it's all fun and games until medicosis starts teaching pharmacology what is going on wonderful people it's medicosis perfectionis where medicine makes perfect sense today is an important day because we'll talk about an introduction to pharmacology in this video you'll understand what general pharmacology is which includes pharmacokinetics and pharmacodynamics you will learn about autonomic pharmacology neurop pharmacology which is pharmacology of the central nervous system and of course the central nervous system is the brain and the spinal cord we will talk about metabolism of medications and their elimination in many a case it's the kidney that eliminates the medication we'll talk about cardiac pharmacology we'll talk about medications for asthma and other respiratory diseases we will briefly discuss renal pharmacology GI pharmacology and endocrine pharmacology so click the like button click the Subscribe button and let's get started this is my pharmacology playlist it has more than 250 videos about every single pharmacology topic that you can imagine this playlist begins with a bunch of miscellaneous subjects to get you interested in Pharmacology once you start loving pharmacology you will cruise through medicine like a sharp knife in warm butter so what are we going to talk about today we'll talk about phaco kinetics and phaco Dynamics together we call them General pharmacology everything else is systemic pharmacology because we we deal with systems this is the autonomic nervous system this is the central nervous system pharmacology cardiovascular pharmacology endocrine pharmacology anti-cancer pharmacology namely chemotherapy toxicology what happens if I take too much ID pharmacology and I'll tell you what uid means and what ioso means and then antibiotics or preferably antimicrobials because antimicrobials is a more inclusive term that includes antibacterials antivirals antifungals and anti-parasitic medications once we finish this video if you want to take it to the next level I have a special course about each one of these pharmacology subjects on my website medicosis Perfection n.com you can download these courses and keep them for you forever my website is medicosis perfect.com if you have studied physics before you will recall that kinema means motion first things first medicosis symbols for pharmacology when I use the symbol it means the clinical uses of the medications but when I use this it means the side effects or the adverse effects of the medication this means resistance for example the bacteria can resist your medication rendering it ineffective this said liver means that the medication is toxic to the liver or hepatotoxic this Tad kidney means that the medication is nephrotoxic this gear means the mechanism of action of the medication this means contraindications of the medication look at this running action for me kinetics motion this is an oral pill or tablet this is an intravenous medication this is an intramuscular medication this is Under the Skin subcutaneous medication this is a topical medication this is a transdermal patch drug plus drug equals danger so drug drug interaction this is a gram positive caucus this is a gram positive Rod gram negative caucus and gram negative Rod all of these are bacteria this means bacteria Cal meaning that the medication will kill the bacteria bacteria means bacteria cidal means killer as in homicide and suicide but this means that the medication is bacteriostatic it's not going to kill the bacteria but it will hinder its replication this clam means clamidia this symbol means that the medication is a liver enzyme inducer meaning inducer of the p450 liver enzyme system also known as liver microsomal enzyme but this means that the medication is a liver enzyme inhibitor which means it's an inhibitor of the p450 system when you are a p450 inducer you will stimulate the metabolism breakdown of other medications so they will last shorter but if you are a p450 inhibitor you will inhibit the metabolism or degradation of other medications so the other medications will last longer causing more toxicities this means neuropathy this is myopathy or pathology in the muscles some medications cause muscle weakness this means myo suppression or suppression of the bone marrow myo means core the bone marrow is in the core of the bone this means the medication is given via infusion this means that the medication causes nause vomiting diarrhea or GI distress whenever a professor asks you hey what are the side effects of this specific medication whatever the medication might be and if you have not studied well you have no idea how to answer just say nause your vomiting diarrhea and in 99% of cases you would be correct because many medications cause nause your vomiting diarrhea this means that the medication is autotoxic this symbol means that the medication causes Cardiac Arrest this means heart block or Brady cardia this means that the medication causes hypotension this is upper respiratory tract infections and this is again is Milo suppression Now what is pharmacokinetics what your body does to the drug and what does my body do to the drug it is Adam spelled funny what is this a DME the a is absorption D is distribution m is metabolism or degradation e is excretion or elimination but pharmacodynamics is the opposite it's what the drug does to your body and not what your body does to the drug the way I remembered is that pharmaco Dynamics is what that drug does to the body forac kinetics what your body does to the drug a d m absorption distribution metabolism elimination what is absorption mean absorption means that the drug is going to reach your body by passing through a barrier by passing through a membrane if the drug was here and then passed through a membrane and now it was able to reach your blood supply or vascular system then this process is called absorption but remember you have to has a membrane in order to be absorbed famous sites of absorption your gut or gastrointestinal system and that's why we take oral medications because they will be absorbed through the gut and also your lungs and that's why we have inhalers or nebulizers or atomizers they will be absorbed through the mucous membrane lining your respiratory system moreover the mucosal surface of the mouth can absorb medications have you ever heard of people who chew tobacco how does that work when you chew tobacco it will be absorbed through the mucus membrane lining your oral cavity next there are vaginal medications like vaginal suppository same thing for the rectal so all of these are sites of absorption next distribution what does that mean absorption took me to the blood distribution will take me from the blood to the tissue okay what kind of tissue any cell in your body oh tissue yeah a tissue is a bunch of cells gathered together next the M is for metabolism what does that mean it means that the drug changes from one form to another form usually but not always the drug starts as active and then it becomes inactive and this is degradation for example let's say that you took acetaminophen or paracetamol or Tylenol it's the same thing all right who's going to metabolize this body the liver well what does that mean it means that after the acetaminophen has done its job which is antipyretic analgesic but not anti anti-inflammatory after it helped you with the pain symptoms Etc and after it has performed its function now it's