Chapter 2
Drug Classes and Schedules
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Table 2.1Organizing Drug Information by Therapeutic Classification
Table 2.2Organizing Drug Information by Pharmacological Classification
Table 2.3Examples of Brand-name Products Containing Popular Generic Substances
Table 2.4U.S. Drug Schedules and Examples
Table 2.5Three-Schedule System for Drugs Sold in Canada
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Learning Objective 1
Explain the basis for placing drugs into therapeutic and pharmacologic classes.
Concepts for Lecture
1.Drugs can be organized by therapeutic classification and pharmacologic classification.
2.The therapeutic classification is based on what a particular drug does clinically. Examples of therapeutic classifications are anticoagulants, antidepressants, and antineoplastics.
3.The pharmacologic classification of a drug refers to how a drug produces its effect in the body, such as at the molecular, tissue, or body-system level. This classification is more specific than a therapeutic classification and requires an understanding of biochemistry and physiology. Examples of pharmacologic classifications are calcium-channel blockers, angiotensin-converting enzyme inhibitors, and proton-pump inhibitors.
PowerPoint Lecture Slides
(NOTE:The number of each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1Drugs Are Organized in Two Ways
lTherapeutic classification
lPharmacologic classification
2Therapeutic Classification of Drugs
lBased on what the drug does clinically
lExamples
°Anticoagulants
°Antidepressants
°Antineoplastics
3Pharmacologic Classification of Drugs
lBased on how the drug produces its effect
°At molecular, tissue, or body-system level
lMore specific than therapeutic classification
lRequires understanding of biochemistry and physiology
3aExamples
lCalcium-channel blockers
lAngiotensin-converting enzyme inhibitors
lProton-pump inhibitors
Suggestions for Classroom Activities
lHave students provide examples of therapeutic classifications for central nervous system (CNS) drugs, gastrointestinal (GI) drugs, etc.
lHave students provide examples of pharmacologic classifications for antidepressant agents, diuretics, antihypertensive agents, and so on.
Suggestions for Clinical Activities
lAsk students to classify the drugs their assigned client has ordered.
Learning Objective 2
Discuss the prototype approach to drug classification.
Concepts for Lecture
1.A “prototype” drug is one drug from a class of drugs that is well understood and serves as a model for other drugs in that pharmacologic class to be compared to. By knowing the prototype drug, the actions and adverse effects of other drugs in that class can be predicted.
2.Newer drugs in the same class may replace prototype drugs because they are more effective, have a more favorable safety profile, or have a longer duration of action.
PowerPoint Lecture Slides
(NOTE:The number of each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1“Prototype” Drug—Serves as Model for a Drug Class
lIs well understood
lHas known action and adverse effects
lIs used to compare other drugs in same pharmacologic class
2Newer drugs in same class may have replaced its use because they
lAre more effective
lHave more favorable safety profile
lHave longer duration of action
Suggestions for Classroom Activities
lDiscuss the prototype drug for different pharmacologic classes. Is the original prototype drug still being used or has it been replaced by a newer drug in that pharmacologic class? If the prototype drug has been replaced, why?
Learning Objective 3
Describe what is meant by a drug’s “mechanism of action.”
Concepts for Lecture
1.A drug’s mechanism of action is how the drug produces its effect in the body.
PowerPoint Lecture Slides
(NOTE:The number of each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1Mechanism of Action
lHow a drug produces its effect in the body
Suggestions for Classroom Activities
lBriefly discuss two or three mechanisms of action.
Learning Objective 4
Distinguish between a drug’s chemical name, generic name, and trade name.
Concepts for Lecture
1.Most drugs have a chemical name, a generic name, and a trade name.
2.A drug has one chemical name, which is assigned using standard nomenclature established by the International Union of Pure and Applied Chemistry (IUPAC). The chemical name describes the physical and chemical properties of the drug but is often complicated and difficult to remember and pronounce. For example, the chemical name for diazepam is 7-chloro-1,3-dihydro-1-methyl-5-phenyl-2H-1,4-benzodiazepin-2-one.
