Over-the-Counter OTC Medicines Part 3

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An overview of over-the-counter pharmacology Part 3, 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 part three of Over-the-Counter Pharmacology. We’re gonna go over the respiratory and immune over-the-counter medications, and then after that, we’ll go on to neuro and endocrine. So this is part three.

So, Diphenhydramine is brand name Benadryl, and this is a first-generation antihistamine. What first-generation means is that something in the second generation has happened to distinguish it from the first. In the book, it talks about antipsychotics and the first generation has significant extrapyramidal symptoms and somnolence associated with some of the drugs where the second-generation antipsychotics don’t really cause that extrapyramidal symptoms in the same degree as that first generation but they have very specific metabolic effects: diabetes, hypercholesterolemia, things like that.

The point I want to make is that this is a first generation; it was one of the first ones that came along. It doesn’t mean it’s worse; we use it all the time. But because of this side effect of drowsiness, we want to recognize that you know we shouldn’t be driving with it or something like that. But it’s also used in a positive way in the PM in Tylenol PM which we’ll get to a little bit later.

It’s an H1 receptor antagonist and I mentioned the H2 receptor antagonists in the GI section: Renitidine, Famotidine. And you really want to be careful with the stems so Diphenhydramine doesn’t actually have a stem but on many of the YouTube videos, many of those guys that kind of create these videos and get you to their website or whatever it is, they talk about EN as being a stem and that you can recognize antihistamines from it.

But if you think about it, that’s just a heuristic cognitive bias. A heuristic is a shortcut and a cognitive bias means that because you’ve only seen maybe Diphenhydramine and Theratidine you think oh everything I’ve seen that ends in EN has always been an antihistamine so it must be so.

But just think about Morphine - well that ends with EEN or INE and there’s many many drugs - 20 percent of all drugs actually end with IN so there is no stem with Diphenhydramine and I’ll show you the stem that goes along with Loratadine or Claritin but you really want to be careful with those stems make sure they’re coming from a credible source.

Here in the states, it’s the United States Adopted Names Council; they’ve got theirs on the American Medical Association website. If you’re in the UK for example there’s the British Approved Names and then there’s the World Health Organization that has their stem book and those stems are there as well but we want to be careful with that.

As far as the brand name and remembering it: well first, the word BED is in there if you take the N A out so you can think of Benadryl as something that can help you get to bed but also there’s the word there’s the beginning of BEN so something like benefit and then DRY because anti-histamines tend to dry up the secretions from allergies and things like that so Benadryl starts us off with the first-generation antihistamine.

Then we’re going to go to a couple of second-generation antihistamines that aren’t supposed to cause this sedation. The first one I put in here - And again I’m sticking with this if you’re in a category or subcategory I’m going to alphabetize it so Satirizing comes first and Loratadine will be next for Claritin.

So Cetirazine is brand name Xertech; this is a second-generation antihistamine. It is an H1 receptor antagonist now be careful some students get that confused maybe under the pressure of the exam Benadryl or Diphenhydramine is first generation H1 receptor antagonist Satirizing Loratadine these are second-generation antihistamine but still an H1 so that one and two sometimes students get the generation versus the receptor mixed up a little bit.

The Satyrizine - It’s spelled T-I-R but you pronounce it T-E-A-R so Satirizing - You can think of the tearing from allergy eyes as a way to remember this one.

Loratadine - This one does have a stem; It’s A T A D I N E and its brand name Claritin. The commercials Claritin Clear tend to help students really remember what this one’s for: clearing up allergies.

But I want to talk about this stem a little bit so TADINE and TADINE are pronounced the same so Famotidine and Rhinitidine those are both H2 blockers for GI. The T-A-D-I-N-E or A-T-A-D-I-N-E in Loratadine has a very similar sound and those can be mixed up when talking so it’s very important to be very clear and there’s this push towards well just talking generic names but just talking in generic names to me is like just talking in first names.

But if you talk in first and last names then you clear something up oh I wanted to talk to Bob. Bob? Well, Bob Smith. Oh okay so that gives you a little bit more information so I know that some of the exams are going towards all generic but patients talking brand names brand names help you remember what the generic is for and sometimes the easiest way to get to remembering the generic name is through the brand name.

