PHARMACOLOGY UNIT 3

DRUG CLASSIFICATIONS

Classifications Terminology Pharmacologic Profile

General Use

General Action and Information

Refers to all information presented in drug reference book

How is the medication used?

How does the medication work? What ‘other’ information is needed before reading further

◦ Contraindications

◦ Precautions

◦ Interactions

Why shouldn’t a pt take this?

What does the nurse need to do before administering the medication?

What medications interfere with normal drug action?

Nursing Implications

Potential Nursing Diagnoses

Implementation

Actions and thoughts the nurse has before administering the medication

Added feature in some drug books

Actions the nurse takes while administering medications

Patient/Family Teaching

Evaluation / Desired Outcomes

Suggestions for the nurse to use to educate pt and family about orderedmedications

What is expected if the medication has been successful

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

ANTI-ALZHEIMER’S AGENTS

Nursing Implications:◦ Assessment

Assess cognitive function throughout therapy Monitor nausea, vomiting, anorexia, and

weight loss

Medications:◦ donepezil (Aricept)◦ rivastigmine (Exelon)

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

ANTIANEMICS

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)◦ folic acid (Folate)

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 O2

consumption

ANTIANGINALS

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)◦ dilitazem (Cardizem)◦ nitroglycerin (Nitro-Dur)

General Use:◦ Used in mgmt of various forms of anxiety

including generalized anxiety disorder

General Action:◦ Most agents cause generalized CNS depression

ANTIANXIETY AGENTS

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 (Paxil)

diazepam (Valium)

General Use: ◦ Suppression of cardiac arrhythmias

General Action: ◦ Correct cardiac arrhythmias by a variety of

mechanisms, depending on group used.◦ Goal - symptomatology

Hemodynamic performance

ANTIARRHYTHMICS

Nursing Implications:◦ Assessment

Monitor ECG, pulse and BP periodically throughout oral administration

Medications:◦ procainamide (Pronestyl)◦ lidocaine (Xylocard)◦ propranolol (Inderal)◦ amiodarone (Cordarone)

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

ANTICOAGULANTS

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◦ warfarin (Coumadin)

General Use:◦ Used to 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.

ANTICONVULSANTS

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)

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.

ANTIDEPRESSANTS

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)

General Use:◦ Used in mgmt of type 1 and type 2 Diabetes

General Action:◦ Insulin lowers blood glucose by transport of

glucose into cells and promotes conversion of glucose to glycogen

◦ Oral medications stimulate secretion of insulin by beta cells

ANTIDIABETICS

Nursing Implications:◦ Assessment

Observe for s&s of hypoglycemic reaction Monitor serum glucose

Medications:◦ metformin (Glucophage)◦ sitagliptin (Januvia)◦ glimepiride (Amaryl)

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

ANTIEMETICS

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)

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

ANTIHYPERTENSIVES

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)

General Use:◦ Treatment and prophylaxis of various bacterial

infections

General Action:◦ Kill (bacteriocidal) or inhibit growth

(bacteriostatic)of susceptible pathogenic bacteria

ANTI-INFECTIVES

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)

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

ANTINEOPLASTICS

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:◦ cisplatin (Platinol)◦ tamoxifen (Tamoxifen)◦ methotrexate (Folex)

General Use:◦ Used to tx and prevent thromboembolic events

such as stroke and MI

General Action:◦ Inhibit platelet aggregation◦ Prolongs bleeding time

ANTIPLATELET AGENTS

Nursing Implications:◦ Assessment

Assess pt for s&s increased thrombosis Monitor bleeding time

Medications:◦ dipyridamole (Persantine)◦ clopidogrel (Plavix)

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

ANTIPSYCHOTICS

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)

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 response◦ Suppresses inflammation

CORTICOSTEROIDS

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)

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

DIURETICS

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)

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

HORMONES

Nursing Implications:◦ Monitor pt for sx’s of hormonal excess or

insufficiency

Medications:◦ calcitonin (Miacalcin)◦ estrogens◦ levothyroxine (Synthroid)◦ insulins

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

NONOPIOID ANALGESICS

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

General Use:◦ Used to control mild to moderate pain, fever , and

various anti-inflammatory conditions

General Action: NSAIDs have analgesic, antipyretic and anti-

inflammatory propertiesAnalgesic and anti-inflammatory are d/t

inhibition of prostaglandins

Non Steroidal Anti-Inflam Drug

Nursing Implications:◦ Pts w/ asthma, allergies and nasal polyps 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 GI blood loss – give w/ food

Medications:◦ ibuprofen - Advil, Motrin◦naproxen sodium – Aleve◦celecoxib – Celebrex◦Ketorolac - Toradol

General Use:◦ Mgmt moderate to severe pain

General Action:◦ Opioids bind to opiate receptors in the CNS◦ Alters perception of and response to pain

OPIOID ANALGESICS

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)

General Use:◦ Sedatives provide sedation◦ Hypnotics are used to manage insomnia

General Action:◦ Cause generalized CNS depression

SEDATIVE/HYPNOTICS

Nursing Implications:◦ Assessment

Monitor BP, pulse, resp status frequently w/ IV Assess sleep patterns if for insomnia

Medications:◦ phenobarbital (Luminal)◦ lorazepam (Ativan)◦ zolpidem (Ambien)

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

SKELETAL MUSCLE RELAXANTS

Nursing Implications:◦ Assessment

Assess for pain, muscle stiffness, ROM before and periodically throughout tx

Medications:◦ carisoprodol (Soma)◦ baclofen (Lioresal)◦ diazepam (Valium)

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

THROMBOLYTICS

Nursing Implications:◦ Begin tx ASAP after onset sx’s◦ Monitor VS q 4 hours

Medications:◦ streptokinase (Streptase)◦ alteplase (Activase)

General Use:◦ Acute vascular headaches

General Action:◦ Smooth muscle vasoconstriction

VASCULAR HEADACHE SUPPRESSANTS

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)

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!

ADDITIONAL CLASSIFICATIONS