Speaker 1 00:00 Welcome 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 10 of Rosalind Franklin University's top 200 drugs podcast. Spring edition. I'm your co host, Dr. Kane, and I'm Dr. Weatherton. And initially, Dr. Weatherton and I were going to talk about women's health. I mean, who could be better experts? But we figured we should probably have some female professors join in the conversation. Good idea. Speaker 3 00:51 So joining now it's Dr. Patel and Dr. petty. Dr. Sean Kane 00:55 So to kick things off, we're going to start with conjugated estrogen. And there's two different brand names to know with this product, Premarin and Cenestin. Where does Premarin come from? Premarin might be the best brand name on the market. So Premarin as a preparation, comes from pregnant mare's urine, and a mare is a female horse, pregnant mare's urine Premarin. So because of that, some patients prefer to use the non horse urine variety of tablet, which is Cenestin, which is of plant based origin. Unknown Speaker 01:27 So what are conjugated estrogens used for? Speaker 3 01:30 They're mainly used for hormone replacement therapy, so obviously, to treat the symptoms of menopause. And those symptoms can be hot flashes or vaginal atrophy, and even symptoms of vaginal atrophy leading to atrophic vaginitis. Speaker 4 01:46 And so these are essentially just estrogens. So menopause is a deficiency of estrogen, and we just replace it with estrogen, right? You got it, right? Dr. Sean Kane 01:55 So it seems like this should be pretty safe, right? Because all we're doing is we're giving back the estrogens that a woman in their menopausal age is missing, right Speaker 3 02:04 only, it was that easy. Dr. Kane so conjugated estrogen actually carry a lot of boxed warnings. We do see higher risk of invasive breast cancer, higher risk of uterine cancers, and also higher risk of stroke thromboembolic events such as DVTs and PEs and myocardial infarctions, Dr. Sean Kane 02:25 that seems way more serious than what I was expecting, Speaker 4 02:28 especially when you consider that these are used essentially just for symptomatic resolution. So really, it's a it's a big decision on whether or not you want to remove a couple of inconvenient symptoms for the sake of putting a patient at all these risks Speaker 5 02:41 exactly, and you always have to consider the side effects of the medication, just like be a teenage girl again. Got those enlarged breasts, vaginal bleeding, nausea, headache and fluid retention, just like in your teens at times. Speaker 3 02:54 So talking about different dosage forms, we have conjugated estrogen, especially Premarin, available in pills and cream form. The cream is vaginal cream. Cenestin is mainly available in pills. Dr. Sean Kane 03:06 So our next product is ethinyl estradiol, slash, norethindrone. The brand name is loestrin fe, but there's multiple products under the loestrin name. Speaker 4 03:15 Now, what does the FE in loestrin fe stand for? Speaker 3 03:18 Pull out your elemental chart, Dr. Weatherton, fe stands for the iron, sure. Speaker 4 03:23 So why would we need to supplement iron in birth control pills, which are generally given to menstruating females? Speaker 3 03:30 Very good question. Dr. Weatherton, because menstruation would result in loss of blood. And so to avoid any anemic symptoms, or possibly anemia, we are just replacing iron. So these are combination estrogen and progesterone products, and they're used as birth controls. And the way these products work is they suppress the hypothalamus and pituitary production of those stimulating hormones such as GnRH, LH, as well as FSH and so what happens later on is it eventually inhibits the ovulation and also makes the uterus less prone to carrying a pregnancy. So are these very effective? If you're taking it, according to the FDA approved label, they're believed to be about 98% effective. Speaker 5 04:18 And something just to point out, when you're hearing people talk about 98% effective, 85% effective, and things of that sort, realize those are under controlled conditions and certain patient populations that were told how to use it. So then you're thinking about your lay population and people that aren't really knowledgeable on these types of things. Just kind of assume a little bit lower or just take the approach of educating them further, assuming they don't know those types of things. Dr. Sean Kane 04:44 So I know at least with loestrin, many of the products have the number 24 in them, like loestrin, 24 loestrin, 24 fe, what does that 24 mean? Speaker 5 04:54 So the 24 actually refers to the number of pills in there that are active. So in some birth controls, you. Up all active pills and other ones, there's only a certain number. So for this one, there's 24 active pills and then four days of inactive pills, or in this case, iron. Dr. Sean Kane 05:09 So why would we have any inactive pills in a birth control product? Why would we just start over a new