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What is a 'drug stem' and why do nursing/medical students learn them?
Answer: A common syllable (prefix, infix, or suffix) shared by generic drug names within the same pharmacologic class
Learning stems lets you predict a drug's class, mechanism, and likely side effects/nursing considerations even if you've never seen that specific drug name before (e.g., any drug ending in '-olol' is a beta blocker).
Drug stem '-olol' → class, prototype, mechanism?
Answer: Beta blockers; prototype metoprolol (also propranolol); block beta-adrenergic receptors, decreasing heart rate, contractility, and renin release
Nursing consideration: check apical pulse and BP before giving; hold if HR <60 bpm; never stop abruptly (risk of rebound tachycardia/angina).
Drug stem '-pril' → class, prototype, mechanism?
Answer: ACE inhibitors; prototype lisinopril; inhibit angiotensin-converting enzyme, blocking conversion of angiotensin I to angiotensin II
Nursing consideration: watch for persistent dry cough and angioedema; monitor potassium and renal function; contraindicated in pregnancy.
Drug stem '-sartan' → class, prototype, mechanism?
Answer: Angiotensin II receptor blockers (ARBs); prototype losartan; block angiotensin II at the AT1 receptor, causing vasodilation
Nursing consideration: alternative for patients who develop ACE-inhibitor cough; still monitor potassium/renal function; avoid in pregnancy.
Why might a patient be switched from an ACE inhibitor to an ARB?
Answer: ARBs do not increase bradykinin, so they rarely cause the dry cough or angioedema seen with ACE inhibitors
ACE inhibitors block ACE, which also degrades bradykinin, so bradykinin accumulates and causes cough; ARBs act downstream at the receptor and spare bradykinin metabolism.
Drug stem '-dipine' → class, prototype, mechanism?
Answer: Dihydropyridine calcium channel blockers; prototype amlodipine; block L-type calcium channels in vascular smooth muscle, causing vasodilation
Nursing consideration: monitor for peripheral/ankle edema, hypotension, and reflex tachycardia.
Drug stem '-statin' → class, prototype, mechanism?
Answer: HMG-CoA reductase inhibitors (statins); prototype atorvastatin; inhibit HMG-CoA reductase, decreasing hepatic cholesterol synthesis and upregulating LDL receptors
Nursing consideration: monitor liver enzymes and for myopathy/rhabdomyolysis (muscle pain, elevated CPK); give most statins in the evening.
Drug stem '-prazole' → class, prototype, mechanism?
Answer: Proton pump inhibitors (PPIs); prototype omeprazole; irreversibly inhibit the H+/K+ ATPase pump in gastric parietal cells
Nursing consideration: give before meals; long-term use linked to fractures, C. difficile infection, and vitamin B12 deficiency.
Drug stem '-tidine' → class, prototype, mechanism?
Answer: H2 receptor antagonists; prototype famotidine; block histamine H2 receptors on parietal cells, reducing gastric acid secretion
Nursing consideration: less potent acid suppression than PPIs; cimetidine especially can cause confusion in older adults and has many CYP450 drug interactions.
How do PPIs and H2 blockers differ in potency and onset?
Answer: PPIs produce more complete, longer-lasting acid suppression than H2 blockers, which act faster but are weaker
PPIs irreversibly block the final step of acid secretion (the proton pump), while H2 blockers only block one of several stimulatory pathways to the pump.
Drug stem '-azole' → class, prototype, mechanism?
Answer: Antifungals (azole class); prototype fluconazole; inhibit fungal cytochrome P450 enzyme (lanosterol demethylase), impairing ergosterol synthesis in the fungal cell membrane
Nursing consideration: monitor liver function; numerous CYP450 drug interactions since azoles inhibit human CYP450 as well.
Drug stem '-cillin' → class, prototype, mechanism?
Answer: Penicillins; prototype amoxicillin; inhibit bacterial cell wall synthesis by binding penicillin-binding proteins and blocking transpeptidation (beta-lactam)
Nursing consideration: always assess for penicillin allergy before administration due to anaphylaxis risk.
