Structural Biochemistry/Drug Classification

Drugs are grouped into different major therapeutic classification that describes the therapeutic use of each drug.

Adrenocortical Steroids:

The adrenal cortex of the adrenal glands (located near the kidneys) produces Glucocorticoids which play an important role on reducing inflammatory response. This steroids help reduce the sign of inflammation like redness, swelling, heat, and tenderness at the inflammation site. Therapeutic use: Glucocorticoids have been synthesis to use widely in treatment of the symptoms of drug serum and transfusion reactions, bronchial asthma, allergies, and to use as adjuncts in chemotherapy.

Analgesics

1/ Narcotic Analgesics: pain relief drugs work by binding to opiate receptors within the CNS. Warning: drowsiness and dangerous when use with alcohol. The narcotic antagonist must be available to use in case of accidental overdosing.

2/Non-narcortic Analgesics and Antipyretics: -Inhibit the synthesis of prostaglandin. -Inhibit other substances that sensitize pain receptors. -Affect the heat-regulating center of the brain=> fever reduction. Therapeutic use: Are used to reduce pain and fever.

Nonsteroidal Anti-Inflammatory Drugs

Inhibit prostaglandin synthesis. Therapeutic use: produces anti-inflammatory, anti-pyretic, and analgesic effects. Cautious: Some variety of this drug are enteric-coated thus not to be crushed, broken, or chewed when taking. This type of drugs is required to be taken with milk or foo to minimize GI discomfort. This drug is prohibited when patients have peptic ulcer disease. With patients who are taking the anticoagulant warfarin, this drug must be used really cautiously.

Antianginals

1/ Organic Nitrates: help relax coronary arteries thus increase blood flow in the cardiac muscle.

2/Calcium Channel Blockers: prevent Ca+ to go into cardiac muscle cells and cause the blood vessels of the heart to open.

3/Beta Blockers: -block beta 1 receptor thus suppress the activity of the heart. -cause a slight decrease in blood pressure thus protecting the heart by decrease its workload.

Antiarrhythmics

1/Class I: Sodium Channel Blockers 2/Class II: Beta-Adrenergic Blockers 3/Class III: Potassium Channel Blockers 4/Class IV: calcium Channel Blockers 5/Miscellaneous Antiarrhythmic Agents

Anti-Infectives

This types of drugs are capable of killing or preventing pathogenic organisms to proliferate in the body. Bacteicidal agents will stop acting on growing organisms if encounter with bacteriostatic agents.

Note:completing full course of therapy is required.

1/ Amebicides

• chloroquine:aralen
• eflornithine:Ornidyl
• iodoquinol:Yodoxin
• flurazolidone:Furoxone
• hydroxychlooquine:Plaquenil
• mefloquine:Lariam
• metronidazole:Flagyl
• pentamidine: NebuPent, Pentam

2/ Aminoglycosides

This group acts on the protein synthesis pathway in the pathogenic organism thus kills the bacterial, used mainly for tough gram-negative organisms (Pseudomonas, E.coli, Proteus, Klebsiella, and Enterobacter). Dosage and frequency of this drug Kidney function must be monitored when assigning this type of drug because its dosage and frequency are depended strongly on the kidney function.

Warning: : These drugs can damage the kidney and ear.

• amikacin: Amikin
• entamicin: Garamycin
• kanamycin:Kantrex
• neomycin:various
• Netilmicin: Netromycin
• streptomycin
• tobramycin

3/ Antifungals -Systemic and Antifungals-topical Antifungals-systemic interferes with the cell wall synthesis pathway or the protein synthesis pathway in fungal. Liver functioning must be strictly under control because any of these agents can damage the liver.

Antiungals-Systemic

• amphotericin B: AmBisome
• fluconazole: Diflucan
• flucytosine: Ancobon
• griseofulvin: Fulvicin, Grifulvin
• itraconazole:Sporanox
• ketoconazole:Nizoral
• metronidazole:Flagyl
• mystatin:Mycostatin, Nilstat
• terbinaine:Lamisil

Antifungals-Topical

• bacitracin: various
• cicloprox: Loprox,Penlac
• clotrimazole: Lomitrin, Mycelex
• enconazole: Spectazole
• gential violet
• ketoconazole:Nizoral
• miconazole:Micatin, Desenex, Zeasorb-AF
• nystatin:Mycostatin, Nilstat
• oxiconazole: Oxistat
• terconazole:Terazol
• tioconazole:Vagistat
• tonaftate: Tinactin
• terbinafine: Lamisil
• metronidazole: varios

4/ Cephalosporins

This drug usually are used to destroy bacterial because it affects the synthesis of cell wall in pathogenic organisms. Need to be carefully prescribed for patients who are sensitive to penicillins or patients with kidney impairment.

