Ep 1. Top 200 Drugs Gastrointestinal Pharmacology

Free Pharmacology Course Podcast

Hi, I’m Tony Guerra, I teach college pharmacology and I created the Free Pharmacology Course Podcast to help you recognize, understand, and memorize pharmacology and drug names on the run. This first seven lecture series provides a basic understanding of how to recognize common drug names, understand the basic classifications, and quickly memorize them for exams. The print, e-book, and audiobooks these lectures are based on, Memorizing Pharmacology: A Relaxed Approach, can be found in the show notes taking you to Audible.com. If you’ve never had a book from Audible, you may be able to get the seven-hour professionally narrated version for free. Please do take the time to subscribe, rate and review these episodes it helps other people find out about them.

Welcome to Episode 1, Gastrointestinal Pharmacology.

Audiobook: https://www.amazon.com/Memorizing-Pharmacology-A-Relaxed-Approach/dp/B01FSR7XZO/

Full Transcript:

Male speaker: Welcome to the Pharmacy Leaders Podcast, with your host, Tony Guerra. The Pharmacy Leaders Podcast is a member of the Pharmacy Podcast Network. With interviews and advice on building your professional network, brand, and a purposeful second income from students, residents, and innovative professionals.

Tony: Welcome to the Pharmacy Leaders Podcast. The semester for me starts tomorrow. Monday the 8th and I need to get up the top 200 in audio form on this forum as well. So, I just wanted to let you know that today, Sunday January 7th, I'm going to put up the top 200 drugs in two hours and it's just seven audio podcasts. We'll get back to Brandon Dyson from TLDR Pharmacy on Monday morning where we will talk about residency interviews and we'll do a number of mock interview questions.

So, for now please enjoy the top 200 drugs in two hours.

Welcome to Episode One: Gastrointestinal Pharmacology.

What I want to do is I want to go through the seven chapters and I'm going to go through them on the board from memory. As we get to the later chapters I might just do them ahead of time just to make the clips shorter, but these first two clips at least I'm going to do it from memory just to show you that hopefully after you've read the book you've got it to the point where you're at the instructor's level. As an instructor with those 200 drugs I see them all as seven pictures. I don't need two hundred note cards, I can just do it from memory, and that's where I want you to get to.

So, we'll start with chapter one gastrointestinal and we'll talk about thirteen medications and while I talk about the thirteen medications I'll also talk about grouping them, and grouping them when you're first learning these top 200 drugs, when you group them students are good at grouping them as these are analgesics and these are maybe for some kind of stomach upset and then these are for pain, but this is another level where we're connecting all 200 drugs in one order.

So, let's start with two drugs that you're probably very familiar with, two antacids. Then from the antacids we're going to go to the H2 blockers and these are better known as histamine-2 receptor antagonists. So, there is a histamine-1, that's the antihistamine you think of when you think of Claritin and things like that. The receptor just means that the drug is going to affect the receptor and an antagonist means it blocks it. So, histamine two must release gastric acid if we're using a drug to block it and then proton pump inhibitors.

So, within each of these categories, I'm going to alphabetize them because it makes it easier to remember.

Although magnesium is above calcium on the periodic table, we're going to put calcium carbonate first. So, calcium carbonate is Tums, but I also want you to know that it's something called Children's Pepto. This is important because regular Pepto has a salicylate component that's a lot like aspirin and that can be very dangerous in children, especially if a child has some kind of chickenpox or fever and things like that and get Reye's syndrome, spelled r-e-y-e apostrophe "s". There's Magnesium hydroxide and that's Milk of Magnesia.

So, these antacids they work very quickly and because they work quickly what we're going to do for the way that we're going to remember them is these work in a couple minutes, maybe five minutes. These work in about 30 minutes, the H2 blockers, and then these work in about a day.

But antacids are probably the first thing you'll reach for because they work so quickly. Then if it persists you might go to an H2 blocker and we have two that we're going to use, famotidine and ranitidine. I'm not going to put the brand names yet because I want you to notice that there's a -tidine ending t-i-d-i-n-e. The first thing I want you to know is that the [een] ine is not the ending. A lot of the videos on YouTube show that as the ending just because 20% of all drugs end in -ine. So, you don't want to classify it by that.

The -tidine has been set by a couple of organizations, the World Health Organization the United States Adopted Names Council and they're the ones that make this into a group so that it's a -tidine makes it a cimetidine like H2 blocker and cimetidine was the first H2 blocker that came out.

