(CC/JPG) Drawing Pharmacology Video 3 Chapter 3 Respiratory Pharmacology / NAPLEX NCLEX Review

By Adem Lewis / in , , , , , , , , /

Welcome we’re gonna do drawing pharmacology again. These are not final videos. We’re just kind of working through some of the things that we’ll need. Trying to use generation synthesis, the higher end of bloom’s taxonomy, as we think through these, try to remember them. For respiratory, before we get into any of the medications, the medications we’ll go through are going to be the Antihistamines Allergic Rhinitis Decongestants And then we’ll talk a little bit about cough steroids and inflammation bronchoconstriction Asthma/COPD We’ll talk about, and I’ll explain all these drawings later, that we can treat bronchoconstriction alone or inflammation alone and then we’ll have some more drugs a little bit later. Okay, so the first thing we want to do A while back my students came up with the antihistamines snowman. I don’t know where they came up with that thought but, noticing that there’s one carrot for the nose and then two buttons to remember that H1 antihistamine, or a histamine 1, is like loratadine, which is brand Claritin, and it only has one i. Letter i. So -tadine Versus H2 which is an H2 blocker for GI acid reduction that is -tidine or 2 i’s So we want to be very careful to make sure that we’re not confusing H1 versus H2. Histamine 1 versus a histamine 2 antagonists Then every once in a while a student will confuse h1/h2 with the first and second generation. You could call this third-generation in here a little bit. We’re not going to call anything third generation. It gets a little bit confusing, but we’ll start with the first generation. So the first generation crosses the blood-brain barrier into the brain and that’s what causes that sedation. So something like diphenhydramine, which is Benadryl, causes this drowsiness. Although in children sometimes it’ll cause the opposite effect. Then another example is hydroxyzine. Usually we see hydroxyzine for itching or something like that. and that’s Atarax. I for whatever reason, I always think of racks and rash to remember that hydroxyzine is for some kind of rash or some kind of itching The second generations, I put them in alphabetical order. There is cetirizine, which matches up to levocetirizine or levocetirizine That’s Zyrtec and Xyzal. and then there’s desloratadine and loratadine which is Clarinex versus Claritin. I don’t think desloratadine took off as much as levocertirizine and it might be because of the Xyzol owl I don’t know if you see the commercials and then fexofenadine is Allegra. So let’s go through them I just put them in alphabetically. Ceterizine with a C. so Zyrtec Desloratadine, this is Claritin except they took out the -ti and put an -ex So an excellent Claritin, or was it supposed to be the next generation of Claritin, maybe? but it I don’t know if it really took off. Fexofenadine, this is an important one that we use for children for over-the-counter allergies Things like that And then you can see the word “allergy” is sort of in there in Allegra. and Allegra is also something that you like Might be a Disney princess. I don’t know. Loratadine This is the one that I really feel like came first as a first generation which is Claritin. You hear the commercials Claritin clear? And then on the box you see a bright blue sky and then the grass and everything’s green. and then levocetirizine They’ve got the Xyzal owl And for whatever reason that seems to be a good image But the big difference between 2nd and 1st generation drowsiness versus non-drowsy We don’t want truck drivers with allergies to fall asleep at the wheel Allergic Rhinitis will divide into acute versus prophylaxis, so if we have some kind of congestion This is really decongestants Oxymetazoline, which is Afrin, you’re not supposed to use it for more than 3 days because you’ll get this rebound congestion You may need to use a steroid if you do have that effect. Phenylephrine is the PE in many the over-the-counter medications and this comes also as NeoSynephrine Then pseudoephedrine Is brand Sudafed You have to go behind the counter You’ll also see this as the -D for decongestant on something like Claritin-D For prophylaxis, there is really no better drug than an intranasal Glucocorticoid or a steroid. and I put in green where it’s not really technically a stem, but it’s something that you might see. So budeSONide fluticaSONE, momentaSONE, triamcinolONE You see of those a lot with the steroids but rhine- for nose. -court for corticosteroid Flo- for you’re going to now be able to, the air is going to be able to flow in the nose, -nase. NasoNEX, so the next so the next generation of nasal or something for the nose. and then Nasacort, nasal corticosteroid allergy 24-hour It’s pretty explicit what it’s going to do. So the division you really want to make is the decongestant which will clear up the nose right away versus prophylaxis, long-term. It might take a couple of weeks for those to work Then we get into cough, and I just think of kind of that break at the bronchi. and that making kind of an upside down “C” so “C” for Cough The first thing that you might take is guaifenesin with dextromethorphan, over-the-counter or Robitussin DM. Could also be Mucinex DM. That’s another brand name. Guaifenesin with codeine is Cheratussin AC There are a number of different names for this. This comes after the cherry flavoring. Hydrocodone with chlorpheniramine is combining a first-generation antihistamine that makes someone drowsy with hydrocodone which will also make someone drowsy. Then they take the Tuss- because it’s an antitussive And then I guess it’s the next generation, but this is when we really have some kind of severe cough that the Codeine