Unknown Speaker 00:00 Hi, welcome Speaker 1 00:07 to Rosalind Franklin University, College of Pharmacy top 200 drugs podcast. Speaker 2 00:12 This podcast is produced by the pharmacy faculty members to supplement study material for students learning the top 200 drugs we're hoping that our real life clinical pearls and discussions from practicing pharmacists will help you study for your next drug quiz. Dr. Sean Kane 00:28 And now on to the show. Welcome to week eight of Rosalind Franklin University's top 200 drugs podcast spring edition. I'm your co host, Dr. Kane, I'm Dr. Weatherton. Speaker 3 00:40 I'm Dr. Patel, and I'm the super special guest Dr. petty. I'm a PGY one resident with North Shore University Health System at Highland Park, and I'm on rotation at Roslyn franklin. Dr. Sean Kane 00:51 Fantastic to have you. Thanks. So this week we're talking about antiemetics, cough suppressants and allergy medications. Now the first agent that we'll be discussing is hydroxyzine. The brand name is Atarax. Speaker 4 01:03 Hydroxyzine is a first generation antihistamine, which I understand means it has a pretty characteristic set of adverse effects. Is that correct? Dr. Patel, that Dr. Khyati Patel 01:12 That is very correct. And the first thing that comes in my mind is the anticholinergic kind of effects, such as sedation, drying and constipation, but but these affect this medication is used for anxiolytic property because, again, it's sedating anti histaminic properties because of the allergy mediated reactions and also used as antiemetic. I just wanted to mention that it's not approved for use in nausea and vomiting in pregnancy. Speaker 4 01:41 Though, you know what it's also not used for is blood pressure. I had a project as a student to go through pharmacy records and pick out hydroxyzine, this allergy medicine versus hydralazine, or a blood pressure medicine that's also used for chest pain. And we found some patients who needed an allergy medicine were getting blood pressure medicine, and some patients who needed a blood pressure medicine, we're getting an allergy medicine. So that's a very dangerous thing to mix up, and you want to be sure that you're not mixing up hydroxyzine or hydralazine. Dr. Sean Kane 02:09 So as far as the adverse effect profile, as we already said, we see a lot of anticholinergic effects. Now, no, we talked we've talked about this a lot in the podcast already, but the main ones that we're seeing are sedation and drying of mucous membranes, constipation and maybe even some orthostatic hypotension with it. So for that reason, something like hydroxyzine or Atarax is probably not a good medication be mixed with something like alcohol or other opioids, because we could get a combination of CNS depressive effects. Dr. Khyati Patel 02:40 So I understand Dr. petty that this medication is also available in a different brand name. Can you elaborate on that? Speaker 3 02:46 Yes, it comes in two salt forms, so not the salt you see on the table, but also so it's Vistaril. And so that's as pamoate salt, and then also as a hydrochloride salt. And so Atarax, that's for the similar names, so Vistaril is marketed for anxiety and sleep, versus Atarax is actually for itching. So make sure you kind of pay attention to there that the different brand names are actually for two different indications. Dr. Sean Kane 03:11 So as far as dosage forms, we've got a hydroxyzine or adirax capsule, tablet, oral solution, oral suspension, and even an injection. Speaker 4 03:19 Now I understand that hydroxyzine is actually metabolized into another drug that we've heard of before. Is that right? It is. Dr. Sean Kane 03:25 So hydroxyzine in the body will get metabolized to a second generation antihistamine called cetirizine, but you might know it better by its brand name of Zyrtec. Speaker 4 03:34 So the next drug on the list is meclizine, which goes by the brand name Antivert, which is a pretty explicit brand name based on what the drug does, is that, right? Yeah. Dr. Sean Kane 03:44 So this medication is commonly given for vertigo, hence the brand name of Antivert. But it also isn't a first generation antihistamine, so it has the same properties, and in theory, can be used for the same things as as hydroxyzine or attarax. So we could use it for motion sickness and even as an antihistamine for allergy related symptoms. Speaker 4 04:05 And I imagine we can accept expect the same side effect profile as well the dried out anticholinergic type things, absolutely same stuff. Dr. petty, how does the duration of action of meclizine Compare to hydroxyzine? Speaker 3 