So let's start with chapter 7 endocrine this is our last chapter and we're going
to start with three OTC medications. Most people don't know that insulins are
over-the-counter because they aren't literally over-the-counter they're in
the refrigerator in the pharmacy but they don't require a prescription or two
of them don't. Regular insulin which is humulin R and NPH insulin which is humulin
N and alphabetically you say that well why didn't you put the N first why did
you put the R first? traditionally insulins
when we talk about them and list them, we list them in the order of the speed that
they work so I'll mention these in the insulin column but regular insulin works
for less time than NPH insulin so that's how we would put it, regular then
NPH. Emergency contraception: so the stem here is the -gest- that lets you know it's
a progestin so levonorgestrel is Plan B one step. Why is it called one
step? Well it used to be two steps, used to be two pills and the plan B comes
from, well plan A might have been a condom or something like that that broke
and Plan B was to take this pill for emergency contraception it used to be by
prescription then it went behind the counter then recently it's gone
over-the-counter and available readily. So let's go with the prescription
medications now so we'll start with the oral anti-diabetics and to remind us
that diabetes is an issue of a blood glucose that's elevated so what we're
trying to do is reduce that blood glucose the order that I put them in is
by alphabetically by their class so that if you have other medications you want
to put in you can just put in more biguanides or more DPP-4 inhibitors
but the B proceeds the D proceeds the sulfonylurea. So metformin has the
-formin stem, f-o-r-m-i-n but you'll usually see some kind of g-l-
in these generic names and metformin is the exception. So the manufacturer made
Glucophage, the gl- is in the gluco for glucose and then phage to phage something
is to eat it so if you've heard of cell eating it's phagocytosis, cell drinking is
pinocytosis so that's kind of where that comes from. The DPP-4 inhibitor sitagliptin
some people just call them 'gliptins' because it's just hard to say
DPP-4 and that's Januvia. So the second generation sulfonylureas, glipizide and
we have the gli- prefix its brand name Glucotrol so you can see glucose
control is what I think they were going for with a brand name and then glyburide
the gly- prefix and Diabeta is the brand name so you can see most of the
word diabetes is in there or you can think of the beta cells and insulin
secretion and what they do there and the islets of Langerhans so those are if
you have a patient that has too much blood sugar, however sometimes we have a
condition of hypoglycemia and you would use glucagon when the glucose is gone is
the best way I think to think of that and that brand name is Glucagen
so we are generating glucose where there isn't any. So let's go on to the insulins
and another situation where we have too much or too little of a hormone. So I've
put the insulins here in order of how long they work so insulin lispro works
very quickly should be taken with a meal and because it works so quickly it's by
prescription and the brand name is Humalog which is a combination of human
insulin and analog insulin. The regular insulin and NPH I already talked about
but this is where they would be placed if you were to put the four insulins
together in terms of how long they work so insulin
lispro, regular insulin, NPH insulin then insulin glargine I've heard lazy
Lantus to remind you that it's very slow acting it works all day and then Toujeo is
a newer brand name but those four insulins in that order
just as diabetes was an issue with high glucose and sometimes we get
hypoglycemic, hypothyroidism is simply adding thyroid if you want to treat that
so levothyroxine is the actual hormone and the brand name comes from Synthroid
which is synthetic thyroid is how they came up with that brand I believe and
then hyperthyroidism when we have too much thyroid hormone we would use
something like propylthiouracil which just uses the P, the T, and the U from
propylthiouracil to make PTU. Hormone replacement, so testosterone the
-ster- is the stem indicating it's a steroid
and then Andro- meaning man and then gel because testosterone is generally
regarded as a male hormone. So from there let's go on to some birth control and
issues with the bladder. So beginning with the combined oral contraceptives or
the pill as most people would call it. The estr- is an estrogen and then the
'gest' again is a progestin and these get really complicated but if you want to
look at the estrogens you see that in all four of these ethinyl estradiol is
the estrogen so we don't have to change anything there what we're doing is we're
either adding a supplement or we're adding a progestin. So the first one is
norethindrone ethinyl estradiol and ferrous fumarate which makes
Loestrin 24 and then we use the Fe, the abbreviation
from the periodic table of elements for iron.
