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  • Okay let's go over chapter five neuro of our review so let's start with local

  • anesthetics and these are OTC and what a local anesthetic is it's just something

  • that's going to numb a certain area. Anesthetics, when injected, will make a

  • person pass out but what I want to talk about is the ester vs the amide so

  • benzocaine is an ester it's a type of organic chemistry molecule and that

  • tells you that the esters we don't really want to inject because they can

  • become allergenic where a patient might have an allergic reaction

  • lidocaine has less of that allergenicity but they're both related by this -caine

  • stem c-a-i-n-e and that might look like cocaine and that's right because cocaine

  • was one of the original anesthetics and they found or developed some anesthetics

  • that weren't addicting but if you look at Anbesol you see two of the letters

  • from the word numb so that's one way to remember that one and then Solarcaine

  • Solarcaine takes the -caine ending that's still frowned upon by the World Health

  • Organization but solar meaning sun so we're using something to take care of

  • the pain from a sunburn but lidocaine has many uses, an injectable in an

  • emergency, patch, some other different things that it can be used for. OTC anti-

  • vertigo so meclizine if you put this, if I were to do meclizine in small letters

  • like this, m-e-c-l-i-z-i-n-e you could kind of put this C in this L

  • together to make a D and then you see dizzy so it's for dizziness but the

  • brand name's Dramamine that you might know but there was also a brand name

  • that was a prescription item, Antivert for anti vertigo but that one told the

  • whole story, anti-vertigo. Another OTC under neuro would be a sedative

  • hypnotic and we see diphenhydramine you might say well I remember that one but

  • that was an antihistamine you told me and that's what's kind of infuriating

  • about pharmacology is that things can be, for prescription drugs can be for many

  • different things and all this is OTC but diphenhydramine as an adverse effect

  • made someone drowsy but here we're using that side-effect as a good thing so

  • tylenol acetaminophen diphenhydramine the antihistamine that

  • makes you tired Tylenol PM and that PM means post-meridian after literally

  • afternoon but we just use it at night time so Tylenol PM is something used at

  • night time sometimes sleep is disturbed because of pain and that's what the

  • acetaminophen is there for. Benzodiazepine-like sedative hypnotics

  • now we're going to the prescription items and benzodiazepine-like means

  • it's not a benzodiazepine but it works a little like one so eszopiclone with the

  • -clone stem and we see this es- again so the S isomer and you can think of Luna

  • or rest in Lunesta and then zolpidem -pidem is the stem, p-i-d-e-m

  • and this is Ambien or Ambien CR, Ambien controlled release so Ambien works to

  • help somebody fall asleep but if the person has trouble staying asleep the

  • controlled release, much longer acting version works well. Melatonin receptor

  • agonist so ramelteon the -melteon is the stem and it looks like melatonin for

  • a reason because it is a melatonin receptor agonist and you can think of

  • Rozerem, roz- rhymes with doze, REM for rapid eye movement sleep, so a lot of

  • hints in these brand names certainly worth remembering. So those are some

  • OTC neuro drugs something to help you sleep. In the next column we're going to

  • go into antidepressants and how those can help us. The first thing that throws

  • students off is the classifications as SSRI, SNRI, TCA, MAOI and each one has

  • its own acronym so an SSRI is a selective serotonin

  • reuptake (I didn't think about space there) inhibitor okay and that means that

  • serotonin is going to normally be re-uptaken or if you want to think of it as

  • recycling that's maybe a better way but instead what happens is we inhibit that

  • recycling it stays in the synapse and it's supposed to make the patient

  • happier. It's that hypothesis of norepinephrine

  • and serotonin not having enough of it so there's five of them I'm going to

  • go over citalopram and escitalopram we see two drugs with the same root just

  • like we saw esomeprazole and omeprazole. Celexa was the first one that came out

  • it reminds me of relaxed these SSRIs can also be used for anxiety

  • and then Lexapro you can think of a professional upgrade from the first one

  • so it takes part the ending of Celexa and then just adds -pro to make Lexapro

  • but those are related in the escitalopram is supposed to be better than the

  • citalopram. The -traline stem for Zoloft so it lofts your mood and then the

  • -oxetine. So -oxetine is a little bit tricky the adopted names council calls -oxetine

  • a fluoxetine-like entity but fluoxetine and paroxetine are SSRIs then we're

  • going to see that duloxetine is an SNRI and later we're going to find a non

  • stimulant ADHD medication atomoxetine so this -oxetine ending you really have to

  • be careful. Fluoxetine is interesting it's got two brand names

  • Prozac was the first brand name that came out it was

  • antidepressant sounds like a strong drug with the P, Z and the C or with a K sound

  • and then Sarafem I'm not sure what they were going for a seraphim it's like the

  • highest angel so maybe it was the work of angels but that's for something

  • called premenstrual dysphoric disorder, PMDD. Paroxetine, Paxil and then

  • Paxil controlled release so again another medication that works a little

  • bit longer. Then we have the serotonin norepinephrine reuptake inhibitor and

  • I'll try to do a little better job with my writing here serotonin norepinephrine,

  • and I'll abbreviate it NE, reuptake

  • inhibitor and so we're just affecting different neurotransmitters where

  • selective serotonin reuptake inhibitor was just serotonin now we're talking

  • about serotonin and norepinephrine again the -oxetine be careful with that

  • it's supposed to indicate a SSRI Cymbalta so my mnemonic was to remember

  • that symbol players all would always seem to be happy and alta means above in

  • Spanish so higher mood maybe. Then the -faxine is the stem here in

  • venlafaxine and for Effexor so that's a way to remember that one. So the TCA so

