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. ⠀ ⠀ 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:⠀ ⠀ 💊 Prilosec (omeprazole): Pr (short for proton), lo (low), sec (secretions) meaning lowered secretions of protons (acid)⠀ ⠀ 💊 Aciphex (rabeprazole): aci (acid), phex (fix) which means it can help fix acid problems⠀ ⠀ 💊 Prevacid (lansoprazole): Prev (prevent) acid ⠀ ⠀ 💊 Protonix (pantoprazole): Proton (acid) nix (get rid of) or in other words nix protons⠀
Atypical bacteria are bacteria that do not color with gram-staining but rather remain colorless, they are neither Gram-positive nor Gram-negative (they’re atypical! 😛). These include Chlamydiaceae, Legionella, and Mycoplasma; though Rickettsiaceae are also often considered atypical bacteria.
Pseudomonas is a type of bacteria (bug) that is found commonly in soil and in water. Of the many different types of Pseudomonas, the one that most often causes infections in humans is called Pseudomonas aeruginosa, which can cause infections in the blood, lungs (pneumonia), or other parts of the body after surgery.
🔺 Pseudomonas aeruginosa treatment has become increasingly difficult as bacteria become more resistant to the available antibiotics on the market. If they develop resistance to several types of antibiotics, these germs can become multidrug-resistant.
Anaerobic bacteria are bacteria that do not live or grow when oxygen is present. In humans, these bacteria are most commonly found in the gastrointestinal tract.
🔺 They play a role in conditions such as appendicitis, diverticulitis, and perforation of the bowel so it is important to make sure we have adequate anaerobic coverage when empirically treating these infections.
💊 There are several antibiotics that cover anaerobes in addition to other bacteria.
💊 Morphine is considered the classic opioid analgesic with which other painkillers are compared. Like other medications in this class, morphine has an affinity for delta, kappa, and mu-opioid receptors.
💊 This drug produces the majority of its analgesic effects by binding to the mu-opioid receptor within the central nervous system (CNS) and the peripheral nervous system (PNS).
💊 Morphine can potentially be a lethal medication when not used properly. It causes a host of symptoms related to depression of the CNS. Severe respiratory depression is the most feared complication of morphine in cases of overdose. Immediate injection of naloxone is required to reverse the effects of morphine.
👉🏻 Drugs that are inducers increase CYP450 enzyme activity by increasing enzyme synthesis.
👉🏻 A drug also may be metabolized by the same CYP450 enzyme that it induces. Carbamazepine (Tegretol), a potent enzyme inducer, must be initiated at a low dose and then increased at weekly intervals as its half-life gradually decreases over time.
The CYP450 enzymes are essential for the production of numerous agents including cholesterol and steroids. Additionally, these enzymes are necessary for the detoxification of foreign chemicals and the metabolism of drugs.
Drugs that are CYP450 inhibitors block the metabolic activity of one or more of the CYP450 enzymes. The extent to which an inhibitor affects the metabolism of a drug depends upon factors such as the dose and the ability of the inhibitor to bind to the enzyme.
💊 Premarin is an estrogen-replacement drug prescribed for the treatment of menopause. It is made from horse urine noted by the drug’s name Premarin which is short for ‘PREgnant MARes’ urINe’.
💊 Ursodiol‘s active chemical, ursodeoxycholic acid, is one of the acids found in bear bile that has been shown to be effective in treating gallstones. Since the 1950s, the drug has been produced synthetically.
💊 Forfivo is the brand name of the once-daily bupropion 450 mg formulation. It is indicated for the treatment of major depressive disorder (MDD). The brand name hints at its dosing ‘four-five-O’ for 450 mg.
👉🏻 Cholinergic muscarinic agonists are drugs that bind to and activate muscarinic cholinergic receptors and increase the activity of the parasympathetic nervous system. They are most commonly used when it is desirable to increase smooth muscle tone, especially in the GI tract, urinary bladder, and eye. They may also be used to reduce heart rate.
👉🏻 Direct cholinergic agonists work by resisting acetylcholinesterase, thus preventing its breakdown. Drugs in this class include bethanechol, carbachol, and methacholine, and pilocarpine.
👉🏻 Indirect cholinergic agonists work by inhibiting the acetylcholinesterase enzyme preventing the degradation of acetylcholine. Drugs in this class include neostigmine, physostigmine, galantamine, donepezil, and rivastigmine.
💊 Valproic acid is used in seizures, bipolar disorder, and migraine prophylaxis. It works by increasing the availability of gamma (y)-aminobutyric acid (GABA), an inhibitory neurotransmitter.
🖇️ Divalproex sodium is a compound of sodium valproate and valproic acid. Divalproex dissociates to valproate in the GI tract.
🖇️ Use special caution with the combination of valproic acid and lamotrigine due to the risk of serious rash called Stevens-Johnson Syndrome.
Hypoglycemia is often defined by a plasma glucose concentration below 70 mg/dL; however, signs and symptoms may not occur until plasma glucose concentrations drop below 55 mg/dL.
⭐ It is important to note that beta-blockers can mask common signs and symptoms that diabetics use to recognize hypoglycemic episodes (tremors and palpitations).
💊 Cisplatin is a chemotherapy medication used to treat a number of different cancers. Its name tells you that it is an isomer of a platinum-containing compound.
💊 Maalox is used to treat heartburn, acid indigestion, sour stomach, and upset stomach. The name is an acronym that refers to the solution’s compositional elements: MAgnesium and ALuminum Oxide.
💊 Sonata is the brand name of Zaleplon, a sedative used to treat insomnia. The prefix Sona means ‘sleepy’ in Portuguese to help you remember its indication.
🖇️ High levels of sodium can lead to a condition called hypernatremia, where the serum sodium concentration > 145 mEq/L (> 145 mmol/L).
🖇️ Sodium is a dominant cation in extracellular fluid and necessary for the maintenance of intravascular volume. When there is a large increase in sodium in the serum, the signs and symptoms often relate to fluids as you can see with today’s mnemonic.
🖇️ The human body maintains sodium and water homeostasis by concentrating the urine secondary to the action of antidiuretic hormone (ADH) and increased fluid intake by a powerful thirst response.
💊 Selective serotonin reuptake inhibitors (SSRIs) work by inhibiting 5-HT reuptake by the presynaptic cleft, thus increasing serotonin levels in the synapse. It is commonly used to treat depression, a condition thought to be linked to low levels of serotonin, dopamine, and norepinephrine.
⭐ As you can see, this mnemonic is similar to the mnemonic on the side effects of SNRIs. Since they both block serotonin reuptake, they exhibit very similar side effect profiles except SNRIs can also impact blood pressure (increase or decrease) due to the norepinephrine reuptake inhibition. SSRIs do not affect blood pressure.
In addition, SSRIs can cause weight gain in adults on long-term therapy, while SNRIs cause less of this long-term weight gain and are more associated with weight loss.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressants that work by blocking serotonin and norepinephrine reuptake in the synapse (as the name suggests).
🗒️ It is important to educate patients that there is an increased risk of suicidal thinking and behavior in children, adolescents, and young adults during the first few months of therapy and it may take up to 8 weeks before therapeutic effects are recognized.