• cefaclor: Ceclor
• cefadroxil: Duricef, Ultracef
• cefazolin: Ancef, Kefzol
• cefoxitin: Mefozin
• cefdinir: Omnicef
• cefditoran: Spectracef
• cefepime: Maxipime
• ceftazidime: Fortaz
• ceftizoxime: Cefizox
• cefixime: Suprax
• cefoperazone: Cefobid
• cefotaxime: Claforan
• cefotetan: Cefotan
• cefpodoxime:Vantin
• cefprozil: Cefzil
• ceftriaxone: Rocephin
• cefuroxime: Ceftin
• cephalexin: Feflex
• cephradine: Anspor, Velosef

5/ Erythromycins

Erythromycins' functions, either killing the bacterial or preventing its growth, is depending on the dosage use. It can block the protein synthesis in pathogenic organisms by binding to the 50S subunit of bacterial ribosomes. This drug can harm the stomach and are used for patients who are allergic to penicillin.

• azithromycin:Zithromax
• clarithromycin: Biazin
• erythromycin: base, Staticin, Emgel, Illotycin, estolate, ethyl succ, stearate. lactobionate
• Eythromycin+sulfasoxizole: Pediazole
• telithromycon: Ketek

6/ Penicillin Derivatives:

Penicillin Derivatives are capable to kill bacterial by stopping bacterial cell wall synthesis in pathogenic organisms during replication. Side Effects:: rash, hives, anaphylactic shock. Storing: must be shaken well and refrigerated.

• amoxicillin+clavulanate: Augmentin
• amoxicillin: various, Amoxil
• ampicillin: various
• bacampicillin: Geocillin
• cloxicillin: Tegopen
• dicloxicillin: Dynapen, Dycil
• mezlocillin: Mezlin
• nafcillin: Unipen, Nafcil
• oxacillin: Bactocil, Prostaphlin
• penicillinG: Bicillin-LA
• penicillin B, procaine: Wycillin
• penicillin VK: various
• piperacillin: Pipracil
• ticarcillin: Ticar

7/ Tetracyclines

It is a broad-spectrum antibiotics. It binds to the 30s ribosomal subunit to stop protein synthesis thus stops the growth of pathogenic organisms. Cautious: causes permanent tooth discoloration, photosensitivity, exaggerated sunburns. Must not be taken during last half of pregnancy or giving to children under 8. Outdated tetracycline can damage kidney.

• doxycycline: Vibramycin
• minocycline: Minocin
• tetracycline: various

8/Antivirals

9/Sulfonamides

10/Antimalarials

11/Antituberculars

12/Anticholinergic Agents:

Antihypertensive Agents

1/Diuretics

2/Beta blocking Agents

3/Ace Inhibitors

4/Calcium Channel Blockers

5/Other Agents:

Thyroid Hormones

(Thyroxine). This category involves in several important process in the body includes: protein synthesis, lipid and carbohydrate metabolism, energy storage, body temperature, etc.

• levothyroxine: Synthroid, Levoxyl
• liothyronine: Cytomel
• thyroid dessicated: Armour Thyroid

Bronchodilators

This type of drugs are commonly used to treat asthma. It affects the respiratory system through the bronchial airways or the area which controls respiration in the central nervous system. Helps relax bronchial smooth muscle.

Common drugs:

• albuterol: Proventil, Ventolin
• aminophylline
• epinphrine: Adrenalin
• ipratropium: Atrovent, Isuprel
• levabuterol: Xopenex
• metaproterenol: Alupent
• pirbuterol: Maxair
• salmeterol: Serevent
• Tertbutaline: Brethine
• theophylline: various

Drugs used in shock

This type of drugs force the heart to beat faster with stronger contraction thus lead to vasoconstriction in blood vessels, increase the volume of blood in the circulatory system and increase blood pressure.

dobutamine	Dobutrex	injection only, mixing with sodium bicarbonate is strictly forbidden
dopamine	Intropin	injection only,mixing with other drugs is strictly forbidden

Laxatives

Laxatives are used to assist the defecation in patients with constipation.

1/Irritants: used to cause increasing in muscular activity

2/Saline Cathartics: are used to produces osmotic effects in the small entestine.

3/Bulk-forming: are used to increase bulk and moisten contents of stool.

