drug classifications

PHARMACOLOGY UNIT 3 DRUG CLASSIFICATIONS CLASSIFICATIONS TERMINOLOGY Pharmacologic Profile - Refers to all information presented in drug reference book General Use - How is the medication used? General Action and Information - How does the medication work? What 'other' information is needed before reading further Contraindications - Why shouldn't a pt take this? Precautions - What does the nurse need to do before administering the medication? Interactions - What medications interfere with normal drug action? Patient/Family Teaching - Suggestions for the nurse to use to educate pt and family about ordered medications Evaluation / Desired Outcomes - What is expected if the medication has been successful Drug Actions ❖ Depressing ❖ Stimulating ❖ Destroying ❖ Replacing Substances ANTI-ALZHEIMER'S AGENTS General Use: ● Management of Alzheimer's Dementia General Action: ● All agents act by increasing the amount of acetylcholine in the CNS by inhibiting cholesterase ● No agents can slow the progression of A.D. ● Current agents may temporarily improve cognitive function and therefore improve quality of life Nursing Implications: ● Assessment ○ Assess cognitive function throughout therapy ○ Monitor nausea, vomiting, anorexia, and weight loss Medications: ● donepezil (Aricept) ● rivastigmine (Exelon) ● Memantine (Namenda) ANTIANEMICS General Use: ● Prevention and treatment of anemias General Action: ● For iron deficiency anemia to promote transport of hemoglobin ● For water soluble vitamins needed for RBC production ● For low RBC count to promote production of RBC Nursing Implications: ● Assessment ○ Assess patient's nutritional status and dietary history to determine possible causes for anemia ○ Assess for patient teaching needs Medications: ● iron polysaccharide (Niferex) ● epoetin (Epogen)(Procrit) ANTIANGINALS General Use: ● Nitrates are used to treat and prevent attacks of angina ● Calcium channel blockers and beta blockers are used prophylactically in long-term management of angina General Action: ● Nitrates dilate coronary arteries and cause systemic vasodilation ● Calcium channel blockers dilate coronary arteries ● Beta blockers decrease myocardial 02 consumption Nursing Implications: ● Assessment ○ Assess location, duration, intensity, and precipitating factors of pt's anginal pain ○ Monitor BP and pulse periodically throughout therapy Medications: ● atenolol (Tenormin) ● nitroglycerin (Nitro-Dur) ANTIANXIETY AGENTS General Use: ● Used in mgmt of various forms of anxiety including generalized anxiety disorder General Action: ● Most agents cause generalized CNS depression Nursing Implications: ● Assessment ○ Assess degree of anxiety and level of sedation before and periodically throughout therapy ○ Prolonged high-dose therapy may lead to physical or psychological dependence Medications: ● Benzodiazepines SSRI'S ○ alprazolam (Xanax) paroxetine hcl ○ lorazapam (Ativan) (paxil) ○ diazepam (Valium) ANTIARRHYTHMICS General Use: ● Suppression of cardiac arrhythmias General Action: ● Correct cardiac arrhythmias by a variety of mechanisms, depending on group used. ● Goal ○ decrease ⇩ symptomatology ○ increase ⇧ Hemodynamic performance Nursing Implications: ● Assessment ○ Monitor ECG, pulse and BP periodically throughout oral administration Medications: ● Lanoxin/Digoxin ○ propranolol (Inderal) ○ amiodarone (Cordarone) ○ Cardizem ANTICOAGULANTS General Use: ● Prevention and treatment of thromboembolic disorders including DVT, PE and A Fib w/ emboli General Action: ● Used to prevent clot extension and formation ● DO NOT dissolve clots Nursing Implications: ● Assessment ○ Assess for signs of bleeding / hemorrhage ○ Monitor bleeding time ○ Toxicity / Overdose - needs to be reversed immediately. Use protamine sulfate for Heparin and Vitamin K for Warfarin Medications: ● fondaparinux (Arixtra) ● Heparin (PTT) ● warfarin (Coumadin) (PT/INR) ● Lovenox ANTICONVULSANTS General Use: ● Used to decrease ⇩ incidence / severity of seizures General Action: ● Depresses abnormal neuronal discharges in CNS that may result in seizures ● May also work by preventing spread of seizure activity, depressing motor cortex, raising seizure threshold, or altering levels of neurotransmitters depending on the group. Nursing Implications: ● Assessment ○ Assess location, duration, and characteristic of seizure activity ○ Monitor serum drug levels routinely Medications: ● phenobarbital (Luminal) ● diazepam (Valium) ● phenytoin (Dilantin) ● valproic Acid (Depakene) ● Tegretol