TonyPharmD

As you head towards the finish line, you want to speed up your study, but with pharmacology, it often feels like you are getting nowhere. I always felt that at the end of the pharmacology semester, I had done a good job helping students understand pharmacology, but not a great job helping them remember the material at least long enough for their NCLEX exams. Over the last year I've developed over 131 original mnemonics that combine multiple drugs, side-effects and nursing considerations. In this article, I want to show you in a free video, the technique I used to create the mnemonics for what is the #1 book in Nursing Pharmacology eBooks on Amazon.com. I want you to have the tools you need to memorize something for an exam because in many ways the NCLEX is artificial, you're not allowed to look anything up, so we need to work with tools that help us succeed in a "no looking up anything" environment. That's when we really have to have our memory down so that we can do the higher level understanding and working through. Mnemonics: How It Works First, we take the content we want to learn, four antacids and four side-effects/interactions and frame it in the form of a question. Question 1 Name four antacids and four side-effects or interactions that concern you about antacids. Then we take the medications and side-effects and put them into a list. Aluminum hydroxide (Amphojel) Calcium carbonate (Tums, Pepto Children's) Magnesium hydroxide (Milk of Magnesia) Sodium bicarbonate (in Alka-Seltzer) Decreased phosphate with Al(OH)3, CaCO3, Mg(OH)2 Ions, chelation with fluoroquinolones, levothyroxine, and tetracyclines Constipation from Al(OH)3 and CaCO3 As needed (PRN) rather than scheduled Laxative effect of magnesium hydroxide Now, you might say, you're not creative. You don't have to be, you can go to a Scrabble cheat website and start putting words in. What you find is that if you do that, you can come up with a few words that make sense and you list those vertically like this. Then fill in the drug names. Aluminum hydroxide (Amphojel) Calcium carbonate (Tums, Pepto Children's) I D I C Magnesium hydroxide (Milk of Magnesia) E A L Sodium bicarbonate (in Alka-Seltzer) (or fill in the side effects) A C I Decreased phosphate with Al(OH)3, CaCO3, Mg(OH)2 Ions, chelation with fluoroquinolones, levothyroxine, and tetracyclines Constipation from Al(OH)3 and CaCO3 M E As needed (PRN) rather than scheduled Laxative effect of magnesium hydroxide S (then both) Aluminum hydroxide (Amphojel) Calcium carbonate (Tums, Pepto Children's) I Decreased phosphate with Al(OH)3, CaCO3, Mg(OH)2 Ions, chelation with fluoroquinolones, levothyroxine, and tetracyclines Constipation from Al(OH)3 and CaCO3 M Magnesium hydroxide (Milk of Magnesia) E A As needed (PRN) rather than scheduled L Laxative effect of magnesium hydroxide S Sodium bicarbonate (in Alka-Seltzer) Now you have the mnemonic of side effects and drug names that will help you keep this in mind for the board exam. While it may seem a little slower to create mnemonics or take the time to go through them slowly in this way. Our goal is not to sprint like a middle schooler who wins the first 50 yards of a race. Rather, we are looking to retain and memorize as much information as we can in the shortest amount of time possible. Even if your mnemonic doesn't make a lot of sense, or you don't like it, my students have found that they will remember it because of the heavy mental lifting they did to create it. Please do take the time to comment, it really helps me add more value for my students and to create better content for my YouTube pharmacology channel.

I had a request from a number of students to put my pharmacology content from the coming Spring semester as just audio on iTunes. Watching on YouTube is sometimes inconvenient or takes up too much bandwidth. So I wanted to share this new podcast with the allnurses.com community. If you would like to listen to the audio content from the Memorizing Pharmacology videos, they are the first seven episodes of the Free Pharmacology Course Podcast on iTunes which you can link to here: Free Pharmacology Course Podcast by Tony Guerra on Apple Podcasts I'm open to adding more, just leave me a comment or contact me and I'll try to put up relevant audio pharmacology content for you. I look to add additional content to help students translate, understand, and memorize the relevant pharmacology content. To find the podcast using the podcast app: Press the magnifying glass in the iTunes app Type "pharmacology" You may have to push "See All" or scroll a little to the right to find it. Look for the orange runner on top of "Free Pharmacology Course" on a black background. I want to wish you all a Happy New Year and an excellent next semester of pharmacology!

