Medications — Drug Classes & Top 200 Drugs

Learning Objectives

By the end of this chapter, you will be able to:

4.Identify the primary therapeutic uses and key side effects of the most commonly prescribed medications (Top 200).

5.Differentiate between major drug classes (e.g., ACE inhibitors, statins, SSRIs) and their mechanism of action.

6.Recognize brand and generic names for high-volume prescription drugs.

7.Apply knowledge of drug interactions, contraindications, and storage requirements.

8.Identify drugs on the ISMP High-Alert Medication list and explain the special handling they require.

9.Interpret prescription sig codes and calculate days’ supply for common dosage forms.

1.1 The Core of the PTCE: Brand vs. Generic

The PTCE heavily emphasizes your ability to match a brand name to its generic equivalent. You will see both names on the exam. While you do not need to know every drug on the market, you must be fluent in the Top 200 drugs, which represent the vast majority of retail prescriptions.

Key Rule: The generic name is the official medical name (e.g., atorvastatin). The brand name is the proprietary name given by the manufacturer (e.g., Lipitor). A single generic can have multiple brands, but you only need to know the most common one.

Common Confusion: Drugs that sound alike (e.g., hydroxyzine vs. hydralazine) are frequently tested. Pay attention to the suffix of the generic name, which often indicates the drug class (e.g., "-pril" for ACE inhibitors, "-statin" for cholesterol-lowering agents).

1.2 Cardiovascular Drug Classes

This is a major section of the exam. You must know the indication, common side effects, and monitoring parameters.

Antihypertensives (Blood Pressure)

ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors): Generic names end in -pril (e.g., lisinopril, enalapril, ramipril). They are used for hypertension and heart failure. Key Side Effect: A persistent, dry cough. They are teratogenic (contraindicated in pregnancy).

ARBs (Angiotensin II Receptor Blockers): Generic names end in -sartan (e.g., losartan, valsartan). They are an alternative for patients who cannot tolerate the ACE inhibitor cough.

Beta-Blockers: Generic names end in -olol (e.g., metoprolol, atenolol, carvedilol). They are used for hypertension, angina, and heart failure. Key Side Effect: Bradycardia (slow heart rate) and masking of hypoglycemia symptoms in diabetics.

Calcium Channel Blockers (CCBs): Two main types. Dihydropyridines (e.g., amlodipine) primarily affect blood vessels. Non-dihydropyridines (e.g., diltiazem, verapamil) affect the heart and are used for arrhythmias. Key Side Effect: Peripheral edema (swelling in the ankles) with amlodipine.

Lipid-Lowering Agents (Statins)

Statins: Generic names end in -statin (e.g., atorvastatin, rosuvastatin, simvastatin). They are the first-line treatment for high cholesterol. Key Side Effects: Myopathy (muscle pain) and hepatotoxicity (liver damage). Major Interaction: Simvastatin and atorvastatin interact with grapefruit juice, increasing the risk of toxicity. They are typically dosed at bedtime because the liver produces cholesterol primarily at night.

Antiarrhythmics & Anticoagulants

Anticoagulants (Blood Thinners): These do NOT dissolve existing clots; they prevent new ones from forming.

Warfarin (Coumadin): The classic anticoagulant. Critical Monitoring: INR (International Normalized Ratio). It interacts with many drugs and Vitamin K-rich foods (e.g., leafy greens). It is a narrow therapeutic index drug.

Direct Oral Anticoagulants (DOACs): e.g., apixaban (Eliquis), rivaroxaban (Xarelto). These have fewer dietary restrictions than warfarin but are more expensive.

Antiplatelets: e.g., clopidogrel (Plavix). Used to prevent heart attacks and strokes. Note: Omeprazole (a PPI) can reduce the effectiveness of clopidogrel.

1.3 Endocrine & Metabolic Agents

Diabetes Medications

Metformin (Glucophage): First-line for Type 2 diabetes. It decreases glucose production in the liver. Key Side Effect: GI upset (diarrhea, nausea). Contraindication: Must be held before procedures using iodinated contrast dye due to risk of lactic acidosis.

Insulins: You must know the onset, peak, and duration of the main types.

Rapid-Acting: Insulin lispro (Humalog), insulin aspart (Novolog). Given with meals.

Short-Acting: Regular insulin (Humulin R). Given 30 minutes before meals.

Long-Acting: Insulin glargine (Lantus), insulin detemir (Levemir). Provides basal (background) insulin. Do NOT mix with other insulins in the same syringe.

Sulfonylureas: e.g., glipizide, glyburide. They stimulate the pancreas to release more insulin. Key Side Effect: Hypoglycemia (low blood sugar).

SGLT2 Inhibitors: Generic names end in -gliflozin (e.g., empagliflozin, canagliflozin). They work in the kidneys to excrete glucose in the urine. Key Side Effect: Increased risk of urinary tract infections and dehydration.

