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Drug Mechanisms of Action Mnemonics/Tips

In pharmacology, the mechanism of action (MOA) is the specific biological process through which a drug produces its pharmacological effect AKA how it works. ⁠

Not only is knowing the mechanism of action important for exams and NAPLEX (as they are popular test questions), it gives you a baseline to understand/remember the drug indication, side effects, and underlying pathophysiology of the disease state.⁠⠀

Some MOAs are more complicated than others while some MOAs are unknown. Often, we get lucky and the drug class hints at the mechanism of action such as calcium channel blockers, angiotensin receptor blockers, beta-blockers, etc. but this may not always be the case. ⁠⠀

Check out some tips and tricks on how to remember the MOA of some other common medications below:⁠⠀

-Rivaroxaban, apixaban, edoxaban – anticoagulants⁠⠀
-Montelukast (Singulair) – used for allergic rhinitis and asthma⁠⠀
-Sulfamethoxazole – used in combination with trimethoprim as an antibiotic ⁠⠀
-Metformin (Glucophage) – antidiabetic medication⁠⠀
-Nitroglycerin – antianginal agent⁠⠀

Drug Mechanisms of Action Mnemonics/Tips Read More »

Respiratory Fluoroquinolones

Fluoroquinolones are highly effective antibiotics with many advantageous pharmacokinetic properties including high oral bioavailability, large volume of distribution, and broad-spectrum antimicrobial activity. Some antibiotics in this class include moxifloxacin, levofloxacin, and ciprofloxacin. ⁠⠀ ⁠⠀ 💊 Fluoroquinolones act by inhibiting two enzymes involved in bacterial DNA synthesis, both of which are DNA topoisomerases that human cells lack and that are essential for bacterial DNA replication, thereby enabling these agents to be both specific and bactericidal.⁠⠀

Respiratory Fluoroquinolones Read More »

Top 25 Drug Suffixes You Need to Know

Pharmacology can be a difficult subject due to the numerous drug names and facts that are required to be committed to memory. Fortunately, generic names tend to follow patterns, with prefixes and suffixes to help determine which class of medications they belong to. An example is the class angiotensin converting enzyme inhibitors (ACEIs) which all end in the suffix ‘-pril’ such as lisinoPRIL or benazaPRIL.

Learning the roots of common medication classes can definitely come in handy as it can save time from having to memorize every single drug on the market. Instead, you can group them into classes and identify them based on the prefix or suffix. This can be helpful as drug classes often share common contraindications, black box warnings, and side effects, all of which are commonly tested.

Learning and recognizing these prefixes and suffixes could SAVE you on an exam and is a subject that may or may not be emphasized enough in pharmacy, nursing, or medical school.

Check out the list below of the top 25 drug roots you need to know. If you are on the lookout for the best way to study for this, check out our drug suffix cheat sheet here that can serve as a great reference guide or if folded down the middle can be used in flashcard format to quiz yourself!

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Antibiotics 1: Mechanisms of Action Simplified

Think of yourself as a visual learner? Check out our video above that uses graphics and animations to discuss the material below

Background

In this overview, we will be talking about how some of the most common antibiotics work. Let’s begin with a reminder of the structure of bacteria.

There are two main groups of bacteria – Gram-negative organisms and Gram-positive organisms. They are classified based on their Gram stain. What is a Gram stain? Gram stain is named after the Danish physician Hans Christian Gram who created this staining technique for visualizing bacteria; therefore, when you refer to Gram stains, use a capital “G.” Bacteria cell walls are made up of a substance called peptidoglycan, a polymer of amino acids and sugars that serves a fundamental role in the structure and integrity of the cell.

Bacteria differ in the types of walls they have. Gram-positive organisms have a thick peptidoglycan layer that retains crystal violet stain, making them purple after Gram staining. Gram-negative organisms have two distinct layers, a lipopolysaccharide (LPS) membrane that surrounds a thin layer of peptidoglycan. The LPS membrane does not retain crystal violet stain – they are stained later in the process by a pink counterstain called safranin, making Gram-negative organisms pink after Gram staining.

A great memorization tip is to keep your P’s together

  • Gram-Positive bacteria has a ‘P’ in the name to help you remember that it stains Purple
  • Gram-negative bacteria doesn’t because they stain different shades of red such as reddish-pink.

Once you have made it passed the cytoplasmic membrane and cell wall, you have reached the organism’s cytoplasm wherein resides the organism’s ribosomes, genetic material, and other enzymes important to the bacterium’s survival – all things that antibiotics have been designed to target. Bacteria have ribosomes that translate messenger RNA into polypeptides and contain two subunits – the large 50S and small 30S subunits. Ribosomes are factories for protein synthesis. Proteins are responsible for all cell functions including things such as protective proteins, transport proteins, toxin proteins, and so much more!

