NCLEX PHARMACOLOGY
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TABLE OF CONTENTS Introduction ............................................................................................................................ 1 How to use this Course ............................................................................................................... 1 Preface .................................................................................................................................... 2 What to expect during this course .............................................................................................. 2 Unit 1 Pharmacology Basics ..................................................................................................... 3 Introduction to Pharmacology .................................................................................................... 3 Review Questions ...................................................................................................................... 13 Classification of Drugs ............................................................................................................... 16 Terminology .............................................................................................................................. 26 Herbs and Nutritional Supplements.......................................................................................... 36 Special Populations ................................................................................................................... 40 Review Questions ...................................................................................................................... 43 Unit 2. Medication administration ........................................................................................ 49 Legal aspects ............................................................................................................................. 49 Safety ......................................................................................................................................... 53 Dosage Calculation .................................................................................................................... 56 Formula Tips .............................................................................................................................. 57 Review Questions ...................................................................................................................... 59 Administering Medications Orally and Via Enteral Tubes ........................................................ 61 Preparing and Administering Topical, Transdermal, Vaginal, Rectal, Otic, and Ophthalmic Medications ............................................................................................................................... 64
Preparing and Administering Parenteral Medications.............................................................. 68 Review Questions ...................................................................................................................... 73 Unit 3. Pain Management, Corticosteroids, and Perioperative Medications .......................... 77 Introduction to pain management ............................................................................................ 77 Non-Narcotic Medications for Pain Management .................................................................... 82 Glucocorticoids .......................................................................................................................... 86 Review Questions ...................................................................................................................... 88 Opioid Narcotics ........................................................................................................................ 91 Pediatric dosing of narcotics ................................................................................................... 109 Review Questions .................................................................................................................... 111 Specialty medications to relieve pain ..................................................................................... 114 Perioperative agents ............................................................................................................... 119 Review Questions .................................................................................................................... 126 Unit 4. Medications Used to Manage Emergencies .............................................................. 130 Antidotes ................................................................................................................................. 130 Emergency Medications .......................................................................................................... 133 Review Questions .................................................................................................................... 138 Unit 5 Anti- Infective Agents ................................................................................................ 144 How anti-infective agents work .............................................................................................. 144 Review Questions .................................................................................................................... 174 Unit 6. Antidiabetic Agents .................................................................................................. 182 Review Questions .................................................................................................................... 191 Unit 7: System-specific Medications ................................................................................... 195
Cardiovascular ......................................................................................................................... 195 Respiratory .............................................................................................................................. 206 Nervous System/ Mental Health ............................................................................................. 215 Review Questions .................................................................................................................... 228 Gastrointestinal ....................................................................................................................... 236 Urinary ..................................................................................................................................... 243 Endocrine ................................................................................................................................ 244 Immune ................................................................................................................................... 246 Hematological System and Oncology ...................................................................................... 249 Musculoskeletal ...................................................................................................................... 255 Reproductive ........................................................................................................................... 258 Integumentary, Eyes ............................................................................................................... 261 Review Questions .................................................................................................................... 263 Unit 8: Mixed Questions ..................................................................................................... 271
INTRODUCTION Congratulations! You are a graduate nurse! It’s time to review everything you know about medications. We will cover all the areas that you will be tested on. We highlight Key Takeaways which are critical points throughout the program. By taking this course, you will be prepared to take and pass your boards.
HOW TO USE THIS COURSE While we recommend setting aside a block of time each day to review the materials, one of the benefits of the program is that you can do it in long or short blocks of time. Listen during your commute. Note the types of questions and areas on which you need to focus. The program is highly flexible. Use it to meet your individual needs. You know how you study best. Capitalize on the study skills you already possess. Relax, and view the course merely as the tool that it is. Be sure to take care of your mind, body, and spirit in the weeks leading up to taking your exam. Be confident, knowing that, by completing this course, you are thoroughly covering pharmacology.