norgestimate with ethanol estradiol is Tri-Sprintec, the Tri- comes from
that it's triphasic. And those are oral contraceptives, so if we're trying to
remember something again we try to go head to toe and the patch would probably
be something you put on the belly and norelgestromin, the -gest- for the
progestin with ethanol estradiol is Ortho Evra so that patch you can put on
your belly the ring is a vaginal ring so we're going further down. Etonogestrel
and ethanol estradiol. Again we're using those stems and the brand name I think
comes from new vaginal ring where they just took the Nu- from and make the sound
new, the -va from vaginal and then ring. While the tablets or the pill we have
you know seven-seven-seven and then usually off for a week for 28-day cycle
these, the patch and the ring, are used for seven days and then a new one
replaces it. Overactive bladder so some of these brand names actually helped
quite a bit so with oxybutynin, the detrusor muscle
is an issue with overactive bladder so Ditropan alludes to the detrusor muscle
and then that -trol- from control you could think of you're in control with
Oxytrol OTC. the -fenacin in solifenacin is the stem and VESIcare
vesicae actually means bladder in latin and somebody must have been a classics
major that helped make this brand name but VESIcare is care for the bladder
and then tolterodine, again detrusor muscle control
in the brand-name. Urinary retention, so we've talked about a little bit about
cholinergic versus anticholinergic and a side effect of anticholinergics is that
everything is dry so there's anhidrosis, stopped sweating
there's blurry vision secondary to dry eyes, there's dry mouth,
there's urinary retention, there's constipation, and then tachycardia
but that urinary retention is what would normally cause this kind of state so to
treat an anticholinergic state what we would do is we would give a cholinergic
so bethanechol, -chol and that's not actually a stem so I'll erase it, is a
cholinergic medication and you can see the part of acetylcholine that's in the
brand name but again that's not a stem I just wanted to point it out. Erectile
dysfunction so these have the -afil stem and I believe there's actually an
infix in here because there's a vardenafil and a sildenafil and those
have that same -den- in there but I won't mess with that right now.
So sildenafil is Viagra it's the first that came out it's prominently talked
about in Love & Other Drugs, a recent movie, and via- means life and gr- are the
first two [letters] in growth. So give life, growth, however you want to take that for
erectile dysfunction. Tadalafil is also an erectile dysfunction medication with
a much longer half-life. They call it the weekend pill this is the one where
the the couples there with the bath tubs next to each other at sunset. I can't
mention the mnemonic really my students used something to the effect of tada but
I'm not going to get to that. Okay alright so we just have
four drugs left we've done 196 so we're going to go on to the benign prostatic
hyperplasia alpha blocker and then benign prostatic hyperplasia 5-alpha
reductase inhibitor. So I mentioned that alpha blockers are used for hypertension
but they also are helpful for a condition called benign prostatic
hyperplasia or BPH and this is a benign growth of the prostate where there's an
issue with urine flow. So to make the brand name the manufacturer must have
thought of you know the urine flow being slowed so now we're going to get maximum
flow to make Flomax. And then alfuzosin also alludes to this urine with
the 'ur-' [in the brand name] and then control '-tral' instead of '-trol' the -osin at the end of
tamsulosin and alfuzosin it's not an actual stem, but some students use it to
remind themselves that the BPH drugs are related. The last two drugs so BPH
5-alpha reductase inhibitors so the dutasteride and finasteride. Avodart is
the brand name for dutasteride. Finasteride is interesting that it has
two brand names and I should have put Proscar first for prostate care because
that really matches up with the Avodart but interestingly enough as people were
taking the finasteride they were growing hair, something called hirsutism, and not
to lose an opportunity the manufacturer said okay well let's create a medication
name that's going to indicate that the person has is going to grow hair so
alopecia is the loss of hair, propecia I guess would be adding here so that's how
that name came about. At the end of movies in the old black and whites
there was always 'fin' or 'fini' or done. So we have finished our 200 medications
and hopefully these videos were helpful.