Ep 35 Proton Pump Inhibitors Mnemonic - ULCER DEVELOPER

Proton Pump Inhibitors Mnemonic - ULCER DEVELOPER

This is advanced pharmacology mnemonic #3 of 134 that we'll be going over, I'll usually do a brief introduction, play the mnemonic from the course, then we'll do a couple of quiz questions to make sure you got what I was throwing down.

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Auto Generated Transcript:

Hey, welcome back to the Memorizing Pharmacology podcast. I’m Tony Guerra, your host and pharmacist. I wanted to go over proton pump inhibitors, not just because we’re going to do proton pump inhibitors and then in our next episode we’ll do the side effects and so forth, but I saw on Reddit somebody asking about, ‘Okay, how do I memorize all these drugs? They’ve given us 200, 300, whatever the number is, whatever the instructor gave you.’ And what I tried to do with the Memorizing Pharmacology book, the first edition was 200 drugs, the second edition is 350 drugs. You can just go to memorizingfarm.com if you just want the link to it.

What I wanted to get into was understanding how to take a drug class, kind of isolate it first and just say, ‘Okay, let me look at the drugs in this class first.’ Put those together and then what I’ll do is I’ll put them in order. So when you go into the Memorizing Pharmacology book, it’s intentional that you see antacids first, H2 blockers second and proton pump inhibitors third. Because when you’re looking at them you’d say, ‘Okay well what would be first? Well first I might just take an antacid. My stomach’s a little bit upset.’ Then you might say, ‘Alright well you know it’s kind of lasting a long time so maybe I’ll use an H2 blocker.’ And then when you have an ulcer as we’ll talk about in the ulcer developer mnemonic well then really proton pump inhibitors are probably where you’re going to go.

And all throughout the book that was the whole point is doing everything in an order that’s memorable because there’s a story with it. So that story that goes along with the book that’s what fixes the problem of ‘Oh I get it. They’ve given me 300 drugs. I just got to put some stories together.’ That makes sense so that I can remember not only the drugs but some of the side effects and what they’re for.

So you’ll hear the mnemonic and what it’s about in a little bit about each of these proton pump inhibitors but what I wanted to kind of get across to you is that in general when you are given a list they are not in the correct order which is why I created that list that you get when you join the email. Is that when you have them in the correct order that’s when your brain’s like ‘Oh I get it.’

And maybe a good example of this is there’s a show I think it’s called The Home Edit and when they organize closets and toys and all those things they actually use the rainbow. So remember ROY G BIV: red, orange, yellow, green, blue, purple, violet whatever it is. And because they have it in that order you always know ‘Oh yeah I remember that book it was a blue book so it’s going to be here or I remember it was a red book so it’s going to be here.’

And all that matters is you do it in a way that is meaningful to you that’s helpful to you. And so when you listen to these and you’re kind of diving into the book or the course or whatever you’re doing you need to be thinking ‘Okay what’s the story I can put together?’ And the reason I wrote the book was my students are so busy and so exhausted it’s like ‘Well do you have time on the way?’ Well that’s the one place I have time alright great.

Just throw the book in before class. You can listen to the GI chapter. You understand the story of going from antacids to H2 blockers to proton pump inhibitors and then later on you kind of understand the story of okay well we’ve got anti-diarrheals versus those constipating drugs and things like that.

And so these stories come along another good example are the diuretics when we get to the cardiology section where you really want to go from the glomerulus all the way to the collecting duct and kind of begin at the glomerulus and then you know you go up the loop of Henle and then the distal convoluted tubule. And so you’ve got a great picture in your head.

Anyway, I went really long with this introduction so here’s the mnemonic for this week. And again if you need me tonythepharmacist@gmail.com.

Question number four: Name six proton pump inhibitors and their class suffix.

Number four: Proton pump inhibitors (PPIs). We’ll use the mnemonic Ulcer Developer: D - Dexlantoprazole (brand name Dexilant), E - Esomeprazole (brand name Nexium), V - Lansoprazole (brand name Prevacid), E - Omeprazole (brand name Prilosec), L - Pantoprazole (brand name Protonix), O - Rabeprazole (brand name Aciphex).

Quick summary: Often someone who is an ulcer developer needs proton pump inhibitors for treatment. Our acrostic becomes Developer.

Before I go into proton pump inhibitors, let’s pause to talk about mistakes with suffixes. I just read another pharmacology mnemonic book that got this wrong. The World Health Organization (WHO) globally and the United States Adopted Names Council (USANC) agree on a drug beginning prefix middle.

The ending these organizations agreed on for the H2 blockers is tidin (T-I-D-I-N-E). I see students quoting quizzing note card websites as reliable sources. They write that drugs ending in en (I-N-E) are always H2 blockers. That’s untrue. Morphine, an opioid, and fluoxetine, an antidepressant, both end in en for example. This build your own suffix error is a cognitive heuristic bias. That means the note card and book authors believe something wrong to be right.

Back to our proton pump inhibitors (PPIs). The ending or suffix is prazol (P-R-A-Z-O-L-E). The suffix is not a zol (A-Z-O-L-E), an organic chemistry molecule. If you use that as your mnemonic or suffix then fluconazole, an anti-fungal, is grouped into proton pump inhibitors. The proper suffix for fluconazole is conazole (C-O-N-A-Z-O-L-E), suggesting anti-fungal. There’s also aripiprazole with the piperazole (P-I-P-R) stem for schizophrenia.