04:17 So hydroxyzine is actually a much shorter duration of action, where meclizine is a lot longer. So if you're doing a comparison, the meclizine is 24 hours versus four to six hours that you would have the hydroxyzine. Speaker 4 04:32 So with just one pill, patients can experience those anticholinergic side effects for a Speaker 3 04:36 whole day, all day, anti sludge, all day, Dr. Sean Kane 04:40 all right. So our next agent is metoclopramide, or Reglan. Now this actually has two very distinct indications from the FDA point of view, and what we use it for in clinical practice. Speaker 4 04:50 The big one that I think of is a prokinetic effect, meaning that it moves things through the GI tract, and it does that by enhancing acetylcholine. In this mechanism, it's essentially the opposite of the anticholinergic drugs that we just talked about. Dr. Sean Kane 05:05 So I would bet that in patients who are taking Reglan, not necessarily for gi motility, but for a different indication, they might expect some diarrhea with the product. Speaker 4 05:14 Then that's a great point. As things start to move along, more quickly, less water is absorbed, and we can see a result in diarrhea. Dr. Sean Kane 05:21 What about the other indication? Speaker 3 05:22 When I think of Reglan, I usually think of it as the anti emetic properties. It's very similar to Zofran, or ondansetron, as you guys may have learned, it's a blockade in the CNS and serotonin blockade, where that five HT three comes in play. Dr. Sean Kane 05:38 So my brother was actually given a prescription for Reglan or metoclopramide for nausea and vomiting, and when he read the package insert, he decided he wasn't going to take it anymore. It's got some pretty scary side effects that I think we should go over. Dr. Khyati Patel 05:51 I think the first one that jumps to mind is the EPS symptoms, extrapyramidal symptoms, and what the heck are those? So that comprises of different conditions such as akathisia, which is just general restlessness, including involuntary movements and twitches and spasms. And these spasms are also known as muscle dystonia, because the tone goes off the whack, so your muscle starts twitching, and it could be just about any muscle. So it could be your eyes, heads, arms and legs. I mean, imagine winking at some people for no given reason. You can get into a lot of trouble. Speaker 3 06:30 Aren't these symptoms caused by some type of blockade? Speaker 4 06:33 They sure are. I believe they're caused by blockade of dopamine, which is similar to what we see in patients with Parkinson's or patients taking second generation antipsychotics. Now I understand that extrapyramidal symptoms tend to be reversible if you stop the drug, but what happens if you don't stop the drug? Dr. Sean Kane 06:51 So Reglan or metoclopramide actually has a boxed warning that it shouldn't be used for long term use. So they say more than 12 weeks for the risk of something called tardive dyskinesia. And tardive dyskinesia is essentially extra pyramidal symptoms or EPS, that can be more permanent and has similar symptoms. But usually when we think of tardive dyskinesia, we think of facial movements. So this is lip smacking, tongue moving in and out, and eye blinking. Speaker 4 07:19 Wow. Those are some scary side effects. What other side effects does this medicine have that maybe aren't related to a dopamine blockade? Dr. Khyati Patel 07:26 I'm thinking of drowsiness because obviously it's working in the CNS, dizziness to go along with that, and other CNS type changes such as depression, anxiety or even hallucinations, also have known to cause some bradycardia and higher doses atrioventricular block. So Dr Dr. Sean Kane 07:45 petty in your institution, what kind of dosage forms of red gland Do you commonly see? Speaker 3 07:49 So we see a lot of different doses forms in our institution, because it is such a commonly used medication. So it comes in injectable, it comes in an oral solution, a tablet, and then also an ODT tablet. So what does ODT mean? Speaker 4 08:04 I think that's orally disintegrating tablet. That's right. Why would they give nausea medicine as an odt? Duh. Dr. Khyati Patel 08:11 Dr. Weatherton, because patient cannot take any po medication. They should just simply put the ODT tablet in the mouth and it will dissolve. Speaker 4 08:19 That's pretty smart. Dr. Patel, what's this medicine used for? Dr. Khyati Patel 08:23 So like we said, there are two different mechanism of actions. This medications prokinetic properties are used in diabetic gastroparesis or sometimes patients with gastroesophageal