Transcript Pharmacy Technician*s Course. LaGuardia Community College

Drug Classifications
 Drugs are a diverse and fall into many categories
 The most common categories of medications will be
covered here
 There are others but in the interest of importance and
simplicity the following lecture should provide a
general starting point
Analgesics
 Narcotics
 MOA: bind to opiate receptors in brain and spinal cord
 Indications: Analgesia
 Main Side effects: N/V, constipation, physical and psychological
dependence. In overdose , respiratory depression.
 See text for complete list.
 Fentanyl is available as a IV injection, patches, oral lozenges but not
as a tablet
 Oxycodone is not available as an injection only orally
 High potency opiates include fentanyl, remifentanil and
hydromorphone (Dilaudid®) . High risk of overdose
 Combination product: Tylenol with Codeine denoted as follows



Tylenol#2 as Codeine 15 mg/APAP 300 mg
Tylenol #3 as Codeine 30 mg/APAP 300 mg
Tylenol#4 as Codeine 60 mg/APAP 300 mg
Anti-Infectives
 Indications: Agents that are used to treat microrganism infection
in the body
 MOA: various (see next slide)
 The class include:
 Antibiotics : Penicillins and cephalosporins
 Antivirals: Acyclovir, ganciclovir,
 Antituberculosis-isoniazid, ethambutol, pyrazinamide
 Antiretrovals: NRTI: Zidovudine, NNRTI-efavirenz, PI-ritonavir
 Fluoroquinolones: ciprofloxacin, levofloxacin
 Antimalarial: (treat miliaria): quinine sulfate
 Antifungals: Fluconazole (Diflucan®), amphotericin (Amphocin®)
 Please see table 20-2 in the textbook for a complete list
Antibiotic mechanism of action
 Penicillin and Cephalosporins: drugs inhibit the formation




of the bacterial cell wall. Bacteria swell and die. Drugs are
bactericidal
Macrolides: inhibits bacterial ribosomes and protein
synthesis. Example includes erythromycin (E-Mycin®) and
azithromycin (Zithromax®). Bactericidal or Bacteriostatic.
Tetracyclines: Bacteriostatic by inhibiting protein
synthesis.
Fluroquinolones: Bactericidal. Binds to DNA gyrase
Aminoglycosides: (Gentamicin) Bactericidal by several
mechanisms
 Penicillins and Cephalosporins are classified as Beta
Lactam antibiotics.
 Very important antibiotics
 Treats a wide variety of bacterial infections
 Penicillins are several classes
Class
Example
Brand name
Natural Penicillin
Penicillin G
Pfizerpen (IV
form)
Aminopenicillin
Ampicillin
Omnipen
Ureidopenicillin
Piperacillin/Tazob Zosyn
actam
Penicillinase
resistance
penicillins
Nafcillin
Nafcil
 Main Side Effects of penicllins/cephalosporins
 Nausea/Vomiting
 Diarrhea
 Type I hypersensivity
 Cephalosporins
 Chemically similar to penicillins (Beta lactam)
 Four generations
 Excellent antibiotics
 Similar side effects
Generation
Generic
Brand
First
Cephalexin
Keflex (oral only)
Cefazolin
Ancef (IV)
Cefaclor
Ceclor (oral only)
Cefuroxime
Ceftin (oral suspension)
Zinacef (IV)
Ceftriaxone
Rocephin (IV only)
Cefdinir
Omnicef (oral only)
Fourth
Cefipime
Maxipime
Carbapenems
Meropenem
Merrem
Second
Third
Third and fourth generations are used to treat meningitis and hospital
acquired infections and pneumonias
Fluoroquinolones
 Must take oral forms of these drugs separate from
antacids (Maalox) by 1-2 hours
 Many drug interactions
 Advised to limit the consumption of caffeine while on
these drugs (ciprofloxacin more than others)
Generic
Brand
Ciprofloxacin
Cipro
Levofloxacin
Levaquin
Moxifloxacin
Avelox
Lomefloxacin
Maxaquin
Tetracyclines
 Broad spectrum antibiotic class
 Effective for use in certain infections
 Clamydial infections: doxycycline
 Lyme Disease: Doxycycline or Minocycline
 Don’t use tetracycline in pregnant women
 Avoid use in young children
 CAUTION: never use expired tetracycline products.
Toxin produces serious kidney damage
 CAUTION: advise patient to wear protective clothing.
Drugs are photosensitive chemicals
Non Steroidal Anti Inflammatory
Drugs
 Called the NSAIDS
 Excellent drugs for pain relief and reducing fever and inflammation
 Developed as an alternative to corticosteroids
 MOA: blocks the COX enzyme to block prostaglandin formation
 Side effects are: severe GI bleeding (possible), GI upset and gastritis, kidney
insufficiency, edema and elevated blood pressure, hyperkalemia risk
Generic
Brand
Ibuprofen
Motrin, Advil
Naproxen
Naprosyn
Ketorolac
Toradol (IV available)
Diclofenac
Voltaren
Celecoxib
Celebrex (COX2 inhibitor)
Cardiovascular Drugs
 Beta Blockers: drugs that block the beta receptors in the heart
which blocks attachment of norepinephrine and results in
bradycardia and reduced blood pressure. Examples are
propranolol(Inderal®), metoprolol (Toprol XL, lopressor ®),
atenolol (tenormin®) This is an important drug used in heart
failure patients, patient that have had an MI, and hypertensive
patients.
 ACE inhibitors (angiotensin converting enzyme inhibitor) blocks
the enzyme (ACE) responsible to converting angiotensin I to
angiotensin II (ATII). ATII is a potent vasoconstrictor in
humans. ATII is also important in kidney function. ATII also
increases aldosterone secretion. This drug is important in
hypertensive patients and patients with CHF and MI. ACEI are
also important in preservation of kidney function in diabetics.
Examples are enalapril( Vasotec®) and Ramipril (Altace®)
 Antianginal agents: used to widen coronary arteries to
increase myocardial oxygen delivery and reduce chest pain.
Examples: nitroglycerin (NTG), and isosorbide (Imdur®,
Isordil®)
 Calcium channel blockers: blocks the entry of calcium ions
in the heart muscle and in the muscle that control blood
vessel diameter. Reduced heart rate and reduces blood
pressure. Some are used to control a type of cardiac
arrhythmia called atrial fibrillation. Examples: Diltiazem
(Tiazac®, Cardizem®), amlodipine (Norvasc®)
 Antiarrhythmial agents: block the entry of sodium into the
heart. The drugs in this class have several mechanisms of
action. Examples: Lidocaine, amiodarone (Cordarone®),
Procainamide (Procanbid®)
 Angiotensin 2 Receptor blockers (ARB’s): similar to
ACEI except these drug works on a receptor for ATII.
Examples are Losartan (Cozaar®), valsartan (Diovan®)
 Anticoagulation agents: drugs that block the
formation of blood clots. Different mechanisms of
action. Examples: warfarin (coumadin®), dibigatran
(Pradaxa®)
 Antiplatelet agents: drugs that block the action of
platelets in the formation of a blood clot. Used in the
prevention of stroke or MI. Examples: Clopidegrel
(Plavix®) and Aspirin (Ecotrin®)
 Antihyperlipidemics: drugs used to treat high blood
lipid levels (cholesterol, triglycerides) Examples are
the statin drugs, Niacin (Niaspan®), Omega 3 fatty acid
(Lovaza®)
 Cardiac glycosides: drugs used to boost the strenght of
the heart’s contraction. Example: Digoxin (Lanoxin®)
Alpha Receptor blockers




