Drug Classes, Names and Indications

This is Unit Five of Medical Assistant Prep. Unit Four named the long-term conditions you will see every week. This unit names the medicines used for them: how drugs are named, how they are grouped into classes, and what each class is for. Carry one idea through this lecture. A drug's class is a starting point that tells you a great deal at once, but the individual drug, the order and a current reference always decide. The unit ends with the method for checking that reference. By the end you will be able to match generic and brand names. To name the classes used for the heart and blood. To name the classes for breathing, infection and hormones. And to look a drug up before you prepare or discuss it.

Three entries on naming: generic and brand names, pairs you will hear often, and why classes matter.

Generic and brand.

MAS 101 Generic Names and Brand Names

Every medication has a generic name, and many also have one or more brand names. An order may use either name, but the generic name is considered the safest, because it names the drug itself and lets the pharmacist substitute an equivalent brand. Two names can mean one drug, so a patient may unknowingly take a double amount.

Names you will hear constantly.

MAS 102 Name Pairs You Will Hear

A few generic and brand pairs come up constantly in outpatient practice. Atorvastatin is sold as Lipitor, furosemide as Lasix, warfarin as Coumadin, acetaminophen as Tylenol, and ibuprofen as Advil. When a patient lists a brand name, record it as given, and let the provider or pharmacist confirm the generic.

Grouped by action.

MAS 103 Drug Classes Group Medications by Action

Medications are grouped into classes, by the way they act or the condition they treat. Knowing a drug's class tells you a great deal at once: beta blockers slow the heart, diuretics remove fluid, and antibiotics fight bacteria. A class is a starting point. Drugs in one class still differ, so check the individual drug in a current reference.

Seven entries on cardiovascular drugs: beta blockers, ACE inhibitors, diuretics, statins, clotting drugs, nitrates and digoxin.

Blocking the sympathetic signal.

MAS 104 Beta Blockers

Beta blockers such as metoprolol block the sympathetic signal that speeds the heart. Metoprolol is used for high blood pressure, chest pain from poor blood flow to the heart, and heart rhythms that run too fast. Stopping a beta blocker suddenly can cause chest pain or a heart attack, so patients must never stop on their own.

Two classes, one hormone system.

MAS 105 ACE Inhibitors and ARBs

ACE inhibitors such as captopril and receptor blockers such as losartan, sold as Cozaar, both act on a hormone system that tightens blood vessels. Both widen blood vessels and are used for high blood pressure; captopril is also used in heart failure. Patients on ACE inhibitors may develop a persistent cough, which they should report to the provider.

More salt and water out.

MAS 106 Diuretics

Diuretics make the kidneys remove more salt and water, which increases urine flow. Furosemide, sold as Lasix, is one example; diuretics lower blood pressure and reduce swelling from fluid overload, and they are often combined with other blood pressure medicines. Patients on diuretics urinate more, so plan for that when you collect a urine specimen.

Lowering bad cholesterol.

MAS 107 Cholesterol-Lowering Drugs

Antilipemic drugs lower high blood fats, which can lead to stroke and heart attack. Atorvastatin, sold as Lipitor, reduces the body's cholesterol production and lowers so-called bad cholesterol. These drugs are meant to work alongside diet and exercise approved by the provider, not to replace them.

Two ways to prevent them.

MAS 108 Drugs That Affect Clotting

Anticoagulants prevent clots by blocking clotting factors; antiplatelet drugs stop platelets from clumping. Anticoagulants include heparin, warfarin, sold as Coumadin, and rivaroxaban, sold as Xarelto; antiplatelets include aspirin and clopidogrel. These patients bleed more easily, so a blood draw site needs extra pressure, as unit twenty-one covers.

Widening the coronary arteries.

MAS 109 Nitrates for Chest Pain

Nitrates such as nitroglycerin treat angina, which is chest pain caused by too little blood flow to the heart muscle. Nitrates widen the coronary arteries and veins; a tablet dissolved under the tongue is often prescribed for use as needed with stable angina. Chest pain in the office is reported to the provider at once, whatever the patient carries.

Stronger, slower heart.

MAS 110 Digoxin for Heart Failure

Digoxin, sold as Lanoxin, is a cardiac glycoside used for centuries to treat heart failure. It makes the heart muscle contract more strongly, slows the heart rate, and slows conduction through the heart. Because digoxin slows the heart, a slow pulse in a patient taking it is reported before anything else happens.

Eight entries on breathing, allergy, infection and hormone drugs, each paired with a limit worth knowing.

Short-acting and long-acting.

MAS 111 Bronchodilators

Beta-two agonists open the airways by relaxing the muscle around them. Albuterol is short-acting and works quickly, delivered by inhaler or nebulizer; salmeterol is long-acting and used for ongoing control. A long-acting drug is not a rescue medicine. Know which inhaler a patient relies on in an attack.

Several routes, one class.