Disrupt Cell Membrane:

There are two main antibiotics that work by disrupting the inner and outer membranes of bacterial cell wall, disrupting their function and leading to bacteria cell death, polymyxin and daptomycin.

Polymixins such as colistin and polymyxin B act like soap. Since these agents bind to the LPS layer, they have no activity against Gram-positive bacteria, which lack this layer.

Daptomycin inserts itself into the cytoplasmic membrane of Gram-positive bacteria, weakening the membrane and causing cations to leak out of the cytoplasm. This rapidly depolarizes the membrane potential, stopping processes essential for the life of the bacterium and killing it.

Cell Wall Inhibitors:

A few antibiotics target the creation of the cell wall itself, including Fosfomycin, beta-lactams (penicillin, cephalosporin, carbapenems), monobactam, and vancomycin. Fosfomycin inhibits an enzyme that catalyzes the first step of cell wall synthesis. Beta-lactam antibiotics like penicillins, cephalosporins, and carbapenems contain beta-lactam rings that irreversibly bind to enzymes on the cell membrane in bacteria called penicillin-binding proteins, or PBPs. This stops the final step in the creation of the peptidoglycan layer of bacterial cell walls, making the cell walls defective and unstable, leading to a series of events that ultimately kills the bacteria. Aztreonam, a monobactam antibiotic, also works this way. its mechanism of action is similar to a Trojan horse sneaking into the cell.

Vancomycin is a glycopeptide antibiotic that also works on cell wall biosynthesis. Glycopeptides are too big to get through the outer layer of Gram-negative bacteria, so, unlike beta-lactam antibiotics, glycopeptides only work on Gram-positive organisms. They bind to the D-alanyl-D-alanine (D-ala-D-ala) precursor – D-alanyl-D-alanine is an important component of the peptidoglycan layer, so when glycopeptides block its formation, they are stopping cell walls from being built. The lipoglycopeptides telavancin, dalbavancin, and oritavancin are like cousins to vancomycin that work the same but with an added mechanism of action similar to daptomycin that disrupts the cell membrane causing it to depolarize and become permeable, killing the cell.

Protein Synthesis Inhibitors:

 Several antibiotics act on the ribosome, a complex molecule that serves as the factory for protein synthesis:

Aminoglycosides like gentamicin, tobramycin, and amikacin and tetracyclines like tetracycline, doxycycline, minocycline, tigecycline, are protein synthesis inhibitors that irreversibly binding to the small 30S ribosomal subunit.

Clindamycin, macrolides, oxazolidinones (linezolid and tedizolid), and lefamulin are protein synthesis inhibitors that interact with the big 50S ribosomal subunit, interfering with polypeptide chain synthesis leading to bacteria cell death.  

Folic Acid Synthesis Inhibitors:

Folic acid is synthesized by bacteria from the substrate, para-amino-benzoic acid (PABA), and all cells require folic acid for growth. However, folic acid cannot cross bacterial cell walls by diffusion or active transport. For this reason, bacteria must synthesize folic acid from PABA. Sulfonamide antibiotics such as sulfamethoxazole and trimethoprim work synergistically with one another by interfering with folic acid production within the bacterium. Trimethoprim binds dihydrofolate reductase, and sulfamethoxazole competitively inhibits dihydrofolic acid synthesis by mimicking p-aminobenzoic acid, or PABA, preventing the final step of the process.

To help you remember this, think of the ‘FO’ in sulFOnamides as inhibiting FOlic acid synthesis.

Nucleic Acid Inhibitors 

Lastly, a few antibiotics work against nucleic acids, the primary molecules that make up DNA, either directly or indirectly by inhibiting their production or repair.

Fluoroquinolones like ciprofloxacin, levofloxacin, moxifloxacin, and delafloxacin inhibit enzymes called DNA topoisomerases (DNA gyrase and topoisomerase 4), interfering with DNA replication, transcription, repair, recombination, and transposition.

Fidaxomicin works specifically on Clostridioides difficile RNA polymerases, making it useful for treating only that bacterium.

Metronidazole targets only anaerobic bacteria like Bacteroides species and protozoa like Giardia – it may be metabolized into a molecule that disrupts DNA and inhibits its synthesis, but we don’t really know how it works. It isn’t the only common antibiotic that we don’t know for sure how it functions – nitrofurantoin, an antibiotic helpful only for treating urinary tract infections, is also metabolized into molecules that may inactivate ribosomes, DNA, and RNA, but we don’t know for sure.