pack? Speaker 4 05:15 Yeah, maybe they'd be 100% effective if you just put all active pills in there. Dr. Sean Kane 05:19 See, we need a man to make one of these products. Yeah. Why did they think of that? Speaker 3 05:22 So basically, when patients taking the active pills, they're not menstruating, but the minute or the second they start taking the placebo pills, that's when the menstruation starts. Dr. Sean Kane 05:31 And I understand that with in the case of loestrin or ethinyl estradiol, norethindrone, that this is unique, that a 24 day cycle is not the norm. Is that correct? Speaker 5 05:43 That's correct. Usually you're thinking of like a three week 21 days, and then seven days would be your menstruation cycle time. Speaker 4 05:50 So what kind of side effects do we see with loestrin Fe Speaker 3 05:54 so because there are hormones, the most common side effect is nausea Speaker 4 05:58 and other hormonal symptoms that I kind of think of might be things like breast tenderness or weight gain and potentially break through spotting or bleeding. And just a second ago, you guys told me that with other estrogens, we have to worry about blood clots and heart attacks and strokes. Do we have to worry about that with loestrin Fe as well? Speaker 5 06:16 Absolutely, it is considered more rare, but that's when you hear on those commercials, if you're over the age of 35 and you're smoking, you're taking these birth control, you're at increased risk. Well, that's exactly what they're saying for us. In addition to this, your blood is more prone to clots, and so that's again, that PE DVT mi stroke, things of that sort, and Speaker 4 06:37 those women over 35 year old who smoke or patients with previous clots, or patients with breast cancer, probably shouldn't take this drug and it's actually contraindicated. So why would it matter with breast cancer? Well, the way I understand it is many breast cancers are estrogen dependent, and so we can actually be feeding the cancer if we're giving an estrogen product. Dr. Sean Kane 06:58 So when you guys dispense a product like ethinyl estradiol, norethindrone or loestrin fe. What are some of the counseling points that you give patients? Speaker 3 07:07 I think the first and foremost thing to stress, like we said, they are only 98% effective, even if they're taken, as it says on the FDA approved label, we want to ask patients to take them every day, at the same time of the day, Speaker 4 07:22 and if the patient misses the dose, is there a standard answer that we can tell them on what to do? Speaker 5 07:28 Unfortunately, when you're looking at all these different birth controls, usually they have their own way of doing things. If you missed, if you like vomit or things that's already missed, your dose is less than three hours from when you took it. You could try to take the next pack, but it's better if you read the package insert, and if you have a patient population that maybe struggles with following those directions to say, anytime you forget a dose, go ahead and call your pharmacist or healthcare provider, and they can jump into that package insert. I actually have a story, a quick story, about this. This was a patient. She came in, she was pregnant. She was irate with us at my retail store, and we found out that she was actually inserting the oral tablets vaginally. And she thought that would work, that they would just dissolve and prevent pregnancy that way. So to her, it wasn't intuitive that the that the tablet should be swallowed. So just realize, again, pay attention to who your patients are. Make sure you explain everything to everyone. Speaker 4 08:26 So moving right along. The next agent on our list is ethinyl estradiol. Hey, we've heard of that one, but instead it's combined with norgestrel in a birth control product called Ovral or Lo/Ovral. What's the difference here? Dr. Sean Kane 08:39 So there's really not a lot of difference. One is that the progestin component, the norgestrel, is more androgenic than our previous product that we discussed. So that means maybe a little bit more acne, and then some dyslipidemia problems, like a higher LDL, which is the bad cholesterol, or a lower HDL, or even some hirsutism or male pattern growth of hair. Speaker 3 09:02 And unlike the little estrogen we discussed earlier, this combination comes into the 28 day pack, which then turns into 21 days of active and seven days of placebo pills. Unknown Speaker 09:15 And how many days of this one Speaker 5 09:16 are iron, none. So you'll notice in the name it does not have that Fe so this one, you know, is a non iron containing product. Dr. Sean Kane 09:25 So moving on to the next product, it's ethinyl estradiol, the same estrogen we've had in our past two products, but instead it's combined with etonogestrel and the brand name is NuvaRing. Speaker 4 09:38 Now, I've heard from my patients that that ring is really big and hard to swallow. Speaker 3 09:42 Dr. Weatherton, please inform your patients that this