Okay let's go over chapter five neuro of our review so let's start with local
anesthetics and these are OTC and what a local anesthetic is it's just something
that's going to numb a certain area. Anesthetics, when injected, will make a
person pass out but what I want to talk about is the ester vs the amide so
benzocaine is an ester it's a type of organic chemistry molecule and that
tells you that the esters we don't really want to inject because they can
become allergenic where a patient might have an allergic reaction
lidocaine has less of that allergenicity but they're both related by this -caine
stem c-a-i-n-e and that might look like cocaine and that's right because cocaine
was one of the original anesthetics and they found or developed some anesthetics
that weren't addicting but if you look at Anbesol you see two of the letters
from the word numb so that's one way to remember that one and then Solarcaine
Solarcaine takes the -caine ending that's still frowned upon by the World Health
Organization but solar meaning sun so we're using something to take care of
the pain from a sunburn but lidocaine has many uses, an injectable in an
emergency, patch, some other different things that it can be used for. OTC anti-
vertigo so meclizine if you put this, if I were to do meclizine in small letters
like this, m-e-c-l-i-z-i-n-e you could kind of put this C in this L
together to make a D and then you see dizzy so it's for dizziness but the
brand name's Dramamine that you might know but there was also a brand name
that was a prescription item, Antivert for anti vertigo but that one told the
whole story, anti-vertigo. Another OTC under neuro would be a sedative
hypnotic and we see diphenhydramine you might say well I remember that one but
that was an antihistamine you told me and that's what's kind of infuriating
about pharmacology is that things can be, for prescription drugs can be for many
different things and all this is OTC but diphenhydramine as an adverse effect
made someone drowsy but here we're using that side-effect as a good thing so
tylenol acetaminophen diphenhydramine the antihistamine that
makes you tired Tylenol PM and that PM means post-meridian after literally
afternoon but we just use it at night time so Tylenol PM is something used at
night time sometimes sleep is disturbed because of pain and that's what the
acetaminophen is there for. Benzodiazepine-like sedative hypnotics
now we're going to the prescription items and benzodiazepine-like means
it's not a benzodiazepine but it works a little like one so eszopiclone with the
-clone stem and we see this es- again so the S isomer and you can think of Luna
or rest in Lunesta and then zolpidem -pidem is the stem, p-i-d-e-m
and this is Ambien or Ambien CR, Ambien controlled release so Ambien works to
help somebody fall asleep but if the person has trouble staying asleep the
controlled release, much longer acting version works well. Melatonin receptor
agonist so ramelteon the -melteon is the stem and it looks like melatonin for
a reason because it is a melatonin receptor agonist and you can think of
Rozerem, roz- rhymes with doze, REM for rapid eye movement sleep, so a lot of
hints in these brand names certainly worth remembering. So those are some
OTC neuro drugs something to help you sleep. In the next column we're going to
go into antidepressants and how those can help us. The first thing that throws
students off is the classifications as SSRI, SNRI, TCA, MAOI and each one has
its own acronym so an SSRI is a selective serotonin
reuptake (I didn't think about space there) inhibitor okay and that means that
serotonin is going to normally be re-uptaken or if you want to think of it as
recycling that's maybe a better way but instead what happens is we inhibit that
recycling it stays in the synapse and it's supposed to make the patient
happier. It's that hypothesis of norepinephrine
and serotonin not having enough of it so there's five of them I'm going to
go over citalopram and escitalopram we see two drugs with the same root just
like we saw esomeprazole and omeprazole. Celexa was the first one that came out
it reminds me of relaxed these SSRIs can also be used for anxiety
and then Lexapro you can think of a professional upgrade from the first one
so it takes part the ending of Celexa and then just adds -pro to make Lexapro
but those are related in the escitalopram is supposed to be better than the
citalopram. The -traline stem for Zoloft so it lofts your mood and then the
-oxetine. So -oxetine is a little bit tricky the adopted names council calls -oxetine
a fluoxetine-like entity but fluoxetine and paroxetine are SSRIs then we're
going to see that duloxetine is an SNRI and later we're going to find a non
stimulant ADHD medication atomoxetine so this -oxetine ending you really have to
be careful. Fluoxetine is interesting it's got two brand names
Prozac was the first brand name that came out it was
antidepressant sounds like a strong drug with the P, Z and the C or with a K sound
and then Sarafem I'm not sure what they were going for a seraphim it's like the
highest angel so maybe it was the work of angels but that's for something
called premenstrual dysphoric disorder, PMDD. Paroxetine, Paxil and then
Paxil controlled release so again another medication that works a little
bit longer. Then we have the serotonin norepinephrine reuptake inhibitor and
I'll try to do a little better job with my writing here serotonin norepinephrine,
and I'll abbreviate it NE, reuptake
inhibitor and so we're just affecting different neurotransmitters where
selective serotonin reuptake inhibitor was just serotonin now we're talking
about serotonin and norepinephrine again the -oxetine be careful with that
it's supposed to indicate a SSRI Cymbalta so my mnemonic was to remember
that symbol players all would always seem to be happy and alta means above in
Spanish so higher mood maybe. Then the -faxine is the stem here in
venlafaxine and for Effexor so that's a way to remember that one. So the TCA so
this SNRI and SSRI are are both named after neurotransmitters but
amitriptyline is named after or the tricyclic antidepressant is named after the
three rings so you can see that -t-r-i- in the stem -tripyline and Elavil elevates
your mood. Isocarboxazid I didn't have a stem that I saw but I had a
student that said I sew car boxes and it just seemed very sad so it's a monoamine
oxidase inhibitor so mono, m-o-n-o, a-m-i-n-e and oxidase inhibitor and
what that monoamine really means is that we're still kind of going back to
serotonin which is a monoamine and that we're affecting it we're just calling it
by a different name. Smoking cessation so bupropion was first
an antidepressant it was Wellbutrin so ideally you would get well or get out
of the rut you're in so you see the r-u-t and then -i-n in there but then they
found that a lot of these antidepressants stop smoking so though
this is great let's make it an anti smoking drug so they renamed it Zyban or
repackaged it that way. Varenicline it's chantix so the new
-nicline stem indicates a smoking cessation medication and and I had a student that
said in a southern accent oh when I take varenicline on their inclined to quit so
or with Chantix, my chant is that I don't need my fix so anyway it just
stuck in my head. So these are antidepressants all the way down to
bupropion which can also be used for smoking cessation then varenicline is
specifically a smoking cessation medication. Next we're going to go on to
some anti-anxiety and ADHD medications and antipsychotics as well.
