Medication Names, Classification & Regulation

Medication Names

• Medications can have up to 3 names: chemical, brand, and generic.
• The chemical name provides a detailed description of the molecular structure.
• The brand name is assigned by the manufacturer marketing the drug.
• The generic name given by the original medication manufacturer.

Abbreviations

• Institute for Safe Medication Practices is abbreviated as ISMP.
• "Look alike and sound alike" medications are abbreviated as LASA.

Medication Classification

• Medications are classified by their effect on a body system, with some belonging to multiple classes.
• Aspirin is classified as an analgesic, antipyretic, and anti-inflammatory medication.

Medication Forms

• Medication form determines the administration route.

Important Dates in Canadian Medication Regulation

• 1884: Medication standards regulation began with the Adulteration Act, which defined conditions for adulteration.
• 1920: The Food and Drugs Act replaced the Adulteration Act.
• 1950: Amendments gave the federal government control over the manufacture and sale of medications (excluding opioids), foods, cosmetics, and certain medical devices.
• 1908: The government first controlled opioids through the Opium Act.
• 1961: The Narcotic Control Act controlled opioid manufacture, distribution, and sale.
• 1996: The Narcotic Control Act was repealed and replaced by the Controlled Drugs and Substances Act.

Solid Medication Forms

Capsule

• Contains particles or powdered medication.
• Has a gelatin shell or container that opens.

Tablet

• Powdered medication is compressed into a hard disc or oblong shape.
• Made with medication, binders, disintegrators, lubricants, and fillers.

Enteric-Coated Tablet

• Coated to protect against absorption in the stomach.
• Dissolves and is absorbed in the intestines.

Pill

• Generally refers to any solid medication.

Sustained Release

• Can be a solid tablet or capsule.
• Contains small, coated medication particles.
• Dissolves over an extended period.

Liquid Medication Forms

Elixir

• A clear fluid.
• Contains medication, water, alcohol, and/or sweetener.

Extract

• Syrup or dried medication.
• It is a concentrated preparation made by evaporating nonactive ingredients.

Oral Solution

• Medication dissolved in water.

Oral Suspension

• Fine medication particles are dispensed in liquid.
• Particles settle at the bottom when standing.

Syrup

• Medication dissolved in concentrated sugar solution.

Lozenge (Troche)

• A flat, round tablet.
• Dissolves in the mouth to release medication but is not intended for ingestion.

Aerosol

• Liquid medication.
• Sprayed or inhaled, not for ingestion.
• Absorbed in the mouth and upper airway.

Topical Medication Forms

Ointment

• Semisolid with moderate consistency.
• Provides a protective film.
• Contains medication and hydrocarbons.

Lotion

• Liquid suspension with thin consistency.
• It moisturizes or cleanses the skin.
• Contains high water content, alcohol, and dissolved medication.

Paste

• Semisolid with thick consistency, porous, and breathable.
• Protects and treats skin excoriation.
• Slowly absorbed and easily confined to one area.

Transdermal Medication Forms

Transdermal Disc or Patch

• Adhesive disc or patch.
• Contains a medication reservoir and membrane.
• Provides controlled release of medication over hours to weeks.

Medication Forms for Parental Administration

Solution

• Sterile liquid.
• Contains water with one or more dissolved medicinal compounds.

Powder

• Solid, sterile particles of medication.
• Dissolved into a sterile liquid.

Medication Forms for Instillation into Body Cavities

Solution

• Liquid medication dissolved in water or another liquid.

Intraocular Disc

• Small, flexible, solid oval.
• Contains two outer layers and one middle layer with medication.
• Slowly releases medication when moistened by ocular fluid.

Suppository

• Solid medicine, shaped into a smooth, narrow tablet.
• Contains gelatin.
• Inserted into a body cavity (rectum or vagina); melts at body temperature and releases medication.

Medication Standards

• Purity: The standard quantity of active substance or drugs in a medication product is defined.
• Potency: Medication strength is affected by the concentration of the active substance or drug.
• Bioavailability: The ability of the active substance or drug to be released, dissolved, absorbed, and transported.
• Efficacy: Medication action and effectiveness demonstrated through laboratory studies.
• Safety: All medications require continuous evaluation to determine the risk of adverse effects.

Provincial, Territorial, and Local Regulation of Medication

• Provincial and territorial governments do not directly regulate medication manufacture or sale.
• These governments have the primary legislative responsibility for healthcare, affecting medication use and sale.
• Each has legislation for medical, dental, pharmacy, and nursing practices, influencing healthcare providers' roles in prescribing, dispensing, and administering medications.
• Legislation includes schedules or lists of medications sold with or without a prescription.
• The National Association of Pharmacy Regulatory Authorities promotes the harmonization of medication sales nationwide.
• Healthcare institutions and employers establish policies that conform to the rules of the territorial regulation.
• Institutional policies are often more restrictive than government controls to avoid issues and promote quality assurance.
• Automatic antibiotic therapy discontinuation policies control the length of time a medication is prescribed, avoiding unnecessary expenses and therapies.

Selective Serotonin Reuptake Inhibitors (SSRIs)

• SSRIs are a class of antidepressants.
• SSRIs are prescribed because of their effectiveness and relatively tolerable side effect profiles compared to tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).

Mechanism of Action

• SSRIs selectively inhibit the reuptake of serotonin (5-HT) in the synaptic cleft.
• Serotonin is a neurotransmitter involved in the regulation of mood, sleep, appetite, and other functions.
• After serotonin is released into the synapse, it binds to receptors on the postsynaptic neuron, transmitting a signal.
• The remaining serotonin in the synapse is then taken back up into the presynaptic neuron through a serotonin transporter (SERT) protein.
• SSRIs bind to the SERT protein, blocking the reuptake of serotonin, which results in increased concentrations of serotonin in the synaptic cleft.
• The increased serotonin can then bind to postsynaptic receptors, enhancing serotonergic neurotransmission.
• The selective action on serotonin reuptake distinguishes SSRIs from older antidepressants that affect multiple neurotransmitter systems.