Thyroid Medications

Levothyroxine (Synthroid): Treatment for hypothyroidism. Critical Administration: Must be taken on an empty stomach, 30-60 minutes before breakfast, and separated from calcium or iron supplements by at least 4 hours.

1.4 Central Nervous System (CNS) Agents

Psychiatric Medications

SSRIs (Selective Serotonin Reuptake Inhibitors): Generic names include -oxetine (fluoxetine, paroxetine) and -opram (citalopram, escitalopram). They are first-line for depression and anxiety. Key Side Effect: Sexual dysfunction, insomnia, or weight gain. Major Interaction: Risk of Serotonin Syndrome if taken with other serotonergic drugs (e.g., tramadol, MAOIs).

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors): e.g., venlafaxine, duloxetine. Used for depression and neuropathic pain.

Benzodiazepines: Generic names end in -azepam or -azolam (e.g., alprazolam, lorazepam, diazepam). Used for anxiety, panic, and seizures. Key Side Effect: Dependence, sedation. DEA Schedule: IV.

Stimulants: e.g., methylphenidate (Ritalin), amphetamine salts (Adderall). Used for ADHD. DEA Schedule: II. They have a high potential for abuse.

Pain Management

Opioids: Generic names include codeine, hydrocodone, oxycodone, morphine, and tramadol. Used for moderate to severe pain. DEA Schedule: II (most common). Key Side Effects: Respiratory depression, constipation, and dependence.

Adjuvant Analgesics: e.g., gabapentin (Neurontin) and pregabalin (Lyrica). Used for nerve pain (neuropathy). Gabapentin is Schedule V in some states but not federally.

1.5 Anti-Infectives

Penicillins: e.g., amoxicillin. Key Interaction: Can decrease the effectiveness of oral contraceptives.

Cephalosporins: e.g., cephalexin (Keflex). Cross-allergy risk with penicillins is low but possible.

Macrolides: e.g., azithromycin (Zithromax, "Z-Pak"), clarithromycin. Key Interaction: Can prolong the QT interval and interact with statins.

Fluoroquinolones: e.g., ciprofloxacin, levofloxacin. Key Interaction: Chelate with cations (calcium, iron, magnesium, antacids). Must be separated by 2-4 hours. Warning: Risk of tendon rupture.

Tetracyclines: e.g., doxycycline. Used for acne and respiratory infections. Key Side Effect: Photosensitivity (sunburn easily). Also chelate with dairy products.

Antivirals: e.g., oseltamivir (Tamiflu) for influenza, acyclovir for herpes.

1.6 Respiratory & Allergy Agents

Beta-2 Agonists (Bronchodilators):

Short-Acting (SABAs): e.g., albuterol (ProAir, Ventolin). Used for acute asthma attacks (rescue inhaler).

Long-Acting (LABAs): e.g., salmeterol, formoterol. Used for maintenance (controller). Never used as monotherapy for asthma.

Inhaled Corticosteroids (ICS): e.g., fluticasone (Flovent), budesonide (Pulmicort). Used for chronic asthma control. Patients must rinse their mouth after use to prevent oral thrush.

Antihistamines:

First-Generation: e.g., diphenhydramine (Benadryl). Key Side Effect: Sedation.

Second-Generation: e.g., loratadine (Claritin), cetirizine (Zyrtec). Non-sedating.

Decongestants: e.g., pseudoephedrine (Sudafed). Regulation: Stored behind the pharmacy counter due to methamphetamine production. Sale is limited by federal law (30 grams per month per person).

1.7 Gastrointestinal Agents

Proton Pump Inhibitors (PPIs): Generic names end in -prazole (e.g., omeprazole, pantoprazole). Used for GERD and ulcers. Key Note: Long-term use can cause vitamin B12 deficiency and increased risk of bone fractures.

H2 Receptor Antagonists: e.g., famotidine (Pepcid). Used for GERD.

Antiemetics: e.g., ondansetron (Zofran). Used to prevent nausea and vomiting. Key Side Effect: QT prolongation.

Laxatives: e.g., polyethylene glycol (MiraLAX), senna. Used for constipation.

Antidiarrheals: e.g., loperamide (Imodium). Used for diarrhea.

1.8 High-Alert Medications (ISMP)

The Institute for Safe Medication Practices (ISMP) maintains a list of drugs that have a heightened risk of causing significant patient harm when used in error. You must know these drugs and the specific risks they pose.

Key High-Alert Classes:

Insulin: All types. Errors often occur with U-500 (concentrated) vs. U-100. Always use an insulin syringe.

Opioids: Especially concentrated solutions and fentanyl patches.

Anticoagulants: Warfarin, heparin, enoxaparin (Lovenox).

Chemotherapy Agents: e.g., methotrexate. Note: Methotrexate is often confused with a daily medication, but it is dosed ONCE WEEKLY for many conditions.

Potassium Chloride (KCl) for Injection: Must be diluted before administration.

Sodium Chloride (NaCl) >0.9%: Hypertonic solutions.

Exam Trap: The exam will ask you to identify which drug is a high-alert medication. Memorize the list above.