Mechanism of Action Mnemonic:

Let’s review some quick mnemonics on how to remember the MOA of some of the antibiotic classes discussed:

Cell membrane/wall inhibitors: remember this mnemonic: 

Destroys Protective Fortification & Murders Various Bacteria.

The first two antibiotics in the mnemonic disrupt bacteria cell membrane and the rest work on the bacteria cell wall.

  • Daptomycin
  • Polymyxin B
  • Fosfomycin
  • Monobactams
  • Vancomycin
  • Beta-lactams

Protein synthesis inhibitors:

You’re AT 30th st. (30S) and you want to COM to 50th st. (50S)

  • 30S: Aminoglycosides, Tetracyclines
  • 50S: Clindamycin, Oxazolidiones (linezolid, tidezolid), Macrolides

Inhibit folic acid synthesis:

Think of the ‘FO’ in sulFOnamides as inhibiting FOlic acid synthesis

  • SulFOnamides (Sulfamethoxazole and trimethoprim)

Inhibits DNA/RNA synthesis:

Think of the F in the first letters of these antibiotics as standing for DNA/RNA “Fiber”. The “x” in the middle of fidaxomicin also looks like a chromosome.

  • Fluroquinolones
  • Flagyl
  • Fidaxomicin

Antibiotics 1: Mechanisms of Action Simplified Read More »

Top 5 Tips on Learning Vasopressors and Inotropes

One of the most intimidating environments for pharmacy students on rotation can be the intensive care unit. Not only is it where the sickest patients in the hospital go, but they are often on many medications and monitors we never see anywhere else in the world of pharmacy. One of the most frequent reasons patients go to the ICU is because of low blood pressure causing organ failure and critical care pharmacists have a big role in helping manage this! While it’s normal to feel intimidated, we’ve put together a “survival pack” of tips and tricks to learning and understanding shock, hemodynamics, and the medications that can be used!

Top 5 tips for understanding hemodynamics:

  • Tip # 1: Understand what caused the shock and what will reverse it. The golden rule of critical care is treating the underlying cause while providing supportive care. Knowing what you’re treating, whether it is sepsis or heart failure, will help you plan out which therapies the patient should start on, like antibiotics or diuretics. In the meantime, you can then focus on supporting the patient’s blood pressure and organ function until the underlying cause is treated.
  • Tip #2: Determine what kind of shock the patient. Sometimes shock is caused by blood vessels being too dilated, sometimes it’s caused by active bleeding, and sometimes it’s because the heart isn’t working correctly to pump blood. No matter the cause, it’s important to categorize the shock to know what the correct supportive therapies, whether they be fluids, vasopressor, or inotropes, should be used.
  • Tip #3: We often think of shock as low blood pressure, but really it’s low blood pressure + organ failure. The ICU can be information overload, but all the numbers are just telling you about how different organs are performing or not performing. For example, if someone’s serum creatinine doubles and their urine output becomes zero, you know they’re going into renal failure. If someone suddenly develops altered mental status, that could be because not enough oxygen is getting to his or her brain. Learn how to interpret the “information overload,” and you can use that to determine how “sick” from shock a patient is.
  • Tip #4: After determining what kind of medications should be used temporarily to manage the shock (e.g., fluids, vasopressors, inotropes), the next step is to monitor the efficacy of these medications. For example: if someone has septic shock with renal failure, we know that it is most often caused by leaky blood vessels or distributive shock. Based on that information, we would want to start a vasopressor which is the first-line treatment to manage this type of shock. Once we start a vasopressor like norepinephrine, we can monitor the patient’s urine output and creatinine to determine if the medication is working!
  • Tip #5: Learn the mechanism of action of all the vasopressors and inotropes. I know you hear this all the time in school but understanding what drugs work at which receptors and what those receptors do will help you UNDERSTAND how to pick between the different agents, not just MEMORIZE which one to use. Remember- critical care is not black and white; you must know how drugs work in order to select the right drug for the right patient.

Written by: Ellen Huang, PharmD, BCCCP. Critical Care Clinical Pharmacist

Looking for study resources to help you master vasopressors and inotropes?

Check out the Vasopressor and Inotrope Mnemonic Workbook! Designed to help save you time and make studying more effective. 

This 28-page digital book includes:

  • Numerous memorization tips
  • Worksheets for active recall
  • Simplified pathophysiology
  • Key points about vasopressors and inotropes

Created by a critical care content expert and perfect for current or aspiring pharmacy students, nurses, doctors, and healthcare students who are visual learners. 

