Drug Definitions and Classification

A drug is a substance that is used to prevent, diagnose, treat, or relieve symptoms

of a disease or brought by an illness and other abnormal conditions that happens in a
person’s body. Drugs have an effect on how a person’s brain and the rest of the body
work and it also causes changes in mood, awareness, thoughts, feelings, or even behavior.
They do this by interfering with the brain’s own chemical signals: neurotransmitters.
Some types of drugs, such as opioids whose main purpose is to block pain signals in the
brain, and are often used to safely help control acute pain a person experiences after
surgery, can lead to addiction if abused.
There are two types of drugs:
● Legal drugs are known as over-the-counter (OTC) and prescription (Rx)
drugs. Alcohol, nicotine, and caffeine are all legal drugs as well.
● Illegal drugs refer to drugs that are not prescribed by a licensed medical
professional, and their use is unlawful like cocaine, crystal
methamphetamine (meth), anabolic steroids, heroin, cannabis, etc.
There are numerous classifications for drugs. Medications are categorized in the
pharmaceutical industry based on the illnesses they cure or the chemical activity of the
drugs. Pharmaceuticals are categorized for a variety of purposes, from figuring out which
sorts of drugs are effective to creating treatment programs based on drugs with
comparable chemical properties. In the world of illicit drug use, there are essentially 7
different types of drugs. Each has a unique collection of traits, risks, and adverse effects.
Drug categories include:
● Cannabis: Cannabinoids, the active ingredients in Cannabis, were
approved for clinical use in 1985 to alleviate nausea and vomiting
resulting from cancer treatment. These agents may be prescribed for
patients receiving chemotherapy who do not respond to or are unable to
take other antiemetics. They are contraindicated for patients with
psychiatric disorders.
● Depressants: These medications work by interacting with the
neurotransmitter GABA (gamma-aminobutyric acid). Although they have
diverse effects on the body and mind, they typically have relaxing and
sedative effects. These addictive medicines are frequently used to treat a
range of psychiatric and sleep disorders.
● Dissociative anesthetics: a group of hallucinogenic medicines. People
who use this class of drugs have a sense of bodily or environmental
disconnection.
● Hallucinogens: This class of medications affects the perception of reality,
space, and time through interacting with the CNS. They could lead a
person to make up scenarios or things that don't actually exist.
● Inhalants: Dangerous chemicals with psychotropic effects are found in
inhalants. The majority of inhalants are found in daily items like cleaning
products, glue, and spray paint, making them accessible to teenagers and
young children. They are extremely deadly but tend to be less addictive
than other drugs.
● Opioids: The class of medications known as opioids interacts with
neurotransmitters in the brain to inhibit messages that can result in strong
 pleasurable feelings and lessen pain. Opioids are derived from the opium
poppy plant or synthetic equivalents that resemble the chemical structure
of opium.
● Stimulants: a class of medications that hasten the transmission of
information between the brain and body. They may awaken, alert, boost
confidence, or energize a person.

Drug Standards and Drug Information

A drug reference standard is a standardized substance that serves as a baseline for
measurements of other compounds that are similar. A reference standard offers a
calibrated level of biological effects against which new preparations of the medicine can
be compared when the precise active ingredients of a new drug are unknown. Clinicians
and patients have access to the greatest information available thanks to drug reference
solutions and patient education resources. They offer crucial details on dosage,
effectiveness, interactivity, and allergies, and, where necessary, they even suggest
alternatives to the recommended treatments. Drug information is also known as medical
information or drug informatics. Actually, it's the discovery, application, and
management of knowledge regarding the usage of pharmaceuticals. The range of
information about drugs includes identification, price, pharmacokinetics, dose, and side
effects. To make the most of the pharmacological information, you might also need
knowledge of the human body, health, and diseases.

Pharmacodynamics
Pharmacodynamics is the study of the effects of drugs on the body. Drugs act
within the body to mimic the actions of the body’s own chemical messengers. Drug
response can cause a primary or secondary physiologic effect or both. A drug’s primary
effect is the desirable response, and the secondary effect may be desirable or undesirable.
The primary effect of diphenhydramine is to treat the symptoms of allergy; the secondary
effect is a central nervous system (CNS) depression that causes drowsiness. The
secondary effect is undesirable when the patient drives a car, but at bedtime, it could be
desirable because it causes mild sedation.
Pharmacodynamic actions include:
● Stimulating activity by directly inhibiting a receptor and its downstream
effects
● Depressing activity by direct receptor inhibition and its downstream
effects
● Antagonistic or blocking a receptor by binding to it, but not activating it
● Stabilizing action, where the drug apparently behaves as neither an agonist
nor antagonist
● Direct chemical reactions (beneficially in therapy and also as an adverse
event)
A. Therapeutic Index and Drug Safety
The dosage range at which a medicine is effective without causing
unacceptably serious side effects is known as the therapeutic index (TI). The
larger the therapeutic index (TI), the safer the drug is. The drug must be dosed
cautiously and the patient should be constantly watched for any signs of drug
toxicity if the TI is tiny (the difference between the two concentrations is very
small).