1.9 Compounding & Storage Standards

While compounding is a separate chapter, you must know the storage requirements for specific drugs.

USP <797>: Applies to sterile compounding. Requires an ISO Class 5 environment (laminar airflow hood) for low-risk compounding.

USP <795>: Applies to non-sterile compounding.

Refrigeration: Many antibiotics (e.g., amoxicillin suspension) require refrigeration after reconstitution. Insulin vials that are in use can be stored at room temperature for up to 28 days.

Light-Sensitive Drugs: e.g., nitroglycerin, must be stored in amber containers.

1.10 Regulatory Frameworks (Name Recognition)

You must be able to identify the regulatory body associated with a specific rule.

DEA (Drug Enforcement Administration): Enforces the Controlled Substances Act (21 CFR). Regulates the prescribing and dispensing of Schedule II-V drugs.

FDA (Food and Drug Administration): Approves drugs for safety and efficacy. Enforces drug labeling standards and REMS (Risk Evaluation and Mitigation Strategies) for high-risk drugs (e.g., isotretinoin, clozapine).

HIPAA (Health Insurance Portability and Accountability Act): Protects patient health information (PHI). A pharmacy technician cannot discuss a patient's medication with their family member without the patient's consent.

USP (United States Pharmacopeia): Sets the standards for compounding, drug purity, and storage.

Common Exam Traps

Students often miss questions due to careless errors or confusing similar concepts. Here are the classic traps:

108.q.d. vs. q.i.d.: This is the most common sig code error.

q.d. = once daily (every day).

q.i.d. = four times daily.

Trap: Students see the "q" and assume they are the same. Always read the middle letter: "d" = daily, "i.d." = in die (four times).

112.DEA Schedule Mix-ups:

Trap: Confusing Schedule III (e.g., Tylenol #3 with codeine) with Schedule II (e.g., oxycodone). Remember: Schedule II drugs have a high potential for abuse and NO accepted medical use in some cases (like heroin). Schedule III-V have decreasing potential.

Memory Aid: Schedule II drugs require a written (or electronic) prescription; no refills are allowed. Schedule III-V allow refills (up to 5 in 6 months).

115.Metric Conversion Errors:

Trap: Confusing 1 gram = 1000 mg with 1 mg = 1000 mcg. Always write it out.

Trap: 1 kg = 2.2 lbs. If a patient weighs 150 lbs, the weight in kg is 150 / 2.2 = 68.2 kg. Students often multiply by 2.2 instead of dividing.

118.Days' Supply Calculation:

Trap: For insulin, if a patient uses 20 units of U-100 insulin in the morning and 15 units at night, the total daily dose is 35 units. A 10 mL vial of U-100 contains 1000 total units. Days' supply = 1000 units / 35 units per day = 28.5 days.

Trap: For eye drops, if a patient uses 1 drop in each eye twice a day, that is 4 drops per day. A 5 mL bottle of a 0.5% solution typically contains about 100 drops (20 drops/mL). Days' supply = 100 drops / 4 drops per day = 25 days.

121.Drug Interaction Oversights:

Trap: A patient is prescribed ciprofloxacin and takes a calcium supplement. The technician should counsel the patient to take the ciprofloxacin 2 hours before or 6 hours after the calcium. Students often forget this chelation rule.

Trap: A patient on warfarin is prescribed a new antibiotic (e.g., metronidazole). This will increase the INR and the risk of bleeding. The pharmacist must be alerted.

124.Brand/Generic Mismatches:

Trap: Confusing Crestor (rosuvastatin) with Celexa (citalopram). They sound similar but are completely different classes.

Trap: Confusing Zyprexa (olanzapine, an antipsychotic) with Zyrtec (cetirizine, an antihistamine).

127.Insulin Concentration:

Trap: U-500 insulin is 5 times more concentrated than U-100. A dose of 0.1 mL of U-500 is 50 units, not 10 units. This is a fatal error.

129."Once Weekly" Drugs:

Trap: Methotrexate for rheumatoid arthritis is taken once a week. If a patient takes it daily by mistake, it is toxic. This is a classic ISMP high-alert scenario.

131.Teratogenic Drugs:

Trap: Isotretinoin (Accutane) and statins are contraindicated in pregnancy. The exam will ask which drug is unsafe in pregnancy. Always look for these.

133.OTC vs. Behind-the-Counter:

Trap: Pseudoephedrine is not a prescription drug, but it is not on the open shelf either. It is "behind the counter" (BTC). The exam will test your knowledge of this legal distinction.

Final Review Strategy

To master this chapter, create flashcards for the Top 200 drugs. On the front, put the brand name; on the back, put the generic name, the drug class, the primary indication, and one key side effect. Drill these daily. Focus on the suffixes for drug classes, and always double-check your sig codes and calculations. Remember that the PTCE is a test of safe practice; when in doubt, choose the answer that prioritizes patient safety and clear communication with the pharmacist.

Medications — Drug Classes & Top 200 Drugs