So the first thing with the benzodiazepines is that on a lot of YouTube channels you'll see
-lam and -pam are stems and that's just incorrect you want to be careful because
there's a drug lamotrigine which is an anti epileptic and there's verapamil
which is a calcium channel blocker and that's for high blood pressure those are
not benzodiazepines so use the whole stem -azolam or -azepam. Xanax has part
of the word anxiety and it's so easy enough to remember. Versed, I can't
remember the verse you just said. Klonopin and clonazepam are very similar
and then Ativan I don't even remember what I use for that one so but really
stick with the generic stems that's what you want to use for the benzodiazepines.
Dexmethylphenidate, methylphenidate I couldn't really find a stem for them
but you can see what the brand names what they're for so these are stimulant
schedule twos for ADHD they can help you focus, Focalin, or they can help you
concentrate and they just kind of turn the last couple letters around there.
Non-stimulant ADHD medication atomoxetine again we see this -oxetine
stem this does not mean it's an SSRI you have to memorize that it's a non-
stimulant ADHD medication, Strattera can straighten out your attention. Bipolar is
a simple salt so lithium and Lithobid so BID, bis in die, is the Latin for twice
daily so lithium is taken twice daily in this particular dose. First generation
antipsychotics there's also a term called so these would be the typical, t-y-p-i-c-a-l
antipsychotics and then when we get to second generations those are atypical
but we don't usually use antipsychotic as a term because to say someone is
psychotic is just not a nice way of saying it so usually we say anti
schizophrenic. So chlorpromazine was the first one that came out its Thorazine
and this is low potency that's important because the low potency drugs tend to
cause sedation and low potency just means that you need a hundred milligrams
to get the same thing out of chlorpromazine as two milligrams of
haloperidol which is high potency can do. So the haloperidol has the -paridol stem
and a lot of students think of the halo to remind them or the halo in
haloperidol to remind them that this is high potency first-generation
antipsychotic but you can also replace first-generation with typical anti
schizophrenic. So that's first generation some of the drugs for anxiety ADHD
bipolar and psychosis let's look at the second generation antipsychotics and the
anti-epileptics. So the second generation antipsychotics
the -peridone in risperidone and the
haloperidol and Haldol are very similar somebody said that the 'risper' sounds
like whispers so like you're hearing the whispering voices. Quetiapine if you
change this T and I and then put the I over one and kind of turn it around you
end up with quiet so quiet the voices but the stem is -tiapine
and that's Seroquel to quell something is to calm something down so
risperidone quetiapine are both second-generation antipsychotics we
would also call these atypical. Why is that important?
atypical antipsychotics have less extrapyramidal symptoms but would have
more dyslipidemia, more dyslipedema, diabetes, weight gain, things like that in
general again you don't want to generalize too much there's certainly a variation
within the class. Anti-epileptics we break them down into traditional versus
newer so we've got carbamazepine (I missed a B there)
carbamazepine and the -pine just means that we have some kind of, I think it's a
tricyclic molecule, but the way to maybe remember it is that you carb or curb the
convulsions or you control them so you see the T the R the O and the L that
could be from the word control that's one way to look at it.
Divalproex is Depakote 2nd traditional one and then phenytoin has the -toin, t-o-i-n
stem and this is Dilantin and you would want to remember it from the -toin
stem. The newer ones now I only just happen to pick two drugs that happen to
have gab in them, gab is a stem it's for the gamma-aminobutyric acid and
gabapentin is Neurontin and you can think of the n-e-u which is pronounced
new as the newer anti epileptic and then Lyrica also is a newer one.
Lyrica if something's lyric it's musical so we're taking this very disordered
epilepsy and making it more ordered so that's one way to think of it.
Parkinson's disease so dopamine or lack thereof is a real problem
so levodopa goes, you can't put dopamine in the brain directly the blood-brain
barrier will block it but levodopa can as a precursor get into the brain and
then be converted to dopamine but we lose so much as we get there so
carbidopa is really there as a protectant to protect levodopa, allow
more of it to enter the brain. the -giline stem selegiline that's an MAO-B it's
Eldepryl and so you can see the word elderly in there that Parkinson's
affects many elderly people but certainly it affects younger people as
well, that's highlighted in a couple movies and then the actor Michael J Fox
certainly so that's Parkinson's and then let's look at just our last two here
Alzheimer's and motion sickness.
Alzheimer's donepezil so the way that I remembered it was my memory is done I
can't remember zilch and just put z-i-l-c-h or you can think of perception and
Aricept and maybe you lose some degree of perception. Memantine, the m-e-m from
memory tends to ring a bell but then Namenda has the NMDA and that's what
kind of receptor it affects. The last medication is for motion sickness so
scopolamine is Transderm-Scop so across - trans, derm - skin, scope and then
taking the first four letters of scopolamine. This is usually used for cruise
ships and things like that, a person puts on a patch and they don't have to keep
taking Dramamine or something like that. That's neuro in a nutshell.