Memorizing Cyp450 Inducers & Inhibitors

One of my favorite new apps on my Android phone is made by Pendragon Entertainment: USMLE Pharmacology.  Definitely recommend it – while I was setting it up yesterday, it asked me about cytochrome p450 inhibitors and inducers so many times that I accidentally learned them.

(I know, right?  Technology!)

It seems like the first step was being able to recognize that a drug is a cytochrome p450 something.  The commonly tested ones, at least on that app, were these:  Erythromycin, quinidine, rifampin, isoniazid, griseofulvin, cimetidine, carbamazepine, phenytoin, and phenobarbital.

And that’s basically the hard part, because I realized the names themselves are simply divided into “quick” names (inducers) and “slow” names (inhibitors).

Of course, you don’t need pictures to recognize that QUICKidine, GRIZZLYofulvin, CARbamazepine, RifAMPin, and PHENPHEN (Phenytoin & Phenobarbital) are “fast” names.

No, I don’t know where the grizzly bear got the illegal drugs. I suspect his dealer was in the car, and the mosquito’s all “Dude, Phenphen isn’t legal. LET ME TAKE CARE OF THAT FOR YOU.”

Similarly, no one should need a poorly-drawn picture to recognize that ICEoniazid, ERRORythromicin, and CEMENTidine are “slow” names.

Why is there a block of cement in the middle of the ice rink? I don’t know. Maybe someone just hates that poor robot.

But then, where would be the fun in that?

Bones

Endocrinology is such a mixed, random bag of topics: ob/gyn, bones, diabetes, pituitary, thyroid.  (Which makes sense, since ‘Endocrine’ really just means ‘things secreting things that go places and do stuff“.  So this is not a system like cardiovascular is a system.  This is the “lost and found” box of physiology.)

It’s easy to motivate myself to learn about the obviously cool things – like birth control – or obviously important things, like menopause or diabetes.

It’s also easy to motivate myself to learn about the terrifyingly complicated things, like cancers.

But I have never been able to motivate myself to learn about bones.  It’s the worst thing ever:  Show me a picture of Haversian canals and – oh god, I need a Red Bull now.  That phrase is just awful.

The closest I’ve ever come to successfully learning about bone biology is knowing that osteoclasts absorb bone – because while in class, I’m supposed to be absorbing the bone information - but osteoblasts do the opposite, because blast, I never absorb anything.  (Osteocytes are grown-up osteoblasts.  Because since I never absorbed anything, when I grow up I will cite all bone information directly from a textbook.)

Luckily, since this is the 3rd time this year we’re learning about bones, now I can at least remember the names of those cells without that ridiculous mnemonic.  Progress!

But despite that, you could still say I have an intense Haversian to this material.

*crickets*

(… I’ll be here all week, folks!  Tip your waiters!)

Quote Of The Day: Can’t believe I missed that lecture.

Pathology Lecturer:  ”My supervisor always told us we could really connect with the students if we memorized all of your names. So I had an even better idea! I decided to just give everyone a new name. So… “Bob!” What do you think of this slide – normocellular, or hypercellular?”

And he continued to call on students randomly, by made-up names, for the rest of the morning.  (I love pathologists.  They all do awesome stuff like that.)  (Hi, Boyfriend.  Way to pick your future specialty!  Ten points to Gryffindor!)

Anyway.  This same lecturer came up with a mnemonic for the causes of papillary necrosis.  It’s a solid mnemonic, but I always forget what syndrome the mnemonic is for… so I thought “Hey, maybe if I come up with a terrible pun and draw a picture of it, I’ll remember.”

(Or, let’s be honest, “Hey, I over-caffeinated myself and can’t sit still enough to study anymore!  How can I justify drawing awkward pictures instead.“)

How to memorize origins and insertions

Last night I got a question about how to memorize origins and insertions for anatomy.  My comment quickly turned into a book, so I figured I’d make it a post and call it a day.  Skip to the double astericks** if anatomy bores you.

You’re right, mnemonics don’t really work for muscle attachments -too many of them.  It demands a different strategy – here’s what I believe in:

1.  First, make a table.  I use 5 columns across the top of the page for “muscle name” “origin” “insertion” “action” and “innervation”.  If you’re feeling fancy, you can color-code, but it’s not necessary. Once everything you need to know is in one place for easy reference, memorizing it starts to seem possible – and you won’t be wasting time flipping pages around.

