drug classifications
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Copyright © 2011 F.A. Davis Company
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Understanding Drug Understanding Drug ClassificationsClassifications
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Drug ClassificationsDrug Classifications
Drugs can be classified by their therapeutic use (e.g., antidepressants) or by their pharmacologic profile (e.g., selective serotonin reuptake inhibitors).
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Drug Classifications (Cont’d)Drug Classifications (Cont’d) Most texts use a combination of therapeutic and
pharmaceutical classifications
Healthcare workers use both terms when discussing medications
Other methods of classification are used for various purposes
For example, the Schedule of Controlled Substances that classifies drugs by risk for abuse
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Therapeutic ClassificationsTherapeutic Classifications Therapeutic classes are broad categories based on
therapeutic intent
Antianginals, sedatives, and analgesics are examples of therapeutic classes
Therapeutic classes include several pharmacologic classes
The therapeutic class antihypertensives has at least 13 pharmacologic classes
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Therapeutic Classifications (Cont’d)Therapeutic Classifications (Cont’d) Drugs grouped by therapeutic class work in very
different ways
They are not chemically similar
They have different mechanisms of action
Therapeutic class is useful when speaking of drugs in a general way
“Antihypertensive drugs save lives”
“You will need antihypertensive medication”
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Pharmacologic ClassificationsPharmacologic Classifications Pharmacologic classification is based on
mechanism of action and includes only those drugs that have the same or similar mechanism of action
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
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Pharmacologic Classifications (Cont’d)Pharmacologic Classifications (Cont’d) Pharmacologic classifications describe a drug’s
properties in a specific way
Pharmacologic class is necessary when determining treatment; a nurse might say
“An ACE inhibitor is more desirable than a beta blocker”
“Your heart won’t race as much because the beta blocker prevents beta-adrenergic receptors in the heart from being stimulated”
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Clues to Pharmacologic ClassClues to Pharmacologic Class
Generic names of drugs in the same pharmacologic class often have the same suffix
Beta blockers, the pharmacologic class of medications in the therapeutic class of antihypertensives, end in “-olol”
Copyright © 2011 F.A. Davis Company
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Clues to Pharmacologic Class (Cont’d)Clues to Pharmacologic Class (Cont’d)
Pharmacologic Class Identifying Suffix
benzodiazepines “-epam” (e.g., diazepam)
5-HT3 antagonists “-setron” (e.g., ondansetron)
HMG-CoA reductase inhibitors
“-statin” (e.g., rosuvastatin)
Monoclonal antibodies “-mab” (e.g., rituximab)
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Drugs in a Pharmacologic Class Drugs in a Pharmacologic Class Have Similar AttributesHave Similar Attributes
Indications
Mechanism of action
Contraindications and precautions
Interactions
Adverse reactions and side effects
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
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Drugs in a Pharmacologic Class Drugs in a Pharmacologic Class May DifferMay Differ
Dosages Time action profile Availability
Copyright © 2011 F.A. Davis Company
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
ACE Inhibitors: An Example of a ACE Inhibitors: An Example of a Pharmacological Class of DrugsPharmacological Class of Drugs
ACE Inhibitors: Includes at least 10 individual drugs (right)
All end in “-pril”
Commonly prescribed drugs
benazepril moexipril
captopril perindopril
enalapril quinapril
fosinopril ramipril
lisinopril trandolapril
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Indication and Action Indication and Action of ACE Inhibitorsof ACE Inhibitors
IndicationsIndications Alone or with other agents in the management of
hypertension ActionsActions
ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II
ACE inactivates the vasodilator bradykinin and other vasodilatory prostaglandins
ACE inhibitors increase plasma renin levels and reduce aldosterone levels; net result: systemic vasodilation
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Therapeutic EffectsTherapeutic Effectsof ACE Inhibitorsof ACE Inhibitors
Lowering of blood pressure in hypertensive patients
Decreased afterload in patients with CHF Decreased development of overt heart failure Increased survival after MI (selected agents
only) Decreased progression of diabetic
nephropathy (captopril only)
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Side Effects ofSide Effects of ACE Inhibitors ACE Inhibitors CNS: dizziness, fatigue, headache, insomnia, weakness Resp: cough, eosinophilic pneumonitis CV: hypotension, angina pectoris, tachycardia GI: taste disturbances, anorexia, diarrhea, hepatotoxicity (rare), nausea GU: proteinuria, impotence, renal failure Derm: rashes F and E: hyperkalemia Hemat: AGRANULOCYTOSIS, NEUTROPENIA (CAPTOPRIL ONLY)
Misc: ANGIOEDEMA, fever
Note: CAPITALS indicate life-threatening effects; underlines indicate most frequent
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Nursing Care oNursing Care of Patients f Patients on ACE Inhibitorson ACE Inhibitors
Hypertension Monitor frequency of prescription refills to determine
adherence Monitor blood pressure and pulse frequently during initial
dose adjustment and periodically during therapy; notify healthcare professional of significant changes
CHF Monitor weight and assess patient routinely for resolution
of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention)
Davis’s Drug Guide for Nurses, 12th EditionDavis’s Drug Guide for Nurses, 12th Edition
Copyright © 2011 F.A. Davis Company
Patient SafetyPatient Safety Always check other sources if you are uncertain
about a medication’s Use
Effect
Side effects
Dosage
Route of administration
Monitoring criteria
Any other parameter of safe and responsible medication administration