Drug classification final

Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.


Cholinergic or Parasympathomimetic Drugs These drugs are classified as either direct or

indirect acting agents. Direct acting drugs act directly on the

parasympathetic receptors. Indirect acting drugs work by either of two

methods. They can cause the release of the

neurotransmitter which then goes to the receptor site or they inhibit the enzyme cholinesterase.

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Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 10


These drugs prevent the action of acetylcholine at postganglionic parasympathetic endings.

Acetylcholine is released but its receptor site is completely blocked by anticholinergic drugs.

These drugs only block muscarinic receptors.

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Belladonna Alkaloids: Atropine Methscopolamine Homatropine Belladonna Scopolamine hydrobromideSynthetic Derivatives

GlycopyrrolatePropanthelineTertiary Amines

Benztropinedicyclomine

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Catecholamines Dobutamine Dopamine Epinephrine NorepinephrineNoncatecholamines

Mephentermine and phenylephrineAlbuterolTerbutalineephedrine

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Alpha-adrenergic blockers ergotamine Phentolamine Prazosin trazosin Beta-adrenergic blockers

Nonselective:CarvedilolPindololPropanololtimolol

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Selective:AcebutololAtenololEsmololMetoprolol tartrate

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Types: Muscle Relaxants differ by the location and

mechanism that muscle contraction is inhibited

1. Peripherally (Direct-acting)- within the muscle2. Centrally- within the spinal cord

Muscle Relaxants


A.PERIPHERALLY (Direct) ACTING- Used in MS, cerebral palsy and cord injury Dantrolene Succinylcholine

B.Centrally acting Skeletal muscle relaxantsNote: these drugs are used to control spastic muscle tone

as in epilesy ,multiple scelerosis ,cerebral palsy, stroke,

Used to treat acute spasms caused by: anxiety Inflammation Pain trauma

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For intermittent or chronic spasms: Diazepam Baclofen Tizanidine

For acute spasms: Carisoprodol Chlorphenesin Chlorzoxazone Cyclobenzaprine Metaxalone Methocarbamol Orphenadrine Tizanidine


Any situation where impaired relaxation interferes with function

Before surgery Allows intubation Relax abdominal muscles Orthopedic procedures

fibromyalgia


Non depolarizing- competitive or stabilizing drugs derived from curare alkaloids and synthetically similar compounds: Atracurium Cisatracurium Doxacurium Mivacurium Pancuromium Rocuromium Tubocurarine vecuromium


Depolarizing blocking drugs: Succinylcholine – only depolarizing blocking

drug. Although it’s similar to the nondepolarizing blockers in its therapeutic effect, its mechanism of action differs.

Acts like acetycholine but it is not inactivated by cholinesterase.


Parkinson’s disease (PD) is a progressive disorder of movement that occurs mainly in the elderly. The chief symptoms are: Tremor at rest, usually starting in the hands (‘pill-

rolling’ tremor), which tend to diminish during voluntary activity

Muscle rigidity, detectable as an increased resistance in passive limb movement

--Bradykinesia Suppression of voluntary movements (hypokinesis),

due partly to an inherent inertia of the motor system, which means that motor activity is difficult to stop as well as to initiate.


Sometimes called parasympatholytic drugs They inhibit the action of acetylcholine Two classes: 1. Synthetic tertiary amines

Benztropine Biperidine hydrocholoride Biperiden lactate Procyclidine trihexyphenidyl


2. Antihistamines ( diphenhydramine) –that have anticholinergic properties, which is effective in treating the symptoms of Parkinson’s disease.

DOPAMINERGIC DRUGS• Levodopa• Carbidopa-levodopa• amantadine


Used as adjuncts to levodopa-carbidopa therapy in manging patients with Parkinson’s disease who experience the wearing –off effect at the end of dosing interval.

tolcapone entacapone


Inhibit neuromuscular transmission and are prescribed for:

Long-term management of chronic epilepsy (recurrent seizures)

Short-term management of acute isolated seizures not caused by epilepsy, such as those occuring after trauma or brain surgery.