These folks have clearly just found out there are 600 muscles in the human body and they have to know at least 5 things about each one.

2.  Prioritize.  First, learn just the bone of attachment for each muscle. Then the process/part of the bone.  Then any absurdly specific details your professor wants you to know about that process. It’s okay if you don’t finish the 3rd pass – I sure didn’t – but you’d be surprised by how much further you’ll be ahead of everyone if you start each unit by memorizing what bones the muscles attach to.

What you want to avoid is trying to memorize the long and detailed version for each muscle before moving onto the next.  It’s all too easy for this to take so long that you run out of time.*  If you start with a quick pass of bones, then add detail, you’ll at least know enough about each muscle to guarantee an intelligent guess.

3.  Try memorizing by action. For example, most of the medial rotators of the arm attach to the intertubercular groove.  (Not the “floor of the” or “the lateral lip of the” or, god forbid, the “lateral 3/4 of the inner side of the”- at least not yet.  Those are low-yield details that you can hammer into your brain with flashcards the day before a test if you have time).  So, that’s great – but subscapularis is the exception.  How to remember subscapularis?  Well, I remember that the lateral rotators attach to the greater tubercle (because I made a list of where the lateral rotators attached)- so since the subscap is a medial rotator, by elimination I know it must attach to the lesser tubercle.

Okay, so this guy is probably capable of memorizing everything on the 1st try. But he also "aced his MCATs" and "cleverly has no personal life". So.

4.  Try memorizing by common insertion points. Making a list of which muscles attach at a given location (rather than the reverse) and doing some rudimentary memorization of that list can speed things up quite a bit.  (Only worth doing with common insertion points – greater trochanter, ASIS, etc.)  For example – the coronoid process of the ulna.  What attaches there?  The brachialis and a bunch of forearm muscles.  What do they have in common?  They’re all flexors – FDP, FDS, and FDP longus flex digits, while Pronator Teres and brachialis flex the elbow.

Cool.  Now I have two ways of potentially remembering this information during the test.  If I’ve forgotten Pronator Teres’ attachments, but I remember it’s a flexor – then I might remember that most flexors attach to the coronoid process.  If I’ve remembered its attachments but forgotten its secondary action, then I can just remember “hey, everything attached to the coronoid process is a flexor.  It must flex.”

“Too long, didn’t read” version: Get all the info down in one place and start by memorizing everything according to general attachments only.  Then group the info in various ways by writing simple lists, thereby increasing the number of ways you can remember it on the test.

Anyone else have any anatomy advice?

* For example, once you know that the brachialis attaches to the ulna (and not the radius)  - then you can start adding “coronoid process and tuberosity of the ulna” to your memory.  Otherwise, if you draw a partial blank on test day, it’s anyone’s guess what part of that sentence you might remember – maybe you’ll only remember “tuberosity”.  Not as helpful as “ulna”.

** Fun fact:  Shania Twain’s real name is Eileen Edwards.  If that doesn’t surprise you, then you should know that Tina Turner’s real name was Anna Bullock, and Tori Amos was really named Myra.  Hopefully this entry was now not a total waste of your time.

Coagulation Cascade: In Limericks!

It’s like Rule 34 of the internet… for science: If you can imagine it, there is a mnemonic for it. And somebody has put it on the internet.

So late last night, I was contemplating whether I should open my book and start diagraming the coagulation cascade (lame), or open the internet and search for mnemonics for the coagulation cascade (awesome). The internet won and Rule 34 (of science!) was proven correct again.

This may not be the most efficient way to memorize the coagulation cascade, but gosh darn it, it’s peer-reviewed, they made it rhyme, and they included regulation. Score one for science.

Coagulation Cascade: A Series of Limericks, by Mark A. Vande Haar and Karyn A. Fay

Medicine: Battlestar Galactica Edition

Boyfriend’s studying for his medical boards, and he just called me up to tell me that he’d made up the greatest mnemonic ever.

The CAG is hunting 4 cylons.

Hunting = Huntington’s Disease, CAG = a CAG trinucleotide repeat, 4 = chromosome 4.

Because Huntington’s Disease is caused by having multiple CAG repeats on the 4th chromosome.

Now whenever someone brings up Huntington’s, you can nod your head and act all sage and say, “Yeah, isn’t it scary just how much damage a CAG repeat can do? It’s on the 4th chromosome for Huntington’s, isn’t it?” and they will think you’re a complete nerd GENIUS.