3.Drugs are sometimes classified by their chemical group name, which is a portion of their chemical structure. Some common examples are phenothi-azines, cephalosporins, and benzodiazepines.
4.A drug has one generic name, which is assigned by the US Adopted Name Council and used by many organizations, including the US Food and Drug Administration, the US Pharmacopoeia, and the World Health Organization. The generic name is less complicated and easier to remember. It describes the active ingredient of the drug and is written in lowercase. An example of this is the drug name diazepam.
5.The company marketing the drug assigns the trade name of a drug, which is usually short and easy to remember. The trade name is sometimes called the proprietary or product or brand name. In the United States a drug developer has exclusive rights to name and market a drug for 17 years after a new drug application is submitted to the FDA. After 17 years, competing drug companies may sell a generic-equivalent drug using a different trade name approved by the FDA. The trade name is capitalized. For example, the trade name for diazepam is Valium.
PowerPoint Lecture Slides
(NOTE:The number of each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1Most Drugs Have Three Names
lChemical
lGeneric
lTrade
2Drug Has One Chemical Name
lAssigned using standard nomenclature established by International Union of Pure and Applied Chemistry (IUPAC)
lDescribes physical and chemical properties of drug
lComplicated, difficult to remember and pronounce
°Example: chemical name for diazepam: 7-chloro-1,3-dihydro-1-methyl-5-phenyl-2H-1,4-benzodiazepin-2-one
3Drugs Are Sometimes Classified by a Portion of Their Chemical Structure
lCephalosporins, phenothiazines, benzodiazepines
4A Drug Has One Generic Name
lAssigned by the US Adopted Name Council
lLess complicated and easier to remember
lDescribes active ingredients
4aA Drug Has One Generic Name
lUsed by many organizations
°Food and Drug Administration (FDA)
°US Pharmacopoeia
°World Health Organization
lWritten in lower case
lExample: diazepam
5A Drug Has Several Trade Names
lAssigned by company marketing the drug
lShort, easy to remember
lAlso called proprietary, product, or brand name
lDrug developer has exclusive rights to name and market a new drug for 17 years in US
lTrade name is capitalized
lExample: trade name for diazepam is Valium
Suggestions for Classroom Activities
lAssign each student a selected drug to present to the class, identifying its chemical name, generic name, and trade name, plus its pharmacologic and therapeutic classifications.
lDiscuss why drug companies may have selected the trade names of several drugs.
lDiscuss what combination drugs are and why it is difficult to match one generic name with one product name. Give examples of combination drugs.
Suggestions for Clinical Activities
lHave students prepare drug cards for assigned clients, including the chemical, generic, brand, and trade names.
Learning Objective 5
Explain why generic drug names are preferred to trade drug names.
Concepts for Lecture
1.Drugs have several trade names but only one generic name that is assigned by the US Adopted Name Council. These names are generally less complicated than chemical names, making them easier to remember.
2.Communication is enhanced between health-care providers and other health organizations by utilizing the generic drug names. Generic names are always written in lower-case letters.
PowerPoint Lecture Slides
(NOTE:The number of each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1A Drug Has One Generic Name
lAssigned by the US Adopted Name Council
lLess complicated and easier to remember
2Communication Enhanced
lHealth-care providers and other health organizations use generic names
lWritten in lower case
Suggestions for Classroom Activities
lHave students compare five common drugs, looking at their generic names vs. all trade names.
Suggestions for Clinical Activities
lHave students present in postconference the medication list for their assigned client, listing both the generic and trade names of each drug.
Learning Objective 6
Discuss why drugs are sometimes placed on a restrictive list and the controversy surrounding this issue.
Concepts for Lecture
1.Some states have compiled a negative formulary list, which is a list of trade-name drugs that pharmacists may not dispense as generic drugs. The bioavailability (physiologic ability of a drug to reach its target cells and produce the desired effect) of a drug is the reason for the negative formulary list.
2.Pharmaceutical companies and some health-care practitioners support a negative formulary list because they claim that generic drugs could adversely affect patient outcomes in those with critical conditions or illnesses due to possible differences in the bioequivalency between generic and trade name drugs.
