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TonyPharmD

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  1. 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. Let me show you 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 Magnesium hydroxide (Milk of Magnesia) E As needed (PRN) rather than scheduled Laxative effect of magnesium hydroxide 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. Here's the video tutorial of how I did this:
  2. 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!
  3. To start off this video, Jaclyn covers the 6 different indications of vancomycin backed neatly into the acronym 'HOMES.' In our last video, we noted that vancomycin is a glycopeptide that interferes with cell wall synthesis to destroy certain types of bacteria. Next, we march on ahead and cover more antibiotic drug classes and their respective medications 1. Altered cell membrane a. Daptomycin 2. Nucleic acid synthesis a. Fluoroquinolones i. Ciprofloxacin ii. Levofloxacin iii. Moxifloxacin 3. Protein synthesis a. Aminoglycosides i. Tobramycin ii. Amikacin iii. Gentamicin iv. Streptomycin b. Tetracyclines i. Minocycline ii. Doxycycline c. Macrolides i. Azithromycin ii. Clarithromycin iii. Erythromycin d. Lincosamide i. Clindamycin e. Oxazolidinones i. Linezolid ii. Tedizolid Cyclic lipopeptide Daptomycin works differently than vancomycin. Instead of interfering with the bacteria's cell wall synthesis, daptomycin target's the cell membrane and creates tiny, leaky holes that eventually lead to the bacterial cell's demise. What's interesting is that even though vancomycin and daptomycin work differently, they can be used for the same indications except for one. The H in 'HOMES' stands for hospital-acquired pneumonia. Vancomycin can get in the lungs to treat this infection, but the same can't be said for daptomycin. Fluoroquinolones (quinolones) Instead of working on the outer portion of cells, quinolones must cross the cell membrane to exert their effect. They inhibit an enzyme called topoisomerase. This enzyme cuts bacteria's DNA so that it can be read and copied by other enzymes. Without properly working topoisomerase enzymes, bacteria cells can't replicate and the cell is eventually destroyed. All fluoroquinolones share the stem -floxacin, making them easy to recognize. Patients taking quinolones are subject to a variety of side effects, including neuropathy, tendon rupture, QTc interval prolongation. We especially worry about tendon rupture in patients concurrently taking corticosteroids, such as oral prednisone. Protein synthesis The next 5 drug classes disrupt bacteria's ability to create proteins. Like us, bacteria need to make proteins to survive. Inhibiting this process prevents the cells from properly replicating. These 5 drugs all work differently. Aminoglycosides Jaclyn talks about 4 different aminoglycosides in this video: tobramycin, amikacin, gentamicin, and streptomycin. If it helps, you can remember the acronym 'TAGS' for this drug class. Side effects are serious concerns in practice. For this reason, aminoglycosides aren't usually first-line medications. Tetracyclines Here we focus on minocycline and doxycycline, which share the stem -cycline. Drugs in this class all share a 4 hydrocarbon ring structure, hence tetra + cycline. Watch for the tooth discoloration side effect, prominent in children whose teeth are still growing. Macrolides Medications include azithromycin, clarithromycin, and erythromycin with a stem -thromycin. Just like with the fluoroquinolones, these medications can prolong the QTc interval. Lincosamide Watch you don't confuse clindamycin, clarithromycin, and vancomycin looking at the endings. They come from different classes. Oxazolidinones This drug class end in -zolid, this drug class provides a last line against some of the toughest bacteria.
  4. 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. Here's the video....