So, let's put the brand names in there, Pepcid, which combines peptic and acid. Zantac, you can kind of see the word antagonist in there for acid, and then two proton pump inhibitors and we're going to see similar ending or that they're going to have similar endings and then I'm going to introduce something new as well there. So, esomeprazole there's (brand) Nexium (generic) omeprazole (brand) Prilosec. So, the -prazole ending is what lets us know it's a proton pump inhibitor, but you'll notice we have omeprazole and omeprazole. What's the es- what's this doing? If you look in and Wiki is a good place to look because it has good pictures of molecules, this omeprazole is actually an R- plus S-, Where this omeprazole is just an S- what does that mean?

There's a right-handed rectus and left-handed sinister omeprazole, so it's mixed. There's two sides to the molecule and only the S- does anything. So, Prilosec came first "protons low secretion" is how you remember the brand name and then esomeprazole or Nexium came next and you can remember that from Nexium, but just notice that these have the same root, but they still have this ending -prazole. Be careful some of those YouTube videos call it -azole and those are maybe people that haven't had organic chemistry, an -azole is just an organic chemistry compound, but -prazole is an actual stem by the United States Adopted Names Council.

So, let's look at our first six drugs in order. We start with antacids calcium carbonate and magnesium hydroxide alphabetized, although on the periodic table I know magnesium comes first, it's 12, calcium carbonate is 20. H2 blockers alphabetize them, famotidine Ranitidine. Notice the -tidine stem, the -tidine, and then the proton pump inhibitors esomeprazole omeprazole. Although omeprazole came first esomeprazole should be alphabetized before omeprazole, and this es- means that it's the S- isomer and that's supposed to work a little bit better.

Let's move on to the next group. So, after you have a stomachache sometimes you get diarrhea. So, let's look at some drugs for that. We're going to do again two anti diarrheals and then what we want to do is we want to do the opposite, so we'll do two laxatives and so the anti diarrheals we'll start with and again alphabetical order bismuth subsalicylate, Pepto-Bismol, and loperamide, that's Imodium. So, the -sal- is the stem s-a-l and the way to remember this is bismuth subsalicylate, it's this big pink bottle many people know about it, but just recognize that bismuth subsalicylate Pepto-Bismol is different than Pepto Children's. Loperamide you see low for slow and per for peristalsis, so slowing peristalsis or making Imodium looks a little like immobilized, so we're slowing things down if a patient has diarrhea.

Now again, we don't use those drugs if the patient has some kind of infection. We'll treat that with antibiotics, but let's go to the opposite, let's go to the laxatives on what we can use. Start with Docusate and you can see as docusate or docusate sodium, that's Colace and then we'll also see polyethylene glycol that's MiraLax. So, Polyethylene Glycol, sort of has a stem. The p the e and the g tells you that it's pegylated, but Docusate sodium I know I have an under laxative it's really a stool softener, but think of the word docusate and penetrate as rhyming and then polyethylene glycol, this is the miracle laxative is a way you can remember it, but also Colace allowing the colon to race now giving a laxative.

So, we've gone from the stomach now to the intestines and these have all been over-the-counter, so let me put that in front of these OTC OTC and what we want to do is we again want to have a logical order of the things. So, we're going to go from OTC to Rx and the Rx drugs, we'll look at are the antiemetics.

Antiemetics are those drugs that help with nausea and vomiting and a very important drug that came out, it's called ondansetron. Ondansetron is Zofran and it has the -setron stem, you'll see another couple of medications that have the -setron stem, and then we use promethazine, which is Phenergan. I'm also going to put something here next to the Zofran and ODT. Zofran comes as an orally disintegrating tablet because sometimes if somebody's vomiting even just taking a little bit of water would make them vomit again, so the orally disintegrating tablet allows it to just dissolve. The Phenergan comes as a rectal suppository, again because the patient is vomiting they would lose the medication if they took it as a pill. It's another form.

So, what we've done is we've gone from the stomach down to the intestines back up to the mouth, if you want to put it that way, and then we're going to go back to the intestines. There's two ways that I look at it You're already there if you're thinking of the rectal suppository promethazine and so the last one we're going to do is something for ulcerative colitis. This drug is infliximab and that's Remicade "Remission Aide". So, sometimes ulcerative colitis can go into remission, and that's how you remember it. This has one of the most complex stems. It's a monoclonal antibody, so m-a-b for monoclonal antibody. The -li- and -xi- both have meaning, and I go over into detail in the book, but just since we're just reviewing, but the -liximab is actually the stem and the monoclonal antibody doesn't tell you anything really about what it does it just tells you it's a monoclonal antibody. The -li- and the -xi- are much more useful because we're going to see in later chapters things like Xolair and Etanercept and other biologics that have these complicated stems.

