Jan 8, 2022
Over-the-Counter OTC Medicines Part 4
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An overview of over-the-counter pharmacology Part 4, 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. We are in part four of the Over-the-Counter Pharmacology series of videos. So this is going to be it and if you want to check out the books Memorizing Pharmacology Mnemonics or Memorizing Pharmacology Relaxed Approach either eBook, print book and audiobook welcome here.
We have the last kind of three categories: Neural, Cardio and Endocrine and there’s not a ton over the counter for them but I think the principles are sound and it gives us an opening into the brand name medications which are in the book.
So start with Benzocaine we look at and brand name Ambisol. We start with the Cane stem and if you think of Cocaine which was one of the initial local anesthetics until we found out that they’d had those addictive properties and came up with Benzocaine, Lidocaine some other choices.
So it is an anesthetic and I want to go over there between something that’s an anesthetic and something that’s an analgesic. So an Analgesia can help with pain but an Anesthetic is going to normally numb something but also put somebody to sleep. Obviously this is a topical anesthetic so that’s not going to happen but it works differently it works by blocking axonal conduction.
This is one of the only drug classes that does this all most of the others work by some kind of transmitter neurotransmitter and you know I get into that in the book but so Anesthetic it’s a Dermatologic form Benzocaine you don’t want to inject it because it can cause some allergenicity so there’s a choice of Lidocaine which is a better choice as an injectable but Dermatologically it’s fine.
And then recognize the stem is Kane somebody mentioned that if you take the U and the M out of the word NUM you get the N and B in Anbisol so that might also be a good way to remember what Ambisol is for or Benzocaine.
The Lidocaine I have here again it’s that Cane stem and the brand name for this particular product is Solar Cane now after going out in the sun and maybe burning a little bit Solar Cane can be used to help numb all of the pain from that burning.
And if you look at the back of this bottle it says it’s an External Analgesic maybe we can use those words interchangeably if we’re talking about something topical but we understand that we’re just trying to relieve pain and that’s kind of the bottom line.
Lidocaine though if you start talking about an injectable you start talking about something that can treat dysrhythmias or which are rhythms of the heart that are not quite right you can use it there’s a it’s kind of a jelly form that you can put into a compound to help numb the throat if there’s some issues there there’s a patch that you can use.
So Lidocaine is very versatile and what I want to get across is that these over-the-counter ones are over-the-counter and are safe over-the-counter because they’re topical but if you’re talking about using something systemic some kind of injection then Lidocaine would be by prescription and you know maybe Paramedic would use them Physician something like that.
And again back to the stem, The Cane - That’s what connects Benzocaine and Lidocaine is in a similar class and the original Cocaine is how many students remember it because that’s something they’re familiar with movies and things like that.
Meclizine is Dramamine. This is where that IN stem really gets you in trouble. So an Amine is just something with a Nitrogen atom in it and I won’t get into the organic chemistry of it but IN in Meclazine and then EN in a brand name well brand names don’t have stems and The World Health Organization absolutely indicates that you know any kind of a brand name well I think I saw it in World Health Organization maybe it was The British National Formulary one of those two basically said don’t do that okay you’re gonna cause trouble if you use a stem.
So examples of where somebody might have used a stem in a brand name is like Monopril or Facinopril. That Prill ending means that it’s an Angiotensin-Converting Enzyme Inhibitor and that’s not really something you want to do but Meclizine this is actually an Antihistamine but we found that it helps with motion sickness so somebody going on a cruise or something like that can help.
You see the word Antiemetic. So, emesis is nausea and vomiting or vomiting so antiemetic means against that vomiting. I mentioned again the EEN and the brand and amine don’t use EN as a mnemonic and then dizzy and Izzy. Somebody told me that the IZI they just put it because if you squish the C and the L together it looks like a D and then you have a Z and then an I so you can remember that it’s for dizziness. That might help you remember what Mechlazine is for.
In the book, I use this Anti-Insomnic as a segue to the Sedative Hypnotics. So a lot of times pain keeps people up and Acetaminophen helps with that pain as a non-narcotic analgesic and then Diphenhydramine well it was an adverse effect that people got sleepy but you have a safe medication, a relatively safe medication that just happens to make people drowsy so why not put it with a pain reliever and see if it helps people sleep and that’s what Tylenol PM is.
So the non-narcotic analgesic Acetaminophen, Diphenhydramine is the H1 antihistamine, the first generation and then pain plus insomnia what’s the PM stand for? If you really care it means Postmeridium so well actually probably pronounced Meridium but the Mary means mid and then DM means day so after midday but we really use PM for evening.
I’m really talking about that but that’s just like Anti-Meridium would be the AM so Anti means before just like before you play poker they throw out the ante that comes out before any of the cards come out or your Anti Brachium is your forearm what’s in front of the arm.
So those are the four that I would classify under Neuro if you’re talking about over-the-counter most neural drugs are by prescription but these have some effect that can help us understand better the nervous system medications a little bit.
The Cardio drugs really I’ve just got a couple that help with cholesterol and then I’ll talk about Aspirin not as an analgesic but an anti-platelet so Omega-3 Fatty Acids these are an essential fat. What an essential fat means is that you have to get it from your diet. It’s essential well I didn’t mean to use that word but it’s part of the cell. It’s important for cell membranes formation of those and then lowering cholesterol can help reduce heart disease.