reflux, which are not managed by the usual therapy. And also it's been used for nausea and vomiting related to either chemotherapy or post surgery. Speaker 4 08:44 Gastroparesis isn't Rhesus a kind of monkey. Does that have to do with having monkeys in your belly? Dr. Khyati Patel 08:51 That's how pretty much a patient feels when they have the gastroparesis. Dr. Sean Kane 08:55 I think of gastroparesis as where the nerves that move, that are responsible for gi motility die off so you don't you lack gi motility, so food and other substances stay in your stomach longer than they really should Speaker 4 09:08 Interesting all right? The next drug on our list is called Prochlorperazine, or a much easier to say brand name, is Compazine. Now, I understand this medicine used to be used as an anti psychotic. Is that? Right? Dr. Kane, it Dr. Sean Kane 09:20 is, which is kind of funny that we'd give it to patients in the hospital who actually don't have any psychoses. Now we use it as an antiemetic, but historically, it actually does have FDA approval as an antipsychotic, similar to haloperidol or Haldol. Unknown Speaker 09:34 Dr. petty, why isn't this used as an antipsychotic anymore? Speaker 3 09:37 It says it's not as effective as other typical antipsychotics, so it's really not used for the purpose. Dr. Sean Kane 09:42 So I like to think of Prochlorperazine, or Compazine, to have a promiscuous receptor profile. And what I mean by that is that it hits a lot of different type of receptors. It doesn't just stick to one monogamous receptor. It gets around so it definitely hits the dopamine receptor. So it's a dopamine antagonist, which is why. It has the effect it does in schizophrenia, we also see Alpha One blockade, which can cause some orthostatic hypotension, or even hypotension with rapid IV infusion. Speaker 4 10:10 I understand that's a common feature of antipsychotics, is that right? It is. Dr. Sean Kane 10:13 Many of our typical antipsychotics are very promiscuous in their receptor profiles. Then the last thing is that it also has anticholinergic effects, like many of our other antiemetics. Speaker 4 10:23 So that causes things like sedation and dry mouth and the classic anticholinergic profile, I guess. What sort of side effects do patients experience from Dr. Khyati Patel 10:31 this drug? So with the dopamine antagonist properties, I'm thinking again, the EPS, the extrapyramidal symptoms, just like metoclopramide or Reglan. And as you mentioned, Dr. Weatherton, the alpha one antagonism leads to hypotension. So particularly with the injection form, there is a risk of orthostatic hypotension and increased heart rate, good Speaker 4 10:54 old fashioned reflex tachycardia. Exactly how does this medicine come Dr. Khyati Patel 10:59 so, like I said, it is available in an injection form, but we do see it in oral tablets or even suppositories, which is a good feature, because patients with severe nausea and vomiting, like we said, cannot maintain po intake, and those patients can use the suppository. Speaker 4 11:15 Very interesting. Now, these medications for nausea and vomiting seem like they've got tons of side effects. Is there anything better that patients can use for nausea and vomiting? Dr. Sean Kane 11:24 So actually, our next drug, funny you mention it is on dance, atron or Zofran, which is really a game changer when it comes to management of nausea and vomiting in many different types of patient populations, everywhere from pregnancy to chemotherapy to post surgical patients. Dr. Khyati Patel 11:40 And I believe it works similarly to how metal copramide works, where it hits the five HT three serotonin receptor and antagonizes those receptors and the chemo receptor zone. Dr. Sean Kane 11:53 The only difference, though, is that on Dan Citron or Zofran is a very monogamous drug, so it's very specific to that five HT three, whereas reg gland hit a lot of different receptors, including dopamine, that gave us those EPS symptoms that we don't have with Zofran or on van citron. Speaker 4 12:08 Very interesting. So in the FDA approved package insert, is this drug approved for treatment of nausea and vomiting, it's Speaker 3 12:17 It's only used for prevention and because it's actually acting at that receptor in the chemotherapy Trigger Zone. It is frequently used for chemo induced nausea and vomiting, but also it is safe to use in pregnancy as well. So that's something to consider for all of your patients that are pregnant. Dr. Sean Kane 12:34 So I can tell you clinically, particularly in the ICU, where I work at we give Zofran all the time for patients who