This is chapter two, we will do musculoskeletal system and the first
thing that we're going to talk about are the first group of drugs and all of this
that I'm going to put up there is all in my head so I'm just going to do this
from memory but you might learn it piece by piece. I'm going to show you the
pieces and how they group together and then within those groups we'll have three
larger groups so that you can learn this column then hopefully next column the
next column. So the first column I'm going to talk about are the OTC NSAIDS
The non-steroidal anti-inflammatory drugs There are three of those. Start
with aspirin, ibuprofen which has two brand names, Advil and Motrin and then naproxen
So the first thing we want to do is make sure that we check for any stems
and a stem is something that indicates what drug class it's in. -profen is a
non-steroidal anti-inflammatory stem. -proxen isn't. It looks very similar though so if
you're trying to memorize it that's one good way to do it. So we go from the OTC
NSAIDs aspirin ibuprofen naproxen to what would be a non narcotic analgesic
also over-the-counter
and the one that you're probably most familiar with is
acetaminophen Tylenol. There's no stem here but what you can see just like with
the aspirin, aspirin is actually acetylsalicylic acid which is abbreviated ASA
We also have an abbreviation that actually comes from acetaminophen which
is from N-acetyl-para-aminophenol which is APAP and we'll use that in just a
minute. So then we've got those and these take
care of most things that most analgesia most pains over-the-counter but maybe
it's some kind of a migraine or something like that so we're going to
combine them and we'll combine the OTC NSAID plus non-narcotic in a
medication called Excedrin Migraine that includes aspirin ASA, Tylenol APAP, and
also caffeine and the caffeine is a vasoconstrictor it helps narrow the
blood vessels in the brain so that there's less pain
So we started with the OTCs and the natural movement or progression is from
OTC to Rx so let's go to the Rx NSAID and the first one we'll look at is
meloxicam and this also has a stem -icam okay and that's mobic and then we
also have another Rx NSAID that's a COX-2 inhibitor. That one's going to
be Celebrex or celecoxib
And that's Celebrex. So the first kind of panel,
first group of drugs that we want to look at are these seven and we see that
we have nonsteroidals and non-narcotic we're going to combine the two to help
memorize these two groups then we're going to have prescription NSAID that
works just like ibuprofen and naproxen, meloxicam
And then we have this COX-2 inhibitor which is supposed to protect the stomach
Okay so again in order, aspirin ibuprofen naproxen acetaminophen aspirin
acetaminophen caffeine meloxicam and celecoxib. So that's the first group
and that's how we would do that within the groups though make sure that you
want to try to alphabetize it so A comes before I before N and I'll show you
where I'll break that rule a little bit here. Okay so the next group we're
going to look at are the opioids and narcotic antagonist
And we'll start with the scheduled two so again the DEA schedules, one is one
that has no medical value two is the most addicting three is less addicting
than that four is less addicting than that and five and so forth so we'll go
over a two or three and a four. So the first one is morphine
MS Contin
And fentanyl has a couple brand names. One is Duragesic
an analgesic that lasts for a long duration and Sublimaze although it's not subQ
you can think of it going intramuscularly
Then we have hydrocodone
with acetaminophen
That's Vicodin
And then oxycodone with acetaminophen and that's Percocet
That's an R. Okay all right so we've got four C-II opioids and you'll notice that I've got
it alphabetically here but not here. Why? Well morphine was the first drug
It's a prototypical drug. If you have something like that you want to take it
and put it at the top and then you'll alphabetize the ones that come after it
But now we're going to go in DEA order from C-II to narcotic C-III
And the C-III is going to be Tylenol with codeine but we call it
Acetaminophen with codeine
and one of them is Tylenol #3 then we have a narcotic C-IV
It's a mixed opioid so I'll just call it a mixed opioid but it is
scheduled four
and that's tramadol
and we'll just underline -adol and that's
the stem there. So over here we used the NSAIDs and we did them from OTC
to Rx over here what we're going to do is we're going to use the number of DEA
schedules from two to three to four to help memorize them and then we've got a
narcotic antagonist
and it's nice to have usually the agonist before the
antagonist it just makes sense intuitively and that's noloxone
Or Narcan and the stem there is the nal- So these are the opioids and how
you remember them use them in DEA schedule order agonist first
antagonist next. Next we're going to go actually in the body from head to toe
and the first group that we're going to have
are the triptans and the triptans are going to be the migraine medications
eletriptan Relpax and you can think of relief and pax means peace in
Latin and then sumatriptan which is Imitrex there's an IM version so you can
think of the IM and imitrex but really it's these -triptan stems
that tell you what kind of medication you have then from there we're going to
go to what are called the DMARDs and DMARDs are disease-modifying
antirheumatic drugs and I'll show you why I'm going to put this not in
alphabetical order
Methotrexate Rheumatrex because it's
for rheumatoid arthritis and methotrexate has the -trexate stem
and this is a non-biologic then we have two biologics, abatacept and
etanercept. So [brand names] Orencia and Enbrel
I'm going to underline the -cept because that's the stem for these
biologics but also the -ta- so we'll double underline the -cept and the -ner-
and so the -tacept and -nercept means that it's a certain kind of disease
modifying antirheumatic drug but you see we don't have alphabetical order here
because we have a non biologic then we have two biologics in alphabetical order
so after the DMARDs come, the way I remember it is we start
with the head then we go to the joint and then from the joint we're going to
go to the bone. So we have two bisphosphonates,
alendronate
Ibandronate
[brand] Fosamax. Students like to think of fossil. [brand] Boniva has the word bone in it
that's how I remember those. And these aren't for osteoarthritis like the NSAIDs would be
these are for osteoporosis so some degradation of the bone from there we
have the muscle relaxants up and then the -dronate stem that tells you that
these are bisphosphonates. Then we have the muscle relaxers and the muscle
relaxers include cyclobenzaprine which is Flexeril and diazepam which is Valium
and the -azepam is a stem so cyclobenzaprine you can see the word
-benz- and it's like you're bending and then flex for Flexeril. diazepam it's a
benzodiazepine we'll see benzodiazepines in the neuro section but these are also
used for muscle relaxation so I put one here we actually have one more set of
drugs but I want you to notice where we've gone we started with the head so
triptans for headache then we went into the joint and then from the joint
we went to the bone and then out to the muscle so you're thinking inside out and
I'll put it over here anti-gout okay so I'm going to have 2 anti-gout
medications allopurinol which is Zylorpim and febuxostat which is Uloric
and the -xostat is the stem. These anti gout medications are for
chronic gout so what we're doing is we're preventing uric acid from forming
and you can kind of see the uric from uric acid in here and then the -lo- for lower
so "you lower" uric acid. Both of these prevent having too much uric acid if
you have less uric acid you'll have less gout but again alphabetize them within
the group and here we are gout 50% of the time is in the toe so a
good place to memorize
so those are the 25 musculoskeletal drugs in a nutshell