Using suffixes is powerful but when an author cites various suspect internet sources, you might want to look elsewhere. With this prazole ending, we can now talk about six proton pump inhibitors.

Some students connect the prazol stem with preventing and protons all starting with the per sound to remember this order. We’ll use the mnemonic Ulcer Developer with these drugs using the D, E, L, O, P and R of the word Developer.

D - Dexlansoprazole’s brand Dexalant stands for right-handed excellent because the right-handed enantiomer lasts longer than its racemic lansoprazole counterpart does.

E - Esomeprazole: While the prazole (P-R-A-Z-O-L-E) ending means PPI, the E-S means S for sinister or left-handed, the active enantiomer. The manufacturer released Nexium after Prilosec as the next PPI drug.

V E L - Lansoprazole’s Prevacid prevents acid. The prev in prevents coupled with acid will help you to remember.

O - Omeprazole’s Prilosec has the PR for hydrogen protons. Protons or hydrogen ions are what make an acid acidic. The low (L-O) for low (L-O-W) and the sec for secretion of those protons or the O in Prilosec looks like a zero and Pry O Sec provides zero heartburn.

P - Pantoprazole’s brand Protonix reverses nicks and protons. Pantoprazole like esomeperzole and rebeprazole comes in an IV form.

E and R - Rabeprazole brand Aciphex combines aci from acid, ph little p capital h from the ph scale and x to excrete.

We try to avoid working on more than four drug names at a time because it taxes our short-term memory. Here we have six drug names however two drug pairs have parallel routes.

Esomeprazole and omeprazole only differ by ES (S). These two letters ES mark esomeprazole as the left-handed enantiomer, the one with therapeutic benefit. Omeprazole is an S and R enantiomer mixture with the omeprazole root.

The other pair includes dexlansoprazole, the R plus enantiomer of lansoprazole, the racemic mixture with lansoprazole roots.

Your brain chunks these four medications into two couples like your credit card chunks four groups of four numbers: esomeprazole pairs with omeprazole and dexlansoprazole pairs with lansoprazole. Then it adds two singles: pantoprazole and rabeprazole to chunk down to a group of four units like this:

1 - Dexlantoprazole and Lansoprazole 2 - Esomeperzole and Omeprazole 3 - Pantoprazole 4 - Rabeprazole

Knowing these groupings is what makes pharmacology easier. If you had a pile of 400 coins stacked with pennies, nickels, dimes and quarters you could separate them by their properties: the pennies are copper, the quarters are largest and dimes smallest; what’s left are nickels.

In pharmacology we need to take two minutes to figure out what the properties are for the individual drug classes then it’s easy to sort them.

Although I focused on peptic ulcer disease you can use these PPIs for conditions like gastroesophageal reflux disease (GERD) which can rarely turn into Barrett’s esophagus. Barrett’s esophagus, when tissue like the intestinal lining replaces the esophageal tissue, often comes with a higher risk of esophageal cancer. Regular doctor visits for dysplasia or pre-cancerous cells are critical.

Ideally, a patient should take these medications 30 minutes before a meal to get the maximum benefit. Make sure to let the patient know that these medicines may take a few days to take effect and don’t work as quickly as antacids.

Now let’s take a look at the side effects related to PPIs. So as always we’re going to go into our quiz and what we recognize is now we’ve seen esomeprazole, omeprazole, pantoprazole. We see that these all have the same prazole endings and cetirizine does not. So cetirizine is an antihistamine, thus this would not be a proton pump inhibitor.

Okay, we go to the next one. What is the brand name of omeprazole? And again we could go back up but we want to see alright well Dexilant, that doesn’t sound right. Nexium, no that’s esomeprazole. Prevacid, that’s not quite it either. Oh yeah, Prilosec, that’s right.

Omeprazole was supposed to be Losec but Losec actually was so close to Lasix that they made them change it. So they thought, what about protons? So protons low secretion, that’s what they were thinking when they made the brand name Prilosec for omeprazole. We check and we see that that’s correct.

So again, the big thing with these is making sure that you’ve taken the time to look at many of them in the same place so that you recognize them. I will tell you about one drug class it’s a little bit goofy something like aripiprazole. It’s not supposed to be that way where you have a stem in a stem but those are antipsychotics and that would not be correct. So again, prazole is what we’re looking for as an ending.

Hey, thanks again for listening to the Memorizing Pharmacology podcast. Again, everything that I talk about is on the memorizingfarm.com webpage. Whether you need to do the Memorizing Pharmacology: A Relaxed Approach for those, the second edition is the one that I put on there just because it’s the newest but that’ll get you to 350 medications.

And then the Memorizing Pharmacology Mnemonics is what we’re going through now and making sure that you know once you get to that advanced level and you need to know those side effects and all those things that those are there as well.

If you are a pharmacology instructor, I’ve got a PDF here of a number of resources for you that could be helpful and again if you need my help tonythepharmacist@gmail.com.

Like to learn more?

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