This is Chapter three respiratory or respiratory and I'm going to do the same
thing just for efficiency sake I've already written everything up on the
board so that I'm just going to highlight stems. I'm going to highlight
drug classes drug classifications and in the order in which I put them the first
section we're going talk about are antihistamines and you're dividing it to
histamines in first and second generation there's controversy over
whether there's a third generation drugs like fexofenadine which is Allegra is
one that might be in the third generation a third generation drug would
be something that's maybe a metabolite or one of the isomers of the racemic
mixture so I'm not going to go into a third generation, first and second is
enough for just our purposes right now so antihistamines H-1 first generation is
diphenhydramine and again we have this non-alphabetical order so I put an ABC
with a slash and then ABC with an arrow here to explain why so we begin with
first-generation diphenhydramine. Diphenhydramine is in that generation
that was first invented and these made people very drowsy you can see B E and D
in benadryl so you can think of bed and you can also see the D R Y because it's
drying helps with allergy symptoms okay but diphenhydramine that's first
generation that goes through the blood-brain barrier makes them on drowsy
second generation on the other cetirizine and loratadine so [brands] Zyrtec
and Claritin these don't cause the drowsiness because they can't get
through the blood-brain barrier or they can't stay through the blood-brain
barrier and loratadine has a stem it's -atadine and I know spelling has
been de-emphasized since I was a kid so I'm a gen X-er I was clapping erasers and
had chalkboards and things like that but in drug name spelling is incredibly
important because you pronounce loratadine the same as you pronounce
famotidine and the ta-da ine and the actual stem is
-atadine sounds just like the -tidine in the H-2 blockers but if you spell it
-tidine by accident you've just made this drug instead of for allergies for
acid and we don't want to do that so paying attention to spelling is very
important with these medications. So cetirizine, [brand] Zyrtec this -tir- in cetirizine
is pronounced "tear" so you can think of tearing from allergy eyes. Loratadine
has the -atadine stem and the Claritin Clear commercials have been very clear
about what it's for you see people outside having fun on the
picnic you even look at the box it's blue sky so Claritin Clear for allergies
but what I want to talk about also is this loratadine-D so what is that D? Well
D is for decongestant and that decongestant is pseudoephedrine so
pseudoephedrine is brand name Sudafed and you'll see it as loratadine-D or
Claritin-D and what's the rationale for that well if you have allergies and
nasal congestion if you just use loratadine or claritin it's not going to
help but if use loratadine with a
decongestant then it will take care of the allergy symptoms and the
congestion. This decongestant pseudoephedrine where Sudafed is
actually BTC it's behind the counter you have to show ID for it this -rin
or -drin I think is the is the stem and
because it's behind the counter there's a certain amount that any person can get
in a single day certain amount you can get in a month because the
pseudoephedrine can be used to make methamphetamine or meth but one of my
students said I'm so fed up with being congested and that's how you remember
pseudoephedrine or sudafed so what we're doing to remember these is we start
over-the-counter with these antihistamines in this decongestant and
what we're going to do is we're going to go into the nose so we're physically
thinking okay we're in the nose now and phenylephrine is the PE in many oral
liquids and it's very similar to pseudoephedrine
except this one is not regulated you can get as much of it as you want the brand
name for the nose one is Neo-Synephrine and then another one which can be used
in the nose another decongestant is oxymetazoline which is Afrin and this
nasal spray you should really only use for three days otherwise you might get
some kind of rebound congestion so we're staying in the nose and that's how we're
just like in the in the GI chapter we went from stomach down to intestines
we're staying in the nose and then we'll go down to the chest so we have
triamcinolone and this -lone some people use as a way to remember
that it's a steroid, it's not a proper stem. The brand name, the '-cort' stands for
cortical steroid and nasa- for nose again it's not a stem you can't have a stem
in a brand name but these are hints that let you know what it's for but
allergic rhinitis you have an -itis that means you have an inflammation so
informations we can use some kind of steroid so for the first group here
we're starting with anti-histamines then we go to the decongestant then allergic
rhinitis and we're being very mindful of where we are in the body. So we're
going to go from the nose to then cough which is going to be in the chest so
just as we've done before we're going to go from an OTC to a prescription and
this is where we make our jump. Everything before just now is
over-the-counter behind the counter. So guaifenesin is a mucolytic and some
people get that confused because they've seen robitussin for coughs so long but
the guaifenesin is actually just m-u-c-o-l-y-t-i-c a mucolytic is something that
breaks up mucus or breaks up chest congestion the stem is in
dextromethorphan but you may never see that word you might just see the DM
okay so guaifenasin with dextromethorphan is Robitussin DM
there's also Mucinex DM either one of those
but the -orphan stem is the one that tells you it's dextromethorphan if the
cough doesn't subsist and maybe you go to the prescriber and say you know I've had