ring won't be swallowed, but they will actually insert it vaginally to be used as a contraceptive. Speaker 4 09:52 Oh, that makes sense. I bet it's more effective than taking pills, right? Speaker 5 09:56 There's no data to support that it's more effective or. Are least effective. Dr. Sean Kane 10:01 It also has the same adverse effect profile that we saw specifically looking at nausea and then some of the more rare but serious side effects, like blood clots. Speaker 3 10:09 And so like I said, this product is inserted vaginally. One ring will be kept inserted for three weeks, and then after three weeks, you remove it for one week, and when you remove it, that's when the females will have the menstruation. Speaker 4 10:23 That seems like it might be easier to remember for patients who have compliance issues with a daily pill, right? Speaker 5 10:29 It can be, but for some patients, it can also work in the opposite sense. It's sometimes easy to do the same thing every single day, but it's hard to remember at three weeks to take something out. So just be aware for certain populations whose might be good Dr. Sean Kane 10:43 for so does this ring work by blocking any sperm or anything like that? Speaker 4 10:49 No Dr. Kane, the sperm can swim right through the ring. However, because of the hormones, the chances of pregnancy are reduced in the same mechanism of action as the oral Dr. Sean Kane 10:58 contraceptives, seems like it might be easy for this to fall out or be dislodged in some way. Is that ever a concern Speaker 3 11:06 if it ever falls out, you ask patient to rinse it and put it back within three hours and then follow the same schedule of three weeks and one week out? Dr. Sean Kane 11:17 Is this something that has to be put in by a healthcare provider? It seems like you have to get the position pretty accurate. Speaker 3 11:23 So the exact position, again, doesn't matter, because it's the hormone that's leaching out of the ring that's affecting the contraception. So the exact position doesn't matter. You teach the patient in the clinic once how to insert it, and after that, they're self capable of doing it. Speaker 4 11:38 I bet this is even more effective if you use it with a cervical diaphragm, right that way, you're blocking things from multiple angles. Speaker 3 11:46 So like I said, the exact position of the ring doesn't matter, but if you're if the female is using diaphragm on top of using the NuvaRing, then it interferes with the placement, and you don't want to do that. Speaker 4 11:57 Now, once this ring is used, is it okay to just flush it? Speaker 3 12:02 No. And I think the reason behind that to flush it down the toilet because it can still contain some amount of hormone, and we don't want to contaminate our water system with those hormones. Speaker 4 12:12 Yeah, we certainly don't want our fish swimming around with mood swings and tender breasts. I want to ask our resident female anatomy expert here, Dr. Kane, about this next point in the package insert, it says to ensure proper vaginal placement of the ring to avoid inadvertent urinary bladder insertion. Dr. Sean Kane 12:31 Well, Dr. Weatherton, there's actually been a few case reports of women inserting the NuvaRing in the urinary bladder, and they've actually had to use the cystoscope to remove it. So in very rare circumstances, patients may not understand the proper placement of NuvaRing. And actually, in the package insert, it states that healthcare providers should assess for ring insertion into the urinary bladder if in NuvaRing users who present with persistent urinary symptoms and are unable to locate the ring. So with that said, our next method of contraception is actually fairly foolproof. So this is medroxyprogesterone. The brand name is Depo-Provera. And how is this one administered? Speaker 3 13:10 So, like the name says depot, it creates a depot under in the muscle and releases the active medication over the time. So this medication is given, in turn, muscularly, and it's a sustained release injection and used for contraception. Speaker 4 13:25 Sustained release How long does it last? It will last Speaker 3 13:28 for three months. So the patient will need to get one injection every three months. Dr. Sean Kane 13:32 So because they do it in a doctor's office, I'd imagine that it's easier to maintain an adequate schedule, and you don't have a lot of compliance issues, because patients have to make an appointment and then show up for Unknown Speaker 13:43 it, that is correct. Speaker 4 13:45 So does this agent need to be injected into a muscle in or around the female reproductive area? Speaker 5 13:52 Absolutely not. You can treat it like any other im injection. It can be shot into the arms or other muscles. Dr. Sean Kane 13:59 So it is important to note that although medroxyprogesterone, or Depo-Provera, is approved for contraception, it has a number of other indications that it is approved for that are kind of beyond the scope of this