Jul 26, 2021
Steroid Drug Suffixes Sone and son (Corticosteroid suffix)
The body system we continue to cover is gastrointestinal and omeprazole, esomeprazole, lansoprazole, pantoprazole are all proton pump inhibitors PPIs.
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Suffixes -sone, -son- (GI)
Because we’re working through the seven major body systems starting with gastrointestinal, I’m going to hold off on talking about steroids for asthma and other respiratory conditions, but there are respiratory and inhaled steroids available such as fluticasone, a component in Advair and budesonide which is a component in Symbicort, both longer acting steroids.
First, let’s talk about the difference between an official stem and a useful drug suffix. An official stem is on the big list I have at memorizingpharm.com/drugsuffix PDF as these 800 or so are the agreed upon stems for medications by the governing bodies that decide such things.
However, there are common endings that are still useful like -sone, s-o-n-e and son, s-o-n. For example, you can see -sone at the end of fluticasone and prednisone. However, budesonide (Enterocort) and ciclesonide (Alvesco) have son, s-o-n, as an infix, in the middle of the word. There are very few infixes in common English. So, look for the letters as an ending or in the middle.
However, if you look on the big drug suffix list, pred, p-r-e-d is on the list. That’s because prednisone is actually the prodrug for prednisolone, p-r-e-d-n-i-s-o-l-o-n-e which has neither sone, s-o-n-e nor son, s-o-n, but we want to show they have a relationship. Officially pred is for prednisone and prednisolone derivatives. Prednisone can be used for a very powerful medicine for an acute flare up, but it’s not one that a patient can use long-term without significant side effects, so we’ll talk about that and budesonide (Enterocort) is a steroid for Crohn's disease and ulcerative colitis. Crohn’s disease can throughout the small or large intestine and rectum. Ulcerative colitis (UC) typically is at the end of the GI tract and the colon. The letter “U” which starts “Ulcerative colitis” is almost at the end of the alphabet to help you remember the difference. Since UC is at the end of the GI tract, that’s a good candidate for rectal formulations.
The reason we use steroids is that they reduce prostaglandin and kinin action, which are important inflammation modulators. Our target therapy length for these conditions might be 4 to 8 weeks.
Side Effects
In the short term, you will see insomnia and stomach upset. That makes sense, the body releases cortisol when you are stressed putting blood glucose in the blood stream, all of that fight or flight action will keep you awake with too much steroid.
That is also an important issue with long term use and the raising of diabetics blood sugar. For example, if there is a diabetic patient with UC we have the problem of needing steroid but raising blood glucose as a side effect. Other notable side effects include increased risk of osteoporosis, affecting the bone strength and immunosuppression. When the immune system is reduced, the chance of infection increases.
The liver breaks down budesonide very quickly which is good for a localized condition, it doesn’t stay in the body as long. However, prednisone, does not break down as quickly which is good for a condition that might affect the whole body like lupus erythematosus.
Interactions
Remember we want to try to put our interactions and drugs on the patient chart in the GMRINCE order, GI, musculoskeletal, respiratory, immune, neuro/psych and endocrine. So, when you look at a CYP3A4 inhibitor chart and see dozens of medicines, try to order and group them. Here are some examples:
Immune - Antibiotics/Antifungals
CYP3A4 inhibition can affect macrolide antibiotics such as azithromycin (Zithromax), clarithromycin (Biaxin), and erythromycin (E-Mycin). Note their suffix is thromycin, t-h-r-o-m-y-c-i-n vs. just mycin, m-y-c-i-n.
While we call azole antifungals, “azole antifungals,” the actual stem is -conazole, c-o-n-a-z-o-l-e. Remember we talked about differentiating fluconazole (Diflucan), ketoconazole (Nizoral), and itraconazole (Sporanox), with proton pump inhibitors esomeprazole and the -prazole ending and the antipsychotics, -piprazole such as aripiprazole.
Cardio
Verapamil (Calan) is a calcium channel blocker with the pamil, p-a-m-i-l ending.
Endocrine
We discussed the issue of diabetes and increased blood sugar earlier.
