USAN Nomenclature Classification & Drugs Flashcards
Nomenclature Categories - Chemical
- Based on Chemical Structure*
- Structure similarity ensures the Pharmacologic Mechanism of Action will be the same*
- Drugs within the same chemical class may differ in other properties based on difference in Function Groups (not always clinically significant)*
- Bioavailability: Potency based on weight dosing*
- Pharmacokinetics: Solubility*
- Duration of Activity: Chemical stability*
- Adverse drug reaction: Patient adherence*
Ex. of drug classes often referred to by their chemical class name
- The Benzodiazepines : Anxiety
- The Thiazolidinediones : Type 2 Diabetes
- The Beta-Lactams : Infection
- The Corticosteroids : Inflammation/Immunosuppression
- The Aminoglycosides : Infection
- The Opioids : Pain
- The Statins : Dyslipidemia
Nomenclature Categories - Pharmacologic
- Drugs with the same pharmacologic class all have the same MOA*
– Not always from the same chemical class* - MOF is expressed through anatomical, Physiological (Depressant Vs Stimulant), Biochemical (Inhibitor Vs Activator), Genetic (Antagonist Vs. Agonist)*
Ex. of Pharmacologic MOA descriptors
- ACE inhibitors : Hypertension
- Beta-blockers : Hypertension
- Proton Pump Inhibitors : Acid Reflux
- Histamine Receptor Antagonists: Acid Reflux
- Vitamin K Antagonists : Anticoagulation
- Neuromuscular blocking agents : Paralysis
- HMG CoA Reductase Inhibitors : Dyslipidemia
Calcium Channel Blockers
Calcium influx into heart and vascular smooth muscles
- Lead to vasoconstriction and contraction of these muscles
Nomenclature Categories - Therapeutic
- Based on FDA’s approved Indications (may also have off label uses)*
- Indication: disease, symptoms, or conditions for which the FDA have approved the drug to treat*
- Therapeutic Interchange (replace a medication with a chemically different medication)
– Reasons: Financial incentive from the manufacturer, Limit brands in inventory, Formulary substitution, Drug shortages*
– Regulatory Implication: explicit physician approval and/or follow the institution’s formulary policies*
Therapeutic - Factors to Considers
- Must be in the same therapeutic class*
- Patient specific factors*
- Bioavailability*
- ADME*
- ADR/ADE and DDI*
- FDA approved indication and clinical practice norm (clinical Sig)*
- Cost*
- Generation*
USAN Names
- USAN(USP dictionary of the US adopted names) and international Drug Names Council
– All approved official Generic Drug names (USAN=Generic)*
– Names are chosen and approved by USP, FDA, APhA, AMA
– Led to NDC Codes - Ideal Characteristics of USAN Names
– Short, Distinctive , and indicative of the chemical, Pharmacologic, or Therapeutic class*
Common Syllables
Dronate
Farin/-Parin
Xaban
Grel
Entan
Dronate (Chemical, Pharmacologic, and Therapeutic Class)
- Chemical Class: Bisphosphonates*
- Pharmacologic Class: Bone Resorption Inhibitors*
– Inhibit loss of bone* structure that occur over time
– Rate of bone loss exceed replacement => Osteoporosis* - Therapeutic Class
– Osteoporosis, Hypercalcemia of malignancy, Paget’s disease, Breast Cancer, Multiple Myeloma
Osteoporosis (Risk factors)
- A systemic bone condition*
– Decreased bone mass and deterioration leading to increased bone fragility and risk of hip, spine, and wrist fracture (asymptomatic until fracture occurs) - Risk Factors
– > 45 age*
– Female > males*
– Smoking: Increased*
– Family History: Increased*
– Calcium and Vitamin D: Deficient (when Vitamin D is low calcium reservoir of bone is depleted to correct for low calcium absorption in gut)*
– Race: Caucasian*
Bisphosphonates (Warning, Interaction, and Comparison)
Warning:
- GI mucosal irritation (esophagitis, esophageal ulcer, esophageal irritation)*
- Hypocalcemia*
- Osteonecrosis of the jaw (ONJ)*
Interaction
- Take on an empty stomach (30 min before meal) and 6 oz of water to minimize GI upset*
- Stay upright for at least 30 min*
Pregnancy Consideration
- Limited data in pregnancy but fetal exposure is expected
Comparison with alternative pharmacotherapy
– Monoclonal antibodies (mAb)
– Denosumab (Prolia): Subcutaneous(SQ)* injection every 6 months
– Romosozumab-aqqg (Evenity): SQ injection monthly*
- Parathyroid hormone receptor agonists: SQ injection monthly
– Teriparatide (Forteo)
– Abaloparatide (Tymlos)
Farin/-Parin - Chemical and Pharmacologic Class
Chemical Class
- Warfarin: 4-hydroxy-3-2H-chromen-2-one
- -Parin: Polysaccharide-like macromolecular structure of varying molecular weights* consistent of glycosaminoglycans
Pharmacologic Class: Coagulation pathway inhibitors*
- Warfarin: Vitamin K Antagonist*
- Dalteparin and Enoxaparin: Low molecular weight heparin*
Anticoagulants (-Farin/-Parin)-Therapeutics class, and Warning
Therapeutic Class
- Myocardial Infarction
- Atrial Fibrillation
- Venous Thromboembolism (VTE)
– Deep Vein Thrombosis*
– Pulmonary Embolism*
- Heparin Induced Thrombocytopenia (HIT)
Warning
- Warfarin - Dosing titration based on International Normalized Ratio (INR)*
– Blood based clinical lab test that measure the prothrombin time (PT)*
– If INR fall outside the recommended range (2-3) it can indicate: Bleeding (INR > 3-3.5), Clotting (INR < 2-2.5)*
Anticoagulant (-Farin/-Parin) -BBW, Interactions, Reversal
Black Boxed Warning (BBW):*
- Warfarin: risk of major or fatal bleeding
- LMWH: Hematoma expansion with concomitant epidural catheter use.
Interactions:
- Warfarin: Many clinically significant DDI*
- Concurrent CYP2C9* medications
Pregnancy Considerations:
- Warfarin - Contraindicated ( Former Category X) in pregnancy
– Crosses the placental barrier causing fetal bleeding in the fetus
-Parins: Can be used in pregnancy but with appropriate precautions
Antidotes:
- Warfarin Reversal: 4-factor prothrombin complex concentrate (KCentra)*
– Dosing based on INR and (units/kg)
- Heparin (LMWH) Reversal: Protamine sulfate*
– Dosing based on LMWH dose (most recent 2 hours)