  5. In this third video, I review how to list many respiratory drugs from memory by linking images to drug names and properties, but I also write about the Americans with Disabilities Act. I've taken a little break from posting videos to Allnurses.com because in a recent faculty meeting the dean made us aware that in January 2018, some new federal regulations would take effect regarding websites and the Americans with Disabilities Act. I have over 1200 videos on YouTube and had always let YouTube do the transcribing. I'm sure nursing schools have already started to work and deal with this immense challenge of making sure all of their instructors understand that anything they post or use in class must comply with these standards. However, with pharmacologic information, YouTube is a poor substitute for a human transcriber. While some of the translations are at first comical, what was not comical was knowing that some students were getting these kinds of translations and depended on them for their success, so we're working hard to get all of these videos transcribed as fast as we can. Here is a small sample of the YouTube mistranslations we are working through. nitro foreign tow-in = nitrofurantoin bolognese leg = linezolid stab Eugene = stavudine back of the ear = abacavir to know phobia ear = tenofovir Dilute egg revere = dolutegravir in ten aunt egg race = integrase Sauce am pregnant year = fosamprenavir Soprano year = tipranavir a zip through my son = azithromycin From now on, all videos we'll post on Allnurses.com will include closed captioning reviewed by a human and we're almost done going back and transcribing previous videos. Look for the (CC) in the title. Here's an overview of the drug classes in this Drawing Pharmacology Respiratory Video: Antihistamines Allergic Rhinitis Decongestants Cough Suppression Steroids as Antiinflammatories Bronchodilators Leukotriene Inhibitors Anti IgE monoclonal antibody Anaphylaxis
  6. TonyPharmD

    Drawing Pharmacology Video 2 of 7

    While memorizing gets a bad name in education now, there are a number of reasons it's useful, the most important of which is chunking. At some point we know our credit card number by heart, in four blocks of four numbers. So instead of that taking up 16 spaces in our memory, it might take only four. In class, as we memorize the foundational material, there is now room for us to work with the new material in our working memory. In pharmacology, for example, a person might take up a lot of working memory when first working with a drug name like infliximab (Remicade) for rheumatoid arthritis. But as we work more with it, we move from thinking of it as separate letters i-n-f-l-i-x-i-m-a-b to a word, to maybe an image of the dosage as we provide care to the patient. Let's also look at why some think we don't need to memorize. First, we can Google most information that we might need so the content out of context is available. However, what do we do if we get three different links for our answer, two say one way is correct, one says a different way is correct. Let's say that the two are from personal blogs and the one is from the National Institutes of Health. Which do we believe? So while the information is available, the veracity or context of that information may not be. This next video goes over musculoskeletal medications and their therapeutic pearls. You'll find that the same memorization strategies used in the video for chapter one are also used here. We use acronyms to remember the first letter of multiple drug names and illustrations to organize the related musculoskeletal conditions. In this video, I start from a plain whiteboard to show you that it's okay to do it from memory and make a few mistakes along the way. My Advanced Practice Pharmacy student is here helping me with the video. In later videos, we will zoom in on the contents in response to feedback from YouTube comments. In this video, the drug classes I go over are: 1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). There are quite a few NSAIDs available both over the counter and through a prescription. To help us remember them all, we use the acronym "PAIN CAVE" as a guide. NSAIDs can be used for a variety of conditions and symptoms, including pain, inflammation, headaches, and osteoarthritis. 2. Opioids. Just like NSAIDS, there are many opioids available, however this class of medication is only available as a prescription. Because of their addictive properties, opioids are controlled medications. To help remember them all, we classify opioids by their DEA schedule (C-I, C-II, C-III, C-IV, or C-V). Note that not all opioids are for pain; opioid antagonists and partial agonists can be used to treat opioid dependence. 3. Triptans. For the next 5 medication classes and their corresponding conditions, we draw a stick figure, our pain cave skeleton, and list his conditions from head to toe. The first drug class is called the triptans and they are used for migraines. The individual medications in this class all contain the stem -triptan, making them easy to identify. 4. Medications for rheumatoid arthritis. Some medications used to treat rheumatoid arthritis are DMARDs, or disease modifying anti-rheumatic drugs. There are a few biologic drugs in this category. Biologics can be very effective against auto-immune diseases such as rheumatoid arthritis. 5. Medications for osteoporosis. The most common drugs used for osteoporosis, bisphosphonates, all have use the stem -dronate. Bisphosphonates inhibit the type of cell that's responsible for breaking down bone tissue. 6. Medications for muscle spasms. There are multiple drugs used for muscle spasms. They don't share a common drug class, so it's a bit more difficult to memorize them all, but I show some techniques to get a few down. 7. Medications for gout. The last condition this poor stick figure has is gout. Gout commonly affects the big toe, hence why it's the last of our list of conditions from head to toe. Medications for gout either reduce inflammation, reduce the amount of uric acid produced, or increase the excretion of uric acid into the urine. Stay tuned for the next Drawing Pharmacology Video on Respiratory Pharmacology soon! [video=youtube_share;gkeqOH6SCoo]