ANTIDEPRESSANTS General Use: ● Used in tx of endogenous depression, often in conjunction with psychotherapy General Action: ● Attempts to prevent the reuptake of dopamine, norepinephrine, and serotonin by presynaptic neurons, resulting in accumulation of these neurotransmitters. Nursing Implications: ● Assessment ○ Assess mental status and affect ○ Assess for suicidal tendencies ○ Restrict amount of drug available to pt Medications: ● duloxetine (Cymbalta) ● amitriptyline (Elavil) ● phenelzine (Nardil) ● Zoloft ● Paxil ● Proza ANTIDIABETICS General Use: ● Used in mgmt of type 1 and type 2 Diabetes General Action: ● Insulin lowers blood glucose by increasing ⇧ transport of glucose into cells and promotes conversion of glucose to glycogen ● Oral medications stimulate secretion of insulin by beta cells Nursing Implications: ● Assessment ○ Observe for s&s of hypoglycemic reaction ○ Monitor serum glucose Medications: ● metformin (Glucophage) ● glyburide (Diabeta) ● Pioglitazone (Actos) ● liraglutide (Victoza) ANTIEMETICS General Use: ● Used to manage nausea & vomiting of many causes General Action: ● Act on the chemoreceptor trigger zone to inhibit n&v ● Some act by diminishing motion sickness ● Others decrease n&v by its effect on gastric emptying Nursing Implications: ● Assessment ○ Assess n&v, bowel sounds, abdominal pain before and following administration ○ Monitor hydration; I&O Medications: ● ondansetron (Zofran) ● promethazine (Phenergan) ● metoclopramide (Reglan) ANTIHYPERTENSIVES General Use: ● Tx of hypertension of many causes, most commonly essential HTN General Action: ● Used to lower blood pressure to a normal level or to the lowest level tolerated ● Classified into groups according to their site of action Nursing Implications: ● Assessment ○ Monitor BP, pulse frequently during dosage adjustment and periodically throughout therapy ○ Monitor I&O ○ Monitor compliance through frequency of refills Medications: ● clonidine (Catapres) ● ramipril (Altace) ● olmesartan (Benicar) ● propranolol (Inderal) ● metoprolol (Lopressor) ANTI-INFECTIVES General Use: ● Treatment and prophylaxis of various bacterial infections General Action: ● Kill (bacteriocidal) or inhibit growth (bacteriostatic) of susceptible pathogenic bacteria Nursing Implications: ● Assessment ○ Assess for s&s of infection prior to and throughout tx ○ Check allergies especially for penicillin & cephalosporins ○ Obtain specimens for C&S prior to beginning tx Medications: ● gentamicin (Garamycin) ● piperacillin / tazobactam (Zosyn) ● levofloxacin (Levaquin) ANTINEOPLASTICS General Use: ● Used for tx of various solid tumors, lymphomas and leukemias General Action: ● Act by many different mechanisms ● Action may not be limited to neoplastic cells Nursing Implications: ● Assessment ○ Monitor for bone marrow depression ■ Assess for bleeding (gums, bruising, urine etc) ○ Monitor I&O, appetite, nutritional intake ○ Monitor IV site carefully & maintain patency Medications: ● methotrexate (Folex) ANTIPLATELET AGENTS General Use: ● Used to tx and prevent thromboembolic events such as stroke and MI General Action: ● Inhibit platelet aggregation ● Prolongs bleeding time Nursing Implications: ● Assessment ○ Assess pt for s&s increased thrombosis ○ Monitor bleeding time Medications: ● dipyridamole (Persantine) ● clopidogrel (Plavix) ● Aspirin ANTIPSYCHOTICS General Use: ● Tx of acute and chronic psychoses, particularly when accompanied by increased psychomotor activity General Action: ● Blocks dopamine receptors in the brain ● Alters dopamine release and turnover Nursing Implications: ● Assessment ○ Assess pt's mental status before / periodically ○ Monitor BP, pulse, resp before / frequently ○ Observe pt taking meds to prevent hoarding ○ Monitor pt for onset of akathisia, parkinsonian and dystonia, tardive dyskinesia Medications: ● chlorpromazine (Thorazine) ● risperidone (Risperdal) ● Haldol CORTICOSTEROIDS General Use: ● Used in replacement doses systemically to tx adrenocortical insufficiency ● Larger doses used for the anti-inflammatory, immunosuppressive, or antineoplastic activity General Action: ● Produce profound and varied metabolic effects ● Modify normal immune responses ● Suppresses inflammation Nursing Implications: ● Assessment ○ Assess involved systems ○ Assess for signs of adrenal insufficiency ○ Children should have periodic evaluations of growth Medications: ● hydrocortisone (Solu-Cortef) ● methylprednisolone (Solu-Medrol) ● dexamethasone (DexPak) DIURETICS General Use: ● Thiazide and loop diuretics used for tx HTN, edema d/t CHF or other causes General Action: ● Enhance selective excretion of various electrolytes and water by affecting renal mechanisms for tubular secretion and reabsorption Nursing Implications: ● Assessment ○ Assess fluid status throughout tx ○ Monitor daily wt, I&O, amt & location edema, lung sounds, skin turgor, mucous membranes ○ Monitor electrolytes - esp potassium Medications: ● furosemide (Lasix) ● mannitol (Osmitrol) ● hydrochlorothiazide (HCTZ) ● Aldactone HORMONES General Use: ● Used in tx of deficiency states including diabetes, hypothyroidism, menopause General Action: ● Natural or synthetic substances have specific effect on target tissue ● Differ greatly in their effects depending on individual agent and function or target tissue Nursing Implications: ● Monitor pt for sx's of hormonal excess or insufficiency Medications: ● calcitonin (Miacalcin) ● estrogens ● levothyroxine (Synthroid) ● insulins NONOPIOID ANALGESICS General Use: ● Used to control mild to moderate pain and/or fever General Action: ● Most inhibit prostaglandin synthesis ○ peripherally for analgesic effect ○ Centrally for antipyretic effect Nursing Implications: ● Assessment ○ Assess pain and limitation of movement ○ Assess fever, note associated S&S ○ Monitor liver, renal and hematologic lab values Medications: ● ibuprofen ● ASA ● acetaminophen Non Steroidal Anti-Inflam Drug General Use: ● Used to control mild to moderate pain, fever, and various anti- inflammatory conditions General Action: ● NSAIDs have analgesic, antipyretic and anti-inflammatory properties ● Analgesic and anti-inflammatory are d/t inhibitions of prostaglandins Nursing Implications: ● Assessment ○ Pts w/ asthma, allergies and nasal polyps are more at risk for hypersensitivity. ○ Assess pain, limitation of movement, fever ○ Evaluate effectiveness ○ Most NSAIDS prolong bleeding time due to suppressed platelet aggregation ○ Monitor for Gl blood loss - give w/ food Medications: ● ibuprofen - Advil, Motrin ● naproxen sodium – Aleve ● celecoxib – Celebrex ● Ketorolac – Toradol OPIOID ANALGESICS General Use: ● Mgmt moderate to severe pain General Action: ● Opioids bind to opiate receptors in the CNS ● Alters perception of and response to pain Nursing Implications: ● Assessment ○ Assess pain type, location, intensity ○ Assess BP, pulse, resp before and during therapy ○ Assess prior analgesic hx ○ Assess bowel function periodically Medications: ● fentanyl transdermal (Duragesic) ● hydromorphone (Dilaudid) ● oxycodone (Oxycontin) ● Morphine SEDATIVE/HYPNOTICS General Use: ● Sedatives provide sedation ● Hypnotics are used to manage insomnia General Action: ● Cause generalized CNS depression Nursing Implications: ● Assessment ○ Monitor BP, pulse, resp status frequently w/ IV ○ Assess sleep patterns if for insomnia Medications: ● phenobarbital (Luminal) ● lorazepam (Ativan) ● zolpidem (Ambien) SKELETAL MUSCLE RELAXANTS General Use: ● Spasticity associated w/ spinal cord lesions ● Symptomatic relief of acute painful MS conditions General Action: ● Act either centrally or directly to relax muscle fibers Nursing Implications: ● Assessment ○ Assess for pain, muscle stiffness, ROM before and periodically throughout tx Medications: ● Flexaril ● baclofen (Lioresal) ● diazepam (Valium) THROMBOLYTICS General Use: ● Acute mgmt coronary thrombosis (MI) ● Mgmt massive pulmonary emboli, DVT, arterial thromboembolism General Action: ● Converts plasminogen to plasmin which then breaks down fibrin in clots Nursing Implications: ● Begin tx ASAP after onset sx's ● Monitor VS q 4 hours Medications: ● streptokinase (Streptase) VASCULAR HEADACHE SUPPRESSANTS General Use: ● Acute vascular headaches General Action: ● Smooth muscle vasoconstriction Nursing Implications: ● Assessment ○ Assess pain, location, intensity, duration ○ Assess for photophobia, phonophobia, n&v ○ Assess for frequency of migraine attacks Medications: ● ergotamine (Ergomar) ● sumatriptan (Imitrex) Anti-Lipid ● Statin drugs ● Pravastatin (Pravachol) ● Atorvastatin (Lipitor) ❖ Assess for severe muscle soreness ❖ Meds should always be taken in the evening (6pm) Anti - Parkinsons ● -dopa drugs. ● Levodopa ● carbidopa (Lodosyn) ● (Sinemet) - mix of Levodopa and Carbidopa ADDITIONAL CLASSIFICATIONS ● There are more classifications listed in the 12th Edition of Davis Drug Guide ● Additional review of these classifications will occur during the coming 'systems' lectures ● Independent study is always an option as well!