drug classifications

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



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).



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



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



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”



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



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”



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”



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)



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



Drugs in a Pharmacologic Class Drugs in a Pharmacologic Class May DifferMay Differ

Dosages Time action profile Availability



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



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



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)



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



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)



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

drug classifications

Health & Medicine

pharmacologic classes

drug classifications

therapeutic class work

pharmacologic classmay

drugs properties

individual drugs

drugs worksthey

effects of ace inhibitors