So that’s why this is so popular but you’ll find Omega-3 in small letters and you’ll really find Fish Oil as you know the big letters for Omega-3 Fatty Acids. I mentioned earlier the Omega-3 Ethyl Esters in the very beginning and that’s something that is in Lavazza which is a prescription form of these Omega-3s. It’s gone undergone rigorous FDA testing and can be prescribed by a physician.
Niacin or Nicotinic Acid this is really just Vitamin B3. It’s supposed to improve cholesterol increase HDL decrease triglycerides but there’s something called The Niacin Flush and that is some people get very flushed with it. You can take an Aspirin 30 minutes before you take Niacin and doing that will help deal with this flush but Niacin is a very good drug. I mean it’s a vitamin over-the-counter and relatively inexpensive as is Aspirin.
So when you’re comparing especially if you don’t have insurance some of the options that you have for cholesterol lowering this might be a good option if money is a real issue.
Aspirin, I mentioned before as an analgesic at 325 milligrams here we have Echotrine Low Dose so again the brand name Ekatrin is talking about Enteric Coded and then Aspirin and Low Dose means that it’s 81 milligrams. I think I’ve seen it abroad at 75 milligrams but you get the idea we’re at a fraction of that analgesic dose maybe a quarter something like that.
And so it is a non-steroidal anti-inflammatory drug but that’s not what we’re using it for here now what we’re using it for here is it has an effect on platelets and you’ll hear the term sticky so if you have some kind of Atherosclerotic Plaque that is some buildup of this plaque in a coronary artery.
And if you think of your fist as or your heart is a little bit larger than fist and then the little tiny arteries that are on there it doesn’t take much to create a blockage so the idea is to keep those platelets from sticking together keep them from clotting.
And in that very high speed arteriolar artery 365 tablets, That’s an easy way to remember that you know it’s something that you take every day. And really patients that have had prior stroke heart attack things like that the morbidity mortality is much improved with Aspirin.
So, those are just some drugs that have to do with Cardio. It introduces some basic concepts but just not a lot for Cardio over the counter. I’ll finish these slides with three endocrine slides so two insulins and then talk about Plan B.
So, Regular Insulin or Humulin R, Human R is the Eli Lillian company product. It’s Regular Insulin and this is the one thing about over-the-counter medications when somebody goes to look for an over-the-counter medication they’re usually looking for one thing but that’s why I tried to put this whole video series together so that you get a bigger picture of everything and then you kind of understand where it fits in you know whether it is a GI Musculoskeletal Respiratory or in this case Endocrine to understand where Regular Insulin fits in you really want to know Humalog which is the shortest acting you really have to take it with food it happens so quickly then Human R is Regular so it’s kind of in the middle or on the left side N lasts a bit longer but not quite all day and then Lantis you know we’re talking about all day long.
So to understand where Regular Insulin fits in you have to know that Humalog is the shortest acting R comes after that N comes after that Atlantis comes after that to really get perspective. I say it’s over the counter it just means you don’t need a prescription for it but it’s probably going to be kept in a refrigerator back in the pharmacy and here you see a vial that comes from a hospital pharmacy but generally it’s going to be in a white box sealed so that you know no one is tampered with it.
NPH Insulin is just a bit longer acting in Hemel and R and again to understand where it fits in you want to know Hemolog the prescription insulin and his prescription because it’s so dangerous if you really need somebody to give you the instructions make sure that you know that you have to take it with food or very near food.
The R is usually given if you’re going to move the dosages up and down that’s the one you would adjust. The N this is going to last a little bit longer you wouldn’t really mess with that too much throughout the day and then Lantis again that longer acting one OTC again I mentioned that if you’re talking about insulin you’re going to have to actually go to the pharmacy counter ask them for it and then I recommend asking for the needles at the same time you get insulin so that you don’t have that kind of awkwardness where you go in say you know I’d like buy a bottle 100 box of needles when you’re a diabetic and there’s nothing going on there.
Last one, Levonorgestrel it’s Plan B One Step. Why do they call it One Step? Well, it used to be Two Step. It used to be two pills and now there’s only one. And Plan B, well what’s Plan A? Well, Plan A was to use some kind of contraception that something like condom or something like that where you would plan ahead that you’re not trying to have this pregnancy happen but Plan B, uh… It’s just a way of saying okay well Plan A didn’t work so let’s go to Plan B.
And what’s Plan B coming afterwards as an emergency contraceptive to reduce the chance of pregnancy after having unprotected sex. The stem is just that means it’s Progestin so we contrast that to an Estrogen which would be Estr and Progestins alone you’ll see but Estrogens alone for contraceptions is something that you won’t see.
So again, I hope this series was helpful as always if you want to contact me I’m always happy to talk to anybody that has questions about the videos and so forth and you can contact me at aa guerra at dmacc.edu.
Like to learn more?
Find my book here: https://geni.us/iA22iZ
and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd
Here is the Link to my Pharmacy Residency Courses: residency.teachable.com