Top 5 Tips on Learning Vasopressors and Inotropes Read More »

Antibiotics that Cover MRSA

Methicillin-resistant Staphylococcus aureus (MRSA) is an infection caused by Staphylococcus (staph) bacteria that has an oxacillin minimum inhibitory concentration (MIC) of greater than or equal to 4 micrograms/mL. ⁠ ⁠ ⭐ MRSA infection is one of the leading causes of hospital-acquired infections and is commonly associated with significant morbidity, mortality, length of stay, and cost burden. ⁠ ⁠ ⭐ MRSA infections can be further divided into hospital-associated (HA-MRSA) infections and community-associated (CA-MRSA) infections. They differ not only in respect to their clinical features and molecular biology but also to their antibiotic susceptibility and treatment⁠

Antibiotics that Cover MRSA Read More »

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are one of the top 200 drugs prescribed (sometimes over-prescribed 😔) and are the strongest medications used to treat stomach acid disorders such as gastroesophageal reflux disease or peptic ulcers. ⁠⠀
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The generics in this class all end in “prazole”, however, if you pay close attention, the brand names of these drugs also hint at what they do. See below for some examples:⁠⠀
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💊 Prilosec (omeprazole): Pr (short for proton), lo (low), sec (secretions) meaning lowered secretions of protons (acid)⁠⠀
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💊 Aciphex (rabeprazole): aci (acid), phex (fix) which means it can help fix acid problems⁠⠀
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💊 Prevacid (lansoprazole): Prev (prevent) acid ⁠⠀
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💊 Protonix (pantoprazole): Proton (acid) nix (get rid of) or in other words nix protons⁠⠀

Proton Pump Inhibitors Read More »

Drug Allergies

While any drug can cause an allergic reaction, let’s focus on the top 3 most common drug allergies:⁠⠀
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💊 Penicillin allergies⁠⠀
💊 Sulfa allergies⁠⠀
💊 Opioid allergies⁠⠀
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When you realize a patient has an allergy to a medication you are about to prescribe, verify, or administer, always assess to see if the patient is TRULY allergic to the medication by:⁠⠀
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✏️ Asking what reaction they had to it⁠⠀
✏️ Determine if the reaction is a considered side effect/intolerance vs. a true allergy that is IgE mediated (anaphylaxis or angioedema) ⁠⠀
✏️ If it is a true allergy, replace the medication with an alternative drug⁠⠀
✏️ If using another agent that could potentially cross-react be sure to monitor the patient closely ⁠⠀
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Most often patients who report they have an allergy to one of these medications are truly not allergic to it but are often just intolerant to its side effects which can lead to costlier and less effective medications being used in its place. ⁠It’s important to assess the nature of the allergy and weigh the risks and benefits of using other alternatives.

Drug Allergies Read More »

Singular (Montelukast)

💊 Montelukast is an oral leukotriene modifier that reduces the proinflammatory and bronchoconstriction effects of leukotrienes that occur in asthma patients or allergies. ⁠⠀
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⭐ They are not used to treat acute exacerbations and must be taken on a regular basis, even during symptom-free periods. ⁠⠀
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This medication is dosed based on age not weight and is often dosed once daily! ⁠⠀
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🧠 Memory tip: When you hear the brand name Singulair, think of the word ‘singular’ which refers to one person or thing or in this case, once a day!⁠⠀

Singular (Montelukast) Read More »

Drug Antidotes⁠ #1⠀

🚦 Antidotes are substances used to reverse the effects of poisoning. The word “antidote” itself derives from the Greek word, antidoton, meaning “administered as a remedy’.⁠⠀
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Some antidotes are used to treat one specific drug while other antidotes (ex: charcoal) can reverse the effects of many different toxins. ⁠⠀

Drug Antidotes⁠ #1⠀ Read More »

Statins

Did you know statins are one of the top 10 most prescribed drugs in the United States? 🤔

Medications in this class end in the suffix “-statin” and include:
Atorvastatin
Lovastatin
Pravastatin
Fluvastatin
Rosuvastatin
Simvastatin

Statins Read More »

Metformin (Glucophage)⁠⠀

Metformin (Glucophage)⁠⠀ Read More »

Pharmacokinetics in Pregnancy

🤰🏻 Choosing an effective yet safe antibiotic during pregnancy requires you to weigh the risks and benefits. It can often be a gray area based on limited clinical studies in pregnant patients. ⁠⠀
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Some tips include:⁠⠀
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👉🏻 Only using antibiotics when no other treatment options are available ⁠⠀
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👉🏻 Avoid prescribing antibiotics during the first trimester if possible. ⁠⠀
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👉🏻 Chose a safe medication with available clinical studies that have been tested in pregnancy⁠⠀
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👉🏻 Dose at the lowest possible amount proven effective.⁠⠀

Pharmacokinetics in Pregnancy Read More »