Major classes: Hydantoins- Ex. phytoin and phenytoin sodium

Barbiturates- Ex. phenobarbital for long term treatment of epilepsy

Iminostilbenes- Ex. Carbamazepine for partial and generalized tonic-clonic seizures; mixed seizure types; complex partial seizures


Benzodiazepines- Ex: clonazepam;diazepam(parenteral form);lorazepam;clorazepate

Carboxylic acid derivatives- Ex. Valproic acid also available as: valproate; divalproex

Phenyltriazines- FDA approved as adjunctive therapy for adults who have partial seizures and for children older than age 2 with generalized seizures.


1-(aminomethyl) cyclohexane-acetic acid- Ex. Gabapentin(GABA agonist)

Carboxamides- Ex: Oxcarbazepine

Sulfamate-substituted monosaccharides

Succinimides-Ex: ethosuximide and methsuximide-used to manage absence seizures

Sulfonamides- Ex: Zonisamide


Common primary headache disorders: pounding, pulsating, or throbbing

May be preceded by an aura


1) 5-HT1-receptor agonists (triptans)AlmotriptanEletriptanfrovatriptan\NaratriptanRizatriptanSumatriptanZolmitriptan

2) Ergotamine preparationsErgotaminedihydroergotamine



Pain control and antipyretic (fever control) and anti-inflammatory

Salicylates Choline magnesium trisalicylateCholine salicylateDiflunisalSalsalateSodium salicylateAcetaminophen

Nonsteroidal anti-inflammatory drugs Phenazopyridine hydrochloride


Opioid agonistsCodeineFentanyl citrateHydrocodoneHydromorphone hydrochlorideLevorphanol tartrateMeperidine hydrochlorideMethadone hydrochlorideMorphine sulfate


Mixed opioid agonist-antagonistsBuprenorphine hydrochlorideButorphanol tartrateNalbuphine hydrochloridePentazocine hydrochloride

Opioid antagonistsNaloxone hydrochlorideNaltrexone hydrochloride


Inhalation anesthetics Desflurane Enflurane Halothane Isoflurane Nitrous oxide sevoflurane


Intravenous anestheticsBarbiturates (methohexital, thiopental)Benzodiazepines (midazolam)Dissociatives (ketamine)Hypnotics(etomidate, propofol)Opiates (fentanyl, sufentanil)

Local anesthetics“amide” drugs (with nitrogen in the molecular chain

lidocaine, prilocaine,bupivacaine)“ester” drugs (with oxygen in the molecular chain

chloroprocaine, cocaine,procaine and tetracaine.)


Topical anestheticsLidocainetetracaine



Cardiac glycosides Digoxin PDE Inhibitors (phosphodiesterase)

InamrinoneMilrinone


Class IA Disopyramide phosphate Procainamide hydrochloride Quinidine (sulfate and gluconate) Class IB

Lidocaine hydrochlorideMexiletine hydrochlorideTocainidine hydrochloride


Class IC Flecainidine acetate Moricizine Propafenone hydrochloride Classs II

Composed of beta-adrenergic antagonists, or beta-adrenergic blockers

AcebutololEsmololPropranolol


Class III Amiodarone hydrochloride Dofetilide Ibutilide Sotalol

Class IV-composed of calcium channel blockers Verapamil Diltiazem

Adenosine


Nitrates Amyl nitrite Isosorbide dinitrate Isosorbide mononitrate Nitroglycerin Beta-adrenergic antagonists- beta blockersAtenololCarvedilolMetroprolol tartrateNadololPropanolol hydrochloride


Calcium channel blockers Amlodipine besylate Diltiazem hydrochloride Nicardipine hydrochloride Nifedipine Verapamil hydrochloride


SYMPATHOLYTIC DRUGS -inhibits or blocks the sympathetic nervous

systemCentral-acting sympathetic Nervous System

Inhibitors: Clonidine hydrochloride Methyldopa Alpha-adrenergic blockers

Doxazosin mesylatePhentolamineprazosin hydrochloride


Mixed alpha-and beta-adrenergic blockers Carvedilol Labetalol Norepinephrine depletors