are actively vomiting, which isn't really how the drug has been studied, but clinically, that's how we use it. Speaker 4 12:45 And so with regard to preventing nausea and vomiting, I always think of it like pain. It's much easier to stay ahead of it and control it before it flares up and becomes acutely bad. Speaker 3 12:55 Sounds like this drug is pretty great and has a really nice side effect profile. Are there any downsides to this medication. Dr. Sean Kane 13:02 So I'm a little mad at the FDA because of their warning that they put on ondansetron or Zofran. Recently, the FDA put a boxed warning on Zofran that it can cause QTC prolongation, particularly when given at high doses. So there were some case reports of patients having fatal arrhythmias caused by a prolongation of their QTC and they were given Zofran at about the same time. The problem, though, is that when we give doses for chemotherapy, we're giving something like 32 milligrams of Zofran, whereas in the ICU, we're giving anywhere from four to maybe eight milligrams of Zofran. It's a dose dependent effect that we see, so I don't feel like it deserves that boxed warning, but it's something that every pharmacist should at least be aware of. Dr. Khyati Patel 13:42 Yeah, and you want to be also aware that if this medication is used with other drugs that can cause QTC prolongation, then you can just augment the effect. So you still have to watch out for those drug interactions. Speaker 4 13:54 So aside from that potential dose dependent, very serious side effect, what other side effects are there of this drug? Really? Dr. Sean Kane 14:01 We don't see too much, to be honest with you, which is one of the reasons that Zofran or ondansetron is such a fantastic drug. We see things like headache or constipation, but it's really no different than placebo. Typically, Zofran is given IV in the hospital, but obviously we can't do that in an outpatient setting. So what do you guys see as prescriptions for Zofran. See the tablet a lot, Dr. Khyati Patel 14:23 and I've seen the ODT tablets again, the orally disintegrating tablets. Speaker 4 14:28 And there's also an oral film similar to like a Listerine breath mint type strip, Dr. Sean Kane 14:33 but probably doesn't give you that clean, fresh breath. It doesn't have peppermint. Dr. Kane changing gears to our cough agents, chlorpheniramine and hydrocodone as a combination product. The brand name for this is Tussionex Pennkinetic. Speaker 4 14:46 So what kind of cough would we use an antihistamine and opiate combination for? Dr. Sean Kane 14:52 So usually, the reason that patients will have a cough is either they have a cold of some type or allergies, both of which can cause mucus production. When mucus goes down the back of the throat, it ends up irritating the throat, making you cough to get rid of whatever phlegm is down in the back of your throat. Dr. Khyati Patel 15:09 And so I heard you say it's a combination of hydrocodone and chlorpheniramine. Now I know hydrocodone sounds more like the Vicodin and Norco so it's an opioid and the chlorpheniramine. I'm thinking it's the first generation antihistamine, and they that gives us that drying effect Exactly. Dr. Sean Kane 15:27 So we hit the cough from two different points. We either dry up the mucus so it doesn't end up in the back of the throat, or the hydrocodone, which is all opioids are cough suppressants, so we actually can suppress the cough if they do have that phlegm in the back of the throat, Speaker 3 15:41 but it says it has the hydrocodone in it. Doesn't that change the schedule of the drug. Dr. Khyati Patel 15:45 Absolutely, it's actually a DEA schedule three drug, Dr. Sean Kane 15:49 just like Vicodin or Norco Speaker 4 15:51 now, I remember there are some similar side effects between Anticholinergics and opiates. What's this medicine going to do to the patient's GI tract? Dr. Sean Kane 16:00 So again, we have chlorpheniramine, which is an anticholinergic, so it's going to cause constipation, and so will a narcotic like hydrocodone. In addition to that, both of these are sedating medications. They work differently in how they sedate, but the end effect is that we do have synergistic sedation property to them, so you really shouldn't be drinking, then definitely no alcohol when taking these Speaker 4 16:21 products or any other depressants, I would imagine. So Tussionex is kind of a fancy cough syrup, isn't it? What's special about it? Dr. Khyati Patel 16:29 The special thing about the syrup, or I should actually say suspension, it's an it's formulated as an extended release form. So this is