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Memorizing Pharmacology Podcast: Prefixes, Suffixes, and Side Effects for Pharmacy and Nursing Pharmacology by Body System


Jan 6, 2022

Over-the-Counter OTC Medicines Part 2

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An overview of over-the-counter pharmacology Part 2, if you are looking for the book, you can find it here https://www.audible.com/pd/B09JVBHRXK/?source_code=AUDFPWS0223189MWT-BK-ACX0-281667&ref=acx_bty_BK_ACX0_281667_rh_us

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Auto Generated Transcript:

Hey, welcome to the Memorizing Pharmacology podcast. This is Over-the-Counter Pharmacology Part Two, supporting the Memorizing Pharmacology: A Relaxed Approach series of books, including Memorizing Pharmacology Mnemonics. In this section, we’re going to go over the gastrointestinal and musculoskeletal medications over the counter, and then we’ll get to the other categories: respiratory, immune, neuro, cardio, and endocrine. But here we go.

Okay, let’s start with calcium carbonate or Tums. So we’re going to pair each of these up so that you have a reference point. You really don’t want to try to memorize things by themselves. It’s a lot easier to remember two things together than it is to remember one alone. So what we’ll pair calcium carbonate or Tums up with is magnesium hydroxide milk of magnesia, and that’ll come up in the next slide. Both of them are antacids. They work very quickly; a couple of minutes they should provide some relief, and they’re receptor-less. That just means that they go into your stomach and increase the pH.

Which sounds a little bit strange, but you’re increasing the alkalinity and you’re decreasing the acidity. But these drugs work very quickly because of that. The generic name and chemical name are the same, so calcium carbonate is the generic name; it’s also the chemical name. And magnesium hydroxide is the chemical name; it is the generic name. Calcium is on the periodic table of elements under 20, and then just eight away from it is magnesium. So that means they’re right under each other. So calcium is right under magnesium, and they both have that plus two charge when ionized.

So thinking about how we can remember them: well, Tums - I don’t want to call it chalky but it’s definitely a tablet that kind of breaks apart. They come in fruit flavors; sometimes there’s a mint one. And just like on the periodic table of elements, you’ll find them on the over-the-counter shelf right next to each other or above each other.

So magnesium hydroxide or milk of magnesia as I said is also an antacid. Its generic name and chemical name are the same, and on the periodic table of the elements, magnesium is 12.

What’s important really is that when do we use Tums and when we use milk of magnesia? Well, Tums because of its calcium component can also be used as a calcium supplement. Milk of magnesia if you take enough of it has a bit of a laxative effect. So if you have constipation milk of magnesia would be the right choice; if you want to help with calcium supplementation calcium carbonate would be the choice; and then as an antacid either one would be fine.

But we’re also introducing the idea of solid versus liquid preparations: Famotidine and Ranitidine I’ll put together as the next two. So Famotidine is Pepsid and it’s an H2 blocker.

What that means is that we have antihistamines and technically it’s an antihistamine; there’s a histamine one and a histamine two. And histamine one - that’s the allergies histamine so we don’t say H1 because when we discovered those we didn’t know there would ever be a two.

So antihistamines just talks about allergy antihistamines like Benadryl and Claritin and Zyrtec and Allegra and those types of things. But an H2 blocker - if you block histamine 2 you block the introduction of acid into the stomach.

And we can recognize these by their stem now there’s a lot of misinformation on the internet about stems and suffixes and prefixes and I’m not going to go into it too much into these slides; it’s in the book - the whole book explains it.

But I want you to know that ‘tiding’ is an official stem; it comes from the original Cymetidine and they took the last six letters and said okay if you’re gonna introduce an H2 blocker as a manufacturer of these medications you need to have T-I-D-I-N-E at the end of them.

And this is helpful because this lets you know the four that are out there: Cymetidine Famotidine Nizadine by just knowing those six letters uh… The brand name - I think they did a pretty good job - you’re not allowed to say exactly what it is but peptic means digestive and acid obviously you’re trying to reduce acid so peptic plus acid makes Pepcid AC.

Esomeprazole actually came after Omeprazole but I’ll explain while this one’s first so Esomeprazole alphabetically though comes before Omeprazole and within a class I’ve tried to alphabetize them so C before M (Calcium before Magnesium), F before R (Famotidine before Rhinitidine), Esomeprazole before Omeprazole and this will help with memorization.

Now in the book I go over the 200 drugs and my expectation is that by the end of the book you can memorize all 200 drugs in order. I’ve done it and I know that you can do it as well. But in here, I’m just keeping those pairings to make it easy to recognize which one should be on the shelf next to each other.