time for deliver to degrade it from something active to something inactive from something that is functional to a piece of trash and then this piece of trash will be eliminated elimination of drugs can occur via the kidney or via the bilary system or the stool you can pee the drug out or poop the drug out you can even sweat the drug out depending on the typee of the medication this is pharmacokinetics by the way throughout the rest of this pharmacology playlist we will talk in great detail about each one of these topics phaco kinetics and pharmacodynamics or general pharmacology is covered in 10 videos autonomic pharmacology 15 videos neuro pharmacology 20 videos cardiac pharmacology including diuretics 50 videos endocrine pharmacology 15 videos chemotherapy another 15 videos toxicology 25 videos IDs 20 videos and antibiotics 40 videos not just antibacterials but antivirals antifungals and antiparasitics as well you can watch all of these videos in my pharmacology playlist or you can download them from my website medicosis perfect.com keep in mind that there are two types of medications there is the lipid soluble and the water soluble the lipid soluble is water insoluble and the water soluble is lipid insoluble which means if you are soluble in fat you are not soluble in water but if you're soluble in water you will not be soluble in fat because oil and water do not mix if you're lipid soluble you are fat soluble you are water insoluble and we call you non-polar but if you're water soluble you are polar and we call you lipid insoluble if you want to see more videos like this in the future please drop some W Emoji in the comments why should I care pharmacologically speaking because your blood is made of plasma and the plasma is mostly water and some electrolytes so the blood is water okay which means if you are a medication that happens to be water soluble you will have no problem floating freely in the blood you do not need help from anyone because your blood is your land you like it you cruise through it but don't forget that that the cell membrane is lipid by layer meaning the cell membrane is fat and if you are a water soluble medication like this you cannot enter and pass through the lipid by layer AIS denied because you are water soluble and the membrane is lipid soluble so you're not going to be able to diffuse through it now contrast that with a lipid soluble medication it is made of lipid and the cell membrane is made of lipid so of course the lipid will cruise through the lipid like a sharp knife through warm butter no pun intended your blood is made of plasma and blood cells the plasma is water with electrolytes and a bunch of plasma proteins but for the most part your plasma is water so if you are water soluble you'll float freely in the plasma but what if I'm lipid soluble oh you are a lipid soluble medication and the plasma is made of water so you do not mix well therefore if you are a lipid soluble medication someone else has to carry you on his shoulder this someone could be Albin or globulin basically a plasma protein so if you are water soluble keep cruising through the blood no problem but if you are lipid soluble someone needs to carry you and this carrier is a protein carrier could be albumin or globulin which one is more abundant albumin which one is more big globulin the plasma is water but the cell membrane is a lipid by layer and the cell membrane is made of all kinds of lipids phospholipids check cholesterol checks other lipids including spingle lipids check on the distinction between the lipid soluble medications and the water soluble medications Charles Dickens wrote it was the best of times was the worst of times it was the age of wisdom it was the age of foolishness it was the epoch of belief it was the epoch of incredulity it was the season of light it was the season of Darkness it was the spring of hope it was this winter of despair nothing says winter of Despair like studying pharmacology for your final exam now I am a lipid soluble medication now what you cannot float freely in the blood unfortunately because the blood is water okay so someone has to carry on his shoulder and this is a plasma protein all right however if you reach the lipid by layer cell membrane you can cruise through it like olive oil in butter no problem whatsoever contrast that with a water soluble medication in the plasma float freely I do not need any help from any plasma protein because I am water soluble in a water soluble medium in a water medium however once I reach the cell membrane I cannot enter ax is denied because I am water soluble and the membrane is lipid soluble so I cannot access which means that I need a receptor on the outside and I need a middle man and this middle man is a connector it will connect the the receptor on the outside with the nucleus on the inside and this midal man will help me transfer the signal please note that if you are a lipid soluble medication your receptor will be on the inside because you can cruise through you can pass through the membrane so we will put the receptor on the inside could be in the cytoplasm could be in the nucleus doesn't matter but if you are a water soluble medication your receptor has to be external because you cannot enter every everything was lipid soluble everything was water soluble it was bound to plasma proteins it was freely floating in the serum its receptor was internal its receptor was external it was genomic action it was a non genomic action it was slowly acting it was rapidly acting why genomic action because when you are lipid soluble your receptor is inside sometimes in the nucleus oh nucleus has DNA and DNA has genes genomic why did we learn about all of that in order to understand this glorious slide if you are a medication that is water soluble we can give you intravenously because your blood is water and the drug is water soluble but if the medication is lipid soluble we cannot give it intravenously will be a problem but we can put it on your skin because your skin has cells and the cells have cell membrane which is lipid by layer or we can give it orally because it will be absorbed let's say in your gut in the intestines and the int have cells and these cells have membranes and the membranes are lipid what determines the solubility of the drug water soluble versus lipid soluble and how much the polarity the size and the charge these three factors determine the solubility of the drug which determines the route of administration whether intravenous transcutaneous or oral some medications are more acidic others are more basic and acidity or basicity determine whether the medication will be charged or or not if you are charged we say ionic which is polar which is water soluble what if the medication is basic and water insoluble well we can make it react with an acid now acid plus base equals salt plus water okay and this salt would be water soluble this is called a neutralization reaction conversely if the medication is acidic and water ins Sol you can react it with a base to achieve the same neutralization reaction which means acid plus base equals salt plus water now you converted it into something water soluble if you have a compound that is protonated by protonate I mean protons it has lots of protons and it's acidic and a cation which is a positive ion if you reacted with a base you will neutralize it and release it from its salt now it's water in