only taken every 12 hours and not more frequently. One thing to note, it contains propylene glycol, so it should be avoided in the kids less than six years old, and the liquid is very distinguished, yellow, thick, gooey liquid. So make sure you ask your patient to thoroughly shake the bottle before they take any doses. Speaker 4 16:56 The liquid is cool. But this is also available as capsules. Is that right? Dr. Sean Kane 17:00 It is. So it's available as a different brand name called Tussicaps, which are capsules that are also taken every 12 hours. Dr. Khyati Patel 17:06 So moving on in the categories of cough syrups, the another one we have on board is promethazine and codeine combination. The brand name is Phenergan with Speaker 4 17:17 codeine, and you can remember it has codeine in it because the brand name is Phenergan with codeine. Dr. Sean Kane 17:22 How inventive. So this is actually pretty similar to Tussionex. We have promethazine, which is actually a typical antipsychotic, but really a very poorly potent antipsychotic. So we're actually using it more for its antihistamine properties, because it really lacks any significant typical antipsychotic dopamine antagonist properties, Dr. Khyati Patel 17:43 and so with the codeine on board is that also schedule three. Dr. Weatherton, Speaker 4 17:47 no codeine containing products when they're in combination, are actually schedule five. So this cough syrup is a schedule five. Oh, I see. And can be bought over the counter in some states if you sign a log. So an anti histaminergic type drug and an opiate type drug, are we looking at the same side effect profile here? Dr. petty, absolutely. Speaker 3 18:05 Then you're dealing with the same type of side effects, those anticholinergics, especially with constipation, something to look out for. It is contraindicated in our tots population. So anytime you have six year olds or less, you have a big risk of respiratory depression and death, so be sure that this is more for those older kids and for adults. Speaker 4 18:28 So now that our coughs are cured, let's move on to the next agent on the list, which is desloratidine or Clarinex. And when this generic name sort of rings a bell for me, Dr. Khyati Patel 18:38 it's actually an active metabolite of loratadine. Brand name is Claritin. So they just became smarter, and some came up with the new brand name Clarinex. Dr. Sean Kane 18:49 So I understand this is a second generation antihistamine, as opposed to all of the other antihistamines we've talked about, which are first generation antihistamines. What does that actually mean? Speaker 3 18:58 Though, have a big difference in terms of the side effects, because for the second generations, they really don't have that sedation going on along with it, because they don't get into the blood brain barrier all that often or even that much. And so we have zero sedation with these medications. Speaker 4 19:15 So you're saying these medications don't have any of the anticholinergic side effects, dry mouth, constipation, none of that. Speaker 3 19:21 Yes, they do, except there's no sedation, so that's really the only difference there. Dr. Khyati Patel 19:26 Unlike the first generation antihistamine, this lasts for 24 hours. So you pop one Clara next, and you're good to go for a day. Dr. Sean Kane 19:34 So you can really appreciate the profound benefit that patients suffering from allergies probably saw when Claritin or editing Clara Next, bezzler Editing came to the market. You take it once a day, as opposed to every four to six hours, and it doesn't make you sleepy. So that's a pretty big benefit. Speaker 3 19:50 So what are the dosage forms of clarinets? Are they the same as Claritin? Speaker 4 19:54 Yeah, they really are the same dosage forms. We see a syrup for the little guys. We see a tab. Lit and an orally disintegrating tablet of clarinets. Dr. Khyati Patel 20:03 And just like the Claritin and it's also combined with Sudafed, so Clarinex D is also available. The difference Speaker 4 20:09 with Claritin is that this medication is not over the counter and it's much more expensive. So if your patient gets a prescription for Clarinex and doesn't like their copay, Claritin does the same thing. There has to be a difference, though, right? Technically, this is the active metabolite, so the dose is usually half of what Claritin is. Whether that's clinically significant or not, it's not Dr. Sean Kane 20:30 So moving on to our over the counter products. The first is dimenhydrinate or Dramamine. Speaker 4 20:36 So Dramamine, I understand, was a really good brainchild of some