  • this SNRI and SSRI are are both named after neurotransmitters but

  • amitriptyline is named after or the tricyclic antidepressant is named after the

  • three rings so you can see that -t-r-i- in the stem -tripyline and Elavil elevates

  • your mood. Isocarboxazid I didn't have a stem that I saw but I had a

  • student that said I sew car boxes and it just seemed very sad so it's a monoamine

  • oxidase inhibitor so mono, m-o-n-o, a-m-i-n-e and oxidase inhibitor and

  • what that monoamine really means is that we're still kind of going back to

  • serotonin which is a monoamine and that we're affecting it we're just calling it

  • by a different name. Smoking cessation so bupropion was first

  • an antidepressant it was Wellbutrin so ideally you would get well or get out

  • of the rut you're in so you see the r-u-t and then -i-n in there but then they

  • found that a lot of these antidepressants stop smoking so though

  • this is great let's make it an anti smoking drug so they renamed it Zyban or

  • repackaged it that way. Varenicline it's chantix so the new

  • -nicline stem indicates a smoking cessation medication and and I had a student that

  • said in a southern accent oh when I take varenicline on their inclined to quit so

  • or with Chantix, my chant is that I don't need my fix so anyway it just

  • stuck in my head. So these are antidepressants all the way down to

  • bupropion which can also be used for smoking cessation then varenicline is

  • specifically a smoking cessation medication. Next we're going to go on to

  • some anti-anxiety and ADHD medications and antipsychotics as well.

  • So the first thing with the benzodiazepines is that on a lot of YouTube channels you'll see

  • -lam and -pam are stems and that's just incorrect you want to be careful because

  • there's a drug lamotrigine which is an anti epileptic and there's verapamil

  • which is a calcium channel blocker and that's for high blood pressure those are

  • not benzodiazepines so use the whole stem -azolam or -azepam. Xanax has part

  • of the word anxiety and it's so easy enough to remember. Versed, I can't

  • remember the verse you just said. Klonopin and clonazepam are very similar

  • and then Ativan I don't even remember what I use for that one so but really

  • stick with the generic stems that's what you want to use for the benzodiazepines.

  • Dexmethylphenidate, methylphenidate I couldn't really find a stem for them

  • but you can see what the brand names what they're for so these are stimulant

  • schedule twos for ADHD they can help you focus, Focalin, or they can help you

  • concentrate and they just kind of turn the last couple letters around there.

  • Non-stimulant ADHD medication atomoxetine again we see this -oxetine

  • stem this does not mean it's an SSRI you have to memorize that it's a non-

  • stimulant ADHD medication, Strattera can straighten out your attention. Bipolar is

  • a simple salt so lithium and Lithobid so BID, bis in die, is the Latin for twice

  • daily so lithium is taken twice daily in this particular dose. First generation

  • antipsychotics there's also a term called so these would be the typical, t-y-p-i-c-a-l

  • antipsychotics and then when we get to second generations those are atypical

  • but we don't usually use antipsychotic as a term because to say someone is

  • psychotic is just not a nice way of saying it so usually we say anti

  • schizophrenic. So chlorpromazine was the first one that came out its Thorazine

  • and this is low potency that's important because the low potency drugs tend to

  • cause sedation and low potency just means that you need a hundred milligrams

  • to get the same thing out of chlorpromazine as two milligrams of

  • haloperidol which is high potency can do. So the haloperidol has the -paridol stem

  • and a lot of students think of the halo to remind them or the halo in

  • haloperidol to remind them that this is high potency first-generation

  • antipsychotic but you can also replace first-generation with typical anti

  • schizophrenic. So that's first generation some of the drugs for anxiety ADHD

  • bipolar and psychosis let's look at the second generation antipsychotics and the

  • anti-epileptics. So the second generation antipsychotics

  • the -peridone in risperidone and the

  • haloperidol and Haldol are very similar somebody said that the 'risper' sounds

  • like whispers so like you're hearing the whispering voices. Quetiapine if you

  • change this T and I and then put the I over one and kind of turn it around you

  • end up with quiet so quiet the voices but the stem is -tiapine

  • and that's Seroquel to quell something is to calm something down so

  • risperidone quetiapine are both second-generation antipsychotics we

  • would also call these atypical. Why is that important?

  • atypical antipsychotics have less extrapyramidal symptoms but would have

  • more dyslipidemia, more dyslipedema, diabetes, weight gain, things like that in

  • general again you don't want to generalize too much there's certainly a variation

  • within the class. Anti-epileptics we break them down into traditional versus

  • newer so we've got carbamazepine (I missed a B there)

  • carbamazepine and the -pine just means that we have some kind of, I think it's a

  • tricyclic molecule, but the way to maybe remember it is that you carb or curb the

  • convulsions or you control them so you see the T the R the O and the L that

  • could be from the word control that's one way to look at it.

  • Divalproex is Depakote 2nd traditional one and then phenytoin has the -toin, t-o-i-n

  • stem and this is Dilantin and you would want to remember it from the -toin

  • stem. The newer ones now I only just happen to pick two drugs that happen to

  • have gab in them, gab is a stem it's for the gamma-aminobutyric acid and

  • gabapentin is Neurontin and you can think of the n-e-u which is pronounced

  • new as the newer anti epileptic and then Lyrica also is a newer one.

  • Lyrica if something's lyric it's musical so we're taking this very disordered

  • epilepsy and making it more ordered so that's one way to think of it.

  • Parkinson's disease so dopamine or lack thereof is a real problem