soluble again and this is how pharmaceutical companies can manipulate the crud out of of these medications just by understanding chemistry and this is why a doctor who does not know chemistry is like a butcher who does not have a knife what the flip are you doing Quest time which of the following routs of administration offer the fastest absorption rate is it a Oral B intramuscular C intravenous D transdermal e inhalational or F topical please pause the video and let me know the answer in the comments some of you said EAS micosis of course intravenus they have the highest bio availability which means the fastest absorption this is a doofus mistake and now you're just somebody that I used to know what's the problem with the intravenus here is the problem look my friend this is your vein okay and if I give you a medication in an intravenous fashion it means that I injected the medication into your vein correct and the medication was released here now did this cross any membranes no it did not cross any membrane but how about the the syringe is not a living membrane you freaking piece of Melina what is Melina Melina is the color and consistency of my stools when I have upper gastrointestinal bleeding but that's a story for another time remember intravenous does not cross membrane and by definition absorption is crossing membranes intravenous medications do not cross membranes therefore they are not absorbed therefore they cannot be the fastest absorption rate because they are not absorbed period so if I cannot choose intravenous then what else should I choose well the fastest of the choices left is inhalational and that's why patients who have bronal asthma they can take an inhaler to stop the asthma attack which tells you that inhalational medications have fast absorption rate and this is forco kinetics absorption distribution metabolism elimination let's talk about distribution quickly distribution is from the blood to the tissue what is absorption absorption is crossing membrane you give me a pel then it's going to cross the membranes and my intestine and will reach the blood but if you give me an intravenous drug it will reach the blood without being absorbed and then any medication has part of it protein bound meaning inactive and free which is active only the free is active then we're going to distribute the medication to the tissues and at the tissues the medication will have the desired effect or the therapeutic effect and as Dr Thomas Soul said there are no Solutions in life only tradeoffs every medication in the history of the world has side effects and every surgery has complications anyone who says otherwise is lying to you and after the medication has done its job it's time to degrade it and eliminate it and this is forac kinetics absorption distribution metabolism elimination if you have watched my physiology playlist you will remember that cell membrane transport is divided into passive and active pass passive means I do not need energy I do not require ATP but active does require energy or ATP passive happens along the electrochemical gradient from high concentration to low concentration but active is the opposite it's against gradient from low to high passive transport is also known as diffusion and we have many types simple diffusion osmosis which is a simple diffusion for water and facilit ated diffusion which requires a carrier protein simple no carrier osmosis no carrier facilitated I need a carrier medications need to pass across membrane this is the definition of absorption this passage could be passive meaning no energy needed or active which requires ATP the passage of medications could require no carrier or it could require a carrier the moment you require a carrier protein you will have structural specificity competition and saturation structural specificity means the key in the lock model the drug is the key the receptor is the lock when the key binds the lock you can turn the key inside the receptor and then the receptor will start to produce the function competition one medication can compete with another medication for the same receptor third saturation what does that mean there will come a moment where all of your receptor will be occupied and therefore you will be saturated and if we draw a graph it will look like this in the beginning The receptors were available so the more drug you add the more effect you get until you saturate all of the receptors and then you will level off you have reached the maximum velocity or Vmax which medications will pass faster through a membrane or which medications will be absorbed faster lipid soluble will be FAS than water soluble for obvious reason because the membrane is lipid by layer Okay small molecules faster than large ones makes sense liquids faster than solids and crystalloids faster than colloids what is crystalloids well if you've watched my chemistry playlist you will recall that crystalloid is something like sodium chloride in water oh crystalloid oh got you so it's like saline solution that is true what is colloid colloid is something heavy what do you mean by heavy something like a protein oh like Albin yes indeed so if you have a patient who is bleeding to death in a hemorragic hypovolemic shock and you want to give that patient fluids to save the patient's life to prevent and avert hypotension which one should you give crystalloids or colloids well you give the faster crystalloids act faster so we give crystalloids not colloids so if I ever hear that you gave your patient who's bleeding colloid in instead of crystalloids I will smack your gluteus maximus what are the factors that affect diffusion including absorption there is the equation diffusion is directly correlated to Delta C which is the concentration gradient a which is the surface area T which is the temperature but diffusion is inversely related to the square root of M which is the molecular size of the drug and L which is the length meaning the thickness of the membrane so let's start with the direct proportional first so there is a direct correlation between concentration gradient and diffusion the higher the concentration gradient the greater the diffusion there is a direct correlation between surface area and diffusion the higher the surface area the higher the diffusion there is a direct correlation with temperature so the higher the temperature the greater the diffusion of the medication but the inverse correlation is moleular size so if you have a big humongous drug diffusion will decrease if the thickness of the membrane is great diffusion will decrease simple diffusion does not require a carrier so the more you add the more the diffuse however facilitated diffusion which requires a carrier protein will give you what it will give you a seiling effect it will give you a V Max at this moment all of your receptors are saturated so we're done with absorption and distribution here's a quick note on metabolism metabolism also known as biotrans transformation is a biological transformation I'm changing from one phase to another this something to another could be active drug to inactive drug or less active drug inactive to active oh this is a pro drug a pro drug is a drug that you give in an inactive form and then later your body will activate it a classic example is Ison another mode of metabolism is to convert the drug from active to even more active such as morphine becoming morphine six glucuronide