agonist albuterol. So, I kept with that alignment. So, albuterol the -terol is under here in another combination product, but here we have -tropium and -tropium is an anticholinergic. The -chol c-h-o-l is about acetylcholine and acetylcholine is the neurotransmitter we're talking about.
Ipratropium does a really good job with asthma as well and this comes in the medication DuoNeb, literally two a duo that can be nebulized, and so albuterol works as a bronchodilator ipratropium as well and they work in concert together.
Tiotropium also has this -tropium stem to let you know that it's an anticholinergic, but this one is a little bit more long-acting than this short acting one. Tiotropium is a long-acting anticholinergic and this brand name is Spiriva and if you think of the word respire or respiration you see the s-p-i-r in there, but it's the -tropium stems that lets you know this is an anticholinergic medication.
So, again now we've gone from then just using some of the cognitive tools to go from over-the-counter to Rx. We're going from a cough which is in the chest to the lungs which is in the chest and asthma. Then we're going to go on from these medications to three other medications that can be used in asthma incidents and things like that.
The leukotriene inhibitor, Montelukast the stem -lukast seems an awful lot like leukotriene. It's given once a day and that's where that single comes from in Singular and then if you're asthmatic and it's helping your condition then the air a-i-r is what helps. Anti IgE antibody, so again one of these biologics, omalizumab. So, the -mab tells you it's a monoclonal antibody and then -li and -zu also have meaning, I won't go in to it here, but it's in the book.
It's important to understand with the biologics we're going to have these complex stems telling us where it's from and that's Xolair and that to me that just sounds like extra air. So, again a way to remember that it's for it asthma, but this is an injectable. The one thing with omalizumab is that it can cause anaphylaxis, so you always have to have somebody around when it's being injected, an epinephrine or an EpiPen is what you would use. So, epi means above neph means kidney, so above the kidney. What's above the kidney? The adrenal gland. So, epinephrine is an injectable that does something very similar to the adrenal gland, which is secrete epinephrine.
There's another word it's also called that's very similar and I'll just put it here, it's called adrenaline, and this is the Latin version. So, -ad means above or to towards and then -renal means kidney and then so this is the Roman or the Latin and then the epinephrine is the Greek.
That's the respiratory medications in a nutshell.
Male speaker: Support for this episode comes from the audio book, Memorizing Pharmacology: A relaxed approach. With over 9,000 sales in the United States, United Kingdom, and Australia, it's the go to resource to ease the pharmacology challenge. Available on Audible, iTunes, and Amazon.com in print, eBook, and audio book.
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