1. PHARMACOLOGY UNIT 3
DRUG CLASSIFICATIONS

2. 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

3. 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?
Contraindications
Precautions
Interactions

4. 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

5. Patient/Family Teaching
Evaluation / Desired Outcomes
Suggestions for the nurse to use to educate pt and family about ordered
medications
What is expected if the medication has been successful

6. ANTI-ALZHEIMER’S AGENTS
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

7. Nursing Implications:
Assessment
Assess cognitive function throughout therapy
Monitor nausea, vomiting, anorexia, and weight loss
Medications:
donepezil (Aricept)
rivastigmine (Exelon)
Memantine (Namenda)

8. ANTIANEMICS General Use: General Action:
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

9. 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)(Procrit)

10. ANTIANGINALS General Use: General Action:
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

11. 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)
nitroglycerin (Nitro-Dur)

12. ANTIANXIETY AGENTS General Use: General Action:
Used in mgmt of various forms of anxiety including generalized anxiety disorder
General Action:
Most agents cause generalized CNS depression

13. 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 lorazapam (Ativan) (paxil)
diazepam (Valium)

14. ANTIARRHYTHMICS General Use: General Action:
Suppression of cardiac arrhythmias
General Action:
Correct cardiac arrhythmias by a variety of mechanisms, depending on group used.
Goal symptomatology
Hemodynamic performance

15. Nursing Implications:
Assessment
Monitor ECG, pulse and BP periodically throughout oral administration
Medications:
Lanoxin/Digoxin
propranolol (Inderal)
amiodarone (Cordarone)
Cardizem

16. ANTICOAGULANTS General Use: General Action:
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

17. 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 (PTT)
warfarin (Coumadin) (PT/INR)
Lovenox

18. ANTICONVULSANTS General Use: General Action:
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.

19. 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)
Tegretol

20. ANTIDEPRESSANTS General Use: General Action:
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.

21. 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)
Zoloft
Paxil
Prozac

22. ANTIDIABETICS General Use: General Action:
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

23. Nursing Implications:
Assessment
Observe for s&s of hypoglycemic reaction
Monitor serum glucose
Medications:
metformin (Glucophage)
glyburide (Diabeta)
Pioglitazone (Actos)
liraglutide (Victoza)

24. ANTIEMETICS General Use: General Action:
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

25. 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)

26. ANTIHYPERTENSIVES General Use: General Action:
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

27. 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)

28. ANTI-INFECTIVES General Use: General Action:
Treatment and prophylaxis of various bacterial infections
General Action:
Kill (bacteriocidal) or inhibit growth (bacteriostatic)
of susceptible pathogenic bacteria

29. 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)

30. ANTINEOPLASTICS General Use: General Action:
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

31. 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:
methotrexate (Folex)

32. ANTIPLATELET AGENTS General Use: General Action:
Used to tx and prevent thromboembolic events such as stroke and MI
General Action:
Inhibit platelet aggregation
Prolongs bleeding time

33. Nursing Implications:
Assessment
Assess pt for s&s increased thrombosis
Monitor bleeding time
Medications:
dipyridamole (Persantine)
clopidogrel (Plavix)
Asprin

34. ANTIPSYCHOTICS General Use: General Action:
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

35. 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)
Haldol

36. CORTICOSTEROIDS General Use: General Action:
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

37. 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)

38. DIURETICS General Use: General Action:
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

39. 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)
Aldactone

40. HORMONES General Use: General Action:
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

41. Nursing Implications:
Monitor pt for sx’s of hormonal excess or insufficiency
Medications:
calcitonin (Miacalcin)
estrogens
levothyroxine (Synthroid)
insulins

42. NONOPIOID ANALGESICS General Use: General Action:
Used to control mild to moderate pain and/or fever
General Action:
Most inhibit prostaglandin synthesis
peripherally for analgesic effect
Centrally for antipyretic effect

43. 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

44. Non Steroidal Anti-Inflam Drug
General Use:
Used to control mild to moderate pain, fever , and various anti-inflammatory conditions
General Action:
NSAIDs have analgesic, antipyretic and anti- inflammatory properties
Analgesic and anti-inflammatory are d/t inhibition of prostaglandins

45. 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

46. OPIOID ANALGESICS General Use: General Action:
Mgmt moderate to severe pain
General Action:
Opioids bind to opiate receptors in the CNS
Alters perception of and response to pain

47. 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)
Morphine

48. SEDATIVE/HYPNOTICS General Use: General Action:
Sedatives provide sedation
Hypnotics are used to manage insomnia
General Action:
Cause generalized CNS depression

49. Nursing Implications:
Assessment
Monitor BP, pulse, resp status frequently w/ IV
Assess sleep patterns if for insomnia
Medications:
phenobarbital (Luminal)
lorazepam (Ativan)
zolpidem (Ambien)

50. SKELETAL MUSCLE RELAXANTS
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

51. Nursing Implications:
Assessment
Assess for pain, muscle stiffness, ROM before and periodically throughout tx
Medications:
Flexaril
baclofen (Lioresal)
diazepam (Valium)

52. THROMBOLYTICS General Use: General Action:
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

53. Nursing Implications:
Begin tx ASAP after onset sx’s
Monitor VS q 4 hours
Medications:
streptokinase (Streptase)

54. VASCULAR HEADACHE SUPPRESSANTS
General Use:
Acute vascular headaches
General Action:
Smooth muscle vasoconstriction

55. 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)

56. Anti-Lipid Statin drugs Pravastatin (Pravachol) Atorvastatin (Lipitor)
Assess for severe muscle soreness
Meds should always be taken in the evening (6pm).

57. Anti-Parkinsons -dopa drugs. levadopa carbidopa (Lodosyn)
(Sinemet) – mix of Levodopa and Carbidopa.

58. ADDITIONAL CLASSIFICATIONS
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!