and there is the dreaded metabolism of turning the active into toxic all of these are examples of biotransformation # metabolism it's a DME absorption distribution metabolism the E is elimination elimination meaning I'm going to take this inactive drug and dump it you can dump it into the urine into the stool into the bile you can breathe it out or you can sweat it out we're done with phaco kinetics let's have an introduction on pharmacodynamics what is phaco Dynamics what the drug does to your body pharmacokinetics is what your body does to the drug and this is adme absorption distribution metabolism elimination but pharmacodynamics is what the drug does to your body this is the drug this is the receptor in your body if the drug is water soluble it cannot pass through the membrane so the receptor will be on the outside but if the drug is lipid soluble the receptor will be on the inside which could be cytoplasmic or nuclear and the drug is going to bind to the receptor like a key in a lock like a truck in a dock so for macrodynamics studies drugs and The receptors and the drug drug interactions and then when the drug meets the receptor what's going to happen just like when Romeo met Juliet you can open or close a channel you can stimulate or inhibit a pump or you can start a genomic action genomic means related to DNA because of the drug is lipid soluble its receptor will be on the inside near the nucleus and the nucleus has genes how much does the drug and the receptor love one another is called Affinity this is the main drug this is an Agonist to that drug what does that mean Agonist means just like you if you're going to increase the heart rate then I will increase the heart rate as well I have the same effect as you we share the same receptor we produce the same effect but what's an antagonist unfortunately many students think that the antagonist will do the opposite effect but that's not correct for example some students think that if The Agonist is going to raise my heart rate then the antagonist will lower my heart rate nuh-uh the truth is that The Agonist binds to the same receptor or another receptor producing no effect zero not the opposite but hey medicosis wait a second I know that beta agonists are going to raise the heart rate and beta antagonist will lower the heart rate how did that happen well beta blockers did not lower the heart rate per se what beta blockers did is that they got bound to the same receptor blocking the receptor this is a beta receptor which belongs to the sympathetic nervous system so now the sympathetic is blocked but you know who is not blocked parasympathetic nervous system is not blocked so the parasympathetic nervous system will have the upper hand because you inhibited the sympathetic now the parasympathetic is the only game in town lowering the heart rate so what actually lowered the heart rate is not the beta blocker but the parasympathetic function that predominates when you block the sympathetic receptor same medicine makes so much sense once you understand what the french toast you're talking about so here's the full Agonist will give you 100% of the desired effect partial Agonist ah let's say 50% something between zero and 100 what's an antagonist do not say a negative number n antagonist will give you zero it means no effect if you want something that causes the negative or the opposite effect it's called inverse Agonist or super antagonist if up here is a positive value then down here is a negative and I'm going towards the negative so antagonist means Zero Effect okay then you have full Agonist which gives you + one which is 100% partial Agonist between the zero and the one inverse partial Agonist between the zero and the negative 1 and inverse full Agonist or super antagonist ne1 now to learn about efficacy and potency please refer to my video titled pharmacodynamics you will find it in this pharmacology playlist this concludes our introduction to General pharmacology phaco kinetics and phaco Dynamics you can learn more by downloading my general pharmacology course on my website it comes with 10 videos 10 notes questions and answers and my perect fic's ultimate notebook in this course I've presented many problems and their Solutions questions and answers next an introduction to the autonomic nervous system what does autonomic mean it means automatic it means involuntary autonomic Automatic by the way I have an introduction video for every branch in medicine if you have watched my introduction to neuroanatomy video which is part of my neuroanatomy playlist you will remember that the nervous system is divided into somatic and autonomic somatic means voluntary autonomic means automatic involuntary somatic something you can control but autonomic something that you cannot control each one is further subdivided into motor and sensory and this is true for the autonomic as well if you ask the average student or doctor for that matter what is the autonomic nervous system what are the components of the autonomic nervous system they will say with confidence sympathetic and parasympathetic that's it as if the enteric nervous system has left the chat don't forget the ENT nervous system it's part of the autonomic autonomic for your gut it's made of the myeric plexus for motility and the sub mosal plexus for secretions you can learn more about the anic nervous system in my physiology playlist sympathetic versus parasympathetic here we have the sympathetic autonomic nervous system and on the other side parasympathetic autonomic nervous system the sympathetic is fight flight parasympathetic rest and digest sympathetic Thor lumbar but parasympathetic cranio sacral sympathetic is fight flight when you're running from a tiger but parasympathetic is rest and digest eat read and take a dump it's not just a dump it's urination and defecation it's time you relax your sphincters sympathetic nervous system you are running from a tiger when you're running from a tiger what should happen to your heart rate your heart rate should go up what should happen to the force of contraction of the heart it should go up what should happen to your broni they should widen and dilate to breathe more because you are running from a tiger what should happen to your skeletal muscles we should Supply them with more blood by dilating the vessels that reach the muscles what's going to happen to your kidney it will release renin what's going to happen to your adrenal Med it will release epinephrine or epinephrine all of these will raise your blood pressure and you need it when you're running from a tiger also your pupils will dilate in order to see more of your surroundings your lens will become more flat flat for far Vision your spleen which is a blood organ will squeeze itself pushing its Blood Out increasing the blood volume in the peripheral circulation to supply your muscle more and your heart more Etc as for your colon and your urinary bladder well think about it if you are running from a tiger do you want to pee and poop no no what has time for this nonsense so you relax the wall and constrict the sphincter for the colon and for the bladder but parasympathetic is the exact opposite it is rest and digest eat read and take a dump your broni will constrict your eyes will constrict to allow you to read the book better because there is a lot of light in the room reflecting to your eye making it harder to read so that's why you need