Antibiotics Cell Wall synthesis inhibitors B lactams Penicillin -- IV vs Oral G VK Aminopenicillins -- both start with 'A' Amoxicillin Ampicillin Penicillinase resistant -- MSSA Methicillin Nafcillin Oxacillin Cephalosporins -- gram + vs -, 1st gen "-in" Gen 1 Gen 2 Gen 3 Gen 4 Gen 5 Carbapenems -- ESBL (extended spectrum beta lactamase) producers, very BS, not used often Doripenem Imipenem Meropenem Ertapenem Monobactam aztreonam Glycopeptides Vancomycin Lipoglycopeptides Dalbavancin Oritavancin Telavancin For the rest of this video series, I have my 4th professional year Advanced Pharmacy Practice Experience Jaclyn Aremka take her turn as instructor for antibiotics and antivirals. Academic Pharmacy Practice experiences provide pharmacy students with opportunities to teach in the classroom before they go on to residencies or future positions in teaching. She goes over the 3-video series of antibiotic pharmacology as well as HIV medicines in video 7.The pharmacology of antibiotics is a complex topic to say the least. It's a broad topic with hundreds of medications, but there are clear patterns in their use. Trying to decide which antibiotic to use in each patient sometimes often comes down to professional judgment taking into account the practice setting, patient condition, and other factors. The medications themselves are also complex. Some can treat a broad spectrum of bacterial infections, while others are more specific for a few types of bacteria and completely ineffective against others. Perhaps one of the most challenging aspects is the concept of antibiotic resistance. 'Superbugs' that are resistant to even our strongest antibiotics are becoming more common. This is why the proper use of these medications - antibiotic stewardship - is a critical healthcare skill. Proper antibiotic stewardship can reduce the likelihood of resistance. With that in mind, we focus on 3 different types of antibiotics in video 4: beta lactams, glycopeptides, and lipoglycopeptides. What these antibiotic classes have in common is that they all target the bacteria's cell wall. Beta lactams: A Beta lactam is a part of the molecule. If you haven't had organic chemistry, it may be good to check out a picture. We break down this class of antibiotics into 6 sub-classes: penicillins, aminopenicillins, penicillinase resistant penicillins, cephalosporins, carbapenems, and monobactams. They all have a beta-lactam ring within their molecular structure (hence the name "beta lactams") and kill bacteria in much the same way. Even though they work in similar ways, the medications within these 6 sub-classes are used for varying bacterial infections. Glycopeptides: The one drug we'll go over is vancomycin, or vanc for short. This one can be confusing because as we'll see in later videos, there are many antibiotics that end in -mycin, but it's not an official stem. Lipoglycopeptides: Lipoglycopeptides are similar to vancomycin, a glycopeptide. The medications in both of these classes work in much the same way and they share the risk of nephrotoxicity. One major difference is that the lipoglycopeptides medications include a recognized stem, -vancin.

