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. 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 GenericBrand IbuprofenMotrin, Advil NaproxenNaprosyn KetorolacToradol (IV available) DiclofenacVoltaren CelecoxibCelebrex (COX2 inhibitor)

5. 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 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 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: Enalapril( Vasotec®) Ramipril (Altace®) Lisinopril (Prinivil®)

6. 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®)

7. 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®)

8. 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®)

9. 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)

10. 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®)

11. 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

12. 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®)

13. 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.

14. Drugs used to treat ADHD in children and adults Mixed amphetamine salts: Adderall® XR Other agents: Methylphenidate (Ritalin® Concerta ®, Focalin ®) Atomoxetine (Strattera ®) Lisadexamfetamine (Vyvanse ®) Dextroamphetamine (Dexedrine ®) All the above drugs are controlled substances except Atomoxetine

15. 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) GenericBrand LorazepamAtivan ClonazepamKlonopin AlprazolamXanax MidazolamVersed Zolpidem (not a BDZ)Ambien PrimidoneMysoline

16. Skeletal Muscle Relaxants MOA: may block action of calcium in muscles Indications: painful muscle spasms, neurological spinal cord injury Main Side Effects: Drowsiness, weakness GenericBrand CyclobenzaprineFlexeril MethocarbamolRobaxin BaclofenLioresal