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