The cardiovascular system presents an opportunity to readily tie physiologic principles with pharmacology. By working backwards to those principles, these drugs tend to stay in long-term memory. I'll go into just enough detail on physiology in order to provide you a solid understanding of the drugs. OTC antihyperlipidemics and antiplatelet There aren't many OTC cardiac medications, but let's look at three. First, the omega-3-acid ethyl esters form an important part of fish oil. Niacin or nicotinic acid helps reduce blood cholesterol levels. With very effective LDL lowering prescription drugs, we often see prescribers reaching for those first. Fish oil and niacin both have prescription forms as well. Common side effects include belching for fish oil and facial flushing for niacin. Aspirin is the OTC anti-platelet in this section. At 81mg, aspirin doesn't work as an anti-inflammatory as it does at 325 mg, but the low dose prevents platelet aggregation. This effect potentially reduces the chance of serious cardiac conditions such as heart attacks and strokes. We'll discuss other prescription only medications used for the same conditions. Diuretics Have you ever overheard someone say that they forgot to take their water pill? As health practitioners we need to know generic, brand and these shortcut names patients use. Different diuretics work at different parts of the nephron, the functional unit of the kidney. It's critical to know basic renal physiology to help remember the drug classes in order from most to least potent diuretic. Mannitol, an osmotic diuretic, works in the proximal convoluted tubule (PCT) and furosemide in the ascending loop of Henle. The thiazide diuretic hydrochlorothiazide works in the distal convoluted tubule (DCT) with a little less diuresis. Two potassium-sparing diuretics, spironolactone and triamterene, work at the collecting duct, the last portion of the nephron's physiology. A more severe condition pathophysiologically like CHF might warrant furosemide, a less severe indication like initial hypertension warrants a lesser diuretic like hydrochlorothiazide. Diuretics that aren't potassium sparing are considered potassium wasting. Thiazide diuretics normally cause only a little reduction in potassium, but loop diuretics usually lose enough to warrant electrolyte replenishment. Alphas and betas Doxazosin is an alpha-1 antagonist that opposes vasoconstriction and lowers blood pressure through vasodilation. Clonidine, an alpha-2 agonist, also lowers BP through the central nervous system (CNS) and is considered a negative feedback receptor. Thus when they are activated, they inhibit BP increasing norepinephrine, so norepinephrine inhibition lowers BP. Many beta-blockers end with -olol, but you have to memorize which are selective for beta-1 or non-selective. Beta-1 receptors, again, are primarily in the heart while beta-2 receptors are in the lungs. Activating beta-1 leads to increased heart rate (HR), while activating beta-2 leads to bronchodilation. Thus, a non-selective beta blocker such as propranolol will both lower HR and cause bronchoconstriction. Lower HR is good, but in patients with asthma, bronchoconstriction is undesirable. In patients with asthma, it's best to use a selective beta blocker like metoprolol tartrate or metoprolol succinate. The tartrate salt form is short acting while the succinate salt form is long acting. Either way, metoprolol blocks only beta-1 receptors, leading to lower HR. Third generation carvedilol opposes increased heart rate and vasoconstriction keeping the body from counteracting the medicine. Renin angiotensin aldosterone system (RAAS) drugs When kidneys detect low blood flow, it produces more renin to convert angiotensinogen (not in the acronym) to angiotensin I. After further conversion to Angiotensin II via angiotensin converting enzyme (ACE), Angiotensin II increases aldosterone secretion, which makes the kidneys retain more sodium and water, and causes vasoconstriction thus increasing BP. If we block angiotensin-converting enzyme (ACE) then we never get angiotensin II and aldosterone won't be secreted. The vasodilation and lack of fluid retention causes BP to decrease. We can also block angiotensin II receptors with angiotensin II receptor blockers (ARBs) causing a similar BP lowering effect without a coughing side