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 7: Endocrine Pharmacology.
Tony: So, let's start with Chapter 7; Endocrine. This is our last chapter and we're going to start with three OTC medications.
Most people don't know that insulins are over-the-counter because they aren't literally over-the-counter, they're in the refrigerator in the pharmacy, but they don't require a prescription or two of them don't.
Regular insulin, which is humulin R, and NPH insulin, which is humulin N, and alphabetically you say, "Well, why didn't you put the N first, why did you put the R first?" Traditionally insulins when we talk about them and list them, we list them in the order of the speed that they work. So, I'll mention these in the insulin column, but regular insulin works for less time of an NPH insulin. So, that's how we would put it, regular then NPH.
Emergency contraception. So, the stem here is the -gest- that lets you know it's a progestin. So, Levonorgestrel is Plan B One-Step, why is it called one step? Well, it used to be two steps, it used to be two pills, and the Plan B comes from, well Plan A might have been a condom or something like that, that broke, and Plan B was to take this pill for emergency contraception. It used to be by prescription, then it went behind the counter, then recently it's gone over-the-counter and available readily.
So, let's go with the prescription medications now. So, we'll start with the oral anti-diabetics and to remind us that diabetes is an issue of a blood glucose that's elevated. So, what we're trying to do is reduce that blood glucose. The order that I put them in is alphabetically by their class, so that if you have other medications you want to put in you can just put in more biguanides or more DPP-4 inhibitors, but the B proceeds the D proceeds the sulfonylurea.
So, Metformin has the -fromin stem, F-O-R-M-I-N, but you'll usually see some kind of g-l- in these generic names and Metformin is the exception. So, the manufacturer made Glucophage, the gl- is in the gluco for glucose and then phage. To phage something is to eat it, so if you've heard of cell eating as phagocytosis, cell drinking is pinocytosis, so that's kind of where that comes from. The DPP-4 inhibitor sitagliptin. So, some people just call them 'gliptins' because it's just hard to say DPP-4 and that's Januvia.
So, the second-generation sulfonylureas, glipizide and we have the gli- prefix. Its brand name Glucotrol, so you can see glucose control is what I think they were going for with a brand name, and then glyburide the gly- prefix, and Diabeta is the brand name. So, you can see most of the word diabetes is in there or you can think of the beta cells and insulin secretion and what they do there and the islets of Langerhans.
So, those are if you have a patient that has too much blood sugar, however sometimes we have a condition of hypoglycemia and you would use glucagon when the glucose is gone, is the best way I think to think of that, and that brand name is Glucagen. So, we are generating glucose where there isn't any.
So, let's go on to the insulins and another situation where we have too much or too little of a hormone. So, I've put the insulins here in order of how long they work. So, insulin lispro works very quickly, it should be taken with a meal, and because it works so quickly it's by prescription. The brand name is Humalog, which is a combination of human insulin and analog insulin.
The regular insulin and NPH I already talked about, but this is where they would be placed if you were to put the four insulins together in terms of how long they work. So, insulin lispro, regular insulin, NPH insulin, then insulin glargine. I've heard lazy Lantus to remind you that it's very slow acting, it works all day, and then Toujeo is a newer brand name. Those four insulins in that order.
Just as diabetes was an issue with high glucose and sometimes we get hypoglycemic, hypothyroidism is simply adding thyroid, if you want to treat that. So, levothyroxine is the actual hormone and the brand name comes from Synthroid, which is synthetic thyroid, is how they came up with that brand I believe. Then hyperthyroidism, when we have too much thyroid hormone, we would use something like propylthiouracil, which uses the P, the T, and the U from propylthiouracil to make PTU.
Hormone replacement. So, testosterone the -ster- is the stem indicating it's a steroid and then Andro- meaning man and then gel because testosterone is generally regarded as a male hormone.
So, from there let's go on to some birth control and issues with the bladder. So, beginning with the combined oral contraceptives or the pill, as most people would call it. The estr- is an estrogen and then the 'gest' again is a progestin. These get really complicated, but if you want to look at the estrogens you see that in all four of these ethinyl estradiol is the estrogen, so we don't have to change anything there. What we're doing is we're either adding a supplement or we're adding a progestin.
