A Pathophysiologic Approach: Drug Classes and Schedules

Pharmacology for Nurses
A Pathophysiologic Approach
Third Edition
CHAPTER
Drug Classes and Schedules
Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland
Copyright 2011 by Pearson Education, Inc. All rights reserved.
Drug Are Organized in Two Ways

Therapeutic classification Pharmacologic classification
Therapeutic Classification of Drugs

Based on what the drug does clinically Examples
Anticoagulants Antidepressants Antineoplastics
Pharmacologic Classification of Drugs

Based on the drugs mechanism of action, or how the drug produces its effect
At molecular, tissue, or body-system level
More specific than therapeutic classification Requires understanding of biochemistry and physiology May be described with varying degrees of complexity
Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland Copyright 2011 by Pearson Education, Inc. All rights reserved.
Examples
Calcium-channel blockers Diuretics Adrenergic antagonists
Prototype DrugServes as Model for a Drug Class

Is well understood Has known action and adverse effects Is used to compare other drugs in same pharmacologic class May not be most widely used drug in its class Disagreements may exist over which drug should serve as prototype drug
Newer drugs in same class

Newer drugs in same class may have replaced its use because they:
Are more effective Have more favorable safety profile Have longer duration of action
Most Drugs Have Three Names

Chemical Generic Trade
Drug Has One Chemical Name

Assigned using standard nomenclature established by International Union of Pure and Applied Chemistry (IUPAC) Describes physical and chemical properties of drug sometimes helpful in predicting a substances physical and chemical properties
Drug Has One Chemical Name (cont'd)

Complicated, difficult to remember and pronounce
Example: chemical name for diazepam: 7chloro-1, 3-dihydro-1-methyl-5- phenyl-2H-1, 4-benzodiazepin-2-one
Chemical Group Name

Drugs are sometimes classified by a portion of their chemical structure:
Cephalosporins, phenothiazines, benzodiazepines
Chemical group names can become invaluable to a nursing student
Generic Name
Assigned by the US Adopted Name Council Less complicated and easier to remember
A Drug Has One Generic Name

Used by many organizations
Food and Drug Administration (FDA) US Pharmacopoeia World Health Organization
Written in lower case Example: diazepam
A Drug Has Several Trade Names

Assigned by company marketing the drug Short, easy to remember Also called proprietary, product, or brand name
A Drug Has Several Trade Names (cont'd)

Drug developer has exclusive rights to name and market a new drug for 17 years in US. Trade name is capitalized Example: a trade name for diphenhydramine is Benadryl
Trade Names
After 17 years, competing companies may sell a generic equivalent drug, sometimes using a different name, which the FDA must approve
Trade Names (cont'd)

Trade names can be difficult because many drugs contain similar ingredients
A combination drug contains more than one active ingredient rule of thumb is that the active ingredients in a drug are described by their generic name, which is lowercase
Rights Issues
Pharmaceutical company with exclusive rights to a drug often prices it very high When rights end, competing companies offer the generic form of the drug for less money
Rights Issues (cont'd)

Depending on state, pharmacist may offer the generic form of a prescribed drug, or may only be allowed to dispense the exact form written in the prescription
Drug companies lobby against easy substitution of generic drugs; consumer advocates lobby the opposite
Generic vs. Brand-Name Drugs

Difficult to tell if there is a difference in effect between two forms of a drug, even if dosage is same
Inert ingredients may be different
Generic vs. Brand-Name Drugs (cont'd)

Key to comparison is bioavailability - the physiologic ability of the drug to reach its target cells and produce its effect Measuring how long a drug takes to exert its effect gives crude measure of bioavailability
Some States Have a Negative Formulary List

List of trade-name drugs that pharmacists may not dispense as generic-drug substitutes Claim there are differences in bioavailability between generic and tradename drugs
Some States Have a Negative Formulary List (cont'd)

Pharmaceutical Companies and Some Health-Care Practitioners Support List Claim differences could adversely affect patient outcomes Laws relating to these lists often change
Addiction and Dependence

Addiction - the overwhelming feeling that drives a person to use a drug repeatedly Dependence - a physiologic or psychologic need for a substance
Addiction and Dependence (cont'd)

Physical dependence - an altered physical condition caused by the adaptation of the nervous system to repeated drug use
when the drug is no longer available, the individual expresses physical signs of discomfort known as withdrawal
psychologically dependent little physical discomfort when drug is withdrawn, but intense compelling desire to continued use
Controlled Substances
Controlled substances are drugs that:
Are restricted by the Controlled Substances Act of 1970 Are frequently abused Have a high potential for addiction or dependence Have restricted use Are placed into one of five schedules
Controlled Substance Act of 1970