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PREFACE WHAT TO EXPECT DURING THIS COURSE This course is divided into eight units. We start by reviewing pharmacology basics in Unit One. Unit Two covers medication administration. Unit Three is about pain management, glucocorticoids, and perioperative medications. Unit Four covers medications used in emergencies. Unit Five covers anti-infective agents. Unit six covers anti-diabetic agents. Unit seven covers system specific medications and also medications not address in the prior sections. Unit Eight is a one hundred-question review of all topics. There are 200 practice questions with the rationale provided. 100 items are covered in the topic review sections. The remaining 100 questions are randomly mixed at the end of the course review material. The questions are presented in a multiple-choice format. Each item has four possible answers. It is crucial that you choose the best answer for each question. When you answer questions, assume you are providing acute care (unless the question indicates differently). Unless otherwise stated, assume the client is an adult. Base your answers on what you would do if you were working in a facility that has all the needed resources available. If you look at the Preface, Table A of your follow-along PDF manual, you will see the completed Course Outline.
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UNIT 1 PHARMACOLOGY BASICS We begin this course by reviewing an introduction to pharmacology. We'll take a quick look at various drug classes. Terminology and clues for identifying types of drugs will be presented. We will discuss herbs and nutritional supplements. The pharmacology basics unit will finish by looking at special populations. Let's get started.
INTRODUCTION TO PHARMACOLOGY Pharmacology is the study of drugs. It encompasses actions, origins, effects, indications, and the chemical makeup of drugs. Let's review three terms which are essential when studying pharmacology. •
Pharmacokinetics describes how drugs are absorbed, distributed, utilized, and excreted by the body.
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Pharmacodynamics relates to the chemistry of drugs. It looks at how drugs work and the physical effects medications provoke.
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Pharmacotherapeutics examines the use of medications to prevent and treat illness.
PHARMACOKINETICS Pharmacokinetics examines the movement of a drug throughout the body.
TERMS AND DEFINITIONS RELATED TO PHARMACOKINETICS ABSORPTION Absorption refers to how a drug is taken into the body’s tissues, moves, and becomes available for use.
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Medications are absorbed by passive or active transport. Drugs incorporated by passive transport spread by diffusion. Oral medications are distributed by passive transport. Cells use energy to move drugs via active transport. Another example of this is when energy and/or enzymes are used to move electrolytes across a cell membrane into a region of higher concentration. Pinocytosis is a type of active transport most commonly used to mobilize fat-soluble vitamins. A cell surrounds a particle of medication to transport it. Absorption is impacted by multiple factors. These include: •
Route of administration: intravenous and sublingual routes are faster than oral, transdermal or subcutaneous
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Blood flow at the site of administration and throughout the body: better blood flow means better absorption
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Form of medication: instant-release versus sustained-release
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Physical problems: liver disease, intestinal surgery, and pain all decrease absorption
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Food: when oral medications are administered, large fatty meals interfere. Certain foods interact with specific drugs
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Age: older adults absorb less efficiently
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Interactions with other medicines: antacids interfere with many medications
DRUG DISTRIBUTION After a medication is absorbed, it is distributed throughout the body. Distribution varies depending on multiple factors: •
Blood supply: Organs which have a high blood-supply receive drugs quicker than organs and tissues with lower blood supply
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Solubility of the drug: Water-soluble drugs take longer than lipid-soluble drugs to pass through cell membranes. Lipid soluble drugs can cross the blood/brain barrier, but water-soluble drugs cannot
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Protein: The percentage of a drug that binds to a protein is not usable by the rest of the body.