MOA: blocks alpha receptors on smooth muscle in the arteries
Indication: blood pressure control
Side effects: edema, dizziness
Examples
 Prazosin (Minipress)
 Terazosin (Hytrin)
 Doxazosin (Cardura)
 The following alpha blockers are used for enlarged prostate symtom
relief
 Tamsulosin (Flomax)
 Alfuzoxin (Uroxatral)
 The following drugs are both alpha and beta receptor blockers
 Labetolol (Trandate)
 Carvedilol (Coreg)
Oral Contraceptives
 Drugs that contain high doses of estradiol and/or
progestins
 MOA: high levels of hormones “tricks” the body to think its
pregnant and ovulation don’t occurs
 Indication: Birth control, vaginal bleeding control,
endometriosis
 Examples:




LoOvral
Loestrin
Yasmin
Ortho tri cyclen
 Federal law mandates that the patient package insert be
dispensed with Rx to patient in retail
Diuretics
 Drugs that work at the kidney to help remove sodium,
water, calcium, and potassium from the body. Each class of
diuretic is named for the most part according to its
mechanism of action or the site of action in the kidney.
 Loop Diuretics work in a section of the kidney called the
loop of henle. This is where most of the water and sodium
and potassium is lost from the body. These drugs are used
to treat edema in CHF patients and other patient that hold
on the water.
 Example(s): Furosemide (Lasix®), Torsemide (Demadex®)
 Carbonic anhydrase inhibitors act on the proximal
tubule of the kidney by blocking the enzyme, carbonic
anhydrase which cause sodium retention and acid loss.
 Example: acetazolamide (Diamox®)
 Carbonic anhydrase inhibitor are pretty much weak
diuretics and can produce profound lose of potassium
Thiazide Diuretics
 Thiazide diuretics act on the distal convoluted tubule
to block the NaCL cotransporter in the kidney.
 Generally good diuretics
 Produce a sodium rich urine
 Example: Hydrochlorothiazide (HydroDiuril®)
Potassium Sparing diuretics
 Most of the above diuretics cause profound lose of
potassium. To circumvent this, these diuretic are
usually taken with potassium supplements.
 A class of diuretic that “spares” potassium in the body
are know and are used for many indications
 Examples are: spironolactone (aldactone®), Amiloride
(Midamor®), and the ACE inhibitors with ARB’s.
 These diuretics unlike the ones mentioned before
should not be used with a potassium supplement.
Central Nervous System Drugs
 Sedatives and Tranquiller: Drugs that cause depression of the
reticular activating system in the brain. Differences in
mechanisms of action.
 Examples are
 barbiturates: Phenobarbital (Luminal®)
 Benziodiazepines: Chlordiazepoxide (Librium®), Diazepam