effect common with ACE inhibitors. Calcium channel blockers (CCBs) The foundational principle is that calcium is part of muscle contraction: skeletal, smooth, and cardiac. CCBs block these contractions only in smooth and cardiac muscles depending on the type of CCB. They don't block skeletal muscle because of a small physiological difference in channel structure. The two main drug classes include: dihydropyridines and non-dihydropyridines. Dihydropyridines all have the stem -dipine, think "dip in" blood pressure. These have little affinity for cardiac muscle. Dihydropyridines cause vasodilation in smooth muscle causing the decreased BP. Non-dihydropyridines have affinity for cardiac and smooth muscle. This imparts the antidysrhythmic properties. Medications in this class include diltiazem and verapamil. Vasodilator Nitroglycerin is a representative vasodilator. It's used in emergencies when patients suddenly feel short of breath and have intense, crushing pain in their chest; two classic signs of angina or a heart attack. Nitroglycerin quickly opens up the blood vessels. Antihyperlipidemics The HMG-CoA reductase inhibitors or "statins" are a keystone of therapy. HMG-CoA is the rate-limiting enzyme in creating cholesterol. By inhibiting that enzyme, less cholesterol forms. Statins are particularly good lowering LDLs, or 'bad' cholesterol. This medication class has been shown to reduce mortality in patients with cardiovascular diseases. Side effects to watch out for with these medications include liver toxicity and muscle inflammation. Fenofibrate reduces triglyceride levels, a different kind of cholesterol that's also important. Anticoagulants and antiplatelets This section discusses the balance of bleeding versus clotting. Coagulating factors and platelets are constantly working to maintain equilibrium. I use four representative anticoagulants: enoxaparin, heparin, warfarin, and dabigatran. Notice the -parin stem, as well as-farin in warfarin and -gatran in dabigatran. Keep in mind INR checks are required for warfarin and regular checkups to reassess the patients' bleeding risk. Clopidogrel works a lot like low-dose aspirin to prevent platelets from sticking together. Like aspirin, it can improve heart attack prevention. Cardiac glycoside and anticholinergic Two unique medications include digoxin and atropine. Digoxin increases the force of contraction of the heart and for patients with heart failure. Atropine is an anticholinergic or against acetylcholine, a neurotransmitter. It helps in certain cardiac emergencies. OTC antihyperlipidemics and antiplatelet OTC antihyperlipidemics Omega-3-acid ethyl esters Niacin OTC antiplatelet Aspirin Diuretics - water slide Osmotic - PCT Mannitol Loop - Loop of Henle furosemide Thiazide DCT Hydrochlorothiazide Potassium sparing and thiazide Triamterene / hydrochlorothiazide Potassium sparing - collecting duct Spironolactone Electrolyte replenishment Potassium chloride Alphas and betas Alpha-1 antagonist Doxazosin Alpha-2 agonist Clonidine Beta blockers - 1st generation - non-beta selective Propranolol Beta blockers - 2nd generation - beta-selective Atenolol Metoprolol tartrate Metoprolol succinate Beta blockers - 3rd generation - non-beta selective, vasodilating Carvedilol Renin angiotensin aldosterone system (RAAS) drugs Angiotensin converting enzyme inhibitors (ACEIs) Enalapril Lisinopril Angiotensin II receptor blockers (ARBs) Losartan Olmesartan Valsartan Calcium channel blockers (CCBs) Non-dihydropyridines - cause vasodilation and affect the heart Diltiazem Verapamil Dihydropyridines - vasodilation only Amlodipine Nifedipine Vasodilator Nitroglycerin Antihyperlipidemics HMG-CoA reductase inhibitors Atorvastatin Rosuvastatin Fibric acid derivatives - triglycerides Fenofibrate Anticoagulants and antiplatelets Anticoagulants Enoxaparin Heparin Warfarin Dabigatran Antiplatelet Clopidogrel Cardiac glycoside and anticholinergic Cardiac glycoside Digoxin Anticholinergic Atropine

There's always someone in class doing great, ask them, it may seem obvious, but another student has figured this class out, you just need to find him/her. Also, there isn't much talk about metacognition, learning about learning, and if you read Make it Stick, I think it will help you quite a bit.

Yes, you have some very good mnemonics in there, thanks for the link.