METABOLISM Biotransformation, or metabolism, changes a drug from its original form to a water-soluble compound that can be excreted. Most drugs are inactivated and readily excreted. Some remain unchanged and are excreted in their original form. Prodrugs need to be metabolized before they become active. Most drugs are metabolized in the liver. The kidneys, lining of the intestines, and plasma are also sites of metabolism of some drugs. When drugs accumulate in the body, the likelihood of an adverse reaction or drug toxicity increases. Factors which impact drug metabolism •
Illness: liver disease slows metabolism
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Genetics
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Environment
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Age: Infants metabolize drugs slowly because their livers are immature. Elderly patients have decreased liver function, circulation, and enzyme production which cause them to metabolize medication slowly.
EXCRETION The primary organs involved in drug excretion are the kidneys. Most medications are excreted via urine. The intestines, lungs, skin, and salivary glands are also organs of excretion. Many medications are also excreted in breast milk.
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HALF-LIFE OF DRUGS The half-life of a drug is the amount of time it takes for half of the medicine to be excreted by the body. The half-life of the drug influences decisions about how often medication is administered. A drug’s half-life is impacted by the rate at which it is absorbed, metabolized, and excreted.
ONSET, PEAK, AND DURATION OF ACTION OF DRUGS The onset of a drug’s action is the amount of time it takes for the medication to begin working. A drug reaches its peak performance when the absorption rate is the same as the elimination rate. The peak concentration is not always identical to the time of peak response. The duration of action is how long a drug is therapeutically effective within the body.
PHARMACODYNAMICS Pharmacodynamics examines mechanisms that impact chemical or physiological changes in the body. Drug action is determined by the interaction between the medication, cells and their components. These include, but are not limited to, the cell membrane, enzymes, proteins, and receptor sites. The impact on the cells resulting from the action of the medication upon them is known as the drug effect. Medications act by changing the function of the cell or its rate of activity. Agonist drugs bind to receptors and create a response. A medication’s ability to generate a reaction after it attaches to a receptor is called its intrinsic activity. Some drugs have affinities for specific receptors but don't precipitate inherent action. These medications are called antagonists. They prevent responses from occurring. A competitive antagonist competes with an agonist for a receptor site. If large doses of an agonist are administered, the antagonist effects can be overcome.
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Non-competitive antagonists block the effect of agonists. Their impact cannot be overcome regardless of how much of an agonist is administered. Some medications bind to a wide array of receptors. They are non-selective. Because they attach to a wide variety of receptors, these medications can create multiple widespread effects. Drug potency compares medication effects. For example, medication A and B both relieve pain. It takes half as much of medication A compared to medication B to alleviate pain. Medication A is twice as potent as medication B. A dose-response curve is used to visualize the relationship between the dose of the medication and its response. Most drugs produce a small response at a low dose and a larger one as the dose increases. As the dose continues to increase, it provides no or little increase in response. The point where a dose produces little or no increase in response is known as the point of maximum effectiveness. Drugs usually cause multiple effects. Some are desirable, while some are not. The relationship between the desirable and undesirable effects is called a medication’s therapeutic index. Another word for the therapeutic index is the margin of safety, which varies significantly among drugs. Some drugs are considered to have a narrow margin of safety while others have a wide one. Medications which have low or narrow therapeutic indexes can quickly be lethal. A drug with a high or wide therapeutic index or margin of safety presents less risk of toxicity.
PHARMACOTHERAPEUTICS Pharmacotherapy is the use of medication to prevent or treat illness. There are many types of therapies. These include: •
Acute: the use of medicines to address immediate short-term needs
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Empiric: experienced-based decisions are made in determining treatment
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Maintenance: to treat chronic conditions
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Supplemental: replacement drugs
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Supportive: enhance the health of the rest of the body 7
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Palliative: medications used to improve comfort at end-of-life
A client’s response to medication is individual. The following factors may impact the effectiveness of drugs: •
Age
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General state of health-especially the function of the cardiovascular, gastrointestinal, hepatic, and renal systems
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Circulation
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Diet
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Comorbidities
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Stage of disease
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Sex
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Tolerance: when certain drugs are repeatedly used, a higher dosage may be needed to obtain the same result
ORIGINATION OF MEDICATIONS Medications can be made from natural substances, or they can be synthesized in a laboratory. The earliest medications were herbs. Herbs are still the most common medications used worldwide today. Minerals and animal-based drugs are used. Iron is an example of a mineral-based medication. Medicines obtained from animal sources include natural hormones, insulin, and vaccines. Recombinant DNA is used to chemically create organic compounds. The most common examples are some of the newer insulins which are formed by altering the DNA of bacteria to produce insulin which is usable by humans.