Side Effects and Management

• SSRIs can cause a range of side effects, but are generally well-tolerated.
• Common side effects include gastrointestinal issues, sexual dysfunction, sleep disturbances, weight changes, and central nervous system effects.
• Gastrointestinal issues include nausea, diarrhea, and constipation and are often transient.
• Sexual dysfunction includes decreased libido, erectile dysfunction, and anorgasmia.
• Sleep disturbances include insomnia or somnolence.
• Central nervous system effects include headache, dizziness, anxiety, and agitation.
• Strategies for managing side effects include starting with a low dose and gradually increasing it, administering the medication with food, adjusting the timing of the dose, lifestyle modifications, and additional medications to counteract specific side effects.
• Many side effects are temporary and tend to diminish over time.
• If side effects are intolerable, consider switching to a different SSRI or another class of antidepressant.
• Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system.
• Serotonin syndrome can occur when SSRIs are combined with other serotonergic agents, such as MAOIs, SNRIs, TCAs, triptans, tramadol, or St. John's Wort.
• Symptoms of serotonin syndrome include mental status changes, autonomic instability, and neuromuscular abnormalities.
• Mental status changes include confusion, agitation, and anxiety.
• Autonomic instability includes hyperthermia, tachycardia, hypertension, and diaphoresis.
• Neuromuscular abnormalities include tremor, muscle rigidity, myoclonus, and hyperreflexia.
• Management of serotonin syndrome includes discontinuing all serotonergic medications immediately, supportive care, and medications to block serotonin production or receptors.
• Supportive care includes cooling measures for hyperthermia, intravenous fluids for dehydration, and monitoring of vital signs
• Cyproheptadine is a medication used to block serotonin production or receptors.
• In severe cases of serotonin syndrome, neuromuscular paralysis and mechanical ventilation may be required.

Nursing Assessments

• Comprehensive assessment is essential before initiating SSRI therapy, including a thorough medical history.
• The medical history includes past psychiatric diagnoses and treatments, current medications, allergies and adverse drug reactions, history of medical conditions, and family history of psychiatric disorders.
• Assess for contraindications or precautions such as concomitant use of MAOIs, history of mania or bipolar disorder, glaucoma and seizure disorders.
• A baseline physical examination should be conducted, including vital signs, weight and body mass index (BMI), and a neurological assessment.
• A mental status examination should be performed, including mood and affect, thought processes and content, cognitive function, and suicidal ideation.
• Ongoing monitoring is crucial during SSRI therapy for therapeutic and adverse effects.
• Therapeutic effects include improvement in mood, sleep, appetite, and energy levels, and a reduction in anxiety or obsessive-compulsive symptoms.
• Adverse effects include gastrointestinal symptoms, sexual dysfunction, sleep disturbances, weight changes, and central nervous system effects.
• Regularly assess for suicidal ideation, especially during the initial weeks of treatment.
• Vital signs and weight should be monitored periodically.
• Assess for signs and symptoms of serotonin syndrome, particularly when SSRIs are combined with other serotonergic agents.

Patient Education

• Educate patients about the purpose of SSRI therapy and the expected benefits, and that it may take several weeks to experience the full therapeutic effects.
• Instruct patients on how to take the medication correctly, as prescribed, at the same time each day
• Patients should not abruptly stop taking the medication without consulting a healthcare provider.
• If a dose is missed, take it as soon as possible, unless it is almost time for the next dose.
• Tablets or capsules should be swallowed whole, without crushing or chewing them.
• Inform patients about potential side effects and how to manage them, and explain that many side effects are temporary and tend to diminish over time.
• Advise patients to report any bothersome or persistent side effects to their healthcare provider.
• Educate patients about the risk of serotonin syndrome, symptoms, and the importance of seeking immediate medical attention if they occur.
• Advise patients to avoid combining SSRIs with other serotonergic agents without consulting a healthcare provider.
• Regular follow-up appointments are important to monitor effectiveness and assess for any adverse effects.
• Encourage patients to communicate openly with their healthcare provider about their symptoms, concerns, and any changes in their condition.
• Provide education on lifestyle modifications that can complement SSRI therapy: regular exercise, a healthy diet, adequate sleep and stress-reduction techniques
• Advise patients to avoid alcohol and illicit drugs, as these can interfere with the effectiveness of the medication and exacerbate side effects.

Drug interactions

• SSRIs can interact with a variety of other medications, potentially leading to adverse effects or reduced efficacy.
• Concurrent use of SSRIs and MAOIs is contraindicated due to the risk of serotonin syndrome, necessitating a washout period of at least 14 days when switching.
• Combining SSRIs with other serotonergic agents can increase the risk of serotonin syndrome, and caution should be used when prescribing these medications together, monitoring patients.
• SSRIs can increase the anticoagulant effects of warfarin, increasing the risk of bleeding, requiring close monitoring of INR and dose adjustments.
• SSRIs can increase the risk of gastrointestinal bleeding, especially when combined with NSAIDs, requiring caution and advising patients to report signs of gastrointestinal bleeding.
• SSRIs can inhibit certain CYP enzymes, affecting the metabolism of other medications and potentially increasing the risk of adverse effects.
• Awareness of potential CYP enzyme interactions is important when prescribing SSRIs with other medications, and doses should be adjusted as needed.