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 5: Neuro Pharmacology.
Tony: Okay, let's go over chapter five neuro of our review.
So, let's start with local anesthetics and these are OTC and what a local anesthetic is it's just something that's going to numb a certain area. Anesthetics, when injected, will make a person pass out, but what I want to talk about is the ester vs the amide.
So, benzocaine is an ester, it's a type of organic chemistry molecule, and that tells you that the esters we don't really want to inject because they can become allergenic where a patient might have an allergic reaction. Lidocaine has less of that allergenicity, but they're both related by this -caine stem C-A-I-N-E and that might look like cocaine and that's right because cocaine was one of the original anesthetics and they found or develop some anesthetics that weren't addicting.
If you look at Anbesol, you see two of the letters from the word numb, so that's one way to remember that one, and then Solarcaine. Solarcaine takes the -caine ending, that's still frowned upon by the World Health Organization, but solar meaning sun. So, we're using something to take care of the pain from a sunburn, but lidocaine has many uses, an injectable in an emergency, patch, some other different things that it can be used for.
OTC anti- vertigo, so, meclizine. If I were to do meclizine in small letters like this, m-e-c-l-i-z-i-n-e you could kind of put this C in this L together to make a D and then you see dizzy. So, it's for dizziness, but the brand name's Dramamine that you might know, but there is also a brand name that was a prescription item, Antivert for antivertigo, but that one told the whole story, anti-vertigo.
Another OTC under neuro would be a sedative hypnotic and we see diphenhydramine. You might say, "Well, I remember that one, but that was an antihistamine you told me." and that's what's kind of infuriating about pharmacology is that prescription drugs can be for many different things and all this is OTC, but diphenhydramine as an adverse effect made someone drowsy, but here we're using that side-effect as a good thing.
So, tylenol acetaminophen diphenhydramine, the antihistamine that makes you tired, Tylenol PM, and that PM means post-meridian after literally afternoon, but we just use it at night time. So, Tylenol PM is something used at night time. Sometimes asleep is disturbed because of pain and that's what the acetaminophen is there for.
Benzodiazepine like sedative hypnotics, now we're going to the prescription items. Benzodiazepine-like means it's not a benzodiazepine but it works a little like one. So, eszopiclone with the -clone stem and we see this es- again, so the S isomer, and you can think of Luna or rest in Lunesta. Then zolpidem, -pidem is the stem, P-I-D-E-M and this is Ambien or Ambien CR, Ambien controlled release. So, Ambien works to help somebody fall asleep, but if the person has trouble staying asleep the controlled release, much longer acting version works well.
Melatonin receptor agonist. So, ramelteon the -melteon is the stem and it looks like melatonin for a reason because it is a melatonin receptor agonist. You can think of Rozerem, roz- rhymes with doze, REM for rapid eye movement sleep.
So, a lot of hints in these brand names certainly worth remembering. Those are some OTC neuro drugs, something to help you sleep.
In the next column we're going to go in to antidepressants and how those can help us.
The first thing that throws students off is the classifications as SSRI, SNRI, TCA, MAOI and each one has its own acronym. So, an SSRI is a selective serotonin reuptake inhibitor and that means that serotonin is going to normally be re-uptaken or if you want to think of it as recycling that's maybe a better way, but instead what happens is we inhibit that recycling, it stays in the synapse, and it's supposed to make the patient happier. It's that hypothesis of norepinephrine and serotonin not having enough of it.
There's five of them I'm going to go over; citalopram and escitalopram, we see two drugs with the same root just like we saw esomeprazole and omeprazole. Celexa was the first one that came out, it reminds me of relax. These SSRIs can also be used for anxiety. Then Lexapro, you can think of a professional upgrade from the first one, so it takes part of the ending of Celexa and then just adds pro to make Lexapro, but those are related, and the escitalopram is supposed to be better than the citalopram.
