Drug classifications

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Drug classifications

  1. 1. Understanding Drug Classifications
  2. 2. Drug Classifications <ul><li>Drugs can be classified by their therapeutic use (e.g., antidepressants) or by their pharmacologic profile (e.g., selective serotonin reuptake inhibitors). </li></ul>
  3. 3. Drug Classifications (Cont’d) <ul><li>Most texts use a combination of therapeutic and pharmaceutical classifications </li></ul><ul><li>Healthcare workers use both terms when discussing medications </li></ul><ul><li>Other methods of classification are used for various purposes </li></ul><ul><ul><li>For example, the Schedule of Controlled Substances that classifies drugs by risk for abuse </li></ul></ul>
  4. 4. Therapeutic Classifications <ul><li>Therapeutic classes are broad categories based on therapeutic intent </li></ul><ul><ul><li>Antianginals, sedatives, and analgesics are examples of therapeutic classes </li></ul></ul><ul><li>Therapeutic classes include several pharmacologic classes </li></ul><ul><ul><li>The therapeutic class antihypertensives has at least 13 pharmacologic classes </li></ul></ul>
  5. 5. Therapeutic Classifications (Cont’d) <ul><li>Drugs grouped by therapeutic class work in very different ways </li></ul><ul><ul><li>They are not chemically similar </li></ul></ul><ul><ul><li>They have different mechanisms of action </li></ul></ul><ul><li>Therapeutic class is useful when speaking of drugs in a general way </li></ul><ul><ul><ul><li>“ Antihypertensive drugs save lives” </li></ul></ul></ul><ul><ul><ul><li>“ You will need antihypertensive medication” </li></ul></ul></ul>
  6. 6. Pharmacologic Classifications <ul><li>Pharmacologic classification is based on mechanism of action and includes only those drugs that have the same or similar mechanism of action </li></ul><ul><ul><li>For example, “angiotensin-converting enzyme inhibitors” (ACE inhibitors) tell you exactly how the drugs works—they inhibit the enzyme that converts angiotensin I to angiotensin II </li></ul></ul>
  7. 7. Pharmacologic Classifications (Cont’d) <ul><li>Pharmacologic classifications describe a drug’s properties in a specific way </li></ul><ul><li>Pharmacologic class is necessary when determining treatment; a nurse might say </li></ul><ul><ul><li>“ An ACE inhibitor is more desirable than a beta blocker” </li></ul></ul><ul><ul><li>“ Your heart won’t race as much because the beta blocker prevents beta-adrenergic receptors in the heart from being stimulated” </li></ul></ul>
  8. 8. Clues to Pharmacologic Class <ul><li>Generic names of drugs in the same pharmacologic class often have the same suffix </li></ul><ul><ul><li>Beta blockers , the pharmacologic class of medications in the therapeutic class of antihypertensives, end in “- olol ” </li></ul></ul>
  9. 9. Clues to Pharmacologic Class (Cont’d) Pharmacologic Class Identifying Suffix benzodiazepines “ -epam” (e.g., diazepam) 5-HT 3 antagonists “ -setron” (e.g., ondansetron) HMG-CoA reductase inhibitors “ -statin” (e.g., rosuvastatin) Monoclonal antibodies “ -mab” (e.g., rituximab)
  10. 10. Drugs in a Pharmacologic Class Have Similar Attributes <ul><ul><li>Indications </li></ul></ul><ul><ul><li>Mechanism of action </li></ul></ul><ul><ul><li>Contraindications and precautions </li></ul></ul><ul><ul><li>Interactions </li></ul></ul><ul><ul><li>Adverse reactions and side effects </li></ul></ul><ul><li>These attributes are similar or identical in a pharmacologic class; if you know about one drug in a class, you will have some knowledge of other drugs in the class </li></ul>
  11. 11. Drugs in a Pharmacologic Class May Differ <ul><li>Dosages </li></ul><ul><li>Time action profile </li></ul><ul><li>Availability </li></ul>
  12. 12. ACE Inhibitors: An Example of a Pharmacological Class of Drugs <ul><li>ACE Inhibitors: Includes at least 10 individual drugs ( right ) </li></ul><ul><li>All end in “-pril” </li></ul><ul><li>Commonly prescribed drugs </li></ul>benazepril moexipril captopril perindopril enalapril quinapril fosinopril ramipril lisinopril trandolapril
  13. 13. Indication and Action of ACE Inhibitors <ul><li>Indications </li></ul><ul><ul><li>Alone or with other agents in the management of hypertension </li></ul></ul><ul><li>Actions </li></ul><ul><ul><li>ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II </li></ul></ul><ul><ul><li>ACE inactivates the vasodilator bradykinin and other vasodilatory prostaglandins </li></ul></ul><ul><ul><li>ACE inhibitors increase plasma renin levels and reduce aldosterone levels; net result: systemic vasodilation </li></ul></ul>
  14. 14. Therapeutic Effects of ACE Inhibitors <ul><ul><li>Lowering of blood pressure in hypertensive patients </li></ul></ul><ul><ul><li>Decreased afterload in patients with CHF </li></ul></ul><ul><ul><li>Decreased development of overt heart failure </li></ul></ul><ul><ul><li>Increased survival after MI (selected agents only) </li></ul></ul><ul><ul><li>Decreased progression of diabetic nephropathy (captopril only) </li></ul></ul>
  15. 15. Side Effects of ACE Inhibitors <ul><li>CNS: dizziness, fatigue, headache, insomnia, weakness </li></ul><ul><li>Resp : cough , eosinophilic pneumonitis </li></ul><ul><li>CV : hypotension , angina pectoris, tachycardia </li></ul><ul><li>GI : taste disturbances , anorexia, diarrhea, hepatotoxicity (rare), nausea </li></ul><ul><li>GU : proteinuria , impotence, renal failure </li></ul><ul><li>Derm : rashes </li></ul><ul><li>F and E : hyperkalemia </li></ul><ul><li>Hemat : AGRANULOCYTOSIS, NEUTROPENIA (CAPTOPRIL ONLY) Misc : ANGIOEDEMA, fever </li></ul><ul><ul><li>Note: CAPITALS indicate life-threatening effects; underlines indicate most frequent </li></ul></ul>
  16. 16. Nursing Care o f Patients on ACE Inhibitors <ul><ul><li>Hypertension  </li></ul></ul><ul><ul><ul><li>Monitor frequency of prescription refills to determine adherence </li></ul></ul></ul><ul><ul><ul><li>Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy; notify healthcare professional of significant changes </li></ul></ul></ul><ul><ul><li>CHF </li></ul></ul><ul><ul><ul><li>Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention) </li></ul></ul></ul>
  17. 17. Patient Safety <ul><li>Always check other sources if you are uncertain about a medication’s </li></ul><ul><ul><li>Use </li></ul></ul><ul><ul><li>Effect </li></ul></ul><ul><ul><li>Side effects </li></ul></ul><ul><ul><li>Dosage </li></ul></ul><ul><ul><li>Route of administration </li></ul></ul><ul><ul><li>Monitoring criteria </li></ul></ul><ul><ul><li>Any other parameter of safe and responsible medication administration </li></ul></ul>

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