Auto Generated Transcript:
Welcome to the "Memorizing Pharmacology" podcast. I wanted to go over our next suffix, and this one's one that isn't really official, but it is very useful and indicates steroids. We can have quite a bit of a talk with it. The suffixes "sone" and "son," we're going to talk in terms of GI because we're working through the seven major body systems starting with gastrointestinal. I'm going to hold off on talking about steroids for asthma and other respiratory conditions, but there are respiratory and inhaled steroids available, such as fluticasone, a component in Advair for asthma, and budesonide, which is a component in Symbicort. Both are longer-acting steroids. You may even know fluticasone from the nasal spray, which is for allergic rhinitis. But we're going to talk a little bit about those and really kind of focus on GI first. Let's talk about the difference between an official stem and a useful drug suffix. An official stem is on the big list I have at memorizingfarm.com/drugsuffix. Again, that's memorizingfarm.com/drugsuffix, all one word, PDF, as these are the 800 or so agreed-upon stems for medications by the governing bodies that decide such things. However, there are common endings that are still useful, like "sone" and "son." For example, you can see "sone" at the end of fluticasone and prednisone. However, budesonide and terracort, and ciclesonide (Alvesco), have "sewn" and "son" as an infix in the middle of the word. There are very few infixes in common English, so look for the letters as an ending or in the middle. However, if you look on the big drug suffix list, "pred" is on the list. That's because prednisone is actually the pro-drug for prednisolone, which neither has "sone" nor "son," but we want to show that they have a relationship. So officially, "pred" is for prednisone and prednisolone derivatives. Prednisone can be used for a very powerful medicine for an acute flare-up, but it's not one that a patient can use long-term without significant side effects. So we'll talk about that and budesonide, branded as "Terracort," and you can see "entero," meaning like the GI. Okay, so "entero" for the GI. And then "cort" for corticosteroids. So it's a steroid for Crohn's disease and ulcerative colitis. Crohn's disease can go throughout the small or large intestine and rectum. Ulcerative colitis is typically at the end of the GI tract and the colon. The letter "U," which starts ulcerative colitis, is almost at the end of the alphabet to help you remember the difference. Since UC is at the end of the GI tract, that's a really good candidate for rectal formulations. The reason we use steroids is that they reduce prostaglandin and cytokine action, which are important inflammation modulators. Our target therapy length for these conditions might be a month or two, four to eight weeks. Side effects in the short term, you will see insomnia and stomach upset. That makes sense. The body releases cortisol when you're stressed, putting blood glucose in the bloodstream. All that fight or flight action will keep you awake with too much steroid. This is also an important issue with long-term use and the raising of diabetics' blood sugar. For example, if there is a diabetic patient with UC (ulcerative colitis), we have the problem of needing steroid but raising blood glucose as a side effect. Other notable side effects include the risk of osteoporosis affecting bone strength and immunosuppression. When the immune system is reduced, the chance of infection increases. The liver breaks down budesonide very quickly, which is good for a localized condition. It doesn't stay in the body as long. However, prednisone does not break down as quickly, which is good for a condition that might affect the whole body, like lupus erythematosus. Interactions: Remember, we want to try to put our interactions and drugs on the patient chart in the GM Rinse order: GI, musculoskeletal, respiratory, immune, neuropsycin, endocrine. So when you look at a SIP 3A4 inhibitor chart and see dozens of medicines, try to order and group them. Here are some examples: immune, antibiotics, antifungals. SIP 3A4 inhibition can affect macrolide antibiotics such as azithromycin (brand Zithromax), clarithromycin (brand Biaxin), and erythromycin (brand E-mycin). Note their suffixes: "thromycin" versus just "mycin." And that's one of those ones that get really confused because all it really is saying is what bacteria this came from. It may sound strange, but bacteria produce antibacterials, and the "mycin," whether it's "mycin," "thromycin," "mycin," that really we'll get into when we get to antibiotics, but that's a big difference. What we call azole antifungals, azole antifungals, the actual stem is "conazole." C-o-n-a-z-o-l-e. So remember we talked about differentiating fluconazole (Diflucan), ketoconazole (Nizoral), and itraconazole (Sporanox). With proton pump inhibitors, esomeprazole, and the "prazole" ending. At the antipsychotics, piprazole, such as aripiprazole (Abilify). So again, we're going through those drugs that have that SIP 3A4 inhibition. Cardio: Verapamil (brand Calan) is a calcium channel blocker with a "pamil" ending. And then endocrine: Well, we kind of discussed the issue of diabetes and increased blood sugar earlier. But that's really how you want to take it as you go drug by drug, and you see that, okay, we're going to add this budesonide (Terracort) for a patient that has this immunosuppressive condition or this autoimmune disorder where the body's attacking itself, and now we need to be very wary of the other medications that come along with it. Again, I hope you enjoyed this kind of quick episode. What I just want to do is go through the endings. And again, today with "sone" and "son," really a little bit more for the GI. But again, we can use them for respiratory, which would be for asthma conditions, and we can also use them for allergic rhinitis in some over-the-counter products as well. If you need to get a hold of me, the best way is tonythepharmacist@gmail.com. Otherwise, check out the website memorizingpharm.com, where you can find everything else.
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