B. Graded Dose-Response Relationship and Therapeutic Response

The dose-response relationship is the body’s physiologic response to
changes in drug concentration at the site of action. A therapeutic response is a
side effect of a medical treatment whose outcomes are deemed to be good and
advantageous.

C. Potency and Efficacy

Potency refers to the amount of drug needed to elicit a specific physiologic
response to a drug. A drug with high potency, such as fentanyl, produces
significant therapeutic responses at low concentrations; a drug with low potency,
such as codeine, produces minimal therapeutic responses at low concentrations.
The point at which increasing a drug’s dosage no longer increases the desired
therapeutic response is referred to as maximal efficacy.
D. Cellular Receptors and Drug Action
A receptor is a macromolecule found in the cell's membrane or inside of it
that selectively binds a ligand (drug) chemically. The types of chemical bonds
that can be formed between a drug and a receptor determine how a drug will bind
to that receptor. Drugs that attracted the receptors are referred to as ligands, and
they can be either agonists or antagonists. Agonists are effective because they
cause a biological reaction as a result of interactions between receptors and
ligands. Contrarily, following binding to the receptor, antagonists had no
physiologic effect.
There are different types of receptors:
1. Transmembrane ion-channels receptors
2. Transmembrane G-protein-couples receptors
3. Transmembrane receptors with cytosolic domain
4. Intracellular (cytoplasm or nucleus) receptors

E. Types of Drug Receptor Interactions

These are defined as proteins on or within the cell that bind with
specificity to particular drugs, chemical messenger substances, or hormones and
mediate their effects on the body.
Receptors can be subdivided into four main classes:
● Ligand-gated ion channels (LGICs): Ligand-gated ion channels (LGICs)
are membrane proteins that are structurally integral and feature a pore that
permits the controlled passage of particular ions across the plasma
membrane. The electrochemical gradient for the permeant ions drives the
passive ion flux.
● Tyrosine kinase-coupled: A subclass of tyrosine kinases known as receptor
tyrosine kinases (RTKs) is responsible for mediating cell-to-cell
communication and regulating a variety of intricate biological processes,
such as cell proliferation, motility, differentiation, and metabolism.
● Intracellular steroid: Target cells include steroid hormone receptors on
their plasma membrane as well as in their cytoplasm and nucleus. They
are typically nuclear or cytoplasmic intracellular receptors that start signal
transduction for steroid hormones and cause changes in gene expression
over the course of hours to days.
● G-protein-coupled (GPCR): G protein-coupled receptors (GPCRs) are
essential membrane proteins that cells utilize to translate extracellular
signals into intracellular actions. These actions include reactions to
hormones, and neurotransmitters, as well as reactions to signals from the
senses of sight, smell, and taste.
Pharmacokinetics (LADME)
Pharmacokinetics is the process of drug movement throughout the body that is
necessary to achieve drug action. The five processes are liberation, absorption,
distribution, metabolism (or biotransformation), and excretion (or elimination).
Liberation is the process in which a pharmaceutical substance is released from the
formulation it is delivered in. This must occur before the drug can be absorbed into the
body.
There are various release types:
● immediate: the medicine is formulated to release the medicinal drug without
delay;
● delayed: the medicine is formulated to release medicinal drug sometime after it is
taken
● (usually orally);
● extended: the medicine is formulated to make the drug available over an extended
period,
allowing a reduction in dosing frequency compared with immediate or delayed-
release medicines.
Drug absorption is the movement of the drug into the bloodstream after
administration. Approximately 80% of drugs are taken by mouth (enteral). For the body
to utilize drugs taken by
mouth, a drug in solid form (e.g., tablet or capsule) must disintegrate into small particles
and combine with a liquid to form a solution, a process known as dissolution (drugs in
liquid form are already in solution), in order to be absorbed from the gastrointestinal (GI)
tract into the bloodstream. Unlike drugs taken by mouth, parenteral drugs such as
eyedrops, eardrops, nasal sprays, respiratory inhalants, transdermal drugs, and sublingual
drugs do not pass through the GI tract.
Distribution is the movement of the drug from the circulation to body tissues.
Drug distribution is influenced by the rate of blood flow to the tissue, the drug’s affinity
to the tissue, and protein binding.
Metabolism, or biotransformation, is the process by which the body chemically
changes drugs into a form that can be excreted. The liver is the primary site of
metabolism. Liver enzymes—collectively referred to as the cytochrome P450 system, or
the P450 system, of drug-metabolizing enzymes—convert drugs to metabolites. A large
percentage of drugs are lipid soluble, thus the liver metabolizes the lipid-soluble drug
substance to a water-soluble substance for renal excretion. However, some drugs are
transformed into active metabolites, causing an increased pharmacologic response.
The main route of drug excretion, the elimination of drugs from the body, is
through the kidneys. Drugs are also excreted through bile, the lungs, saliva, sweat, and
breast milk. The kidneys filter free drugs (in healthy kidneys, drugs bound to protein are
not filtered), water-soluble drugs, and drugs that are unchanged. The lungs eliminate
volatile drug substances, and products metabolize to carbon dioxide (CO2) and water
(H2O).