Guanadrel sulfateGuanethidine monosulfate

VASODILATING DRUGSDirect vasodilators:DiazoxideMinoxidilHydralazine hydrochloride


ACE INHIBITORS Catopril Enalapril Ramipril ANGIOTENSIN II RECEPTOR BLOCKERS Losartan Olmesartan Valsartan Telmisartan


Thiazide and thiazide-like diuretics Benzthiazide Hydrochlorothiazide Methyclothiazide MetolazoneLoop diurecticsBumetanideEthacrynic acidFurosemidetorsemide


Potassium-sparing diurectics Amiloride Spironolactone Triamterene


Bile-sequestering drugs Cholestyramine Colestipol hydrochloride ColesevelamFibric acid derivativesFenofibrateGemfibrozilHMG –CoA reductase Inhibitors (statins)Atorvastatin calciumFluvastatin sodiumsimvastatin


Nicotinic Acid (niacin) Cholesterol absorption inhibitors

Ezetimibe



Iron Ferrous sulfate

Vitamin B12 Cyanocobalamin hydroxocobalamin

Folic acid Erythropoietin agents

Epoetin alfa darbepoetin


Heparin Oral Anticoagulants

Warfarin sodium Antiplatelet

Aspirin Clopidogrel Dipyridamole

Direct thrombin inhibitors Argatroban Lepirudin Bivalirudin


Alteplase Reteplase Streptokinase urokinase



Short-acting Albuterol (systemic,inhalation) Terbutaline (systemic)

Long-acting Formoterol(inhalation) Salmeterol(inhalation)


Ipratroprium bromide


Inhalation: Budesonide Fluticasone propionate

Oral: Prednisolone Prednisone

I.V: Hydrocortisone sodium succinate Methylprednisolone sodium succinate


montelukast


nedocromil Cromolyn sodium


Theophylline Aminophylline


guaifenesin


Benzonatate Codeine Dextromethorphan hydrobromide Hydrocodone bitartrate



Ephedrine Phenylephrine Pseudoephedrine



Systemic antibiotics Amoxicillin Clarithromycin Metronidazole Tetracycline

Antacids Aluminun carbonate gel Calcium carbonate Magnesium hydroxide


H2-receptor antagonists Cimetidine Famotidine Nizatidine Ranitidine

Proton pump inhibitors Esomeprazole Omeprazole pantoprazole


Adsorbent Activated charcoal

Antiflatulent Simethicone

Digestive Dehydrocholic acid Apncreatin Pancrelipase Amylase protease


Opioid-related Loperamide

Kaolin and pectin 5-HT3 receptor antagonists Hyperosmolar laxatives

Glycerin Lactulose Saline compounds (magnesium salts,sodium

phosphate)


Dietary fiber and related bulk-forming laxatives Methylcellulose Polycarbophil

Emollient laxatives Calcium, potassium,and Sodium salts of docusate

Stimulant laxatives Bisacodyl Castor oil


Lubricant laxatives Mineral oil

5-HT4 receptor partial agonists tegaserol


Antiemetics Antihistamines

Buclizine hydrochloride, diphenhydramine hydrochloride

Phenothiazines Chlorpromazine hydrochloride Promethazine hydrochloride

Serotonin 5-HT3 receptor antagonists Dolasetron granisetron


Emetics Ipecac syrup



Aminoglycosides Amikacin sulfate Gentamicin sulfate Streptomycin sulfate Neomycin sulfate

Penicillins Amoxicillin Ampicillin Carbenicillin


Cephalosporins Cefazoline Cefaclor Ceftazidime

Tetracyclines Demeclocycline hydrochloride Doxycycline hyclate

Macrolides Erythromycin estolate Azithromycin

Vancomycin


Carbapenems Meropenem

Monobactams Aztreonam

Fluoroquinolones Ciprofloxacin Levofloxacin


Synthetic nucleosides Acyclovir

Pyrophosphate analogs Foscarnet

Influenza A and syncytial virus drugs Amantadine Ribavirin

Nucleoside analog reverse transcriptase inhibitors zidovudine


Non-nucleoside reverse transcriptase inhibitors Delavirdine Efavirenz

Nucleotide analog reverse transcritase inhibitors Tenofovir

Protease Inhibitors Amprenavir ritonavir


Drug regimens for treating TB Isoniazid Rifampin Pyrazinamide Streptomycin or ethambutol