really smart medicinal chemists. How did they try to go about making Dramamine? Dr. Sean Kane 20:45 So historically, all of our agents that we've already discussed that are anti histamines are going to cause sedation, and that's kind of actually how they work for things like vertigo and motion sickness. So these smart medicinal chemists said, Well, what if we put something that counteracted the sedative quality and made patients more hyperactive. So they took diphenhydramine or Benadryl, and then they took theophylline, which is kind of like caffeine, and they merged the two molecules together to form a super molecule called dimenhydrinate or Dramamine. Speaker 4 21:14 Wow, what a great idea. I bet that was super successful, right? Dr. Sean Kane 21:19 So I'm not really a medicinal chemist, but it seems like the idea here is kind of the same thing as a Red Bull and vodka. So you combine a stimulant with a depressant, and in the end, they cancel each other out. Dr. Khyati Patel 21:30 No, they just ask you for $10 a drink. Dr. Sean Kane 21:34 So as it turns out, most patients will still have the sedative effect, and they won't be overpowered by the theophylline effect or the stimulant effect, but some patients can be different and can experience one version or the other. Speaker 4 21:47 And so the stimulant type effects that patients might see with this medication are what things like tachycardia and restlessness. Unknown Speaker 21:53 I would think so, just like drinking Dr. Sean Kane 21:56 a cup of coffee or a Red Bull. Dr. Khyati Patel 21:58 And since we're talking about similar structure to diphenhydramine, it's a little bit more drowsy in comparison to meclizine, interesting. Speaker 4 22:06 And like meclizine, I understand that this is used for motion sickness. So if my patient's going on a cruise, should they wait until they're vomiting to take their Dramamine? Dr. Khyati Patel 22:15 No, because it's for prophylaxis or preventative purpose. It should be taken 30 to 60 minutes prior to the travel. Interesting. And how does it come it's available in the tablet as well as the chewable tablet form. Dr. Sean Kane 22:29 So our next over the counter product we've actually already discussed. This is meclizine, and the brand name of the over the counter version is Bonine, which is just a chewable tablet, which is the same stuff is the prescription version, but it must be a lower strength, right? It's actually the same strength, but it'll impact your wallet a little bit differently. Speaker 4 22:47 So now let's get away from medications that dry you out on the inside and talk about some over the counter medications that will dry out your skin. Dr. Sean Kane 22:54 If only we had someone in the room that was going to give an acne lecture to our pharmacy students. That's me. Well then Unknown Speaker 23:01 Dr. petty, tell us about benzoyl peroxide. Speaker 3 23:03 So benzoyl peroxide is a topical acne product, and is actually the most commonly used over the counter product. It kills the bacteria, hence the peroxide, but it has the potential to dry out the skin, so that's kind of a negative downside effect. And because it's benzoyl peroxide. It has those bleaching effects. So you want to make sure that you tell your patients be careful around the hairlines, unless you like that white effect or also staining clothes, pillow cases, towels, things of that sort. Speaker 4 23:35 And when I think of acne, I think of teenagers who might not be the most patient group of people, and as such, they think if they go to the store and get an acne medication and use it way more often than they're supposed to, the acne will go away faster. Is that how it works? Speaker 3 23:51 Unfortunately, no. So with these types of medications, there is the delay type of effect. It can take 2 to 4, even up to six weeks for some of these medications to take effect, for people to even start noticing changes, something to counsel your patient on, though, is what happens when the acne gets worse or the symptoms don't resolve. So what do you think they should do? They should call their doctor exactly, pretty intuitive stuff. So what type of dosage forms do you think this comes in, given that it's the most commonly used acne medication, Dr. Sean Kane 24:26 I've seen it as foams. I've seen it Unknown Speaker 24:28 as bars and cloths Unknown Speaker 24:30 and creams, gels and liquids and Unknown Speaker 24:33 lotions and pads, and it Speaker 4 24:35 goes on. So no shortage of dosage forms here with benzoyl peroxide. Are there any other things we need to counsel our patients about when they're