Also known as Comprehensive Drug Abuse Prevention and Control Act Restricts use of drugs with potential for abuse Restricted drugs placed into the five schedules Hospitals and pharmacies must maintain complete records of scheduled drugs
Drug Enforcement Administration (DEA) Regulates Controlled Substance Act

Hospitals and pharmacies must register with DEA
Must use assigned registration number to purchase scheduled drugs
Controlled Substances
Anyone convicted of unlawful manufacturing, distributing, and dispensing of controlled substances faces severe penalties
Scheduled Drugs
Drugs that have a significant potential for abuse are placed into five categories called schedules
Schedule I drugs have highest abuse potential, Schedule V the lowest
Schedule I Drugs
Restricted to situations of medical necessity, if allowed at all Little or no therapeutic value; mostly used for research
Examples of Schedule I Drugs

Heroin LSD Methaqualone
Schedule II-V Drugs

May be dispersed only in cases where therapeutic value has been determined Some Schedule V drugs may be dispersed without a prescription
Not All Drugs with Abuse Potential Are Regulated

Tobacco, alcohol, and caffeine
Schedule II Drugs
High abuse potential High potential for physical and psychological dependence Therapeutic use with prescription Some drugs no longer used
Schedule II Drugs Have More Restrictions

Need special order form to obtain Orders must be written Orders must be signed by health-care provider Telephone orders to pharmacies not permitted No refills permitted; client must see healthcare provider first
Examples of Schedule II Drugs

Morphine PCP Cocaine Methadone Methamphetamine
Schedule III Drugs

Moderate abuse potential Moderate physical dependence High potential for psychological dependence Therapeutic use with prescription
Examples of Schedule III Drugs

Anabolic steroids Codeine with aspirin or Tylenol Hydrocodone with aspirin or Tylenol Some barbiturates
Schedule IV Drugs
Lower abuse potential Lower potential for physical and psychological dependence Therapeutic use with prescription
Examples of Schedule IV Drugs

Dextropropoxyphene Pentazocine Meprobamate Diazepam Alprazolam
Schedule V Drugs
Lowest abuse potential Lowest physical and psychological dependence Therapeutic use without prescription Examples
OTC cough medicines with codeine
Canadian Restrictions Regulating Drugs of Abuse

Until 1996, controlled substances were those drugs subject to guidelines outlined in Part III, Schedule G, of the Canadian Food and Drugs Act Until 1996, restricted drugs not intended for human use were covered in Part IV, Schedule H, of the Canadian Food and Drugs Act
Part III, Schedule G, of Canadian Food and Drugs Act

Controlled substances only dispensed for specific conditions and diseases Drugs must be labeled with letter C on outside of container Examples
Amphetamines Barbiturates Methaqualone Anabolic steroids
Part IV, Schedule H, of Canadian Food and Drugs Act

Restricted drugs not intended for human use
Drugs used in chemical or analytical procedure Medical, laboratory industrial, educational, or research purposes
Part IV, Schedule H, of Canadian Food and Drugs Act (cont'd)

Restricted drugs, such as
LSD MDMA DOM (street name, STP)
Schedule F Drugs, Canadian Narcotic Control Act and Amended Schedules

Require prescription for sale Include
Methylphenidate (Ritalin) Diazepam (Valium) Chlordiaepoxide (Librium)
Narcotic drugs must be labeled with the letter N on the outside of the container
The Controlled Drugs and Substances Act

New federal Canadian drug control statute Repeals the Narcotic Control Act and Parts III and IV of the Food and Drug Act establishes eight schedules of controlled substances
provides broad latitude to the Governor in Council to amend schedules correlate with agents named in three United Nations treaties
The Controlled Drugs and Substances Act (cont'd)

Throughout Canada, prescription and nonprescription drugs must meet specific criteria Nonprescription drugs provided according to guidelines and acts established by the respective Canadian provinces
One recent system establishes three general drug schedules (province-specific); includes prescription and non-prescription drugs

A Pathophysiologic Approach: Drug Classes and Schedules

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Pharmacology for Nurses

Drug Classes and Schedules

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Drug Are Organized in Two Ways

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Therapeutic Classification of Drugs

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Pharmacologic Classification of Drugs

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Prototype DrugServes as Model for a Drug Class

Newer drugs in same class

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Most Drugs Have Three Names

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Drug Has One Chemical Name

Drug Has One Chemical Name (cont'd)

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Chemical Group Name

Chemical group names can become invaluable to a nursing student

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

A Drug Has One Generic Name

Written in lower case Example: diazepam

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

A Drug Has Several Trade Names

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

A Drug Has Several Trade Names (cont'd)

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Trade Names (cont'd)

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Rights Issues (cont'd)

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Generic vs. Brand-Name Drugs

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.

Generic vs. Brand-Name Drugs (cont'd)

Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Adams Holland

Copyright 2011 by Pearson Education, Inc. All rights reserved.