podcast. Speaker 4 14:10 So I understand it goes intramuscular, and there's a subcutaneous injection as well, right? Speaker 3 14:15 Yeah, that's something new. The subQ products came out. The brand name is depo-subQ Provera, 104, so the dose is 104 milligram instead of 150 milligrams. With the IM injection and Speaker 4 14:29 medroxyprogesterone, this is one of the first ones that we've seen that doesn't contain ethanyl estradiol. So what's the estrogen component of medroxyprogesterone? Speaker 5 14:38 There is none. What true dog stuff. Kane tell us a little bit about it. Dr. Sean Kane 14:42 So actually, we don't need the estrogen component with progesterone. Progesterone only, oral tablets have a higher rate of failure because they have to be taken very, very consistently. So when we give an IM injection, we don't have to worry as much about that. With that said, because we don't have an estrogen component, we have other issues and some benefits that we don't have with our oral contraceptive. Without the estrogen, we have a lower libido and potentially more acne in patients who receive Depo-Provera or medroxyprogesterone. The benefit, though, is that the risk of venous thromboembolism, MI or stroke isn't as high as it is with the estrogen containing products, but still, this does contain a boxed warning about the risk for blood clots. Unknown Speaker 15:25 Are there many drug interactions with this agent? Speaker 5 15:28 This reminds me of a lecture you just gave recently. Funny. Dr. Sean Kane 15:31 I did give a lecture about estrogen and some of the interactions with those products. So unlike our estrogen products, medroxyprogesterone has very minimal drug interactions, and it's actually fairly safe to use with our anti epileptics as an example. Speaker 4 15:47 So I understand that progesterone can affect bone mineral density. Is that right? Speaker 3 15:51 Yes, actually, that is true, and it also carries a boxed warning Speaker 4 15:54 for it. What other sort of side effects can patients expect? Speaker 3 15:59 So patients may experience weight gain and edema, and again, the weight gain can be associated with all the water weight from edema. Patients may have heavy bleeding at the initiation. And then sometimes we'll also have amenorrhea, which is basically no menses, so there could be some irregularities in menstrual cycle. And another thing to keep in mind is, once they're stopped, using the medroxyprogesterone, it takes about as long as a year for the fertility to return. So even though the product is only good for three months, and you have to repeat the injections every three months, once stopping, the contraceptive effect lingers. Speaker 4 16:40 So patients really need to plan ahead when they want to conceive correct. Dr. Sean Kane 16:43 So our next agent is a little bit different. This one's called raloxifene and the brand name is Evista. Speaker 5 16:49 And what is raloxifene Dr. petty, it is a selective estrogen receptor modulator, or you can abbreviate that, what's called a SERM well, how does that work? It binds to the selective estrogen binding sites and blocks estrogen from those and such as the breast and uterine tissues. And it acts like an estrogen to prevent bone loss. So it decreases that bone resorption, increases bone mineral density, decreases fracture incidence. So it's really good to kind of bulk up the bones. Dr. Sean Kane 17:18 So is this agent contraceptive? What is it used for? Speaker 4 17:22 Well, since it blocks estrogen at the breast tissue, it can be used to decrease the risk of breast cancer, recurrent breast cancer. But since it acts like estrogen at the bone, estrogen is actually protective of the bone, and so it can be used for osteoporosis in women. This isn't an agent to use for osteoporosis Speaker 3 17:39 in men, correct. So this is used as both prevention and treatment for osteoporosis in particularly post menopausal women. Speaker 4 17:47 So I understand this is sort of like estrogen. Does it have any similar side effects? Yes. Speaker 3 17:52 So because it has selectivities at certain estrogen receptors, it still has side effects of increased risk of thromboembolism, peripheral edema, chest weight gain, chest pain, abdominal pain and vomiting also carry forward from those oral contraceptives, because we are depriving some of these estrogen receptors from estrogen people might feel the estrogen withdrawal type of symptoms such as hot flashes, insomnia, muscle pain, arthralgia, also irregular menses. Dr. Sean Kane 18:26 So we mentioned some of the thromboembolic disorders that we saw also with our oral contraceptives. Are there any other contraindications or warnings that we should know about raloxifene or Evista? Speaker 4 18:37 Yeah, patients who have had blood clots in the past should not take raloxifene, and there may be an increased risk of stroke death in women with existing coronary artery disease or women with high risk for CAD and that's another boxed warning. Dr. Sean Kane 