PowerPoint Lecture Slides
(NOTE:The number of each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1Some States Have a Negative Formulary List
lList of trade-name drugs that pharmacists may not dispense as generic-drug substitutes
lClaim there are differences in bioavailability between generic and trade-name drugs
lPharmaceutical Companies and Some Health-Care Practitioners Support List
lClaim differences could adversely affect patient outcomes
Suggestions for Classroom Activities
lDisplay a negative formulary list. Discuss why the selected trade-name drugs are on the list.
lDiscuss bioavailability and bioequivalence as they relate to trade-name drugs and generic-name drugs.
lDiscuss the advantage and disadvantages of negative formulary lists.
Learning Objective 7
Explain the meaning of a controlled substance.
Concepts for Lecture
1.Controlled substances refer to drugs that are frequently abused or have a high potential for addiction or dependence. Dependence is a physical or psychological need for a substance. These drugs are restricted for use in situations of medical necessity, if allowed at all, and are placed into five schedules (categories) by law.
2.Not all drugs with an abuse potential, such as tobacco, alcohol, and caffeine, are regulated or placed into schedules.
PowerPoint Lecture Slides
(NOTE:The number of each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1Controlled Substances Are Drugs That
lAre frequently abused
lHave a high potential for addiction or dependence
°Physical dependence
°Psychological dependence
lHave restricted use
lAre placed into one of five schedules
2Not All Drugs with Abuse Potential Are Regulated
lTobacco, alcohol, and caffeine
Suggestions for Classroom Activities
lAsk students to give examples of controlled substances.
lDiscuss why tobacco, alcohol, and caffeine, which have abuse potential, are not regulated. Should they be regulated? Why or why not?
lDivide students into five groups. Assign each group a controlled-substance schedule, and have them pre-sent information on each, including drug examples.
Suggestions for Clinical Activities
lHave students observe nursing personnel procedure for obtaining a controlled substance for client administration.
Learning Objective 8
Explain the US Controlled Substance Act of 1970 and the role of the US Drug Enforcement Agency in controlling drug abuse and misuse.
Concepts for Lecture
1.The Controlled Substance Act of 1970, also known as the Comprehensive Drug Abuse Prevention and Control Act, restricts the use of drugs with a significant potential for abuse. These drugs are placed into five schedules. Under this law, hospitals and pharmacies must maintain complete records of all controlled substances purchased and sold. Schedule II drugs require a special order form to obtain, orders must be written and signed by the health-care provider, telephone orders to pharmacies are not permitted, refills are not permitted, and clients must visit their health-care provider first.
2.Anyone convicted of unlawful manufacturing, distributing, and dispensing of controlled substances faces severe penalties.
3.The Drug Enforcement Administration (DEA) regulates the Controlled Substance Act. Hospitals and pharmacies must register with the DEA and use assigned registration numbers to purchase scheduled drugs.
PowerPoint Lecture Slides
(NOTE:The number of each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1Controlled Substance Act of 1970
lAlso known as Comprehensive Drug Abuse Prevention and Control Act
lRestricts use of drugs with potential for abuse
lRestricted drugs placed into five schedules
lHospitals and pharmacies must maintain complete records of scheduled drugs
1aSchedule II drugs have more restrictions
lNeed special order form to obtain
lOrders must be written
lOrders must be signed by health-care provider
lTelephone orders to pharmacies not permitted
lNo refills permitted
lClient must see health-care provider first
PowerPoint Lecture Slides continued
2Anyone Convicted of Unlawful Manufacturing, Distributing, and Dispensing of Controlled Substances Faces Severe Penalties
3Drug Enforcement Administration (DEA) Regulates Controlled Substance Act
lHospitals and pharmacies must register with DEA
°Must use assigned registration number to purchase scheduled drugs
Suggestions for Classroom Activities
lDiscuss the need for the Controlled Substance Act.
lDisplay forms that hospitals and pharmacies must maintain for controlled substances.