So what is a proton pump inhibitor? Well, going back to our chemistry, proton is something that has to do with acidity and if we stop protons from going into the stomach we reduce that acidity. The stem is ‘prazol’ P-R-A-Z-O-L-E so if something ends in ‘prison’ it should be a proton pump inhibitor.

Now there’s an exception to this with some prescription items antipsychotics that end with ‘piprazole’ P-I-P-R-A-Z-O-L-E this was discouraged by the World Health Organization and you know they still came out I think with the new pip result but for the most part ‘prazol’ you should notice that it’s a proton pump inhibitor.

And then if you think of ‘next’ plus ‘hydronium’ so hydronium is the ionized form of this acid that might be a way to remember it and the ‘next’ means that well Prilosec came first and Nexium came next and they’re the same thing.

We can also look at the colors though and see that they’re very similar so you see a yellow background here with the purple pill and then when we get to the next one you’ll see just a purple background in this purple pill maybe also easy to remember that Omeprazole this came first and this is also a proton pump inhibitor.

The stem is ‘prazol’ and I mentioned that before and if you look at the brand name you can think of ‘protons’ or the PR from protons and then the LO for low and then SEC for the word secretion so protons low secretion to remind you that it’s a proton pump inhibitor and it’s going to help with secretion and hyperacidic conditions.

So we’ve paired two antacids, two H2 blockers, two proton pump inhibitors; next we’re going to pair two anti-diarrheals together: Bismuth Subsalicylate is Pepto-Bismol. Don’t confuse that with Pepto Children’s which is just calcium carbonate or Tums.

So the cell - recognize that as a salicylate - and this is dangerous in children especially if they have some kind of fever or chickenpox or something like that we can have some kind of issue with Rey syndrome. So again this is Pepto-Bismol for adults.

The stem is ‘cell’; I mentioned that already but the salicylate component when we think of salicylates we usually think of analgesia as an aspirin acetyl salicylic acid but in this case we’re really memorizing the cell to remember one of the adverse effects or one of the contraindications that we shouldn’t give it in children.

It’s if you look at the word Pepto-Bismol you can think of peptic which means digestive uh… You can think of bismuth as number 83 on the periodic table; it causes some darkening of the tongue maybe the stool but this effect is harmless.

In this case, it can really dehydrate the patient, so you want to really make sure the patient knows that they should take it with water. If you know, they even get to the pharmacist. Again, this is over the counter; they could just pull it off the shelf and check out without any counseling. And then Colon’s pace - I know it doesn’t exactly work in the colon, but if you think of Colase and slowing the colon’s pace or speeding the colon space, I’m sorry, then maybe that would be a way to remember what Colase does.

Polyethylene glycol or Miralax - so this sort of has a stem. The stem for polyethylene glycol is PEG P-E-G, and you can pull those letters out of the generic name. It’s an osmotic laxative, so it’s very safe; it can be used in children. And when I look at that brand name, I think it’s a miracle laxative or it’s a miracle how well could you feel after you’ve used this laxative something like that. But the word, the letters LAX for laxative are in there.

This is the first of the musculoskeletal drugs: Aspirin and this is the regular analgesic strength aspirin 325 milligrams. Its brand name is Ekatrin. And let me talk about non-steroidal and then I’ll talk about the name. So a non-steroidal anti-inflammatory drug is trying to compare it to maybe like a prednisone that is steroidal and what we’re saying is it’s not that so it’s a non-steroidal anti-inflammatory drug.

And if you take the N, the S, the A, the I and the D, you get NSAID. So it’s pronounced for the first letter N and then we just say the word said. If you really want to get into it, it’s an initialism plus an acronym. The way that you would maybe say like ROTC ROTC ROTC is an initialism; ROTC is an acronym.

But it’s important that you not say Nayset. So a lot of people want to put an A after the N because N and S together - it just doesn’t normally; you don’t say that in English language. So it’s as if it were spelled E-N-S-A-I-D.

ASA and acetylsalicylic acid - so these are different ways that we refer to Aspirin. If you look at acetyl salicylic and acid and you take the A, the S and the A away - that’s where we come up with the initialism ASA.

And then the brand name comes from enteric coated aspirin so something that is enteric is going to go through the enteral system or the GI system something that is paraenteral or parenteral is going to go outside the GI system.

So what this is - this is coated so that it doesn’t hurt the stomach and can pass through to treat some kind of pain fever a couple other things that aspirin is good for.