So, the first one is norethindrone ethinyl estradiol and ferrous fumarate, which makes Loestrin 24 and then we use the Fe, the abbreviation from the periodic table of elements for iron. Norgestimate with ethanol estradiol is Tri-Sprintec, the Tri- comes from that it's triphasic. And those are oral contraceptives.
So, if we're trying to remember something again we try to go head to toe and the patch would probably be something you put on the belly and Norelgestromin, the -gest- for the progestin with ethanol estradiol is Ortho Evra. So, that patch you can put on your belly. The ring is a vaginal ring, so we're going further down. Etonogestrel and ethanol estradiol, again we're using those stems and the brand name I think comes from new vaginal ring where they just took the Nu- from and make the sound new, the -va from vaginal and then ring.
While the tablets or the pill we have seven seven seven and then usually off for a week for a 28-day cycle these, the patch and the ring, are used for seven days and then a new one replaces it.
Overactive bladder. So, some of these brand names actually help quite a bit. So, with oxybutynin, the detrusor muscle is an issue with overactive bladder, so Ditropan alludes to the detrusor muscle, and then that -trol- from control you could think of you're in control with Oxytrol OTC.
The -fenacin- in solifenacin is the stem and VESIcare, vesicae actually means bladder in Latin, and somebody must have been a classics major that helped make this brand name, but VESIcare is care for the bladder. Then tolterodine, again detrusor muscle control in the brand-name.
Urinary retention. So, we've talked a little bit about cholinergic versus anticholinergic and a side effect of anticholinergics is that everything is dry. So, there's anhidrosis, stop sweating , there's blurry vision secondary to dry eyes, there's dry mouth, there's urinary retention, there's constipation, and then tachycardia, but that urinary retention is what would normally cause this kind of state.
So, to treat an anticholinergic state what we would do is we would give a cholinergic. So, bethanechol, -chol and that's not actually a stem so I'll erase it, is a cholinergic medication and you can see the part of acetylcholine that's in the brand name, but again that's not a stem, I just wanted to point it out.
Erectile dysfunction. So, these have the -afil stem and I believe there's actually an infix in here because there's a vardenafil and a sildenafil and those have that same -den- in there, but I won't mess with that right now. So, sildenafil is Viagra, it's the first that came out. It's prominently talked about in Love & Other Drugs, a recent movie, and via- means life and gr are the first two words in growth. So, give life, growth, however you want to take that for erectile dysfunction.
Tadalafil is also an erectile dysfunction medication with a much longer half-life, so they call it the weekend pill. This is the one where the couples there with the bath tubs next to each other at sunset. I can't mention the mnemonic really, my students used something to the effect of tada, but I'm not going to get to that.
So, we just have four drugs left. We've done 196 so we're going to go on to the benign prostatic hyperplasia alpha blocker and then benign prostatic hyperplasia 5-alpha reductase inhibitor.
So, I mentioned that alpha blockers are used for hypertension, but they also are helpful for a precondition called benign prostatic hyperplasia or BPH. This is a benign growth of the prostate where there's an issue with urine flow. So, to make the brand name, the manufacturer must have thought of you know the urine flow being slow, so now we're going to get maximum flow to make FloMax.
Then alfuzosin also alludes to this urine with the 'ur-' [in the brand name] and then control 'tral' instead of 'trol'. The -osin at the end of tamsulosin and alfuzosin it's not an actual stem, but some students use it to remind themselves that the BPH drugs are related.
The last two drugs; So, BPH 5 alpha reductase inhibitors, so the dutasteride and finasteride. Avodart is the brand name for dutasteride. Finasteride is interesting that it has two brand names and I should have put Proscar first for prostate care because that really matches up with the Avodart, but interestingly enough as people were taking the finasteride they were growing hair, something called hirsutism, and not to lose an opportunity the manufacturer said, "Okay, well let's create a medication name that's going to indicate that the person is going to grow hair". So, alopecia is the loss of hair, propecia, I guess, would be adding here. So, that's how that name came about.
At the end of movies or in the old black and whites there was always 'fin' for fini or done. So, we have finished our 200 medications.
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