Polyenes Amphotericin B Nystatin

Flucytosine Imidazole

Ketoconazole Synthetic triazoles

Fluconazole


Glucan synthesis inhibitors Caspofungin

Synthetic allylamine derivatives terbinafine



Histamine -1 receptor antagonists Diphenhydramine hydrochloride Loratidine Meclizine hydrochloride


Glucocorticoids Beclomethasone Cortisone Prednisone Prednisolone

Mineralocoticoids Aldosterone Fludrocortisone acetate

Other immunosuppressants Azathioprine cyclosporine


Probenecid SulfinpyrazoneOther antigout drugs:

allopurinol colchicine



Benzodiazepines Lorazepam Diazepam Alprazolam

Barbiturates Amobarbital Phenobarbital Pentobarbital sodium

Nonbenzodiazepines-nonbarbiturates Zolpidem zaleplon


Buspirone


Selective serotonin reuptake inhibitors Citalopram hydrobromide Escitalopram oxalate Sertraline hydrochloride

Tricyclic antidepressants Amoxapine Doxepin hydrochloride Doxepin hydrochloride

Monoamine oxidase inhibitors (MAOIs) Hydrazines

Lithium


Atypical antipsychotics Aripiprazole Clozapine Olanzapine

Typical antipsychotics Butyrophenones:

Haloperidol Dibenzoxazepines

Loxapine succinate Dihydroindolones

Molindone hydrochloride Thioxanthenes


Dextroamphetamine Pemoline Methylphenidate hydrochloride



Insulin Oral antidiabetic drugs

Chlorpropamide Tolazamide Tolbutamide metformin

Glucagon Estrogens


Anterior Pituitary drugs Adrenocorticotorpics thyrotropics

Posterior pituitary drugs Vasopressin Oxytocin


Thyroid drugs Thyroid USP thyroglobulin thyrotropics

Antithyroid drugs Thioamides: propylthiouracil and methimazole Iodides: iodine and radioactive iodine



Potassium Potassium acetate Potassium bicarbonate Potassium chloride Potassium gluconate Potassium phosphate

Calcium Calcium carbonate Calcium chloride Calcium citrate


Alkalinizing Sodium bicarbonate Sodium citrate Sodium lactate

Acidifying drugs Acetazolamide Ammonium chloride Ascorbic acid



Nitrogen mustards melphalan chlorambusil estramustine

Alkyl sulfonates Busulfan Alkyl sulfonate


Nitrosoureas carmustine lomustine streptozocin

Triazenes Dacarbazine

Ethylenimines Thiotepa

Alkylating–like drugs Carboplatin Cisplatin oxaliplatin


Folic acid analogues Pyrimidine analogues

Capecitabine Cytarabine Fluorouracil

Purine analogues Cladribine Thioguanine pentostatin


Anthracyclines Daunorubicin Doxorubicin

Bleomycin sulfate mitomycin


Aromatase Inhibitors Type 1 or steroidal Type 2 or nonsteroidal

Anastrozole and letrozole

Antiestrogens Tamoxifen citrate Fulvestrant

Androgens Testolactone Testosterone propionate


Antiandrogens Flutamide Nilutamide Bicalutamide

Progestins Hydroxyprogesterone caproate Megestrol acetate

Gonadotropin-releasing hormone analogues Goserelin acetate Leuprolide acetate Triptorelin pamoate


Vinca alkaloids vinblastine vincristine

Podophyllotoxins etoposide teniposide


Alemtuzumab Rituximab


irinotecan topotecan


irinotecan topotecan

Healthcare

Drug classification final