  7. As a pharmacist, I have fourth professional year pharmacy students working with me at my college (APPE stands for Advanced Pharmacy Practice Experience) and those that are with me are specifically in an elective Academic rotation. In this rotation, the student learns best practices in teaching to students such that students can then teach to their patients. Part of that teaching is good board work and the gravitas that comes from putting content on the board from memory. These videos are Beta version videos, eventually, we'll have a professional come shoot the finished products, but with the new semester coming up we thought this would be a valuable share and to see an alternative to flashcards, PowerPoints, and repeated questions. Drawing Pharmacology - Gastrointestinal Chapter 1, reviews the major areas of the gastrointestinal system like the videos from Memorizing Pharmacology: A Relaxed Approach also found on Allnurses.com but 1) Adds many more medications and 2) is meant to provide a foundation for adding therapeutic pearls. It works in two steps. First, a student writes out the information in the video becoming familiar with the medication generic and brand names. While the NCLEX may not test brand names, patients use them often and they are also a key to memorizing the generic. Remembering generic-only makes a person test ready, but less competent to practice. This video shows that step. Second, a student would only put the first letters of a drug name then add the therapeutic pearls, e.g. bismuth subsalicylate causes black tongue and stool, is contraindicated in children because of the aspirin component and has the potential for salicylism and so forth. They would practice this much like a student would go through notecards, but this drawing the pictures provides an opportunity to reinforce the material and teach it to others. The concept centers surround drug classes. The drug classes I go over are: 1. Antacids These drugs include many of the most popular antacids available over the counter. I placed them in alphabetical order because there isn't much of a distinction in generations. These medication names are unique in that the generic name is the chemical name. 2. Histamine-2 receptor blockers These acid reducers include one medication, cimetidine, which affects the cytochrome P-450 system and is often the focus of many NCLEX questions. The others have that -a tidine ending which also looks like "to dine" when many people experience reflux. 3. Proton Pump Inhibitors The PPIs form the foundation for much of acid-reducing therapy and also as a part of treating Peptic Ulcer Disease (PUD). The stem -pyrazole tells us its a PPI, but watch out for -aripiprazole which means a drug is an antipsychotic. Aripiprazole is one of the few stems that include another active stem, something the World Health Organization frowns upon. 3a. Triple therapy for PUD 3b. Quad therapy for PUD 4. Gastric protectants Some medications protect the stomach from insult especially the damage from NSAIDs. One coats the stomach and the other works against the damaging effects of the NSAIDs themselves. 5. Motility agents These drugs propel acid out of the stomach reducing the insult. They tend to have a number of drug interactions and have mostly fallen out of favor. 6. Medications for diarrhea and constipation By placing these medications that have opposite effects close to each other it becomes more readily memorable. 7. Medications for nausea and vomiting By separating those drugs that prevent nausea and those that treat vomiting as distinct, it makes for an easier visual. 8. Medications for irritable bowel syndrome and irritable bowel disease While this content may not be the highest yield, it's important to understand the difference between the syndrome, a non-autoimmune condition and the disease, an autoimmune condition. I welcome your feedback as we work to develop this next book and a series of videos to benefit pharmacology students.
  8. OTC insulin and emergency contraception We'll start with our available OTC medications. Two insulins come without a prescription: regular insulin and NPH insulin. Why don't many people get insulin without a prescription? Insulin is expensive as are the supplies like needles, blood glucose monitor, test strips, and lancets. It's less expensive to get a prescription so prescription insurance might cover part of the cost. We'll continue with insulin in a second, but one other OTC item includes Plan-B One Step, a single pill containing a high dose of a levonorgestrel, a progestin. Diabetes and insulin We make insulin with our pancreatic beta cells, but people with diabetes either don't make enough insulin (Type I diabetes) or are resistant to insulin (Type II diabetes), or both (late-stage Type II diabetes). For Type I patients, insulin is a must; type I patients were born with dysfunctional beta cells and will need life-long exogenous insulin. For type II patients, insulin is held until a patient is on other anti-diabetic medications first. This is for many reasons: insulin is expensive even after insurance, many patients don't like injections, and insulin predisposes people to weight gain and possible hypoglycemia. Now let's look at some different types of insulin Insulin lispro is a rapid-acting insulin. It starts working in 15 minutes and lasts about 4 hours. Regular insulin is a short-acting insulin. It starts working in 30 minutes and lasts about 8 hours. NPH insulin is an intermediate-acting insulin. It starts working in 1-2 hours and lasts about 12 hours. Insulin glargine is a long-acting insulin. It starts working in an hour and lasts about 24 hours. Typically, shorter acting insulin