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CLINICAL TRIALS New drugs must undergo rigorous testing before they are approved for human use. Extensive research and animal studies are conducted before an application can be presented to the FDA to develop an investigational new drug. Clinical trials are then performed. Please Refer to Table 1 A in your follow-along PDF Manual. You will see a chart that describes the different phases of clinical trials.
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Table 1A Clinical Trials
Phase 1
A new medication is administered to healthy volunteers to establish the drug is safe for humans.
Phase 2
The new medication is administered to individuals who have the condition the drug is designed to treat.
Phase 3
The medication is administered to large numbers of people to identify rare side effects. If the medication passes a phase 3 clinical trial, a new drug application may be made.
Phase 4
These are conducted voluntarily after a new drug is available on the market. Phase 4 clinical trials continue to evaluate the safety and effectiveness of medications.
POLYPHARMACY Many people take several medicines, which can interact with each other. Effects of drug interactions include: •
Additive: this can help prescribers to reduce doses of individual drugs which may prevent untoward side effects
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Synergy: this is also known as potentiation. Synergy occurs when two medications work better together than separately
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Antagonistic: two drugs counteract the impact of each other
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Changes in absorption: many medicines cannot be given at the same time as other medicines because they interfere with the absorption of each other
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Changes in binding: medications that bind with the same receptor sites may compete, reducing the effectiveness of each drug
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Toxicity: some drugs inhibit the deactivation and excretion of other drugs creating a buildup and potential toxic interactions
EFFECTS OF MEDICATION The expected therapeutic response is a predictable desired effect of the medication. Adverse reactions or side effects are undesirable effects of medications. They may be predictable or unexpected. They vary in degree. Common side effects include gastrointestinal distress, headaches, photosensitivity, drowsiness, and changes in appetite. Most side effects are dose-related. Most adverse reactions or side effects arise due to the chemical makeup of the medication. For example, a side effect of benzodiazepines is sleepiness. This is due to the chemical composition of the drug. Sometimes, side effects can be used beneficially. For example, haloperidol has a side effect of relieving nausea. It is sometimes used to treat nausea that doesn't respond to traditional antiemetics. An overdose occurs when toxicity results from too much medication. The overdose may be deliberate or unintended. The elderly are at risk for overdose because of changes in metabolism. They may need smaller doses of many medications to avoid overdose. Iatrogenic effects may occur. Medications can precipitate illnesses. This is known as an iatrogenic effect. For example, it is well-known that gentamicin can cause deafness. Hearing loss is a potential iatrogenic effect of gentamicin. Some clients have sensitivity-related reactions caused by hyper-susceptibility of their physiological makeup. For example, some people can only tolerate small doses of narcotics.
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A drug reaction that is the opposite of the expected effect is known as an idiosyncratic response. For example, the herb valerian generally enhances sleep and rest. However, in some people, valerian causes excitability and sleeplessness. An allergic reaction occurs when a severe hypersensitivity reaction arises. The reaction may consist of mild itching and hives or severe, life-threatening anaphylaxis.
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REVIEW QUESTIONS 1.
The study of how medications are absorbed, distributed, utilized, and excreted by the body is called: a. Pharmacology b. Pharmacotherapeutics c. Pharmacodynamics d. Pharmacokinetics
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Drug absorption increases when all the following are true except: a. Medications are administered sublingually instead of orally b. Drugs are given to older adults c. The rate of blood flow at the site of administration is high d. Medications are delivered on an empty stomach
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Drugs are metabolized in each of the following sites except the: a. Lining of the intestines b. Stomach c. Kidneys d. Liver
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Most drugs are excreted via the: a. Large intestine b. Small intestine c. Kidneys d. Liver
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5.
