1. 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

2. 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

3. 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

4. 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

5. Very important antibiotics
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/Tazobactam
Zosyn
Penicillinase resistance penicillins
Nafcillin
Nafcil

6. 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

7. Generation
Generic
Brand
First
Cephalexin
Keflex (oral only)
Cefazolin
Ancef (IV)
Second
Cefaclor
Ceclor (oral only)
Cefuroxime
Ceftin (oral suspension)
Zinacef (IV)
Third
Ceftriaxone
Rocephin (IV only)
Cefdinir
Omnicef (oral only)
Fourth
Cefipime
Maxipime
Carbapenems
Meropenem
Merrem
Third and fourth generations are used to treat meningitis and hospital acquired infections and pneumonias

8. 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

9. 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

10. 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)

11. 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®)

12. 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®)

13. 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®)

14. 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®)

15. 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)

16. 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

17. 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®)

18. 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

19. 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®)

20. 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.

21. 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®)

22. 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®)

23. Drugs used to treat ADHD in children and adults
Mixed amphetamine salts: Adderall® XR
Other agents: Methylphenidate (Ritalin® Concerta ®, Focalin ®)

24. 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

25. 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

26. 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

27. 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®)

28. 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

29. 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