Ibuprofen or Motrin - this has a stem: The profin stem and there are some brand non-steroidals that also have that profane stem. So again this is also a non-steroidal anti-inflammatory drug; it’s similar to aspirin but because it can be safely used in children, it certainly has its own niche.

Just a reminder if you’re looking in the OTC aisles - you really do want to have a pharmacist with you especially if you’re looking for something for kids because the adult Motrin is in a different place than the children’s Motrin and then children’s and infants tend to be different when we’re talking about these kinds of drugs.

So an infant is someone under two and usually you have to have somebody specifically dosing that and then a child is someone from two to twelve something like that but anytime you’re looking for Motrin for a child - you really should get some help.

So again I mentioned - The stem is profane and then this just goes to visual literacy why is it that Motrin is this bright orange and then Advil is that blue? So if you look on the color wheel those are exactly opposite each other.

And I don’t know who came first - The Motrin or The Advil but somebody said you know I really want this to stand out because if it looks just like it then we’re going to look just like we’re the same thing so to have something stand out the most - You just go opposite on color wheel.

So again this is kind of a tangent but a way to remember that they’re both related is that Motrin orange is opposite Advil blue on color wheel.

Okay Ibuprofen or Advil - so the exact same generic drug Advil is another brand name for over-the-counter medication. And as I mentioned - The colors just a way to remember that those are related in some way same thing stem is profin.

And I always thought of Advil helping with the anvil. So in a lot of cartoons, you’ll see an anvil fall on one of the characters and they get a headache and Advil and anvil are only separated by one letter.

So the way to remember that Advil is for that kind of pain is just think of that anvil falling on the character’s head.

So Aspirin, Ibuprofen - those really need to be taken up to four times a day but the next medication Naproxen only needs to be taken probably like twice a day. And this is also a non-steroidal anti-inflammatory drug. We see the endings are similar now proxin isn’t an official stem but peroxin and profin only are separated by that one letter and maybe that’s a way that you can remember those are related as nonsteroidals.

When I think of the brand name, I think of Aleve and alleviating your pain so that also maybe can help you remember this one.

A drug that’s talked about quite a bit with these non-steroidals is Tylenol and this is Acetaminophen or Paracetamol if you’re coming from the UK and the brand name is Tylenol. So this is a non-narcotic analgesic. Tylenol or Acetaminophen is often paired with narcotics so the brand name of Vicodin - A prescription drug has Hydrocodone which is a narcotic and Acetaminophen which is non-narcotic.

So again we’re trying to define it and we have to define it by what it’s not so just as Aspirin, Ibuprofen, Naproxen are non-steroidals non-steroids Acetaminophen is a non-narcotic okay so it’s a little like defining non-fiction by saying it’s not fiction okay so you’re not really defining it you’re just saying what it’s not.

The name or the short names APAP or Tylenol come from the chemical name N acetyl para Aminophenol. What good is N acetopara Aminophenol? Well if you’re an organic chemist you can draw it from just that description relatively easily but you can see that we take the A from acetyl, the P from para, the A from amino and the P from phenol.

As far as Tylenol - They just took the Tyl from the acetyl and the enol from the phenol to come up with that name. That’s how we used to do it but now once you get a stem then every drug coming after that should be similar.

Acetaminophen, Aspirin, and Caffeine - Excedrin Migraine. I like this drug because it’s a combination drug and kind of brings together a number of the drugs that we just talked about. So Acetaminophen - A non-narcotic analgesic that helps with the migraine pain. The Aspirin - It helps with pain and inflammation; Acetaminophen doesn’t help with the inflammatory process so it’s nice to have Aspirin helping in that way.

Why wouldn’t you just use Aspirin and just skip the Acetaminophen altogether? There’s a school of thought that if you have two medications and they do something similar then hopefully you can reduce the dosage of both and hopefully you’ll keep below the adverse effect threshold of both.

So the idea is that we don’t have to do full 325 milligrams of Aspirin; we don’t have to do the full 500 milligrams of Acetaminophen or 650 for the extra strength and that way maybe we can reduce uh… The side effects.

The caffeine seems a little bit weird - You want to be wide awake while you’re having your headache? No, the idea is that maybe the headache is an issue of vasodilation so a vessel in the brain opening up. Caffeine tends to constrict or narrow blood vessels so the idea is that it’s going to narrow the blood vessel in the brain and relieve that pain.

So Acetaminophen - The non-narcotic analgesic; The Aspirin - The anti-inflammatory; And Caffeine - A vasoconstrictor altogether working in concert to help get rid of migraine pain.

 

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