But again, if you're going to try to memorize it you really want to memorize the GI drugs where they're working? So, we went to the intestines down to the rectum with this promethazine and then ulcerative colitis, we would give some kind of injection of Remicade, but that's the ulcers and the inflammation are there in the intestines.

Male speaker: Support for this episode comes from the audio book, Memorizing Pharmacology: A relaxed approach. With over 9,000 sales in the United States, United Kingdom, and Australia, it's the go to resource to ease the pharmacology challenge. Available on Audible, iTunes, and Amazon.com in print, eBook, and audio book.

And I'm going to go through them on the board from memory as we get to the later chapters

I might just do them ahead of time just to make the clips shorter

But these first two clips at least I'm going to do it from memory just to show you that

Hopefully after you've read the book you've got it to the point where

You're at the instructor's level as an instructor

with those 200 drugs I

See them all as seven pictures. [I] don't need two hundred note cards

I can just do it from memory, and that's where I want you to get to so we'll start with chapter one

gastrointestinal

And we'll talk about thirteen medications and while I talk about the thirteen medications also [talked] about grouping them and grouping them

When you're first learning these top 200 drugs when you group them

Students are good at grouping them as okay these are four analgesics and these are

Maybe for some kind of stomach upset and then these are for pain

But [this] is another level where we're connecting all 200 drugs in one

Order so let's start with two drugs that you're probably very familiar with two antacids

And then from the antacids we're going to go to the H2 blockers

and

These are better known as histamine

Two

Receptor

Antagonists

So there is a histamine [1] that's the end of histamine you think of when you think of Claritin and things like that

[the] Receptor just means that the drug is going to affect the receptor and an

Antagonist means it blocks it so histamine

[two] must release gastric acid if we're using a drug to block it and then proton pump inhibitors

So within each of these categories, I'm going to alphabetize them

Because it makes it easier [to] remember

Although magnesium is above calcium on the periodic table. We're going to put calcium carbonate first

So calcium carbonate is Tums

But I also want you to know that it's something called Children's

Pepto

This is important because regular Pepto has a salicylate component. That's a lot like aspirin and

that can be very dangerous in children, especially if a child has

Some kind of Chickenpox or fever and things like that and get Reye's syndrome

spelled Reye

apostrophe "s"

There's Magnesium hydroxide

And that's Milk of Magnesia

So these antacids they work very quickly

And because they work quickly what we're going to do for the way that we're going to remember them is

These work in a couple minutes. Maybe five minutes

These work in about 30 minutes the H2 blockers, and then these work in about a day

But antacids are probably the first thing you'll reach for because they work so quickly

then if it persists you might go to an H2 blocker and

We have two that we're going to use famotidine

ranitidine

I'm not going to put the brand names yet because I want [you] to notice that there's a -tidine ending

t-i-d-i-n-e

The first thing I want you to know is that the [een] ine is not the ending

a lot of the videos on YouTube show that as the ending just because

[20%] of all drugs end in -ine

So you don't want to classify it by that. The -tidine has been set by a couple of [organizations] the World Health Organization

the United States Adopted Names Council

and they're the ones that make this into a group so that it's a -tidine makes it a

cimetidine like H2 blocker and cimetidine was the H2 blocker that came out first and

So let's put the brand names in there Pepcid

Which combines peptic and acid

Zantac

You can kind of see the word antagonist in there for acid okay, and then to proton pump inhibitors

And we're going to see similar ending or that they're going to have similar endings

And then I'm going to introduce something new as well there so esomeprazole

There's (brand) Nexium (generic) omeprazole

(brand) Prilosec, okay

so the

-prazole ending is what lets us know it's a proton pump inhibitor, but you'll notice we have omeprazole and omeprazole

What's the es- what's this doing if you look in and

Wiki is a good place to look because it has good pictures of molecules this omeprazole is actually an R- plus S-

Where this omeprazole is just an S- what does that mean? There's a left-handed

Right or there's a right-handed rectus and left-handed sinister omeprazole, so it's a mixed

there's two sides to the molecule and

only the S- does anything so Prilosec came first

"protons low secretion" is how you remember the brand name and

Then esomeprazole or Nexium came next and you can remember that from Nexium

But just notice that these have the same root, okay?