MAS 112 Corticosteroids

Corticosteroids reduce inflammation and suppress the immune system, and they come in several routes. Fluticasone is a common inhaled corticosteroid for long-term asthma control, and a nasal spray for allergies; prednisone is a common oral corticosteroid. Inhaled corticosteroids prevent attacks over time; they do not stop an attack under way.

Two generations.

MAS 113 Antihistamines

Antihistamines block histamine, the chemical behind many allergy symptoms. Diphenhydramine is a first-generation antihistamine; cetirizine is a second-generation antihistamine, developed to cause fewer side effects. First-generation antihistamines can cause drowsiness, so record them on the medication list even when the patient bought them over the counter.

Not for viruses.

MAS 114 Antibiotics Treat Bacteria

Antibiotics treat bacterial infections; they do not treat viruses. Penicillins such as amoxicillin were the first antibiotic class; patients sometimes ask for antibiotics for viral colds, which antibiotics cannot help. Using the wrong antibiotic, or one that is not needed, can cause harm and increase bacterial resistance.

No drug for every virus.

MAS 115 Antivirals

Antivirals treat specific viral infections, much as antibiotics treat bacterial ones. Oseltamivir, sold as Tamiflu, is commonly prescribed for influenza; other antivirals target herpes viruses or the virus that causes HIV. Each antiviral targets particular viruses, so no single drug treats every viral illness, and none of them is a substitute for the provider's diagnosis.

Insulin by timing.

MAS 116 Types of Insulin

Insulins are grouped by how quickly and how long they act. Rapid-acting insulins, such as insulin aspart, are given with meals; long-acting insulins, such as insulin glargine, provide a steady background level over the day. Timing insulin with meals prevents low blood sugar, so check meal timing when insulin is ordered.

Oral glucose-lowering classes.

MAS 117 Diabetes Medicines by Mouth

Several classes of oral medicines lower blood glucose in type two diabetes. Metformin, a biguanide, is the preferred first medicine for type two diabetes; glipizide is an example of the sulfonylurea class. Some oral diabetes medicines can cause low blood sugar, so report shakiness or confusion at once.

An underactive thyroid.

MAS 118 Thyroid Replacement

Levothyroxine is a thyroid replacement drug used to treat hypothyroidism, an underactive thyroid. It replaces the hormone the thyroid gland is not making enough of, and it is usually taken once a day on an empty stomach. Patients take it for life in most cases, so it belongs on every medication list you record.

Four entries on pain, mood and acid drugs, ending with the method for checking a current reference.

Non-opioid and opioid.

MAS 119 Pain Relievers

Pain relievers fall into two groups. Non-opioids include acetaminophen, sold as Tylenol, for pain and fever, and the nonsteroidal anti-inflammatory drugs such as ibuprofen, sold as Advil, which also reduce inflammation. Opioids, such as morphine and oxycodone, sold as OxyContin, treat moderate to severe pain. They depress the central nervous system, causing drowsiness and slowed breathing, and they are controlled substances, with rules in Unit Twenty-Nine. Over-the-counter pain relievers are medications too. Ask about them by name in a medication history, since patients often leave them out, and some, such as aspirin, affect bleeding and interact with other drugs.

Raising brain messengers.

MAS 120 Antidepressants

Antidepressants raise levels of chemical messengers in the brain, and are used for depression and other conditions, such as chronic pain. Fluoxetine and citalopram are common selective serotonin reuptake inhibitors; their full effect can take weeks to develop. Report any sign of worsening mood or talk of self-harm at once.

Neutralizing and reducing.

MAS 121 Acid-Reducing Drugs

Several classes treat excess stomach acid, from heartburn to ulcers. Antacids neutralize acid that is already present; histamine-two blockers such as famotidine and proton pump inhibitors such as pantoprazole or omeprazole reduce how much acid is made. Ulcers can bleed dangerously, so report black stools or vomiting blood.

A current reference, every time.

MAS 122 Checking a Drug Reference

This entry pays off the opening idea: before you prepare or discuss a drug you do not know well, check a current reference. Find the drug by its generic name and confirm its brands. Confirm its class and use, so the order makes sense for this patient. Read the administration information: route, what to avoid, which warnings apply. Note any warning that needs a check first, such as a pulse check before a drug that slows the heart. Use a reference your practice approves; the federal DailyMed site publishes drug labels, and the package insert carries the same information. Use the most recent edition, since old ones miss new warnings. If the reference and the order seem to conflict, stop and ask the provider.

Look at what you can now do. You can match generic and brand names, and you know why the generic name is the safest. You can name the heart, blood pressure, cholesterol and clotting classes, and the warning each one carries. You can name the classes for breathing, allergy, infection and hormones, including what each one cannot do. And you can name pain, mood and acid classes, and check a current reference before you act. Unit Six turns to medication safety: the rights, safe numbers and dose calculation.