is for mealtime, while longer acting insulin is for daytime glucose control. Patients often use short and long acting insulin, which may mean many shots daily. Metformin is a biguanide oral medication and a foundational part of Type II control. Almost all Type II diabetics are started on metformin because research shows this drug reduces mortality in diabetics. It has little risk of hypoglycemia. The DPP-4 inhibitors, or gliptins, prevent the break down of other hormones that increase insulin secretion, promote insulin sensitivity and a full feeling. If we inhibit DPP-4, we have more GLP-1 and incretin available. We also have an anti-diabetic class called the 2nd generation sulfonylureas. The 1st generation of these drug caused too many side effects, so they were discontinued. Medications in this class have the stem gly- or gli-. Sulfonylureas increase insulin secretion. This mechanism works for patients that still have functional beta cells, but patients with Type I or late stage type II, these medications won't provide much benefit. Sometimes patients have episodes of too little blood glucose, or hypoglycemia. Hypoglycemia leads to coma and death. Glucagon can be used in these cases. It must be injected, so this medication is reserved when a patient's blood sugars are so low, they pass out. If a patient's blood sugars are low but they are conscious, it's best to give them something to eat or drink that will quickly increase their blood sugar level with orange juice, fruit snacks, or glucose tablets. Thyroid hormones Thyroid hormone stimulates metabolism, the heart, and cell growth. Patients can have too much thyroid hormone (hyperthyroidism) or not enough (hypothyroidism). Of the two, hypothyroidism is more common and easier to treat. In hypothyroidism, you see slow heart rate, fatigue, constipation, and weight gain. Much like exogenous insulin treats diabetes, exogenous thyroid hormone treats hypothyroidism. Levothyroxine is exogenous thyroid hormone to help increase levels. Like insulin, patients can be on levothyroxine for life. Patients with hyperthyroidism, will have opposite symptoms like fast heart rate, energy, diarrhea, and weight loss. This may require surgery to remove part or all of the thyroid gland. Nevertheless, patients usually start propylthiouracil, or PTU for short. Hormones and contraception Men with low testosterone can be prescribed exogenous testosterone to bring levels back up. The stem for steroids is -ster- and testosterone is a steroid that comes as an injection, gel, or patch. Many contraceptive combinations include ethinyl estradiol. Progestins differ a bit - some have different side effect profiles - many have the stem -gest-. Contraceptive combinations can come as daily oral pills, a patch, or a vaginal ring. Some packs will include a week's worth of iron pills or sugar pills to help keep the habit of a daily pill with or without an estrogen or progestin ingredient. This triple combination with iron combination is normally reserved for anemic patients. Overactive bladder, urinary retention, erectile dysfunction, benign prostatic hyperplasia The last section includes a mixture of common genitourinary conditions. The primary symptom of OAB is the frequent feeling of urination, even when the bladder is not full. We use anticholinergics like oxybutynin, solifenacin, and tolterodine. Recall anticholinergics tend to be drying, so side effects will include dry mouth, constipation, and dry eyes. Urinary retention is the opposite problem of OAB. So instead of using anticholinergics, we use cholinergics. The one medication you should learn for urinary retention is bethanechol. The -chol suffix is not a stem, but it helps you remember that bethanechol is a cholinergic drug. Side effects will be the opposite of the anticholinergics, including possible diarrhea and excessive tear production. Erectile dysfunction (ED) describes the inability for men to achieve or maintain an erection. The PDE-5 inhibitors with the stem -afil help. They are absolutely contraindicated in patients taking nitrates, including nitroglycerin. This combination can cause a potentially fatal drop in blood pressure. BPH describes a non-cancerous growth of the prostate. Alpha-blockers that include tamsulosin and alfuzosin don't change the prostate size; rather, relax the smooth muscle within the prostate providing less urine flow resistance. 5-alpha reductase inhibitors reduce the prostate size by inhibiting the last enzyme needed to synthesize the hormone helping the prostate to shrink. That concludes the chapter articles on Memorizing Pharmacology. I hope you enjoyed reading the articles as much as I enjoyed writing them. Outline OTC insulin and emergency contraception OTC insulin Regular insulin NPH insulin OTC emergency contraception Levonorgestrel Diabetes and insulin Rapid acting Insulin lispro Short acting Regular insulin Intermediate acting NPH insulin Long duration Insulin glargine Biguanides Metformin DPP-4 inhibitors Sitagliptin Sulfonylureas 2nd generation Glipizide Glyburide Hypoglycemia Glucagon Thyroid hormones Hypothyroidism Levothyroxine Hyperthyroidism Propylthiouracil (PTU) Hormones and contraception Testosterone Testosterone Contraception - combined oral contraceptives (COCs) Norethindrone / ethinylestradiol / ferrous fumarate Norgestimate / ethinylestradiol Contraception - patch Norelgestromin / ethinylestradiol Contraception - ring Etonogestrel / ethinylestradiol Overactive bladder, urinary retention, erectile dysfunction, benign prostatic hyperplasia OAB Oxybutynin Solifenacin Tolterodine Urinary retention Bethanechol ED Sildenafil Tadalafil BPH - alpha blockers Tamsulosin Alfuzosin BPH - 5-alpha reductase inhibitors Dutasteride Finasteride
  9. 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. Outline 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
  10. TonyPharmD

    Failing Fundamentals. Help!

    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.