this cough for a week and it's just not going away it's not productive
they might prescribe something like codeine now in the United States codeine
you can't just get it over the counter you used to be able to get a little bit
but now it's regulated and that Cheratussin the 'cher' is for cherry and then
AC some people just use anti cough but I think and codeine was probably what it
stood for okay and then -tussin an antitussive is something that's for
cough. So if that cough doesn't go away and you still have that chest
congestion if the prescriber is being very aggressive maybe they'll treat the
inflammation in the chest and they'll do that with a steroid with either
methylprednisolone or prednisone and again we're staying with our
alphabetical within the class of steroids and methylprednisolone this is
an infix so in English we can have something that's a prefix before we can
have a suffix which is at the end or we can have an infix and in fixes are
extremely rare in English but they're not rare when it comes to medications
so the -pred- not the -lone is what tells you it's a prednisone type steroid but
some people still use that -lone or -sone as their cue but really the stem is that
-pred- so maybe we go from the chest and we stay in the chest and stay
in the lungs and in the lungs we're going to talk about these asthmatic
medications and so we have budesonide and we pronounce this -son- not as sun
but as sone and I'm not going to underline it because it's not a proper
stem but some people still use it to recognize this is the steroid part and I
put fluticasone this -sone underneath it because these two drugs are doing the
same thing they're long-acting steroids that are going to be inhaled so we have
the steroid part of it for asthma and then we also have what's, I put beta-2 here
a beta-2 agonist is a bronchodilator it's going to open up your lungs and the stem
for that is -terol. t-e-r-o-l. t-e-r-o-l. You're probably most familiar with albuterol
but in these long-acting versions formoterol and budesonide come together
to make symbicort so they're symbiotic together working together with a
corticosteroid and then fluticasone is working together with salmeterol
to give you air or you're adding them together spelling add ad instead of a DD
to get air fluticasone can you can find it alone and what I did was where these
are combination medicines I just staggered this I put a hanging indent
where the fluticasone is on this side under the steroids and albuterol is on
this side just to show you that I'm just separating this out where these are
long-acting these are sure this is long-acting but this is a little bit
more short acting so if fluticasone comes as Flonase for the nose but also
it's Flovent if you're going to use it orally and then this albuterol is that
rescue inhaler that most people are familiar with what I did here was I put
prophylaxis before acute so our healthcare system is really treat once
you've something's happened but ideally you don't get asthma attacks because you
take these long-acting medications but sometimes you might have a breakthrough
asthma attack and you would want that rescue inhaler the beta-2 agonist
albuterol so I kept with that alignment so albuterol the -terol is under here and
another combination product but here we have -tropium and -tropium is an
anticholinergic the -chol c-h-o-l is about acetylcholine and acetylcholine is
a neurotransmitter we're talking about ipratropium does a really good job with
asthma as well and this comes in the medication DuoNeb literally two, a duo
that can be nebulized and so albuterol works
as a bronchodilator ipratropium as well and they work in concert together tiotropium
also has this -tropium stem to let you know there's an anticholinergic but this
one is a little bit more long-acting than this short acting one and
tiotropium is a long-acting anticholinergic and this brand name is
Spiriva and if you think of the word respire or respiration you see the s-p-i-r
and there but it's the -tropium stems that lets you know this is an
anticholinergic medication so again now we've gone from then just using some of
the cognitive tools to go from over-the-counter to Rx we're going from
a cough which is in the chest to the lungs which is in the chest and asthma
and then we're going to go on from these medications to three other medications
that can be used in asthma incidents and things like that
the leukotriene inhibitor montelukast the stem -lukast seems an awful lot like
leukotriene it's given once a day and that's where that single comes from in
Singular and then if you're asthmatic and it's helping your condition then the
air a-i-r is what helps. Anti IgE antibody so again one of these biologics
omalizumab so the -mab tells you it's a monoclonal antibody and then -li- and -zu-
also have meaning I won't go into it here but it's in the book and it's
important to understand what the biologics we're going to have these
complex stems telling us where it's from and that's Xolair and that to me that
just sounds like extra air so again a way to remember that it's for it asthma
but this is an injectable the one thing with omalizumab is that it can cause
anaphylaxis so you always have to have somebody around when it's being injected
an epinephrine or an EpiPen is what you would use okay so epi means above neph
means kidney so above the kidney what's above the kidney the adrenal gland
so epinephrine is an injectable that does something very similar to the
adrenal gland which is secrete epinephrine there's another word it's also
called that's very similar and I'll just put it here it's called adrenaline and
this is the Latin version so ad- means above or to towards and then -renal- means
kidney and then so this is the Roman or the Latin and then this is the
epinephrine is the Greek but that's the respiratory medications in a nutshell