For the last few days, I've been doing my pharmacology review for the USMLE step 1. I know it doesn't exactly sound exciting; nonetheless, I'm excited about it. I think this is the third time I've reviewed pharmacology. The first was, obviously, on the island. The second was last semester (5th semester) during the UMBR course (University Medical Board Review course) that was offered in the evenings. There is a lot of memorization in pharmacology and I think multiple exposures are helping me remember the classes of drugs and the little unique things about each drug.
In medical school lectures, exams and the licencing exams, pharmacological agents are known by their generic names. At times last semester, I felt really dumb because patients would name off their medications and I wasn't sure what class some of the drugs fell into. The reason is that most people know drugs by the trade name (brand name). For example, other than a health care professional, who would know that Benadryl (trade name) is also known as diphenhydramine (generic name)? Honestly, who is going to refer to Benadryl as diphenhydramine--it's too hard to spell let alone pronounce. However, one advantage to the naming system of the generic drugs is that classes of drugs sound similar. Let's consider beta blockers, which are drugs that can be used for several different cardiovascular problems, such as hypertension and some types of heart arrhythmias. All of the generic beta-1 blockers end with -olol. If the drug is a non selective beta blocker (meaning, for example, it blocks beta-1 and beta-2 receptors), it has a slightly different ending, such as -ilol. As far as I know, the trade names, have no rhyme or reason. For example, some beta blockers:
- Acebutolol's trade name is Sectral
- Atenolol's trade name is Tenormin
- Bisoprolol's trade name is Zebeta
- Carvedilol's trade name is Coreg
- Metoprolol's trade name is Lopressor or Toprol XL
- Nadolol's trade name is Corgard
- Nebivolol's trade name is Bystolic
- Propranolol's trade name is Inderal LA
One day last semester, a patient told me he was taking Coreg. I felt so dumb that I didn't know what it was. I knew it was a heart medication because of the commercials, but I didn't realize it was a beta blocker. I sure as heck know what a beta blocker is! This is just one example of how confusing all of these drug names can be, especially when you are still learning. Thank God for pharmacists! It is a bit ironic that I'm finally feeling really confident with my pharmacological knowledge and in a few months I'm going to have to start seriously learning all of the trade names. Up until now, I've left learning the trade names on the back burner, as it isn't on exams and there is only so much room in my brain for information. However, next semester when I see patients full time rather than part time, knowing trade names will be more important since, as already mentioned, most people know trade rather than the generic names. I'm also going to start learning some important economic information--which drugs are available generically and which are not yet available generically. As obvious as it sounds, if patients can afford their medications, they are more likely to stick to the treatment plans and drugs available generically are much more affordable than those that are not. Thus, over the next few years I'll have to start learning what is available generically so I can suggest those medications when applicable. However, some of the newest and best drugs are those that are still under patent and therefore not available as generics yet. Oh, and every hospital has a different formulary (drugs they keep in stock)! It seems in health care, whether you are trying to learn medicine or receive medical care, you can't win for losing.
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