(Valium®), Lorazepam (Ativan®), Alprazolam (Xanax®)
BDZ were developed in the 1960’s with the advent of librium®. BDZ
are safer than barbiturates. Both dangerous with alcohol
consumption.
Used in anxiety disorder, panic disorder, GAD, sleep disorders
Control Substance: CIV
Miscellanous agents in the class are zolpidem (Ambien®), zaleplon
(Sonata®)
 Neuroleptic agents: drug used in the treatment of
schizophrenia and other personality disorders.
Examples include:
 Dopamine block agents: Haloperidol (Haldol®),
Chlorpromazine (Thorazine®), Fluphenazine (Prolixin®)
 Dopamine and serotonin blocking agents: Olanzapine
(Zyprexa®) and Quetiapine (Seroquel®)
 Drugs used to treat ADHD in children and adults
 Mixed amphetamine salts: Adderall® XR
 Other agents: Methylphenidate (Ritalin® Concerta ®,
Focalin ®)
Antiepileptics
 Indications: Drugs used to treat seizures. Off label
use: Neuropathic pain
 MOA: Many of the drugs block the sodium ion
channel in nerves.
 Main Side effects: Drugs in this group are known
to cause birth defects
 Levetiracetam is a known cause of SJS
 Topiramate can cause kidney stones
 For emergency tx: use diazepam or phenytoin IV
Generic
Brand
Phenytoin
Dilantin
Valproic Acid
Divalproex Sodium
Depakene
Depakote
Carbamazepine
Tegretol
Gabapentin
Neurotin
Oxcarbazepine
Trileptal
Levetiracetam
Keppra
Topiramate
Topamax
Phenytoin, Valproic acid, Levetiracetam and Diazepam are available as IV
injections
Drugs used to treat depression
 Drugs that block the reuptake of dopamine, serotonin
and norepinephrine in the brain are called Tricyclic
antidepressants. Drugs in this class include :
amitriptyline, nortriptyline. These drugs have fallen
into disuse over the decades due to their toxicity in
overdose. As little as 1,000 mg of nortriptyline has
resulted in fatal overdoses
 SSRI or selective serotonin reuptake inhibitors are now
most commonly used. Examples include: Fluoxetine
(Prozac®), Paroxetine (Paxil®)
 SSRIs have been used for other indications
Drugs used to treat Diabetes
 Insulin: the nature human hormone needed to clear blood




glucose. Examples: Ultrafast: Novolog®, Humalog®,
Regular insulin (Humulin®), Basal insulin: Lantus®
Sulfonylureas: drugs that increase the release of insulin in
the body. Examples include: Glipizide (Glucotrol®),
Glyburide. Sulfonylurea should be taken with food
Meglitinides: drugs similar to sulfonylurea by faster acting.
Examples: Repaglinide (Prandin®, Nateglinide (Starlix®)
Thiazolidinediones: drugs that increase the body
sensitivity to insulin. Example includes: pioglitazone
(actos®)
Other agents include: exenatide (Byetta®), sitagliptin
(Januvia®) and metformin (Glucophage®)
CNS Depressants
 Benzodiazepines and Barbiturates
 MOA: binds to GABA receptors in brain
 Indications: sedation for anxiety and pre op use
 Main Side Effect: drowiness, Dependence (CIV)
Generic
Brand
Lorazepam
Ativan
Clonazepam
Klonopin
Alprazolam
Xanax
Midazolam
Versed
Zolpidem (not a BDZ)
Ambien
Primidone
Mysoline
Skeletal Muscle Relaxants
 MOA: may block action of calcium in muscles
 Indications: painful muscle spasms, neurological
spinal cord injury
 Main Side Effects: Drowsiness, weakness
Generic
Brand
Cyclobenzaprine
Flexeril
Methocarbamol
Robaxin
Baclofen
Lioresal