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