The amount of time it takes for half of a dose of medication to be excreted by the body is called its: a. Peak absorption time b. Half-life c. Rate of absorption d. Metabolic rate
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A client has had hypertension for ten years. He takes hydrochlorothiazide and metoprolol every day to reduce his blood pressure. What type of pharmacotherapy is this? a. Palliative b. Supplemental c. Empiric d. Maintenance
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What phase clinical trial is used to determine whether or not a new medication is safe for human use? a. 1 b. 2 c. 3 d. 4
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A stimulant drug is administered to a client. The client becomes drowsy and falls asleep. What is occurring? a. An iatrogenic response b. A therapeutic response c. An overdose d. An idiosyncratic response
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ANSWER KEY: 1. D, Pharmacokinetics is the study of how drugs are absorbed, distributed, utilized, and excreted by the body. 2.
B, Older adults are likely to have decreased drug-absorption. The decrease is often due to reduced gastric secretions.
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B, Metabolism changes a drug from its original form to a water-soluble compound that can be excreted. These actions take place in the lining of the intestines, kidneys, liver, and plasma.
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C, Most medications are excreted by the kidneys via urine. Some drugs are excreted via breast milk, the intestines, lungs, skin, and salivary glands.
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B, The amount of time it takes for half of a dose of medication to be excreted by the body is called its half-life. Half-life is impacted by the rate of absorption, metabolism, and excretion.
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D, Maintenance therapies treat chronic conditions such as hypertension.
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A, Phase 1 Clinical Trials establish that drugs are safe for human consumption. The investigational drug is administered to healthy volunteers during Phase 1 Clinical Trials to evaluate toxicity.
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D, An idiosyncratic or paradoxical response occurs when a client has the opposite reaction of that which is expected when a medication is administered.
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CLASSIFICATION OF DRUGS Drugs are classified by the body system they are used to treat, their actions, likelihood of causing addiction, or potential to cause harm. Medications may also be classified by how they are used to treat conditions. The following charts demonstrate different ways drugs are commonly classified. If you look at table 1B in your follow-along PDF manual you will see how drugs are classified by their therapeutic category. Table 1 B USP Therapeutic Categories Model Guidelines
Therapeutic Category
Pharmacologic Class Non-opioid Analgesics
Analgesics Opioid Analgesics Anesthetics
Local Anesthetics Aminoglycosides Beta-lactam, Cephalosporins Beta-lactam, Penicillins Beta-lactam, Other
Antibacterials
Macrolides Quinolones Sulfonamides Tetracyclines Antibacterials, Other
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Therapeutic Category
Pharmacologic Class Calcium Channel Modifying Agents Gamma-aminobutyric Acid (GABA) Augmenting Agents
Anticonvulsants
Glutamate Reducing Agents Sodium Channel Inhibitors Anticonvulsants, Other Cholinesterase Inhibitors
Antidementia Agents
Glutamate Pathway Modifiers Antidementia Agents, Other Monoamine Oxidase Inhibitors Serotonin/Norepinephrine Reuptake Inhibitors
Antidepressants Tricyclics Antidepressants, Other Antidotes Antidotes, Deterrents, and Toxicologic Agents
Deterrents Toxicologic Agents
Antiemetics Antifungals Anti-gout Agents
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Therapeutic Category
Pharmacologic Class Glucocorticoids
Anti-inflammatory Agents Nonsteroidal Anti-inflammatory Drugs Abortive Antimigraine Agents Prophylactic Antimyasthenic Agents