4/Fecal softeners: reduce surface tension of the liquid contents of the bowel

5/Lubricants: are used to prevent water from being absorbed out of the bowel.

Psychotherapeutic Agents

• 1/Antianxiety Agents:

Benzodiazepines are well-known drugs to treat anxiety but with mild effects. It is used to reduce anxiety but cannot block panic attact Depress the Central Nervous Systems at the limbic and subcortical levels of the brain. Serotonin-specific reuptake inhibitors (SSIRs) like Prozac and Paxil are widely used also. Therapeutic Use: reduce anxiety, cause sedation, hypnotics.

Warning: May cause drowsiness and cannot be used with alcoholic substances.

• 2/Antidepressants:

This type of drugs works by changing the concentrations of chemical transmitters in the brain. The effects usually take 2 weeks or longer to show. The basic types of antidepressant medications:

A/Tricyclic antidepressants: Imipramine (Tofranil) is very well-known and is available in tablets, capsules, and injection types. It will alleviate depression but do not completely cure it. It mostly affect norepinephrine system by preventing massive amount of it to be transmitted in the body and restoring appropriate balance. However, other neurotransmitter systems like serotonin are slso affected by Tofranil. This drugs often needs 2 to 8 weeks to show their affects.

Side effects: patients may have blurred vision, dry mouth, constipation, difficulty urinating, drowsiness, wight gain (at least 13lbs on average), sexual dyysfunction. Cautious: Tricyclics are lethal if using overdose.

B/Monoamine oxidase inhibitors: block enzyme monoamine oxidase inhibitors that breaks down norepinephrine and serotonin. The MAO inhibitors seem to have equivalent effects with tricyclics but fewer side effects. Warning: lethal side effects- patients are forbidden to have food with tyramine like cheese, redwine, beer or some over-the-counter drugs may interact with MAO inhibitor and results to death.

C/Serotonin-specific reuptake inhibitors (SSRIs): affect the presynaptic reuptake system of serotonin. Fluoxetin (Prozac) are a well-known drug in this category. Its effectiveness is mostly the same with other antidepressants but with small decrease in suicidal rate among adolescents. Warning: side effects: physical agitation, sexual dysfunction, low sexual desire, insomnia, gastrointestinal upset.

• 3/Antipsychotics

(neuroleptics, major tranquilizers): these medications help people think more clearly and reduce hallucinations and delusions by interfere with the dopamine neurotransmitter system, serotonergic, glutamate system. Therapeutic Use: treat psychosis and schizophrenia.

Side effects: unwanted physical symptoms (groginess, blurred vision, dryness of the mouth), Parkinsonian symptoms, Akinesia (expressionless face, slow motor activity, monotonous speech), Tardive dyskinesia (involuntary movements of the tongue, face, mouth, jaw, or protrusions of the tongue, puffing of the cheeks, puckering of the mouth, chewing movements.

Vitamins

Vitamin	Name	Therapeutic Use
A	Retinol	To give healthy eyes, helps bones and teeth growth, and prevent infections
B1	Thiamine	is used to break down carbohydrates for energy
B2	riboflavin	breaking down fat for energy, tissue respiation
B3	niacin	is used to break down fats, carbohydrates, protein. Involves in the process of making hormones and fat
B6	Pyriodixine	is used to break down polypeptide chains to make energy
B9	folic acid	Function in making new cells like red blood cells
B12	Cyanocobalamin	Function in making new cells like red blood cells, good for nervous cystem
C	Ascorbic Acid	aid in healing wounded tissues, preventing infection, iron absorption
D2	ergocalciferol	Helps body absorb calcium and maintain Ca+ level in blood as well as aids in bone formation
D3	Cholecalciferol	Helps body absorb calcium and maintain Ca+ level in blood as well as aids in bone formation
E	Example	Protects Vitamin A and polyunsaturated fats from oxidation (antioxidant)
K1	Example	Blood Clotting
K3	menadione	Blood Clotting

References

Reifman, Noah. Certification Review For Pharmacy Technicians. 9th ed. the United States of America: AuthorHouse, 2011. 61-88. Print.

"Module 6: Health Assessment." Arizona Department of Health Service. Arizona Department of Health Service. Web. 20 Nov 2012. <http://www.azdhs.gov/azwic/documents/local_agencies/trainingmanual_pdf/module_6.pdf>.

Durand, V. Mark, and David H. Barlow. Essentials Of Abnormal Psychology. 5th. 12. Belmont: Wadsworth Pub Co, 2009. Print.