  11. Welcome to one of the hardest, if not the hardest sections in pharmacology: neuro and mental health considerations in pharmacology. Not only do we have a lot of drugs to learn, but we don't have a lot of useful stems to fall back on because many drugs have been around a long time. The nervous system is a complicated system with complicated diseases when things go wrong. As such, many of these drugs are used for more than one disorder, making them difficult to categorize. This chapter is a giant puzzle with pieces that don't quite seem to fit at first glance. Nevertheless, let's dive right into this chapter and start putting the pieces together. OTC Local Anesthetics and Antivertigo The first drugs we learn about in chapter 5 are the local anesthetics, benzocaine and lidocaine. Both are available OTC as a topical medication, and both have the stem -caine. However, benzocaine is an ester type local anesthetic, while lidocaine is an amide type, this means allergenicity is higher for the ester type because of how it's metabolized. As such, only lidocaine is available as an injection (Rx only) because of its lower chance of causing an allergic reaction. Another drug within this section of the book is meclizine. This drug is also available OTC and helps reduce the feeling of vertigo as its brand name Antivert alludes to. Later in this chapter, we'll learn about an Rx only medication that also treats similar conditions. Sedatives and Hypnotics Within this section, we have three different classes of medication. The first one is available OTC and it's just a combination of two drugs we've already learned: acetaminophen and diphenhydramine. We learned that drowsiness is a common side effect for diphenhydramine, but in this case, we are using this drug's side effect as its main purpose. Acetaminophen has no sedating properties, but it does help if patients have any aches or pains keeping them up at night. The 2nd medication class in this section is the benzodiazepine-like (BZD-like) class. Stems include -clone and -pidem. We'll talk more about real benzodiazepines (BZDs) later in this chapter. Just know these drugs affect the same receptors as real BZDs, but a different subunit of those receptors. BZD-like agents help people fall asleep. To help people stay asleep, a drug like zolpidem has a controlled release formulation. Many BZD-like medications are generally DEA schedule IV. The 3rd class in this section is the melatonin receptor agonist class. The class name speaks for itself, but we need to understand at least a little about melatonin itself to get the full picture. Melatonin is a hormone that binds to melatonin receptors and regulates our circadian rhythms. Melatonin is OTC, but scientists have developed other agents that selectively bind to these melatonin receptors as well. Look for the stem -melteon to identify a melatonin receptor agonist. Antidepressants This section is often the hardest sections for students because of subtle differences. There are a many drugs and medication sub-classes and the same stem appears in more than one class (-oxetine). Let's dive right into the first class, the SSRIs. This stands for selective serotonin reuptake inhibitors. Depression has been linked to low levels of serotonin in the brain, so these medications increase the concentrations of this neurotransmitter by blocking the reuptake. Two of the drugs, fluoxetine and paroxetine, share the -oxetine stem. The next medication class is the serotonin-norepinephrine reuptake inhibitors, or SNRI for short. Norepinephrine is a neurotransmitter too, and it turns out that depression is associated with low levels of it, much like serotonin. This class has just two medications, but one of them is duloxetine. Notice the exact same stem with fluoxetine and paroxetine, yet the drugs are in two different classes. Next we have the tricyclic antidepressants or TCAs. The organic chemistry representation structure includes three rings, hence the name 'tricyclic'. The first TCAs were introduced years before any SSRI or SNRI, but because of their more prominent side effect profile, TCAs aren't used as much anymore. Amitriptyline. Note the stem -triptyline has the tri- within it. This helps remind you that it's a tricyclic antidepressant. Finally, we have the MAOIs, or the monoamine oxidase inhibitors. Instead of blocking reuptake, this medication class simply blocks the enzyme that breaks down monoamines like serotonin and norepinephrine. This class was introduced years before the TCAs and their side effect profile is even worse. This class is often reserved as a last case scenario for patients with depression. Isocarboxazid is an example. Smoking cessation Using oral medications to help quit smoking is a relatively new therapy option for patients. We have two drugs to learn here, bupropion and varenicline. Bupropion is also an atypical antidepressant that was rebranded as a smoking cessation tool. Varenicline is solely a smoking cessation agent that was found to be better than bupropion, but comes with more side effects too. Benzodiazepines Benzodiazepines work for insomnia too, just like BZD-like medications. However, BZDs also work for other conditions like anxiety and muscle spasms. BZDs have one of two stems: -azepam or -azolam. All BZDs are currently DEA schedule IV. You may have heard of the drug class called barbiturates, or barbs for short. BZDs have largely replaced barbs for treating anxiety and insomnia. Barbs have a higher potential for abuse and can more easily cause respiratory depression, which can become fatal. ADHD medications Two DEA schedule II stimulants, methylphenidate and dexmethylphenidate, help ADHD patients focus. No stems here, but the two medications are related. Dexmethylphenidate is the active enantiomer of methylphenidate. So in theory, dexmethylphenidate should be a better drug, although that's not always seen in practice. Another ADHD is a non-stimulant, non-scheduled class - atomoxetine. Note that this medication shares the same stem with fluoxetine, paroxetine, and duloxetine, but it's not for depression. Be