Parasympathomimetics Antituberculars
Antimycobacterials Antimycobacterials, Other Alkylating Agents Antiangiogenic Agents Antiestrogens/Modifiers Antimetabolites Antineoplastics
Aromatase Inhibitors, 3rd Generation Molecular Target Inhibitors Monoclonal Antibodies Retinoids Antineoplastics, Other Anthelmintics
Antiparasitics
Antiprotozoals Pediculicides/ Scabicides
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Therapeutic Category
Pharmacologic Class
Antiparkinson Agents Atypicals Antipsychotics Conventional Antispasticity Agents Anti-cytomegalovirus (CMV) Agents Anti-hepatitis Agents Antiherpetic Agents Anti-Human Immunodeficiency Virus (HIV) Agents, Fusion Inhibitors Antivirals
Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors Anti-HIV Agents, Protease Inhibitors Anti-influenza Agents Antidepressants
Anxiolytics Anxiolytics, Other Bipolar Agents Antidiabetic Agents Blood Glucose Regulators Glycemic Agents
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Therapeutic Category
Pharmacologic Class Insulins Anticoagulants
Blood Products/Modifiers/Volume
Blood Formation Products
Expanders
Coagulants Platelet Aggregation Inhibitors Alpha-adrenergic Agonists Alpha-adrenergic Blocking Agents Antiarrhythmics Beta-adrenergic Blocking Agents Calcium Channel Blocking Agents
Cardiovascular Agents
Diuretics Dyslipidemics Renin-angiotensin-aldosterone System Inhibitors Vasodilators Cardiovascular Agents, Other Amphetamines, ADHD
Central Nervous System Agents
Non-amphetamines, ADHD Non-amphetamines, Other
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Therapeutic Category
Pharmacologic Class
Dental and Oral Agents Dermatological Agents Enzyme Replacements/Modifiers Antispasmodics, Gastrointestinal Histamine 2 (H2) Blocking Agents Irritable Bowel Syndrome Agents Gastrointestinal Agents Protectants Proton Pump Inhibitors Gastrointestinal Agents, Other Antispasmodics, Urinary Benign Prostatic Hypertrophy Agents Genitourinary Agents Phosphate Binders Genitourinary Agents, Other Hormonal Agents, Stimulant/
Glucocorticoids/
Replacement/ Modifying (Adrenal)
Mineralocorticoids
Hormonal Agents, Stimulant/ Replacement/ Modifying (Pituitary) Hormonal Agents, Stimulant/ Replacement/ Modifying (Prostaglandins)
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Therapeutic Category
Pharmacologic Class Anabolic Steroids
Hormonal Agents, Stimulant/ Replacement/
Androgens Estrogens
Modifying (Sex Hormones/ Modifiers)
Progestins Selective Estrogen Receptor Modifying Agents
Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid) Hormonal Agents, Suppressant (Adrenal) Hormonal Agents, Suppressant (Parathyroid) Hormonal Agents, Suppressant (Pituitary) Hormonal Agents, Suppressant (Sex Hormones/
Antiandrogens
Modifiers) Hormonal Agents, Suppressant (Thyroid)
Antithyroid Agents
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Therapeutic Category
Pharmacologic Class Immune Stimulants Immune Suppressants
Immunological Agents Immunizing Agents, Passive Immunomodulators Glucocorticoids Inflammatory Bowel Disease Agents
Salicylates Sulfonamides
Metabolic Bone Disease Agents Ophthalmic Anti-allergy Agents Ophthalmic Antiglaucoma Agents Ophthalmic Agents
Ophthalmic Anti-inflammatories Ophthalmic Prostaglandin and Prostamide Analogs Ophthalmic Agents, Other
Otic Agents Antihistamines Anti-inflammatories, Inhaled Corticosteroids Respiratory Tract Agents
Antileukotrienes Bronchodilators, Anticholinergic Bronchodilators, Phosphodiesterase Inhibitors
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Therapeutic Category
Pharmacologic Class (Xanthines) Bronchodilators, Sympathomimetic Mast Cell Stabilizers Pulmonary Antihypertensives Respiratory Tract Agents, Other
Sedatives/Hypnotics Skeletal Muscle Relaxants Therapeutic Nutrients/Minerals/
Electrolytes/Minerals
Electrolytes
Vitamins
If you look at table 1C in your follow-along PDF manual, you will see how drugs are classified by their legal status. This relates to a medication’s ability to cause harm or addiction. Table 1C DEA / Drug Scheduling- Controlled substances
Drug Schedules Schedule I