18:53 The next drug is tamoxifen, which is also a serum a selective estrogen receptor modulator. Does it Unknown Speaker 18:59 work in the same way as raloxifene? Speaker 3 19:01 The mechanism is just slightly different, so it competitively binds to the estrogen receptors in the tumors and tissue, targets mainly in breast and uterine tissues, and produces the nuclear complex that will decrease the DNA synthesis and will inhibit the estrogen effect. And so in this cancer cells, it's more of a cytostatic than cytocidal. What sort of cancers is this used for? It's used in the treatment of metastatic breast cancer, both female and male, and it is also used in adjuvant treatment of breast cancer, meaning there are other cancer treatments going on along with tamoxifen and used as a prevention, or it's used for the risk reduction of the breast cancer as well. Dr. Sean Kane 19:46 So I would expect that our adverse effect profile should be pretty similar to what we saw with raloxifene or Evista, right? Speaker 4 19:52 Yeah, and you can kind of think of it as being similar to menopause. So folks may experience hot flashes or flushing. Mood changes, depression and changes in their menstrual periods Speaker 3 20:04 and other generalized symptoms, such as those gi nausea, vomiting or those arthritis or generalized muscle pain are still there. The two interesting side effects I wanted to mention is thrombocytopenia or leukopenia. However, this is rare, and patients can also experience vision change, so there is reports of reduced acuity, retinal vein thrombosis, even retinopathy, cataracts Speaker 4 20:31 have reported. So what kind of patients shouldn't take tamoxifen? Speaker 3 20:34 So just like relaxofin, if the patient has or had DVT or PE this product is contraindicated. Also patients who are on warfarin therapy, this medication is contraindicated. Dr. Sean Kane 20:48 So moving on to over the counter products, the first is miconazole, and the brand name is Monistat vaginal. Speaker 4 20:54 I remember we talked about Miconazole in the past for like tinea pedis and athletes foot. So is it also used for a similar thing intravaginally? Speaker 3 21:04 So the topical product definitely is used for any tinea skin infection, and the vaginal products are used for any vaginal yeast infection. Speaker 4 21:13 And is it okay to just use the topical spray or something intravaginally? Dr. Sean Kane 21:17 They'd probably get the job done. But there's other products that would be more appropriate for a vaginal administration, such as so we actually have a vaginal cream and a vaginal suppository form of Miconazole. Speaker 3 21:29 And how are the vaginal products applied or taken or used? Dr. Sean Kane 21:34 There's three different types of Miconazole. One is a low dose, so either a low concentration or a low milligram dose of the suppository, you have to use that for seven days. There's a higher dose, which is basically double the dose, or double the concentration, that can be used for three days. And then there's a gigantic dose that is a one time dose that takes care of the infection with that one dose. Speaker 5 21:57 And the nice thing about these products is you don't have to memorize these milligrams and days. Right on the box, it'll say one day, three days, five days, seven days. So just kind of look out for that. Speaker 3 22:07 Do you expect any common side effects with these products? Dr. Patty, you Speaker 5 22:11 would expect burning and itching the site of application, which is unfortunate, because that's usually what brings you in to get these products. Dr. Sean Kane 22:17 So the next product family that we're talking about is actually one of my favorites, because it's such a marketing scheme, it's just genius. This is the Midol family of products, and what are those used for? So all of them are marketed as temporary relief of menstrual symptoms, but they have a couple different types of products that they market with different subheadings for the Midol brand. Unknown Speaker 22:39 So like, break them down. Speaker 5 22:41 So there's the product called the complete complete product, and so that has a few different active ingredients involved. So it has your acetaminophen, your Tylenol, caffeine and pyrilamine, which is one of those first generation antihistamine. So what type of side effects are we thinking with Unknown Speaker 22:57 that sedation, dry eyes, Unknown Speaker 23:00 dry mouth and others. Dr. Sean Kane 23:02 So do these products have a lot of caffeine in them? They have Speaker 5 23:06 a fair amount, probably about the amount you would get in one of your soft drinks, the 60 milligrams, which should help relieve the bloating and also the fatigue. Speaker 4 23:15 And then, do these have a lot of Tylenol in them? Yeah, they actually have the maximum amount of Tylenol that a patient should take per dose per the recent FDA recommendations, and that's 500 milligrams. Dr. Sean Kane 23:25 So we've got a pain reliever, caffeine