but they still have this ending -prazole Be careful some of those YouTube videos call it -azole and

Those are maybe people that haven't had organic chemistry an -azole is just an organic chemistry compound

But -prazole is an actual stem by the

United States Adopted Names Council, so let's look at our first six drugs in order we start with antacids

Calcium carbonate and Magnesium hydroxide alphabetized although on the periodic table. I know magnesium comes first

It's 12 calcium carbonate is 20

H2 Blockers alphabetize them famotidine

Ranitidine notice the -tidine stem the -tidine and then the proton pump inhibitors

esomeprazole omeprazole

Although omeprazole came first

esomeprazole should be alphabetized before omeprazole, and this es- means that it's the S- isomer and

That's supposed to work a little bit better

[alright], let's move on to the next group. So after you have a stomachache sometimes you get diarrhea

So let's look at some drugs for that

Okay, so the we're going to do again two anti diarrheals

And then what we want to do is we want to do the opposite so we'll do

two laxatives and

[so] the anti diarrheal we'll start with and again alphabetical order bismuth

subsalicylate

That's [p]

Pepto-bismol, okay and loperamide

That's Imodium

okay, so the -sal- is the stem s-a-l and

The way to remember this is bismuth subsalicylate. It's this big pink bottle many people know about it, but just recognize that bismuth subsalicylate

Pepto-bismol is different than Pepto Children's

Loperamide you see low

for slow and per for peristalsis

so slowing peristalsis or

Making Imodium looks a little like immobilized, so we're slowing things down

If a patient has diarrhea now again, we don't use those drugs if the patient has some kind of infection

We'll treat that with antibiotics, but let's go to the opposite. Let's go to the laxatives on what we can use

start with Docusate

And you can see [as] docusate or docusate sodium

That's Colace and then we'll also see polyethylene glycol

That's MiraLax. Okay, so

Polyethylene Glycol, sort of has a stem. The p the e and the g tells you that it's pegylated

but

Docusate sodium I know I have an under laxative

It's really a stool softener, but think of the word docusate and penetrate as rhyming and then polyethylene glycol

[this] is the miracle laxative is a way you can remember it, [but] also

Colace

Allowing the colon to race now giving a laxative

so we've gone from the stomach now to the intestines and

These have all been over-the-counter, so let me put that in front of these

OTC

OTC and

What we want to do is we again want to have a logical order of the things so we're going to go from

OTC to Rx and

The Rx drugs, we'll look at are the antiemetics

Antiemetics are those drugs that help with nausea and vomiting and a very important drug that came out. It's called ondansetron

Ondansetron is Zofran and

It has the -setron

stem you'll see another couple of medications [that] have the -setron stem and then

We use promethazine

Which is Phenergan

I'm also going to put something here next to the Zofran and ODT

Zofran comes as an orally disintegrating tablet because

Sometimes if somebody's vomiting even just taking a little bit of water would make them vomit again

So the orally disintegrating tablet allows it to just dissolve

The Phenergan comes as a rectal suppository again

Because the patient is vomiting they would lose the medication if they took it as a pill. It's another form

Okay, [so] [what] we've done is we've gone from the stomach down to the intestines back up to the mouth if you want to put

It that way and then we're going to go back to the intestines. There's two ways that I look at it

You're already there if you're thinking of the rectal suppository promethazine and so the last one we're [going] to do is something for ulcerative colitis

And this drug is infliximab

and

That's Remicade

"Remission Aide" so sometimes ulcerative colitis can go into remission, and that's how you remember it This says one of the most complex stems

It's a monoclonal antibody so m-a-b

for monoclonal antibody the -li- and -xi- both have meaning and I go over into detail in the book

But just since we're just reviewing but the -liximab is actually the stem

And the monoclonal antibody doesn't tell you anything really about what it does it just tells you it's a monoclonal antibody

The -li- and the -xi- are much more [useful] because we're going to see in later chapters

things like Xolair and

Etanercept and other biologics that have these complicated stems

But again if you're going to try to memorize it you really want to memorize the GI drugs where they're working [ok]?

So we went to the intestines

Down to the rectum with this promethazine and [then] ulcerative colitis

we would give some kind of injection of Remicade, but that's

The ulcers and the inflammation are there in the intestines