to constrict the pupil your lens will become more spherical accommodating for near Vision you are eating so you'll secrete lots of saliva you are digesting so your bowel will contract its wall and relax its sphincter to allow you to poop same thing for the urethra relax the sphincter allow you to pee what's the effect of the parasympathetic on the male organ it points # erection what's the function of the sympathetic nervous system when it comes to the male organ shoot and shrink the S with the S # ejaculate if you want to learn more about the effect of the sympathetic and the parasympathetic and The receptors on the urinary bladder muscles and the urethra please refer to my video titled urinary bladder pharmacology which you can find in this pharmacology playlist this is your brain and spinal cord we call them central nervous system there are some nerves that will supply skeletal muscles these are coleric nerves why do you call them coleric because they secrete eoline and what's the name of the receptor on the skeletal muscle nicotinic subm M for muscle this was somatic meaning voluntary but now let me tell you about autonomic or involuntary one is parasympathetic the second is sympathetic you have a gangion and before the gangan pre ganglionic fiber after the gangan another fiber called postganglionic if you are parasympathetic you are coleric in the preganglionic because you release ail choline and you are coleric postganglionic because you also release ayic Coline but there is a difference on The receptors on the gangan it's nicotinic subn n for nerve but on the smooth muscles we have muscarinic receptors if you are sympathetic preganglionic the same as parasympathetic Coline so coleric but post ganglionic is adrenergic why because they release nor adrenaline or nor epinephrine and The receptors are alphas and betas if you are running from a tiger you need to dilate the pupil this happens through the sympathetic alpha 1 receptors so if you give me a medication that is Alpha 1 Agonist it will dilate the pupil # Medias conversely the parasympathetic is rest and digest I want to constrict the pupil and this happens by constrictor Pell muscle which has M3 muscarinic receptors so if you give me a muscarinic Agonist what do you think is going to happen to my pupil my pupil will constrict # meiosis you can learn more both the alpha Agonist and antagonist beta Agonist and antagonist music Agonist antagonist the neotenic the music sympathetics sympatholytics parasympathetics parasympatholytics and all of this doy stuff when you download my autonomic pharmacology course at medicosis perfect ses.com next introduction to neuropharmacology for the pros glutamate and aspartate are excitatory neurotransmitters but Gaba and glycine are inhibitory neurot transmitters this is your neuron when something positive enters into the neuron we call this depolarization which is activation of the neuron but what do you think is going to happen when something negative enters oh the opposite if the entry of the positive is activation then the entry of the negative is inactivation or hyperpolarization okay let's think about the following if the positive entry is activation what do you think is going to happen when the positive leaves in activation or hyperpolarization there are many medications that work by opening chloride channels in your brain leading chloride to enter into the neuron chloride is negative when it enters the inside becomes more negative and the neuron is inactivated and inhibited such is the mechanism of action of the sedatives and hypnotics these medications calm you down they inhibit your brain by acting on Gaba which is an inhibitory neurotransmitter how do these sedatives and hypnotics work they tell the Gaba receptor which is a complex receptor like this to open its chloride Channel now the chloride will rush into the neuron chloride is negative the inside of the neuron will be more negative # hyperpolarization or inactivation which is sedation and hypnosis when your brain is inhibited examples of medication s that work by this mechanism include benzodiazapines and barbiturates next how does Morphine work it has a bunch of mechanisms here is one of them morphine which is an opioid is going to act on a GI coupled receptor by the way I means inhibition and G because it's GTP related and once the morphine binds to its receptor guess what's going to happen potassium channel will open and potassium will leave the chat when the positive is leaving the inside will become more negative # inhibition and this is how morphine and opioids inhibit pain you can learn about opioids anesthetics General and local stimulant stives and hypnotics anti-epileptics anti-depressants antis psychotics and anti- parkinsonian medications when you download my neuropharmacology course at medicosis perfect.com we have covered this this this and this let's have an introduction to cardiac pharmacology sometimes the heart has arhythmia so we have anti arhythmic sometimes you have hypertension so we have medications to lower the blood pressure and to lower the blood pressure you also need to tell the kidney to pee more in order to lose more fluid and lower my blood pressure these are diuretics sometimes I get anena oh chest pain so we have anti-anginal medications sometimes I have hyper lipidemia and Hyper cholesterolemia so we have lipid lowering agents sometimes my heart muscle is weak and I have congestive heart failure systolic failure what should I do give me a medication to boost cardiac contractility these are called positive inotropes in other cases my heart rate is high what do I do give me medications to lower the heart rate these are called negative chronotropes you know what a chronic disease is it's a disease that takes a long time so Chrono means time oh time per minute BS per minute so when something decreases the number of beads per minute it's a negative chronotropic but when a drug raises my heart rate it's a positive chronotropic let me give you example of a positive anot Trope which boosts cardiac contac ility and this is the famous dexin which is a member of the family of the digitalis medication how does it work it inhibits the sodium potassium ATP the sodium pottassium atps may it rest in peace used to kick the sodium out and kick the pottassium in but now it's not working because the doxin inhibited it which means sodium will not leave and if sodium did not leave it will not enter and if sodium did not enter calcium will not leave it's positive for positive exchange and when calcium cannot leave calcium will pile up inside the heart muscle all of this is the cardiac muscle calcium will release his friends from jail what's the jail sarcoplasmic reticulum so this is called calcium induced calcium release calcium is the he of contraction so your heart will contract more this is a positive anot Trope in this pharmacology playlist there are 50 videos that will teach you about antihyperlipidemics anti-arrhythmics anti-anginal medications anti-hypertensives diuretics and the toxin next introduction to endocrine pharmacology what is the endocrine system first the word Endo means what into into what into the blood oh so when you have a cell secreting something directly into the bloodstream it's called endocrine and for my a students it's not just blood it could be lymph as well that's endocrine think of the endocrine system as a company there is a chief