We gradually increase the difficulty by moving from 13 gastrointestinal to 25 musculoskeletal medicines. To handle this many, we'll divide the drugs into various sub-classes. It's useful to create an outline, not by alphabetical order, but by drug class. It takes a little bit of pharmacologic knowledge to do this, so I recommend starting with the groupings I give you, then branch out after you feel more comfortable with the physiologic system. To start you off, I've typed out the outline making sure to 1) underline/note prefixes and suffixes 2) put the rationale for the drug sub-class order in brackets. Creating these orders is an active learning process and makes it easier to remember not only what the drug is for, but also what makes it different from others for clinical challenges. OTC NSAIDS - [in order of half-life and alphabetically] Aspirin (Ecotrin) (ASA), shorter half-life Ibuprofen (Advil, Motrin), shorter half-life -profen is a recognized NSAID stem Naproxen (Aleve), longer half-life OTC Non-narcotic analgesic Acetaminophen (Tylenol, APAP) OTC NSAID / Non-narcotic analgesic / caffeine combination ASA/APAP/Caffeine (Excedrin) ASA for inflammation and pain APAP for migraine pain Caffeine used as vasoconstrictor RX NSAID - [in order from COX-2 non-specific to COX-2 specific] Meloxicam (Mobic) -icam stem Celecoxib (Celebrex) COX-2 specific -coxib stem Opioids - controlled medications - [in order of DEA schedule] CII - most addicting class Morphine (MS Contin) Is at the top because it's the prototypical opioid medication Fentanyl (Duragesic, Sublimaze) Hydrocodone / APAP (Vicodin) Oxycodone / APAP (Percocet) CIII - less addicting than CII and so forth . . . APAP / codeine (Tylenol #3) CIV - Mixed opioid Tramadol (Ultram) Narcotic antagonist Naloxone (Narcan) Triptans [in alphabetical order] Eletriptan (Relpax) Sumatriptan (Imitrex) DMARDS (Disease Modifying Anti-Rheumatoid drugs) [From non-biologic to biologic] Methotrexate (Rheumatrex) - a non-biologic Abatacept (Orencia) - a biologic Etanercept (Enbrel) - a biologic -cept is a common stem -tacept is a stem with a sub-stem "ta" -nercept is a stem with a sub-stem "ner" Osteoporosis agents Bisphosophonates [alphabetically] Alendronate (Fosamax) Ibandronate (Boniva) -dronate is a stem Muscle relaxers [alphabetically] Cyclobenzaprine (Flexeril) Diazepam (Valium) -azepam is a stem (not -pam) Anti-gout [uric acid reducers in alphabetical order] Allopurinol (Zyloprim) Febuxostat (Uloric) -xostat is a stem Try to take notes from the video with this short outline. Is it easier when you have a head start like a short outline? The same is true with pharmacology lectures. If you start with a lattice or framework, you'll catch a lot more. If you prefer to use notecards, try to group those notecards in this similar order and see if you remember them more easily.

First, I wanted to say, I'm sorry that happened, I know how frustrating it must be. I just listened to an audiobook that I think would help you out. It's only 2 hours and like $5 Called "Unlimited Memory" Kevin Horsley is an expert on memory and a lot of what he talks about are not just techniques, but that confidence in techniques = confidence in memorization = confidence on exams. I think starting your journey with a short non-NCLEX book would be a good start to first get out of your head then get back into it with a refreshed and positive mindset.

It may seem unfair that you would need to watch a series of videos understand your large pharmacology textbook or teacher. I understand. But, if pharmacology is a second language, that is absolutely the best approach. In this 7 video series, I take two hours of content from my bestselling audiobook Memorizing Pharmacology and put it on the whiteboard. This should help you visualize the language of pharmacology especially if you have only had a little bit of chemistry (or remember a little bit of chemistry.) The most important analogy I can start with is that if you were going to sit down in a foreign language class, it's better for you to travel to the country where they speak that language the week before. Instead of looking at pharmacology as something to survive, let's take a quick vacation week to get to know the pharmacology language that can help you in the classroom and clinical. Instead of hoping a nursing professor doesn't call on you, wouldn't it be nice to have the confidence to be able to pronounce and articulate what you do know about the medication? Saying you don't know something in a specific way shows competence and asking questions shows genuine curiosity - both qualities instructors love hearing from students. I recommend you ask questions in this way. "I understand that _____, but I'm not clear on _____" For example, I understand bismuth subsalicylate, Pepto Bismol, helps with stomach upset, but I'm not clear why bismuth subsalicylate is unsafe for children." The salicylate is like aspirin and can cause Reye's syndrome is the answer. But, can you see how this two step approach shows your competence, but allows you to ask a