careful when you see an -oxetine stem. While there are many treatments available for bipolar disorder, one of the most effective is a simple salt on the periodic table of elements: lithium. How it works is not clear, but we know the body has a hard time differentiating sodium from lithium. The therapeutic range of lithium is small, so blood levels are necessary to make sure the patient is neither sub-therapeutic nor toxic. Schizophrenia Schizophrenia agents and antipsychotics are often interchangeable terms. We divide these drugs into: low potency 1st generation, high potency 1st generation, and 2nd generation (also known as atypical). Low potency 1st generation antipsychotics cause more sedation while high potency 1st generation antipsychotics cause more extrapyramidal symptoms (EPS). EPS includes involuntary muscle spasms of the face and extremities, among other movement disorders. Antipsychotics can reduce symptoms of schizophrenia, including hallucinations and delusions. 2nd generation or atypical antipsychotics are less likely to cause EPS but more likely to cause metabolic effects like hyperlipidemia, diabetes, and weight gain. Antiepileptics There are two classes of medication in this section: traditional and newer antiepileptics. Traditional antiepileptics don't have a shared stem, so they can be tough to memorize. Two of the newer antiepileptics have the stem -gab- within them both: gabapentin and pregabalin. Keep in mind these medications have other uses too, like diabetic neuropathy (nerve pain in the hands and feet). Parkinson's, Alzheimer's, and motion sickness Parkinson's is a condition with too little dopamine while Alzheimer's is a condition with too little acetylcholine (ACh) in the brain. A primary Parkinson's drug combination is carbidopa with levodopa. Levodopa is converted into dopamine within the brain. Carbidopa reduces the degradation of levodopa as it travels to the brain. This way, we need a smaller dose of levodopa, reducing the severity of unnecessary side effects like nausea and vomiting. Another medication for Parkinson's is selegiline. Remember the MAOIs for depression? Well, there are two types of monoamine oxidases; MAO-A and MAO-B. Isocarboxazid inhibits both while selegiline only inhibits just MAO-B, the one that degrades dopamine. For Alzheimer's recall that patients with this disease have low levels of ACh. Donepezil inhibits the enzymes that break ACh down. Selegiline is for dopamine like donepezil is for ACh. Unfortunately, Alzheimer's disease is not that simple; there are many other mechanisms at play. Another medication, memantine, has shown to help slow down the progression of the disease. Keep in mind that we don't have any drugs that cure Alzheimer's. A medication for motion sickness is scopolamine. This works as a patch to put behind one's ear to prevent vertigo and motion sickness while on a cruise ship. While the content is difficult, the mental health patient population is one that is often underserved. By taking this chapter section-by-section and adding the puzzles pieces one at a time, it should come together. OTC Local anesthetics and antivertigo Benzocaine Lidocaine Ester vs amide. Lidocaine is injected. Meclizine Sedatives/hypnotics OTC non-narcotic analgesic / sedative hypnotic Acetaminophen / diphenhydramine Using side effect for therapeutic indication Benzodiazepine-like Eszopiclone Zolpidem Use CR form if someone has trouble staying asleep Melatonin receptor agonist Ramelteon Antidepressants SSRIs Citalopram Escitalopram Sertraline Fluoxetine Paroxetine SNRIs - named after neurotransmitters Duloxetine Be careful of this stem Venlafaxine TCAs - named after structure Amitriptyline Nortriptyline MAOIs - named after enzyme it effects Isocarboxazid Smoking cessation Bupropion - also for depression Varenicline Benzodiazepines Alprazolam Midazolam Clonazepam Lorazepam ADHD medications Stimulant - Schedule II Dexmethylphenidate Methylphenidate Non-stimulant - non-scheduled Atomoxetine Watch out for this stem again Bipolar disorder Simple salt Lithium Schizophrenia 1st generation antipsychotic - low potency Chlorpromazine SE - sedation 1st generation antipsychotic - high potency Haloperidol SE - EPS 2nd generation antipsychotics (atypical) Risperidone Quetiapine Atypical have less EPS but more metabolic effects Antiepileptics Traditional Carbamazepine Divalproex Phenytoin Newer antiepileptics Gabapentin Pregabalin Both for nerve pain too Parkinson's, Alzheimer's, and motion sickness Parkinson's Levodopa/ carbidopa Selegiline MAO-B Alzheimer's Donepezil Memantine Mem = memory. Done = my memory is done Motion sickness Scopolamine [video=youtube_share;Fs8WF5sUEzw]
  12. Chapter 4 Immune kicks it up a notch with over 40 drugs to memorize. But like the other chapters, by categorizing them into related groups, we find them easier to remember. I'll continue to stress the importance of knowing the established prefix and suffix by underlining them when appropriate. OTC antimicrobials Brand names help us learn OTC medications. For example, Neosporin combines letters from three topical antibiotics: neomycin, polymyxin B, and bacitracin. Abreva, the brand name for docosanol, ab breviates a cold sore. To further classify the medications in this section, it's easier to use mechanism of action and / or disease state to create only 5 divisions. Five Divisions 1) Antibiotics affecting the cell wall A penicillin class antibiotic, amoxicillin, works by affecting bacterial cell walls. However, some bacteria secrete an enzyme - beta-lactamase - that can break down and render amoxicillin ineffective by destroying the beta-lactam ring. In this case, we add clavulanate which augments amoxicillin as combination Augmentin. Cephalosporins work similarly and have related chemistry. If someone is allergic to penicillins, there's a small chance they will be allergic to cephalosporins. Within the cephalosporin class, it's easiest to use the 5 different generations to outline specific trends in properties. In general, later generations have more gram-negative coverage, are less susceptible to beta-lactamase attack, and more readily cross the blood brain barrier. Providers often reserve vancomycin as a last line of treatment to avoid resistance. It works to destroy bacterial cell walls by a different mechanism of action making it effective against Methicillin Resistant Staphylococcus aureus (MRSA). 