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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.⁠⠀

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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!⁠⠀

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SNRI Side Effects

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.⁠

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SSRIs Side Effects

💊 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. ⁠

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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

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Tricyclic Antidepressant (TCAs) Side Effects

Tricyclic antidepressants (TCAs) are drugs used to treat depression, bipolar disorder, and other conditions such as chronic pain and insomnia. They primarily work by blocking norepinephrine and serotonin (5HT2) reuptake. They also block acetylcholine and histamine receptors which contribute to their side effect profile.⁠ ⁠ 👉🏻 Muscarinic M1 block: anticholinergic side effects including dry mouth, blurry vision, constipation, and urinary retention⁠ ⁠ 👉🏻 Histamine 1 receptor block: sedation and weight gain⁠ ⁠ 👉🏻 Adrenergic alpha block: postural hypotension, tachycardia, and erectile disfunction ⁠ ⁠ 👉🏻 Sodium channel block: QTc prolongation, arrhythmias ⁠ ⁠ 👉🏻 Serotonin uptake block: weight gain⁠

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Valproate Side Effects

💊 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. ⁠

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Warfarin Factor Half-Lives

Warfarin is an oral anticoagulant most frequently used to control and prevent thromboembolic events. ACCP recommends that patients newly started on warfarin be bridged with LMWH or unfractionated heparin for 5 days AND until therapeutic INR is achieved. 🌟High-yield fact🌟 The presence of a therapeutic INR does not confer protection from clot formation and expansion during the first few days of warfarin therapy, so if your patient’s INR is 2.0 on day 3, it is recommended to continue bridging until day 5. This recommendation is based on the fact that the anticoagulant activity of warfarin depends on the clearance of functional clotting factors already present in the body. Warfarin works by inhibiting new clotting factors from forming but requires that the old factors be cleared from the body. The clearance of these clotting factors is determined by their half-lives. The earliest changes in the International Normalized Ratio (INR) are typically noted 24 to 36 hours after a dose of warfarin is administered. These changes are due to the clearance of functional factor VII, which is the vitamin K–dependent clotting factor with the shortest half-life (6 hours: after 3-5 half-lives or 24-36 hours it will be eliminated from the body). The factor with the longest half-life, prothrombin or factor II, will take 5 days to clear from the body, hence why we need to bridge for at least 5 days AND until therapeutic INR is achieved.

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Warfarin Factors

This is a high-yield question that is often asked on exams and clinical rotations.  This mnemonic helps you remember which vitamin K-dependent factors warfarin affects. ⁠ Warfarin, brand name Coumadin, is an anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent clotting factors, which include Factors II, VII, IX, and X, and the anticoagulant proteins C and S.⁠

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Learn with Memory Pharm on Youtube

*Drum roll* Announcing the launch of Memory Pharm’s Youtube channel!

We are so excited to share the great news. For all of our visual and audio learners, these videos are aimed to help you understand medications in a fun and effective way.  With tons of great illustrations and animations PLUS memorization tips, we hope these videos will help make learning medications easier and more enjoyable. It is a great tool all healthcare professionals currently in school and a nice review for practicing clinicians. If this is you, check out our channel below. 

Our first two videos are on the topic of asthma, a common respiratory disorder that affects millions of people worldwide. Stay tuned for more videos coming soon. Until then, happy studying!

-Memory Pharm Team

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Pharmacology Study Tips

If studying pharmacology seems like a daunting task, you are not alone. It is probably one of the most challenging subjects for every student to learn owing to the amount of drug information that needs to be committed to memory. Some might even say it is similar to memorizing a dictionary!

You cannot possibly learn everything about all the drugs available on the market. So, where do you start? Check out these top 5study tips below!

Study Tip #1: Group the information

 

You only have a limited time to study; therefore, you want to get the most bang for your buck. The grouping technique, also known as the chunking method, is an effective way to organize information to enhance the amount of information you can retain to memory. Our brains naturally file things into categories. During exams and in clinical practice, we get asked questions that require us to retrieve information that is grouped (e.g., which antibiotic can I give in a patient with renal insufficiency? anti-nausea medication should I prescribe?) so studying information in this format is ideal.