to help with bloating and fatigue, and then an antihistamine, allegedly, to help with any swelling from water retention. The next four are one of my favorites, because they're absolutely ridiculous and they're strictly marketing schemes to get women to buy their product. Speaker 3 23:44 All right, let's hear it. Dr. Kane, what are they? So the first one is Dr. Sean Kane 23:47 called Midol long acting. You know what it has in it? What naproxen or Aleve but to the average consumer, they see the Midol product line, and then they think, oh, it's the long acting version. I need something that lasts 12 hours. But really, they could just get the naproxen generic and spend a lot less money. That's a great point. Unknown Speaker 24:05 So then what is Midol teen? Speaker 4 24:08 So Midol teen, of course, is acetaminophen again, and pamabrom, which is a diuretic, but it doesn't contain caffeine, I guess, because people don't want their teens to stay up late. So another scam. What's the next one on the list? Speaker 5 24:23 Liquid gels, and what product is that made out of ibuprofen, good old Advil. Dr. Sean Kane 24:29 And then the last one is Midol PM, which is just Tylenol PM, acetaminophen with diphenhydramine. And that's it. Speaker 4 24:36 So Midol products marketed for PMS often just other Speaker 5 24:41 stuff, PMS, PMS. Speaker 3 24:45 And the last over the counter product we're going to talk is Phenazopyridine, and it's sold as AZO standard. Speaker 4 24:52 So I've heard of phenazopyridine, and it's for UTIs, and it cures them, right? Speaker 5 24:57 No, it's not a curative agent. It's. Just for symptomatic relief. Dr. Sean Kane 25:02 What it is good for, though, is giving to a friend, telling them it's Tylenol, and then three hours later, having them panic when they have orange or red fluorescent urine, Speaker 5 25:11 which did stain your clothes, not from experience. Does it have any antibacterial properties? Well, it Unknown Speaker 25:18 must. It's used for UTIs, but it's not Dr. Sean Kane 25:21 used to treat, so it has absolutely zero antibacterial effect. So it's good for symptomatic relief in conjunction with an antibiotic, but it really should only be used for one or two days until the antibiotic is starting to kick in. Speaker 5 25:33 So it can be dangerous for people to use this product because they can delay their therapy Dr. Sean Kane 25:38 absolutely especially over the counter use. Speaker 4 25:40 So what you're saying is it doesn't cure UTIs, Speaker 3 25:44 sorry to burst your bubble. Dr. Weatherton, but it does not the one last Dr. Sean Kane 25:48 thing that I think is important for phenazopyridine, or AZO is that it is basically a dye, and for certain types of urine tests, like urine glucose or urine ketones, that dye can interfere with those testing products and make them inaccurate. All right, so to review the drugs that we discussed this week, the first was conjugated estrogens, and we had two brand names. One was Premarin, the other was Cenestin. Speaker 4 26:12 The next agent on the list was ethinyl estradiol, combined with norethindrone and sometimes iron in the loestrin Fe and other loestrin products. Speaker 3 26:22 The third product on the list was again, ethinyl estradiol. However, with the different component of norgestrel, the brand names are available under many different products, mainly Ovral or Lo/Ovral. Speaker 5 26:34 Next we talk about the NuvaRing, and that generically, is ethinyl estradiol and etonogestrel. Dr. Sean Kane 26:42 Then we talked about the IM injection Depo-Provera, under the generic name of medroxyprogesterone. Speaker 4 26:49 The next agent on the list was definitely not a sperm, it was a SERM and it's raloxifene or Evista. Speaker 3 26:56 The cousin of raloxifene was tamoxifen, and it's been out in the market for so long. Hey, I don't even know its brand name. Speaker 5 27:05 And then we hit the over the counter products for urinary health, and then we have the Miconazole, but more commonly known as the Monistat products. Dr. Sean Kane 27:13 Then we talked about the brain child of some marketing genius, the Midol products, which contain a variety of different ingredients depending on the sub product that you're looking at. Speaker 4 27:22 And finally, much to my chagrin, the agent which does not cure a UTI, phenazopyridine or AZO. So that Dr. Sean Kane 27:31 concludes week 10 and the final podcast of the spring edition of Rosalind Franklin University's top 200 drugs podcast. I'm your co host, Dr. Kane. Unknown Speaker 27:40 I'm Dr. Weatherton. I'm Dr Speaker 5 27:42 Patel and Dr. petty. Study hard. Speaker 1 27:47 This has been an educational production by the Rosalind Franklin University, College of Pharmacy. Dr. Sean Kane 27:52 This podcast is copyright Rosalind Franklin University of Medicine and Science. Speaker 1 27:56 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. The music for this podcast is an excerpt of Metro Mix by sea salt released under Creative comedy.