executive officer on top followed by general managers underneath which we find employees which work for the company and must obey the managers we also have independent contractors which do not belong to the company and that's why they do not respect the managers whatsoever they might say sweet nothings to their ears just to kiss their gluteus maximus but they do not obey the managers your body works the same way what is the CEO of the endocrine system this is the hypothalamus okay and what is the general manager when it comes to the endocrine system it's called the anterior Peary then we have three employees es that have to listen to the pituitary and three independent contractors that do not listen to the pituitary what are the three employees that have to listen to the pituitary number one thyroid gland number two adrenal cortex number three the gonads ovaries in females and testes in males but what are the three independent contractors that do not obey the Peary instead of thyroid say parathyroid instead of adrenal cortex say adrenal medulla and instead of gonads say pancreas this is the hypothalamus which is the CEO this is the anti pituitary which is the general manager this antipituitary secretes growth hormone prolactin TSH for the thyroid which is an employee act for the adrenal cortex another employee FSH and LH for the goet the third employee as for the poster pituitary it does not synthesize anything from scratch it just borrows some hormones from the hypothalamus what kind of hormones ADH and oyos the anti pituitary is called the adino hypothesis whereas the postop pituitary is called neuro hypothesis why is this because the an pituitary is a true gland adino means gland it truly synthesizes these hormones from scratch but the posterior pituitary is not a true gland it's just a nervous pathway that is connected to the hypothalamus and it borrows the hormones that the hypothalamus made hence neuro hypothesis what does hypothesis mean it means growth under the brain because the pituitary is a growing part under your brain this is the hypothalamus or the CEO this is the interior pitutary and this is the posterior pituitary when the hypothalamus wants the pituitary to make growth hormone the hypothalamus will secrete growth hormone releasing hormone to stimulate the an pituitary to secrete growth hormone growth hormone tells the liver to make igf1 or insulin like growth factor one together the growth hormone and the igf1 will help you um grow that's why it's called growth hormone what if the hypothalamus wants the pituitary not to secrete growth hormone then the hypothalamus will secrete somat Statin somato Statin is a universal inhibitor Statin from static not moving oh yeah I do not want the growth hormone to be secreted so mattin is a universal inhibitor it inhibits everything it even inhibits its own secretion it's a doofus and it comes from the Delta cell Delta doofus next when the hypothalamus secretes gonadotropin releasing hormone the pituitary will listen and make gonadotropins such as fs and LH these gonadotropins will tell the gonads to make testosterone in males estrogen progesterone in females when the hypothalamus makes thyrotrope in releasing hormone the at pituitary listens and secretes th thyrotropin which is TSH or thyroid stimulating hormone guess what the thyroid stimulating hormone is a hormone that stimulates the thyroid gland and when the thyroid gland in front of your neck gets stimulated it releases thyroid hormone or T4 NT3 when the hypothalamus makes corticotropin releasing hormone the an pituitary responds by making act or adrenocorticotropic hormone which is a hormone that is going to grow the adrenal cortex which is exactly what happens now the adrenal cortex not Meda will respond by secreting tons of cortisol and androgen but where is aldosterone well aldosterone is not mainly stimulated by act but it's stimulated by renin and to learn more about this please refer to my video titled the renin and ensin aldosterone system which you can find in my physiology playlist next the hypothalamus can secrete TR oh the same TR is this precisely and this will stimulate the release of prolactin from the inter pituitary gland prolactin is prolation it produces milk from the memory glands but what if the hypothalamus does not want the inary to secrete prolactin then the hypothalamus will make dopamine dopamine will inhibit the release of prolactin so we can think of dopamine as a prolactin inhibiting hormone or a prolactin inhibiting Factor and that's it for the inary for the pros notice the red color these red squares tell you that these cells are acidophils which secrete growth hormone and or prolactin but look at this blue color these are basophils inside the in pituitary to make gonadotropins to make TSH and act we're done with the inter pituitary how about the posterior pituitary the posterior pituitary does not make any hormone from scratch but it borrows from the hypothalamus it borrows the ADH from the supr optic nucleus of the hypothalamus and it borrows oxytocin mainly from the paraventricular nucleus of the hypothalamus to learn more about the different nuclei of the hypothalamus and their functions please refer to my neuroanatomy playlist I have a video about the thalamus and a video about the hypothalamus that are epic now what does that have to do with pharmacology everything there is something called hormone replacement therapy which is an umbrella term that means basically that the patient cannot make enough of a certain hormone so therefore you are replacing it we are giving the patient exogenous hormones from the outside one famous example is estrogen after menopause we can give the patient estrogen and this is hormone replacement therapy therefore you need to know the physiological effects of estrogen because if you know them you can predict the pharmacological effect of estrogen they are similar but not identical you can learn more about the endocrine system in my physi ology playlist you can learn about endocrine pharmacology in this pharmacology playlist I also have a video on the dopamine neural Pathways which will teach you about the different Pathways of dopamine such as the Nigro strial pathway the mesocortical the mesolimbic and the tubero infundibular because dopamine has different functions in different parts of the brain you can watch this video in this pharmacology playlist quick note on the thyroid versus the parathyroid gland thyroid has two two types of cells follicular and parap folicular the follicular is the follicles oh the follicles the cells of the follicles will make what they will make T3 and T4 they will make thyroid hormone but the par folicular which are parallel to the follicular cells are here they are interstitial cells so speak because they are interdispersed between the thyroid follicles they are clear cells so we call them C cells and they secrete C calcitonin so follicular cells T3 and T4 PA of folicular cells calcitonin how about the par thyroid which is parallel to the thyroid these parathyroid glands have Chief cells and oxil cells what's the function of the chief cells they are the chief cells they are the main cells the principal cells so they make parathyroid hormone because this is the parathyroid gland and please remember that the parathyroid hormone wants to increase your serum calcium but the parathyroid hormone is also a phosphate trashing hormone so it