2) Protein synthesis inhibitors - bacteriostatic Keep in mind bacteriostatic antibiotics don't kill the bacteria, but provide useful coverage. Tetracyclines have the distinct stem -cycline and many, but not all macrolides like azithromycin end with -thromycin. Be careful; many medications use the stem -mycin, which isn't useful for specific classification. For example, clindamycin is a lincosamide, unrelated to vancomycin, a glycopeptide and azithromycin, a macrolide. The final medication class in this section is oxazolidinone linezolid. We reserve linezolid for the most resistant bacteria, like MRSA and vancomycin resistant enterococci, VRE. 3) Protein synthesis inhibitors - bactericidal The aminoglycosides amikacin and gentamicin can kill bacteria rather than just impede their reproduction. 4) Antibiotics for urinary tract infections (UTIs) and peptic ulcer disease (PUD) Sometimes it's easier to go backwards from disease to drug that works against it. Sulfamethoxazole with trimethoprim prevents bacteria from synthesizing folic acid, something humans can ingest. Fluoroquinolones like ciprofloxacin and levofloxacin end with -floxacin, making them easy to identify. A recent FDA warning reserves fluoroquinolones for more serious infections. Metronidazole, technically an anti-protozoal, finds use in peptic ulcer disease, PUD. 5) Anti-tuberculosis agents Remember the four medications: rifampin, isoniazid, pyrazinamide, and ethambutol with the "RIPE" acronym. Active TB requires multiple medication therapy with long treatment courses. Antifungals We'll use three representative medications to learn antifungals: amphotericin-B, fluconazole, and nystatin. Only fluconazole has a stem, -conazole. Don't confuse this stem with the stem for proton pump inhibitors (PPIs) that we learned in chapter 1, -prazole. Many online resources say "-azole" is the stem, but that word is an organic chemistry moiety. In the next chapter, we learn about cholesterol lowering drugs that have the stem -statin. While nystatin shares those same 6 letters, it is not for cholesterol. Antivirals - non-HIV Most antivirals will have "vir" within their generic names. It's a great tool to identify antivirals, but "vir" doesn't tell you what virus the drug is for. In general, viral infections are naturally resistant to medication. Most viruses replicate within our own cells, making them tough to kill without serious side effects. Because of this, antivirals attempt to do 1 of 2 things: prevent us from getting infected in the first place or keep the virus dormant. Antivirals for influenza A and B share the stem -amivir, making them easy to spot. Antivirals for herpes simplex virus (HSV) and varicella-zoster virus (VSV) include acyclovir and valacyclovir. Notice they both share the -cyclovir stem. We dose valacyclovir less frequently, increasing patient adherence. Respiratory syncytial virus (RSV), a serious risk to neonates especially, responds to the monoclonal antibody palivizumab. Antivirals - HIV To best understand HIV antiviral pharmacology, you should visualize from your pathophysiology class how HIV attacks, enters, and reproduces within a human cell. A full explanation of this mechanism is beyond the scope of this article, but let's pick up a few clues as we learn about our available medications. The first step is to fuse with a human cell. If it can't do this, it can't replicate. One medication, enfuvirtide, is a fusion inhibitor and literally inhibits viral fusion or connection with our cell. Try to remember that the letter "f" in enfuvirtide stands for "fusion." Another antiviral, maraviroc, blocks a specific receptor CCR5. Use the "c" and "r" to help remember this mechanism for CCR5. We treat HIV with multiple drugs to prevent resistance. Efavirenz / emtricitabine / tenofovir helps patients stay compliant with their meds. The brand name, Atripla, has part of "triple" in it, reminding us there are 3 drugs in a single pill. After the HIV gets into the cell, it needs to integrate itself into our DNA with the enzyme integrase. You can see the similarity between raltegravir and integrase to remember this connection. Darunavir is another antiviral inhibiting actions of protease. While the -navir stem bears no resemblance to protease, its brand name Prezista does as "resisting protease." Here are the antimicrobials to make the classifications globally clearer. OTC antimicrobials Neomycin/ polymyxin B / bacitracin Butenafine Influenza vaccine Docosanol Antibiotics affecting cell walls Penicillins Amoxicillin Amoxicillin with clavulanate Clavulanate is a beta lactamase inhibitor, augmenting the antibiotic Cephalosporins Cephalexin - 1st generation Ceftriaxone - 3rd generation Cefepime - 4th generation Glycopeptide Vancomycin Protein synthesis inhibitors- bacteriostatic Tetracyclines Doxycycline Minocycline Macrolides Azithromycin Clarithromycin Erythromycin Lincosamide Clindamycin Watch out for diarrhea / CDAD Oxazolidinone Linezolid Protein synthesis inhibitors - bactericidal Aminoglycosides Amikacin Gentamicin Antibiotics for UTIs and PUD Dihydrofolate reductase inhibitors Sulfamethoxazole / trimethoprim Fluoroquinolones Ciprofloxacin Levofloxacin Antiprotozoal Metronidazole Anti-tuberculosis agents Rifampin Isoniazid Pyrazinamide Ethambutol Antifungals Amphotericin-B Fluconazole Nystatin Antivirals - non-HIV Influenza A and B Oseltamivir Zanamivir HSV/VSV Acyclovir Valacyclovir RSV Palivizumab Antivirals - HIV Fusion inhibitor Enfuvirtide CCR5 antagonist Maraviroc NNRTI w/two NRTIs Efavirenz / emtricitabine / tenofovir Integrase inhibitor Raltegravir Protease inhibitor Darunavir [video=youtube_share;bDTRHCrWhEs]
  13. TonyPharmD

    Memorizing Pharmacology Video 2 of 7

    Yes, you have some very good mnemonics in there, thanks for the link.