question in a way that isn't embarrassing? To get that initial competence, however, you need to do a little, not a lot of preparation for pharmacology class with these videos. The seven videos are in a specific memorizable (not memorable, but memorizable) system-by-system order of gastrointestinal, musculoskeletal, respiratory, immune, neuro/mental health, cardiovascular, and endocrine. This order isn't an accident. It's in order from easiest to hardest based on research articles I've read. Remember them with the mnemonic Grand Mothers RINCE kids hair, GMRINCE with the French spelling of rinse, r-I-n-c-e. Intuitively, it should make sense that you've used over-the-counter medicine for a stomach ache, muscle pain, runny nose, or topical infection so these would be more familiar. Prescription mental health, cardiovascular, and endocrine medications are less familiar and there are many more drugs to know. In your pharmacology class, however, I'm betting most of you will get hit with neuro first and that's one reason you need to make it through this seven video series. This gastrointestinal pharmacology video provides some lessons that are foundational to the system. 1) Each drug class has a specific order, for example antacids work faster than H2 blockers, which work faster than Proton Pump Inhibitors (PPIs), so it goes antacid, H2 blocker, PPI, in that order. Within each class they are alphabetized for easier recall. 2) Anytime a drug has a prefix, infix, or suffix, I underline it to help you learn other drugs related to this one. 3) The temptation is to start making paper or electronic notecards. Notecards work for smaller numbers of drugs, a quiz of 20 for example. However, if you are trying to remember 200 drugs, then 5,000 questions for your boards, you want to employ the serial (in order) techniques I teach in this video as memory anchors. Just as you know in your closet that t-shirts hang in one place, pants in another, when you gain a new t-shirt or new knowledge, you know exactly where to hang it in your mind. For now, let's work with this quick 13 minute video to start your journey to thriving in pharmacology class by learning this important foreign language.

You've heard pharmacology is a tough class and maybe even know someone who had to repeat it. What isn't common knowledge is what you can do about preparing for pharmacology class to not just pass, but thrive in a class that can really help you in clinical and other classes like Mental Health. In this video, I'll answer three specific questions: Why is Nursing Pharmacology hard? What is the Curse of Knowledge? What can you do to pass pharmacology? 1. Why is Nursing Pharmacology hard? The short answer: Nursing students take pharmacology much sooner than pharmacy or medical students and they often take it without organic chemistry. While most pharmacy and medical students complete their undergraduate coursework before they take biochemistry then pharmacology, nursing students take pharmacology as part of undergrad usually in their second year. This isn't as much of an issue if the pharmacology instructor recognizes the nursing path is rooted strongly in the biological and social sciences. However, if the instructor comes from the physical sciences without acknowledging the biological component, the Curse of Knowledge may create a divide between instructor and student. 2. What is the Curse of Knowledge? The Curse of Knowledge recognizes that as one becomes an expert, their brain changes. As nursing students learn to think like a nurse, brain changes resulting in more efficiency and better results follow. As nurses progress through the curriculum, they should be careful not to talk over the comprehension of their patients. Similarly, a pharmacology instructor who teaches for a long time may find it difficult to meet the students where they are. What may seem foundational to the Ph.D. or experienced clinician may be a topic or experience students need to review before moving forward. 3. What can you do to pass pharmacology? If you first treat pharmacology as a language, it becomes a lot easier to know the steps to take to build strong foundational layers. The language of pharmacology is not medical terminology; rather it comes as a unique subset of chemistry. What students can learn before pharmacology class is mnemonics and drug endings that lead to better retention of a drug's purpose, mechanism or class. Careful, many online videos have presenters that derive their own drug endings. If you see -ine, -azole, -pam, -lam, and so on, it's likely that video host didn't consult the established lists. However, if you see complete stems like -triptyline, -conazole, -prazole, -azepam, -azolam, that match the World Health Organization's (WHO) or United States Adopted Names Council (USANC) lists, then you can have more confidence in those lists. In the coming weeks, I'll release a 7 article video series that will provide guidance on drug endings, mnemonics, and serial memory to help you be as prepared as you can for next semester's pharmacology class.