 

Here is how you can group the information:

  • Group the drugs by their class (e.g., cephalosporins, calcium channel blockers, etc.)
  • Mechanism of action of that drug class
  • Side effects common to that drug class
  • Side effects that are unique to a drug in that class
  • Commonalities of drug names in that group of class
  • Indications for that drug class
  • Unique drug interactions for that drug class/drugs
  • Pregnancy considerations for that drug class/drug

 

Study Tip #2: Ask yourself these 2 questions

 

Rather than memorizing information for the exam and then dumping it after, studying with these two questions in mind will help you retain the information longer and improve your confidence. They will help you understand the underlying pathophysiology and why we use certain drugs in certain disease states.

 

  1. What normally happens in the body?
  2. What is going wrong when this disease state happens?
 

Study Tip #3: Understand the mechanism of action

 

If you know this one fact about the drug class, it can help you remember the indication and some of the side effects. For example, lisinopril works by inhibiting an enzyme that converts angiotensin I to angiotensin II, a hormone that causes vasoconstriction of blood vessels leading to hypertension. Less of this active hormone leads to a decrease in blood pressure. From this, you’ll know that lisinopril is used to treat hypertension and some common side effects include hypotension, dizziness, and headache. 

 

This study tip may not be possible for all drugs as some medications (e.g., antiepileptics) have unknown mechanisms of action. 

Study Tip #4: Use mnemonics

 

Mnemonics are popular memory tools used to aid in committing important pharmacology facts. Below are 5 different pharmacology mnemonics that you can use to help you during your studies.

 

Acronyms

Acronym-based mnemonics use the first letters of the target words to assist in remembering large amounts of information. For example, to remember the side effects of statins, think of the acronym HMGCoA: Hepatotoxicity, Myalgia, GI effects (nausea, flatulence), CPK increase, and Avoid in pregnancy.

 

Drug names

Drug companies often name drugs with stem words that hint at their class or mode of action. For example, riivaroxaban, apixaban, edoxaban are direct factor Xa inhibitors as denoted by the stem -xa in their names. Macrobid is dosed BID versus Macrodantin is dosed four times a day. Pay attention to the drug name when studying to see if you can spot some of these stems. 

 

Keyword mnemonics 

Use sound-alikes to help you associate the word to a new key term. Of the second-generation antipsychotics, risperidone and paliperidone have the highest risk for EPS and tardive dyskinesia. Mnemonic: “Movement disorders are no fun, so don’t RISK (Risperidone) it Pal (Paliperidone)!”

Grouping method  ALL antibiotics need to be renally adjusted. The list is endless. It is usually easier to remember the outliers or those that do not need to be renally adjusted: moxifloxacin, linezolid, clindamycin, nafcillin, tigecycline. 

Comprehension Understanding is always best for long-term retention! For example, the respiratory fluoroquinolones are gemifloxacin, moxifloxacin, and levofloxacin (remember Go, My Lungs!). There is a common misconception that ciprofloxacin has poor lung penetration because it isn’t a respiratory FQ when the actual reason is that it lacks activity against streptococcus pneumoniae, a common bacteria that causes pneumonia.

Study Tip #5: Check out Memory Pharm!

 

Memory Pharm is a educational website that aims at simplifying complicated pharmacology topics using humor and practicality. We are updating our content regularly. Check out our social media for weekly drug facts, mnemonics, and encouragement as well as subscribe to our email listing to get the latest updates and tips exclusive to members of our list.

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It’s TEST LAUNCH DAY!

We could not be more excited for this day to finally arrive. There’s been so much put into getting up to this point. But there’s not much time to celebrate; we’re still hard at work adding new products and features. Keep a lookout. We have even more exciting things to come!

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Antibiotic: Pharmacology Coloring Book Presale!

We are excited to release the presale of our first Pharmacology Coloring Book on antibiotics! (Whoohoo!)

Learning antibiotics can be a daunting task, but we aim to make it fun in a creative way. There are so many antibiotics and bacterial organisms to remember and understand. Trust me, I have been there! With matching drugs to bugs to figuring out how to pronounce the names of the antibiotics and bacteria, it can become overwhelming.

We have created this fun coloring book as a supplement to help you learn the material! It has over 30 pages of illustrations, mind maps, humorous mnemonics, and labeling points to test your knowledge! We have also included space for you to incorporate your own notes and doodles! Research have shown that the style of doodle notes can help improve focus, retention, and creativity. 

If you are a visual learner, this coloring book will serve as the perfect supplement during your classes or rotations. 

We are having offering a promotional presale of 25% off. If you order now, you can buy it for $14.99 (originally $19.99) which includes FREE shipping. 

We would love your support! If you think we are doing something great, please share it with your family and friends!

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