decreases serum phosphate next the difference between the adrenal cortex and the adrenal medil the adrenal cortex is mesodermal in origin but the adrenal Medill is ectodermal in origin it came from the neural ectoderm particularly from the neural crest cells which migrate all over the body the adrenal cortex will make mineralocorticoids glucocorticoids and adrenal androgens but the adrenal Medill will make ketamines which include three things epinephrine norepinephrine and dopamine epinephrine is the same as adrenaline and norep penine is the same as nor adrenaline you can learn more about thyroid hormone about the types of insulin and the doses of insulin for patients with diabetes you can learn about cortisol you can learn about estrogen progesterone Androgen and all of this lovely stuff by downloading my endocrine pharmacology course at medicosis Perfection net.com all my courses come with videos notes and cases and the cases are answered of course next introduction to chemotherapy what is chemo well you need to understand the cell cycle first G is for growth you have a G1 and a G2 phase s is for synthesis synthesis of what synthesis of DNA oh you want to copy the DNA yeah we call this DNA replication and what is the M for M is for mitosis oh the actual cell division when one cell becomes two so g0 is resting phase then G1 is growth I'm preparing preparing for what for synthesis okay let's make another copy of the DNA so I started with one one now I have two because I want one cell to divide into two so I better get the DNA ready then grow some more to prepare for what to prepare for mitosis which is the actual cell division when it comes to chemotherapy or anti-cancer medications we divide them into cell cycle specific and cell cycle non-specific cell cycle specific will Target certain phases of the cell cycle for examples the following classes of medication Target the S phase these are the antimetabolites the EP poopy toxins and the chisin analoges who named these things so if I'm taking one of these medications say goodbye to the SAS which means that the cancer cells will not divide but you know what my own cells will also not divide which of my own cells divide the fastest my hair so I get hair loss that's why patients on chemotherapy lose their hair what else my gastrointestinal Linings oh the epithelium oh it's going to be sh Ed a lot I will have diarrhea all the time what else divides fast uh bone marrow cells sure so I get what pan cytopenia anemia lopia and thrombocytopenia next medications that Target the G2 phase include bise medications that Target the M phase include the vena alkaloids and the taxanes then we have cell cycle non-specific so yeah they kill cancer cells but they do not Target a specific cycle phase and these include all the following so the anti caner drugs or the chemotherapeutic agents are many they include antimetabolites alkala agents plant alkaloids antibiotic chemotherapy hormones immunotherapy targeted therapy and miscellaneous you can learn about them all by downloading my anti-cancer pharmacology course at medicosis per fiction.com or if you do not want to download you can simply watch the anti-cancer pharmacology lectures in this pharmacology playlist on YouTube next toxicology introduction it is the study of toxins let's say that we're discussing the join toxicity for example so what is happening for example we had a patient with congestive heart failure took the join took too much and then suffered side effects what are the symptoms and signs of the side effects and then how can we manage this case there is General management there is special management General is for everybody in emergency medicine you always start with your ABCs Airway breathing and circulation and then we have special management which is the an if we have an antidote for a specific medication if you know the name of the antidote for detoxin please comment below many toxid dromes cause acidosis and if you are a physiology buff you will recall that acidosis inhibits synaptic transmission so this neuron will be unable to talk to the next neuron and the patient will suffer from what the patient will be tired all the time drowsy up tund selent Etc aspiration is evil so you need to protect your patient from aspiration the Gasco Coma Scale is important and you need to know by heart the medications with a narrow therapeutic window many agents produce protons in your body which causes acidosis in addition to your normal day-to-day metabolism which also secretes protons acid base imbalances in humans include respiratory acidosis respiratory alkalosis metabolic acidosis versus metabolic alkalosis you have four conditions then the metabolic acidosis is divided into hagma or nagma this is high anion gap metabolic acidosis and this is normal anion gap metabolic acidosis as for the metabolic alkalosis it's divided into two types Salan responsive and Salan resistant let's review aspiration who is at risk of aspiration or aspiration pneumonia well aspiration is what is when something that should not be in the lungs ends up in your lungs people who are susceptible to aspiration include but not limited to anyone with a weak cough reflex what do I mean by this the very old the unconscious the neurop patient what do you mean maybe a brain disease like a brain stem leion swallowing and coughing all of these require centers in the brain and if these are disrupted problems can happen the patient who is intoxicated because many medications inhibit the breathing Center in the Medill of the brain next the intubated patient is at risk of aspiration we call this iatrogenic genic means Genesis of iatro who's that healer oh healer induced which is a polite way of saying my doctor was a doofus the Gasco Coma Scale was discussed in a separate video in my emergency medicine playlist but here's the rule if the score is less than 8 it is time to incubate the galasco Coma Scale ranges from three to a score of 15 there is no such thing as a galasco Coma Scale of zero or one or two it's impossible if you your doctor tells you that your galasco coma scal is too find another doctor immediately next the medications with the narrow therapeutic window include but not limited to dexin warrin lithium iron theophine cine Methotrexate and amone what does that mean what does neurotherapeutic index mean it means that the distance between the minimum effect of concentration and the maximum toxic concentration this Delta is narrow okay so it means what that between the effective dose and the toxic dose is an inch in other words it's very easy to overdose on one of these medications which means toxicity is more likely so be very careful with these medications the ABC is of emergency medicine a is Airway B is for breathing and C is circulation you can also add a d for drugs and T for temperature and here is a song for emergency medicine and toxicology for acute mental status change of unknown iology Naran dextrose thamin for and me any patient who has acute mental status and you have no idea what's going on you need to give nor can because the patient could be a heroin addict this could be morphine intoxication dextrose because the patient could be hypoglycemic in a hypoglycemic coma so you give dextrose thamin which is vitamin B1 because the patient could be an alcoholic alcoholic patients usually have deficiency in vitamin B1 so you give vitamin B1 if your patient is alcoholic