didn’t help or the over-the-counter medication didn’t help. Benzonatate, I was a dungeons-and-dragons-kid so those little pearls are little yellow pearls, and they’re actually tough to get on the counting tray, but you spell it PERLES and the Tessalon Perles are are something that actually kind of numbs the throat to help prevent the cough. so those 4 are cough And then we go into This is my steroid fire if you want to think of a campfire And then we’ll get to our bronchoconstrictor, Boa Constrictor and those are the 2 components of asthma. Now we use steroids for all kinds of things, but this is just a way to remember it. Dexamethasone brand Decadron I just put these in alphabetical order dexamethasone Methylprednisolone Prednisolone and then prednisone So the methylprednisolone you might find in a ready-made pack When I got poison Ivy I would get a Medrol dose pack Prednisolone we usually see for children Orapred is a liquid and then prednisone you can find as a tablet So a number of different ways that we use these, but really getting the -sone or the pred- is really your clue to remind you this is a steroid Then we have the inhalation, and I want to separate Inhalation by itself so you can have budesonide which is Pulmicort flexhaler or you can have fluticasone which is Flovent Now a lot of test prep books tell you you only have to know the generic But that’s problematic because there’s fluticasone which is Flovent, which is an inhaler versus fluticasone, which is a nasal steroid, Flonase and then it gets even more complicated where we can have fluticasone propionate which lasts 12 hours as part of something that has a steroid and a beta-2 agonist which is a bronchodilator So this sameterol, which is in Advair or if you have furoate which is with vilanterol, the ultra long-acting Beta 2 agonist in Breo Ellipta So the way to keep these straight is to think where is it going to happen? So we had the nasal one with the nose over there We have the inhalation alone here, so this is just for inflammation, so this is fire alone Inflammation alone whether it’s one of these oral forms or one of these inhaled forms then we can combine This inflammation with a bronchodilator the Bronco constricting Boa constrictor Budesonide and formoterol which is Symbicort, and symbiosis is when two things come together work together Or you can add things together to get air which is Advair, or Breo Ellipta, I’m not sure what that is and how it how it works with the name But this is the ultra long-acting, vilanterol And it’s nice that it goes alphabetically from these kind of every 12 hour/BID drugs to this every 24 hour, very, very long acting. You can think of “V” for Very long acting You can also get these Bronchodilators alone Albuterol which is Proair HFA HFA is hydrofluoroalkane and if you’ve been around a while you may remember that CFCs, or Chlorofluorocarbons which wear a refrigerant would actually have a cold sensation So it’s important that the patient know that that cold sensation isn’t there if they were used to it before Then levalbuterol is supposed to be a better form of albuterol and you see the word “open”, to help open the airways, but then remember that we need to do these one minute apart Now you can also “Climb the Tropical tree” is the way that I remember these and we’ve got albuterol, which is our bronchodilator for the bronchoconstriction, the Boa constrictor And then we have ipratropium and this -tropium, we don’t really need to get into it too much, This is an anticholinergic So if you remember atropine that’s a tertiary This is going to be a quaternary just like you have ammonia versus ammonium so if you think of the ammonium as the quaternary form This ipratropium is short acting and goes in DuoNeb that ends should be capitalized but albuterol plus ipratropium So my kids when they came out of NICU were on DuoNeb Two different ways bronchodilating working against the muscarinic system to open up the airways But the -cli- is from something like aclidinium which is Tudorza This is actually, I think, long-acting versus ipratropium which is short acting and this is Atrovent which can come as an inhaler There’s also something called tiotropium, and that is actually long-acting, Spiriva So we can have this bronchodilator with the tropical tree or we can have the bronchodilator alone Short acting/Long acting. You kind of have to remember We have a place in Ankeny called Z’Mariks So I thought of z’more respiratory drugs because these don’t really fit in neatly anywhere The leukotriene antagonists like zafirlukast and montelukast Normally I put them in alphabetical order, but just to put the z in there So the z for zafirlukast is Accolate this one you need to use BID Then montelukast came along. You can think of mon- for Mono or Singulair for single dose that you only have to give once a day then omalizumab is for severe allergies, by injection. There’s black box warning that you may need epinephrine later with it You need it certainly handy if you’re initially giving it, but you can see the -AIR in here and then also the stems, the -LI-, the -ZU- and -MAB- for monoclonal antibody. They all have meaning Then we just use the “R” to remind us this is respiratory, and more respiratory drugs, and then epinephrine of course for anaphylaxis So again, this is a just kind of a sketch mock-up of respiratory that we’re kind of working on to get these drawings down

2 thoughts on “(CC/JPG) Drawing Pharmacology Video 3 Chapter 3 Respiratory Pharmacology / NAPLEX NCLEX Review

  1. Tony, why is the video quality so bad for a few of these videos? Also, when you have a chance, could you please link the whiteboard JPG again as the link is down. Thanks in advance!

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