Factors Influencing Responses to Drugs

Pharmacogenetics refers to the study of genetic factors that influence an
individual’s response to a specific drug. Genetic factors can alter drug metabolism,
resulting in either enhanced or diminished drug response. Nurses must integrate the
knowledge of pharmacogenetics into their practice in order to identify patients at
increased risk for adverse drug reactions, and they must effectively monitor patients for
therapeutic drug responses and prevent complications of drug therapy.
Numerous variables, such as food, comorbidities, age, gender, weight, drug-drug
interactions, route of administration, time of administration, pathological state, tolerance,
and genetics, might affect a drug's reaction. The risk of adverse events or treatment
failure can be influenced by individual genetic variation in critical genes involved in
metabolism, transport, or drug targets.

Drug Legislation Controlled Substances, Generic Drugs, Orphan Drugs, and Over-
The-Counter
Federal legislation attempts to protect the public from drugs that are impure,
toxic, ineffective, or not tested before the public sale. The primary purpose of the
legislation is to ensure safety. America’s first law to regulate drugs was the Food and
Drug Act of 1906, which prohibited the sale of misbranded and adulterated drugs but did
not address drug effectiveness and safety.
The Controlled Substance Act (CSA) is a law that establishes federal guidelines
for the production, distribution, importation, and exportation of restricted chemicals, as
well as their use. It establishes the guidelines for classifying controlled substances and
establishes the legal basis for their regulation. The classification schedules,
modifications, prescription criteria, and other important details will be highlighted in this
activity to help the interprofessional team members comprehend the legal framework and
use it in their clinical work.
Generics Act of 1988 states that an act to promote, require and ensure the
production of an adequate supply, distribution, use, and acceptance of drugs and
medicines identified by their generic names.
Statement of Policy. - It hereby declared the policy of the State:
● To promote, encourage and require the use of generic terminology in the
importation, manufacture, distribution, marketing, advertising and promotion,
prescription, and dispensing of drugs;
● To ensure the adequate supply of drugs with generic names at the lowest possible
cost and endeavor to make them available free for indigent patients;
● To encourage the extensive use of drugs with generic names through a national
system of procurement and distribution;
● To emphasize the scientific basis for the use of drugs, in order that health
professionals may become more aware and cognisant of the therapeutic
effectiveness; and
● To promote drug safety by minimizing duplication in medications and/or use of
drugs with potentially adverse drug interactions.
The Orphan Drug Act of 1983 was designed to promote the development and
manufacture of drugs used in the treatment of rare diseases (orphan drugs).
The Over-the-Counter Monograph Safety, Innovation, and Reform Act of
2019 were ratified by the President on March 27, 2020. This law aims to update how the
FDA governs over-the-counter monograph medications. The FDA is putting the act's
modifications into effect and will update the public as soon as they obtain new
information.
NURSING PROCESS IN PHARMACOLOGY
A. Assessment - Data Collection (subjective, objective)
1. Drug History - A patient's drug history is a complete list of all their
medications, both prescribed and over-the-counter.
B. Planning
- Identification of goals (must be patient-centered)
- Outcome criteria (must be SMART and has a time frame)
- Priotitization
C. Intervention - initiation and completion of the nursing care plan as defined by the
nursing diagnoses and outcome criteria
1. Drug Administration - the process of administering a therapy, like a
medication, to a patient. It may also apply to the dosage, administration
method, or frequency.
2. Medical Orders - A medical order is one or more diagnostic or therapeutic
directives created by a doctor or physician assistant that directs the
execution of particular actions to be taken or treatments to be administered
as part of a patient's diagnostic or therapeutic regimen.
3. Medication Safety - Given the extent of drug usage in patient care and the
frequency and seriousness of potential harm, medication safety—which
may be defined as the absence of inadvertent harm resulting from medical
treatment or medical errors during the medication-use process—deserves
the same priority.
4. Seven Rights - right medication, right patient, right dose, right time, right
route, right reason, and right documentation
5. Dosage Calculation
D. Client Education - Patient education is the process of influencing a patient's
behavior and bringing about the modifications in knowledge, attitudes, and
abilities required to preserve or enhance health.
E. Evaluation - Evaluation is crucial to the delivery of healthcare because it
promotes an evidence-based methodology (Moule et al 2017). It aids in
determining how well something is functioning. It can help with judgments
regarding a service's effectiveness and potential improvements to its delivery.
F. Recording and Reporting - Recording: To establish a record of anything by
writing it down so that it can be used or viewed again in the future (something).
Reporting: Information is communicated by oral, writing, or computer-based
communication.
G. Institutional Policies and Guidelines on Safe Drug Administration - Many
prescription medications are packaged with paper handouts called medication
guides. The guides cover topics unique to individual medications and
pharmacological classes and include FDA-approved knowledge that can protect
patients from life-threatening adverse reactions.

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