using these topical these topical or this topical acne medication? Speaker 3 24:45 Yes, it's really important to always use sunscreen with this medication, because it does have that photo sensitivity. Dr. Khyati Patel 24:51 So moving on to another agent in the same category, we have salicylic acid, which is a keratolytic agent, and it is available. In various different brand names. And what is this one used for? So with the keratolytic properties, it is used for acnes, it comes into various different concentration. When it's used for acne it's usually at a lower concentration of point five to 2% but it is seen in a higher concentration when it comes to the treatment for callus corns warts and dandruff. With the treatments of callus corns and warts, it can go up to 40% concentration. Whoa. Speaker 4 25:30 So if I have a patient who wants to get rid of their acne fast, can I just tell them to use some salicylic acid 40% Dr. Sean Kane 25:37 if you want their face to burn off, that's correct. Speaker 4 25:39 Dr. Kane, so patients really need to be conscious to not use too much or too strong of this agent. What sort of adverse drug reactions come with salicylic acid? Speaker 3 25:49 So it's similar types of adverse drug reactions, as we see with the benzoyl peroxide. There's going to be skin irritation, they may have dryness and burning. So it's really pros and cons versus the patient. So when you're talking to patients, really find out what's important to them, and make sure you pick the agent that's most appropriate to them and the side effects that they're willing to tolerate, and always let them know this is going to happen. So I Dr. Sean Kane 26:12 hear the word acid in salicylic acid, so I bet that this probably wouldn't be very comfortable to accidentally get in your eye Speaker 4 26:19 or on open sores or things of that nature. I think you're right. Dr. Kane, how does this particular agent come Dr. Khyati Patel 26:26 It is available as liquids, lotions, gels, creams, bars, foams, Unknown Speaker 26:31 cloths and a Unknown Speaker 26:33 patch and even shampoo. Speaker 3 26:35 So again, lots of different variety to meet every need of every patient. So let's go Speaker 4 26:41 ahead and recap the drugs that we discussed. This is the driest podcast to date, I think so. Dr. Sean Kane 26:46 The first agent we talked about was hydroxyzine, and the brand name is Atarax, but it also comes as another product called Vistaril. Speaker 4 26:53 The next agent we talked about was meclizine, or Antivert in the prescription form and Bonine in the over the counter form. Dr. Khyati Patel 27:02 The third agent on the list is metoclopramide. The brand name is Reglan. Speaker 3 27:07 The next agent is prochlorperazine, brand name, Compazine. Dr. Sean Kane 27:11 Then we moved on to ondansetron or Zofran. Speaker 4 27:14 And then we talked about chlorpheniramine and hydrocodone, which goes by the brand name, Tussionex Pennkinetic. Dr. Khyati Patel 27:20 And moving on to a very clever brand name, promethazine with codeine, sold as Phenergan with codeine. Speaker 3 27:27 Next, we did desloratadine, or Clarinex, not to be confused with loratadine and Claritin, Dr. Sean Kane 27:34 we talked about some over the counter products. The first was dimenhydrinate. Brand name is Dramamine. Speaker 4 27:39 The next was benzoyl peroxide, which goes by many different brand names and comes in many different dosage forms. Dr. Khyati Patel 27:46 And last but not the least was salicylic acid. And just like benzoyl peroxide, it is available under multiple different brand names. Dr. Sean Kane 27:53 I would like to encourage our audience to give us a five star rating in the iTunes store, so that other pharmacy students outside of Roslyn franklin might be able to find us a little bit easier. Us a little bit easier. So that concludes week eight of Rosalind Franklin's top 200 drugs podcast, spring edition. I'm your co host, Dr. Kane. I'm Dr. Weatherton. Unknown Speaker 28:11 I'm Dr. Patel Unknown Speaker 28:12 and I'm Dr. petty. So this has been an Speaker 1 28:18 educational production by the Rosalind Franklin University College of Pharmacy. Dr. Sean Kane 28:22 This podcast is copyright Rosalind Franklin University of Medicine and Science. Speaker 1 28:26 No participants have any conflicts of interest to disclose. This podcast is for educational purposes only and is not intended to treat a particular patient. This information should not be used in lieu of the judgment of a healthcare provider. Theme music for this podcast is an excerpt of Metro Mix by seesaw released on the Creative Commons. You.