The -traline stem for Zoloft, so it lofts your mood and then the -oxetine. So -oxetine is a little bit tricky. The Adopted Names Council calls -oxetine a fluoxetine-like entity, but fluoxetine and paroxetine are SSRIs, then we're going to see that duloxetine is an SNRI, and later we're going to find a non-stimulant ADHD medication atomoxetine. So, this -oxetine ending you really have to be careful with.
Fluoxetine is interesting it's got two brand names. Prozac was the first brand name that came out, it was antidepressant. Sounds like a strong drug with the P, Z and the C or with a K sound. Then Sarafem. I'm not sure what they were going for, a seraphim it's like the highest angel, so maybe it was the work of angels, but that's for something called premenstrual dysphoric disorder, PMDD. Paroxetine, Paxil and then Paxil controlled release. So, again another medication that works a little bit longer.
Then we have the serotonin norepinephrine reuptake inhibitor and I'll try to do a little better job with my writing here serotonin norepinephrine, and I'll abbreviate it NE, reuptake inhibitor. So, we're just affecting different neurotransmitters where selective serotonin reuptake inhibitor was just serotonin, now we're talking about serotonin and norepinephrine. Again the -oxetine, be careful with that it's supposed to indicate a SSRI Cymbalta. So, my mnemonic was to remember that symbol players would always seem to be happy and alta means above in Spanish, so higher mood maybe.
Then the -faxine is the stem here in venlafaxine and for Effexor, so that's a way to remember that one. The TCA, so this SNRI and SSRI are both named after neurotransmitters, but amitriptyline is named after or the tricyclic antidepressant is named after the three rings. So, you can see that -t-r-i- in the stem -tripyline and Elavil elevates your mood.
Isocarboxazid didn't have a stem that I saw, but I had a student that said, "I sew car boxes" and it just seemed very sad. So, it's a monoamine oxidase inhibitor. So, mono, M-O-N-O-A-M-I-N-E and oxidase inhibitor. What that monoamine really means is that we're still kind of going back to serotonin, which is a monoamine, and that we're affecting it we're just calling it by a different name.
Smoking cessation. So, bupropion was first an antidepressant, it was Wellbutrin so ideally you would get well or get out of the rut you're in. So, you see the r-u-t and then -i-n in there, but then they found that a lot of these antidepressants stop smoking. So that was great, let's make it an anti-smoking drug, so they renamed it Zyban or repackaged it that way. Varenicline, it's Chantix. So, the new -nicline stem indicates a smoking cessation medication and I had a student that said in a southern accent, "Oh when I take varenicline I'm very inclined to quit or with Chantix, my chant is that I don't need my fix." Anyway, it just stuck in my head.
These are antidepressants all the way down to bupropion, which can also be used for smoking cessation. Then varenicline is specifically a smoking cessation medication.
Next, we're going to go on to some anti-anxiety then ADHD medications and antipsychotics as well. So, the first thing with the benzodiazepines is that on a lot of YouTube channels you'll see -lam and -pam are stems and that's just incorrect. You want to be careful because there's a drug lamotrigine, which is an antiepileptic, and there's verapamil, which is a calcium channel blocker, and that's for high blood pressure. Those are not benzodiazepines, so use the whole stem -azolam or -azepam.
Xanax has part of the word anxiety and it's so easy enough to remember. Versed, I can't remember the verse you just said. Klonopin and clonazepam are very similar and then Ativan, I don't even remember what I use for that one. So, really stick with the generic stems that's what you want to use for the benzodiazepines.
Dexmethylphenidate, methylphenidate I couldn't really find a stem for them, but you can see with the brand names what they're for. So, these are stimulant schedule twos for ADHD. They can help you focus, Focalin, or they can help you concentrate. They just kind of turn the last couple letters around there. Non-stimulant ADHD medication atomoxetine, gain we see this -oxetine stem. This does not mean it's an SSRI, you have to memorize that it's a non-stimulant ADHD medication. Strattera can straighten out your attention. Bipolar is a simple salt. So, lithium and Lithobid, so BID, bis in die, is the Latin for twice daily. So, lithium was taken twice daily in this particular dose.