Schedule I drugs, substances, or chemicals are defined as having no currently-accepted medical use. They possess a high potential for abuse. Examples of Schedule I drugs include: Heroin, lysergic acid diethylamide (LSD), cannabis (federally), and peyote
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Schedule II
Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are: Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin
Schedule III
Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are: Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone
Schedule IV
Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Some examples of Schedule IV drugs are: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol
Schedule V
Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs are: Cough preparations with less than 200 milligrams of codeine per 100 milliliters (Robitussin AC), Lomotil, Lyrica
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TERMINOLOGY Many drugs can be identified by their names, or different prefixes and/or suffixes. The following table is modified from a list prepared by the United States Food and Drug Administration. (You do NOT need to be knowledgeable about all the drugs on the list to pass the NCLEX, however you should understand the common prefixes and suffixes.) Let’s review drug prefixes and suffixes. Prefixes and suffixes provide valuable clues to the classification of a specific drug. If you look at table 1D in your follow-along PDF manual, you will find a chart of common prefixes and suffixes that give clues to various types of drugs. Table 1D Drug Prefixes and Suffixes
Stem
Type of medicine
Examples
-ac
Anti-inflammatory agents
bromfenac
-actide
Synthetic corticotropins
seractide
-adol, -aldol-
Analgesics (mixed opiate receptor agonists/ antagonists)
tazadolene
-afenone
Antiarrhythmics
alprafenone
-aldrate
Antacid aluminum salts
magaldrate
-alol
Combined alpha and beta blockers
labetalol
-andr-
Androgens
nandrolone
aril-, -aril, -aril- Antiviral
pleconaril
-arol
dicumarol
Anticoagulants (dicumarol type)
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Stem
Type of medicine
Examples
-tricin
Antibiotics (polyene derivatives)
mepartricin
-triptan
Antimigraine agents (5-HT1 receptor agonists)
sumatriptan
-triptyline
Antidepressants
amitriptyline
-troban
Antithrombotics
daltroban
-troline
Antipsychotics (dopamine D2 antagonists)
carvotroline
trop-, -trop-
Atropine derivatives
benztropine
-uracil
Uracil derivatives used as thyroid antagonists and as antineoplastics
fluorouracil
-uridine
Antivirals; antineoplastics
idoxuridine
-vaptan
Vasopressin receptor antagonists
conivaptan
-verine
Spasmolytic agents (papaverine type)
mebeverine
vin-, -vin-
Vinca alkaloids
vinepidine
vir-, -vir-, -vir
Antiviral substances (undefined group)
ganciclovir
Adapted from: U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894 National Institutes of Health, Health & Human Services
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HERBS AND NUTRITIONAL SUPPLEMENTS It is essential that nurses are knowledgeable about herbs and nutritional supplements. Always ask clients if they are taking herbs and supplements when obtaining a list of current medications. Vitamins A, D, E, and K are fat-soluble vitamins. They can accumulate in the body and become toxic.
ACTIVE AND INACTIVE COMPOUNDS IN HERBS Most medications contain both active and inactive compounds. Inactive compounds include binders and coatings that facilitate ease of use. Let's take a look at some common active compounds in herbal medications. •
Alkaloids are the most active components. Alkaloids interact with acids. They form dissolvable salts which are readily used by the body. Alkaloids are often bitter in flavor.
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Gums are often used as binders. They can hold water.
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Resins do not dissolve in water.
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Oils are fats. Fixed oils don't evaporate quickly. Volatile oils evaporate quickly.
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