Suggestions for Clinical Activities
lAssign students to observe how controlled substances are monitored in the hospital and/or at a pharmacy.
Learning Objective 9
Identify the five drug schedules and give examples of drugs at each level.
Concepts for Lecture
1.Schedule I drugs have the highest potential for abuse and physical and psychological dependency. This schedule of drugs has limited or no therapeutic use. Examples of schedule I drugs are heroin, LSD, and methaqualone.
2.Schedule II drugs have a high potential for abuse and physical and psychological dependency. Schedule II drugs may be used therapeutically with a prescription, but some are no longer used. Examples of Schedule II drugs are morphine, PCP, cocaine, methadone, and methamphetamine.
3.Schedule III drugs have moderate potential for abuse, moderate physical dependency, and high psychological dependency. This schedule of drugs is used therapeutically with a prescription. Examples of Schedule III drugs are anabolic steroids, codeine and hydrocodone with aspirin or Tylenol, and some barbiturates.
4.Schedule IV drugs have a lower potential for abuse and physical and psychological dependency. This schedule of drugs is used therapeutically with a prescription. Examples of Schedule IV drugs are dextropropoxyphene, pentazocine, meprobamate, diazepam, and alprazolam.
5.Schedule V drugs have the lowest potential for abuse, physical, and psychological dependency. This schedule
of drugs is used therapeutically without a prescription. Examples of Schedule V are OTC cough medicines with codeine.
PowerPoint Lecture Slides
(NOTE:The number of each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)
1Schedule I Drugs
lHighest abuse potential
lHigh physical and psychological dependence
lLimited or no therapeutic use
1aExamples of Schedule I Drugs
lHeroin
lLSD
lMethaqualone
2Schedule II Drugs
lHigh abuse potential
lHigh physical and psychological dependence
lTherapeutic use with prescription
lSome drugs no longer used
2aExamples of Schedule II Drugs
lMorphine
lPCP
lCocaine
lMethadone
lMethamphetamine
3Schedule III Drugs
lModerate abuse potential
lModerate physical dependence
lHigh psychological dependence
lTherapeutic use with prescription
PowerPoint Lecture Slides continued
3aExamples of Schedule III Drugs
lAnabolic steroids
lCodeine with aspirin or Tylenol
lHydrocodone with aspirin or Tylenol
lSome barbiturates
4Schedule IV Drugs
lLower abuse potential
lLower physical and psychological dependence
lTherapeutic use with prescription
4aExamples of Schedule IV Drugs
lDextropropoxyphene
lPentazocine
lMeprobamate
lDiazepam
lAlprazolam
5Schedule V Drugs
lLowest abuse potential
lLowest physical and psychological dependence
lTherapeutic use without prescription
lExamples
°OTC cough medicines with codeine
Suggestions for Classroom Activities
lDiscuss the importance of knowing what drugs are controlled substances.
Learning Objective 10
Explain how drugs are scheduled according to Parts III and IV of the Canadian Food and Drugs Act and the Narcotic Control Act.
Concepts for Lecture
1.According to Part III, Schedule G, of the Canadian Food and Drugs Act, a health-care provider may only dispense controlled substances to clients suffering from specific diseases or illnesses. The controlled drugs include amphetamines, barbiturates, methaqualone, and anabolic steroids. These drugs must be labeled with the letter C on the outside of the container.
2.Part IV, Schedule H, of the Canadian Food and Drugs Act deals with restricted drugs not intended for human use. These are drugs used in a chemical or analytical procedure for medical, laboratory, industrial, educational, or research purposes. These restricted drugs include hallucinogens such as LSD, MDMA, and DOM (street name, STP).
Concepts for Lecture continued
3.Schedule F drugs are covered under the Canadian Narcotic Control Act and amended schedules. These drugs require a prescription and include methylphenidate (Ritalin), diazepam (Valium), and chlordiaepoxide (Librium). Narcotic drugs must be labeled with the letter N on the outside of the container.
PowerPoint Lecture Slides
(NOTE:The number of each PPT Lecture Slide directly corresponds with the Concepts for Lecture.)