First generation antipsychotics. So, these would be the typical, t-y-p-i-c-a-l antipsychotics and then when we get to second generations those are atypical, but we don't usually use antipsychotic as a term because to say someone is psychotic is just not a nice way of saying it, so usually we say antischizophrenic. So, chlorpromazine was the first one that came out, its Thorazine, and this is low potency. That's important because the low potency drugs tend to cause sedation and low potency just means that you need a hundred milligrams to get the same thing out of chlorpromazine as two milligrams of haloperidol, which is high potency can do. So, the haloperidol has the -paridol stem and a lot of students think of the halo to remind them or the halo in haloperidol to remind them that this is high potency first-generation antipsychotic, but you can also replace first-generation with typical antischizophrenic.
So, that's first generation some of the drugs for anxiety ADHD bipolar and psychosis.
Let's look at the second-generation antipsychotics and the anti-epileptics.
The second-generation antipsychotics the -peridone in risperidone and the haloperidol and Haldol are very similar. Somebody said that the 'risper' sounds like whispers, so like you're hearing the whispering voices. Quetiapine if you change this T and I and then put the I over one and kind of turn it around you end up with quiet, so quiet the voices, but the stem is -tiapine and that's Seroquel, to quell something is to calm something down.
So, risperidone quetiapine are both second-generation antipsychotics. We would also call these atypical. Why is that important? Atypical antipsychotics have less extrapyramidal symptoms, but would have more dyslipidemia, diabetes, weight gain, things like that, in general. Again, you don't want to generalize too much, there's certainly a variation within the class.
Anti-epileptics we break them down in to traditional versus newer. So, we've got carbamazepine and the -pine just means that we have some kind of, I think it's a tricyclic molecule, but the way to maybe remember it is that you carb or curb the convulsions or you control them. So, you see the T the R the O and the L that could be from the word control, that's one way to look at it. Divalproex is Depakote, second traditional one and then phenytoin has the -toin, t-o-i-n stem and this is Dilantin and you would want to remember it from the -toin stem.
The newer ones, now I only just happen to pick two drugs that happen to have gab in them, gab is a stem . It's for the gamma-aminobutyric acid and gabapentin is Neurontin and you can think of the n-e-u, which is pronounced new, as the newer anti-epileptic, and then Lyrica also is a newer one. If something's lyric its musical, so we're taking this very disordered epilepsy and making it more ordered. so that's one way to think of it.
Parkinson's disease, so dopamine or lack thereof is a real problem. So, levodopa, you can't put dopamine in the brain directly, the blood-brain barrier will block it, but levodopa can as a precursor get into the brain and then be converted to dopamine, but we lose so much as we get there. So, carbidopa is really there as a protectant to protect levodopa, allow more of it to enter the brain. The -giline stem selegiline, that's an MAOB, it's Eldepryl, and so you can see the word elderly in there that Parkinson's affects many elderly people, but certainly it affects younger people as well. That is highlighted in a couple movies and then the actor Michael J Fox certainly. So, that's Parkinson's.
Then let's look at just our last two here Alzheimer's and motion sickness. Alzheimer's, donepezil, the way that I remembered it was my memory is done I can't remember zilch and just put z-i-l-c-h or you can think of perception and Aricept and maybe you lose some degree of perception. Memantine, the m-e-m from memory tends to ring a bell, but then Namenda has the NMDA and that's what kind of receptor it affects.
The last medication is for motion sickness. So, scopolamine is Transderm-Scop, so across - trans, derm - skin, scope and then taking the first four letters of scopolamine. This is usually used for cruise ships and things like that, a person puts on a patch and they don't have to keep taking Dramamine or something like that.
That's neuro 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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