1.3 Drug Classifications and Prototypes

Drug classifications help organize medications by their effects and actions. Understanding these groupings is crucial for nurses to provide safe, effective care. Prototypes serve as representative examples for each class, simplifying learning and aiding in predicting drug properties.

Pharmacokinetics and pharmacodynamics explain how drugs move through the body and produce their effects. These concepts are essential for nurses to grasp, as they influence drug dosing, timing, and potential interactions in patient care.

Drug Classifications and Prototypes

Drug categories and classifications

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• Therapeutic classes group drugs based on their clinical use or therapeutic effect
  • Antihypertensives treat high blood pressure by lowering blood pressure through various mechanisms (ACE inhibitors, beta-blockers)
  • Antidepressants treat depression by altering neurotransmitter levels or activity in the brain (SSRIs, SNRIs, TCAs)
  • Analgesics relieve pain by acting on pain receptors or pathways in the body (opioids, NSAIDs, acetaminophen)
• Pharmacologic classes group drugs based on their mechanism of action or chemical structure
  • Beta-blockers block beta-adrenergic receptors in the heart and blood vessels, reducing heart rate and blood pressure (atenolol, metoprolol)
  • Selective serotonin reuptake inhibitors (SSRIs) inhibit serotonin reuptake in the brain, increasing serotonin levels and improving mood (fluoxetine, sertraline)
  • Opioids act on opioid receptors in the brain and spinal cord to produce analgesia and other effects (morphine, oxycodone, fentanyl)

Prototype approach for drug classes

• Prototype drugs serve as representative agents within a therapeutic or pharmacologic class
  • Exemplify key characteristics, mechanisms of action, and effects of the class
  • Allow for comparison and contrast of drugs within the same class
  • Help predict properties, side effects, and interactions of similar drugs
• Benefits of the prototype approach include:
  • Simplifies learning by focusing on essential features of a drug class (pharmacology, indications, adverse effects)
  • Facilitates understanding of relationships between drugs within a class (similarities, differences)
  • Enables educated guesses about unfamiliar drugs based on knowledge of the prototype
• Examples of prototype drugs:
  • Atenolol is a prototype for beta-blockers, demonstrating their mechanism of action and cardiovascular effects
  • Fluoxetine (Prozac) is a prototype for SSRIs, illustrating their antidepressant properties and side effect profile
  • Morphine serves as a prototype for opioids, showcasing their analgesic effects and potential for abuse and addiction

Federal regulations for controlled substances

• The Controlled Substances Act (CSA) regulates the manufacture, distribution, and possession of controlled substances

  • Categorizes drugs into five schedules based on medical use, abuse potential, and safety
    1. Schedule I: High abuse potential, no accepted medical use (heroin, LSD, marijuana)
    2. Schedule II: High abuse potential, accepted medical use with severe restrictions (morphine, oxycodone, amphetamines)
    3. Schedule III-V: Lower abuse potential, accepted medical use with varying restrictions (codeine, benzos, pregabalin)

• Prescribing practices for controlled substances:

  • Prescribers must register with the Drug Enforcement Administration (DEA) to prescribe controlled substances
  • Schedule II drugs require a written, signed prescription and cannot be refilled without a new prescription
  • Schedule III-V drugs may have oral or written prescriptions and can be refilled with limitations (up to 5 refills in 6 months)

• Impact on healthcare providers:

  • Increased responsibility to prevent abuse, misuse, and diversion of controlled substances
  • Thorough documentation and adherence to regulations required when prescribing controlled substances
  • Potential for legal consequences, license suspension, or revocation if regulations are violated
  • Need for ongoing education and vigilance to ensure safe and appropriate use of controlled substances in patient care

Pharmacokinetics and Pharmacodynamics

• Pharmacokinetics describes how the body processes a drug (absorption, distribution, metabolism, excretion)
  • Bioavailability refers to the fraction of an administered drug that reaches systemic circulation
  • Half-life is the time it takes for the concentration of a drug in the body to decrease by half
• Pharmacodynamics explains how drugs affect the body and produce their therapeutic effects
  • Therapeutic index compares the dose that produces a desired effect to the dose that causes toxicity
  • Adverse effects are unwanted or harmful reactions that occur as a result of drug administration
• Drug-drug interactions occur when one drug affects the activity of another drug when both are administered together