As I mentioned Claritin like Xertech is a second-generation antihistamine; it doesn’t cause the drowsiness that we see in Diphenhydramine. It’s an H1 receptor antagonist so again it’s for allergies rather than gastric reduction gastric acid reduction and again just remember that it’s second generation H1.

Try not to get it confused. The antagonist H1 versus the generation and then I mentioned the Adidas stem and then the Claritin Clear. So one confusion patients tend to have is Loratadine versus Pseudoephedrine. When you have a runny nose, that’s something that you would want an antihistamine for. If you have a stuffy nose, that’s something that you want a decongestant for. That is it decongests, removes the congestion from your nose.

Loratadine is the second-generation antihistamine I just talked about. The Pseudoephedrine is the D for decongestant. Now that’s just generic for Sudafed which I’ll get to in the next slide. So we’ve combined a second-generation antihistamine, an H1 receptor antagonist with a sympathomimetic.

Well, what does that word mean? Well, the sympathetic nervous system is one that’s the fight-or-flight system and the mime, mime is to mimic or to do the same thing as. So a sympathomimetic does the same thing as a sympathetic nervous system and in this case, it’s going to decongest because that’s just how it works.

The stems we have Adidene for Loradidine as the second-generation antihistamine and then Dryn D-R-I-N-E is actually a stem for the Pseudoephedrine, the sympathomimetic. The way to remember so again Claritin Clear that tends to help people remember okay clear up my allergies and then one of my students said I’m just fed up with nasal congestion. The Phed in Pseudoephedrine is how they remembered the D in Claritin D and I thought that was pretty good.

Pseudoephedrine and Sudofed so this is a sympathomimetic as I said so it just mimics the sympathetic nervous system but that’s why you get this jitteriness with it is that it does cause that increase in heart rate and things like that so be careful with patients that have uncontrolled hypertension.

Decongestant okay so that’s what it’s for. The stem is Drin and I mentioned the fed up with congestion now the difference between this Claritin D and Sudofed and then just something like Claritin is that you can’t find this over the counter but you’ll have to find it behind the counter.

This might be a little strange to someone that is used to seeing things over the counter and this used to be that way but what we’ve done is because this is a medication that you can make into methamphetamine an illegal drug it’s controlled now so have to show some kind of driver’s license or something like that and then you’re limited to the amount that you can get.

Phenylephrine or Neosinephrine this is the nasal one it also comes in combination with other medications and you’ll see it abbreviated PE so if something has hyphen D it means it’s the decongestant Pseudoephedrine if something has hyphen PE it’s the Phenylephrine and then we went over the DM for Dextromethorphan and then that’s the antitussive or anti-cough and then the PM which is Diphenhydramine which is uh… To help someone sleep.

So like Pseudoephedrine Phenylephrine is also a decongestant but this is a nasal decongestant so it’s a spray but it can also be found in some liquid cold products. It has the F and the Rin so you can see that there’s no official stem here but you can see that there’s certainly some similarities in the words and Neo just means new so you can just think of it as some new decongestant.

We’ve just seen two medications that can be used intra-nasally: The Oxymetazoline, The Afrin and now we get to Triumph Sin alone brand name Nasa Court Allergy 24 Hour. This isn’t for an acute or for acute congestion; this is a medication used prophylactically. That is we want to prevent these allergy symptoms.

So, the brand name reads like exactly what it is: It’s Nasa for the nose; Court - It’s a glucocorticoid which means it’s a type of steroid for inflammation; Allergy - It’s for allergy; And 24 hours - That’s how long it lasts.

So a lot of students tend to use this alone as a stem; It’s not really a stem. Prednisolone is another medication that can be taken; That’s a steroid. And anytime you see similarities at the end, you just want to be careful that you’re using something that’s an established stem.

So I’d be a little bit careful with that one in Prednisolone; The Pred - The Pred - That’s the actual stem. And then how do you remember it? Well, I think the brand name makes it quite easy. The nasal plus glucocorticoid - The Nasal Cord. So it’s a corticos a glucocorticoid for nasal allergies.

Quite Fenesin with Dextromethorphan Robitussin DM so this is a combination product and some students get mucolytic confused with antitussive. So a mucolytic is something that breaks up mucus so Guy Fenusin you’ll find is Robitussin plane or you’ll find it as Mucinex. You might recognize it from the I don’t know what his name is but there’s this green kind of blob looking thing that’s mis I think it’s Mr. Mucus or something like that and that’s Mucinex that breaks up the mucus.