  14. In this third video, I cover respiratory medications for allergies, cough, asthma, and anaphylactic shock. Antihistamines We'll start with two antihistamine generations, 1st and 2nd. First generation causes drowsiness and is shorter acting, while second generation is non-sedating and longer acting. Recall we already learned a different set of antihistamines in the first video, the H2 receptor blockers for acid reflux. Stems are sometimes similar, -atadine vs. -tidine, so be careful. Decongestants Pseudoephedrine is only available behind the pharmacy counter (BTC) and often paired with a 2nd generation antihistamine as the "hyphen 'D'," on the end of a drug name. Phenylephrine is often marked as "P.E." and is available over the counter (OTC). Finally, oxymetazoline, brand Afrin is only meant for a few days of use to avoid rebound congestion. Allergic rhinitis Anti-inflammatories like triamcinolone produce fewer side effects with a nasal spray formulation. Full effects may take a few weeks, but steroid nasal sprays are hands down the best prophylaxis for seasonal allergies. Expectorants / antitussives / oral steroids Expectorants like guaifenesin help remove mucus and antitussives suppress the urge to cough. The choice of antitussive often depends on cough severity. Oral steroids like prednisone and methylprednisolone reduce severe inflammation sometimes from this cough. Asthma Asthma is straightforward, an inflammatory condition paired with bronchoconstriction. Our drugs then work as anti-inflammatories and bronchodilators. An inhaled steroid with long-acting beta-2 agonist is a common combination. While patients can safely use an inhaled steroid like fluticasone alone, in certain conditions beta-2 agonists like salmeterol must be paired with an inhaled steroid for safety. Anticholinergics Also relax bronchial smooth muscle for asthma and COPD and include short-acting ipratropium and long-acting tiotropium inhaled forms.There is also non-inhaler asthma therapy. Leukotriene inhibitors such as montelukast and the biologic omalizumab have their place in respiratory therapy. Anaphylaxis Epinephrine is part of the LEAN acronym, lidocaine, epinephrine, atropine, and naloxone for critical emergency medicines. It's sometimes easier to see the divisions in outline rather than paragraph form of the major classes. Antihistamines 1st Generation Diphenhydramine 2nd Generation Cetirizine Loratadine Loratadine-D Decongestants Pseudoephedrine- BTC Phenylephrine - OTC Oxymetazoline - nasal spray, rebound congestion, 3 days max Allergic rhinitis Triamcinolone - no proper stem Cough Guaifenesin / dextromethorphan (DM) Guaifenesin / codeine (AC) Oral Steroids Methylprednisolone Prednisone Both use "pred" as prefix or infix Asthma Steroid and long acting beta-2 agonist Budesonide / formoterol (Symbicort) Fluticasone / salmeterol (Advair) Nasal / oral steroid Fluticasone comes as both nasal (Flonase) and oral (Flovent) form Short acting rescue inhaler Albuterol Anticholinergic / beta-2 agonist Ipratropium/ albuterol (Duoneb) Anticholinergic alone Tiotropium - long acting Leukotriene inhibitor Montelukast Anti- IgE antibody Omalizumab - monoclonal antibody Anaphylaxis Epinephrine also known as adrenaline
  15. TonyPharmD

    Memorizing Pharmacology Video 2 of 7

    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. OUTLINE 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. [video=youtube_share;elae_w4-nIA]
  16. TonyPharmD

    Failed my NCLEX RN idk what to do now

    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.
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