and you gave dextrose without thamin I would will Smite your gluteus maximus this is a fatal mistake you should always give thamin and I've talked about this in detail in my biochemistry plates and you can learn more about adrenergic toxicity and coleric toxicity toxicity of beta blockers and toxicity of dexin lithium toxicity theophine toxicity amiodarone toxicity toxicity of Hein and warrin and much much more learn about all of this by downloading my toxicology course at medicosis fes.com or you can watch my toxicology videos in this pharmacology playlist next introduction to ooids what does that even mean oid means like so we have cancer and carcinoid which is cancer like we have Andrew which means a man and Android it's a robot that looks like a man and that's why the logo of Android operating system for your phone is a humanoid robot you didn't know that did you I have received some secret information from Google that they are planning on developing a feminist vision of the Android and they will name it gynecoid and will be a female robot so oid means like how about the oo part well it's from AOS which means remedy oh like remedy ooids basically deals with paracrine and autocrine stuff paracrine is when the cell secretes something to influence the surrounding the parallel paracrine okay what is is autocrine autocrine is when the cell secretes something to act on the same cell because the word oos means self as in automatic or autonomy so that was ooids how about eicosanoids iosa is 20 oid means like because these are products of the metabolism of the famous arachidonic acid which has 20 carbons ooids and ioso deal with the study of prostag glandon throx N2 locr and more remember that the prostaglandins and lucrin are derivatives of the arachidonic acid metabolism and then the prostaglandins will give us thromboxane A2 which is procoagulation and prostacyclin which keeps the blood cycl because it's anti-coagulation ooids is the umbrella term and ioso is a subset of ooids to learn more about the arachidonic acid pathway and the prostate gandin and the lucrin and the cyc oxygenase versus lipo genes and more I have a video in this pharmacology playlist titled arachidonic acid pathway one of the best videos that I've ever uploaded because I probably recorded that video when I was under the influence of some high quality apples and bananas you can delve deeper into the topic of uto pharmacology by downloading my uto pharmacology course at medicosis perfect.com it will teach you about cyclic EMP serotonin gastrointestinal pharmacology including the treatment of Pep IC alcer disease treatment of rheumatoid arthritis and the famous dards treatment of asthma and COPD treatment of cystic fibrosis prostate gandin loc triin and much more you can also watch these UT covid pharmacology videos in this pharmacology playlist next an introduction to antibiotics there is a slight difference between antibiotics and antibacterials I love the word or the term antibacterials better because antibacterials just tells me that I am anti bacterials and antibiotics will bio means life so technically this means anti-life so it could Target bacteria fungi parasites Etc but when doctors say antibiotics they usually mean antibacterials so what is a more inclusive term that includes antibacterials antifungals antivirals and anti-parasitic medications just call them anti- microbials this is an umbrella term that includes everything the antibacterials the anti virals the antifungals and the antiparasitic medications these antimicrobials include antibacterials antifungals antivirals and antiparasitic medications keep in mind that when a medication ends in AOL the odds are it's an antifungal and if a medication ends in ve as an acyo it's an antiviral beta lactam describes an antibiotic that kills bacteria but beta Glen is a structure of a fungus we divide bacteria into gram staining and non-r staining or organisms if you are gram staining it means that you acquire this stain really well because you have a very thick peptidoglycan cell wall but if you cannot retain the purple you will stain pink and will call you gram negative cocky and rods then we have other bacteria they are anatomically gram positive but in reality they do not stain that well with gram these include the micro bacteria which does not stain well with grham that's why we need to rely on the acid fast stain such as Zeal neelen and my plasma this is a weird one because this does not have a cell wall so of course in the lab it will not retain the Gram stain in Pharmacology there is synergy there is additive effect could be for a good thing or for a bad thing and there is the antagonist effect antagonist does not mean negative antagonist mean zero give me an example of synergy okay penicillin plus aminoglycosides together they work like crazy or medications to treat tuberculosis ioniz it plus refampin plus romis will give you a synergistic effect what is synergy synergy means 1 + 1 = 3 which is a mathematical insanity but a pharmacological reality so the net effect is greater than the sum of its parts next additive effects 1 + 1 equal 2 it could be for a good thing such as combining cofoxy with metrol or could be for a Bad Thing such as the toxicity to the ear if you take Loop Diuretics and aminoglycosides together say goodbye to your ear are you talking about the cckar apparatus or the the vestibular apparatus in the ear I'm talking about both this combination is ugly we have antagonist as well penicillin and tetracyclin combining penin plus cyclin is pointless so antimicrobials could be antibacterial antifungal antiviral or antiparasitic then the antibacterials are divided into cell wall synthesis Inhibitors or cell membrane disruptors so two groups here protein synthesis Inhibitors could inhibit the 30s or the 50s and nucleic acid synthesis Inhibitors whether direct acting or indirect acting we've talked about all of this in detail in my famous antibiotics course which has 40 videos and questions and cases with answers of course and a mind map to help you memorize these medications and all of this is combined in a perfectionalis ultimate notebook which is just a wonderful PDF to have download this course today at medicosis perfect.com after learning all of this hopefully you're now pumped and ready to learn about pharmacology maybe you will be the author of the next edition of the pharmacopia so you can go to my website to download these courses or you can watch these videos in the pharmacology playlist I have General pharmacology course autonomic pharmacology another for CNS pharmacology another for cardiac pharmacology including diuretics another for endocrine pharmacology including the doses of insulin and how to calculate the dose chemotherapy toxicology ooids and ioso and the lovely lectures of antibiotics every one of these courses comes with videos notes and cases if you value what I do help me make more videos support the channel by going to buy meac coffee.com medicosis there are more than 600 premium videos available on this channel when you click the join button and choose the highest tier Please Subscribe hit the Bell smash like support my channel on patreon PayPal or venmo go to my website to download my courses notes and cases or if you would like me to personally tutor you PE safe stay happy study hard this is medicosis perfectus where medicine chemistry math and physics make perfect sense