The Dextromethorphan is meant to stop the cough so if you break up the mucus and stop the cough, the idea is that we can relieve the patient’s symptoms. This Orphan stem I won’t get into it too much because it is technically a derivative of Morphine but it’s over the counter; It’s so far removed from Morphine there’s no addictive potential and things like that as far as scheduling with a drug enforcement agency though Dextromethorphan by itself has been abused.

And then to remember it from Robitussin well Robitussin robs your cough is one way that a student said that they remembered it.

Bacitracin Neomycin Polymix and B if I said those three names you might not recognize it but if I said Neosporin that might be more familiar and Neosporin’s the brand name. So this brings in a couple of good points if you have certain antibiotics and they might have serious side effects if you use them parentally let’s say IV or something like that but if you use them topically they can be very safe to the patient.

Bacitracin, Neomycin, Polymixin - If you put it as take pieces of each word that’s how you get the word Neosporin. So Neo from Neomycin; The Sulfate part of Neomycin Sulfate takes the S; The PO from Polymixin and then the R, the I and the N from Bacitracin.

I want to talk about that Mice and stem though. Mycin just means that it came from Streptomyces bacteria as how this antibiotic was formed so Mycin doesn’t really mean anything; It doesn’t put it into a class of drugs. There’s Erythromycin - That’s a Macrolide; There’s Gentamicin - That’s an Aminoglycoside; Neomycin is also an Aminoglycoside.

So Mycin - It might mean that it’s an antibiotic but I really really would caution is using that as a stem to remember that it’s in a particular class maybe it’s a hint but I don’t think I would use it that way.

Butanophene so that was an antibacterial Neosporin Butanophine is an antifungal Lotum and Ultra and there’s another drug Terbenaphine which is also you can also get this over the counter as a cream and then by prescription as a tablet.

So I didn’t find enough in stem when I looked at the resource but it seems they’re pretty similar and then to understand that Lochman Ultra might not have the exact same thing as Lotumin if it weren’t for all the showiness and the colors and all that stuff patients would really benefit from all of the OTC drugs being turned around that way you know exactly what the active ingredient is in it.

And why I put them up here Bubutenophine is an antifungal so we start with an antibacterial then to an antifungal and the next one I want to go over is an antiviral so Dicosanol is an acute antiviral. That is if you have some kind of cold sore you can apply this.

And I thought who would ever spend 20 bucks or 25 bucks on this little tube for a virus? And then I thought well if I was going to homecoming and it’s the only time I ever get to go to this dance or something like that then I’d probably pay the money for it.

So, I always thought of Decarsonal and going to the ball. So maybe that’ll help you remember it and then the name Abriva to abbreviate the cold sore, how long the cold sore is going to be around, that’s what it does. So hopefully those mnemonics help you a little bit.

So while this one wasn’t for acute infection, let’s talk about Influenza Virus Vaccine Fluzone. This is a prophylactic vaccine so we’re giving this medication hoping to not get the virus in the first place. It’s over the counter sort of. Pharmacists in Iowa certainly can inject this and provide this kind of vaccination but you can’t just find it on the over-the-counter shelf. So maybe without a prescription would be a better description than OTC because it’s literally not over the counter, it’s behind the counter and you have to go through some paperwork to get it but you don’t need a prescription and then depending on the child’s age you might not need a prescription.

What I do want to talk about is this brand name and this confusion that some students have between flu and this is why you kind of have to remember you have to know all the brand names all the generic names and I think that’s very possible. So the book really goes over hey you can learn these 400 words 200 brand 200 generic and here’s a perfect example of why it’s so important to be that literate in the drug names for your patients.

If you have Tamiflu or Fluzone then likely it’s for Influenza okay but if you have Flu Flu in a generic name then it probably means that it’s got a fluorine atom in it, it has nothing to do with the flu. So we’re talking about something like Fluoxetine which is a selective serotonin reuptake inhibitor antidepressant and that Flu is it’s just a fluorine atom that just happens to be in the molecule there’s Flucytacine there’s Fluconazole which is an antifungal so you really have to know not only the brand and generic but which is which and then this is a great example of where Flu comes in and can be a little bit deceiving.

 

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