Drug stem '-mycin' (aminoglycosides) → class, prototype, mechanism?
Answer: Aminoglycosides; prototype gentamicin; inhibit bacterial protein synthesis by binding the 30S ribosomal subunit
Nursing consideration: monitor peak/trough serum levels; risk of nephrotoxicity and ototoxicity (hearing loss, tinnitus).
How are macrolides (e.g., azithromycin) distinguished from aminoglycosides, since both can end in '-mycin'?
Answer: Macrolides typically end in '-thromycin' and inhibit the 50S ribosomal subunit; aminoglycosides end in '-mycin'/'-micin' and inhibit the 30S subunit
Macrolide nursing consideration: monitor for QT prolongation and GI upset; much safer renal/ototoxicity profile than aminoglycosides.
Drug stem '-cycline' → class, prototype, mechanism?
Answer: Tetracyclines; prototype doxycycline; inhibit bacterial protein synthesis by binding the 30S ribosomal subunit, blocking tRNA attachment
Nursing consideration: avoid in pregnancy and children under 8 (tooth discoloration, bone growth inhibition); avoid dairy/antacids; causes photosensitivity.
Drug stem '-floxacin' → class, prototype, mechanism?
Answer: Fluoroquinolones; prototype ciprofloxacin; inhibit bacterial DNA gyrase and topoisomerase IV, preventing DNA replication
Nursing consideration: risk of tendon rupture/tendinitis and QT prolongation; avoid in children and pregnancy; avoid dairy/antacids (chelation reduces absorption).
Drug stem 'cef-' → class, prototype, mechanism?
Answer: Cephalosporins; prototype cefazolin or ceftriaxone; inhibit bacterial cell wall synthesis by binding penicillin-binding proteins (beta-lactam)
Nursing consideration: assess for cross-allergy with penicillin (small but possible risk); monitor renal function; generation number indicates expanding gram-negative coverage.
Drug stem '-vir' → class, prototype, mechanism?
Answer: Antivirals; prototype acyclovir; inhibits viral DNA polymerase after being phosphorylated, terminating viral DNA chain synthesis
Nursing consideration: maintain adequate hydration to prevent crystalluria and nephrotoxicity, especially with IV administration.
Drug stem '-mab' → class, prototype, mechanism?
Answer: Monoclonal antibodies; prototype infliximab or rituximab; bind a specific antigen or receptor to block an inflammatory pathway or target cancer/immune cells
Nursing consideration: monitor closely for infusion reactions; screen for latent TB and other infections before starting due to immunosuppression.
Drug stem '-nib' → class, prototype, mechanism?
Answer: Tyrosine kinase inhibitors; prototype imatinib; inhibit tyrosine kinase enzymes (e.g., BCR-ABL) that drive abnormal cell signaling and proliferation
Nursing consideration: monitor for hepatotoxicity and myelosuppression; watch for numerous drug–drug interactions via CYP450.
Drug stem '-tropin' → class, prototype, mechanism?
Answer: Pituitary hormone analogs; prototype somatropin (recombinant growth hormone); stimulates growth hormone receptors to promote growth and metabolism
Nursing consideration: administer subcutaneously; monitor growth parameters, blood glucose, and for edema.
Drug stem '-caine' → class, prototype, mechanism?
Answer: Local anesthetics; prototype lidocaine; block voltage-gated sodium channels in neurons, preventing nerve impulse conduction
Nursing consideration: monitor for CNS toxicity (tinnitus, metallic taste, seizures) and cardiac arrhythmias with IV/high-dose use; assess allergy history (ester vs amide type).
Drug stem '-pam' / '-lam' → class, prototype, mechanism?
Answer: Benzodiazepines; prototype diazepam or alprazolam; enhance GABA-A receptor activity, increasing chloride influx and causing CNS depression
Nursing consideration: monitor for respiratory depression and sedation; risk of dependence with long-term use; flumazenil is the reversal agent.
What is the reversal agent for benzodiazepine overdose/sedation?
Answer: Flumazenil
Flumazenil is a competitive GABA-A receptor antagonist that displaces benzodiazepines; use cautiously as it can precipitate seizures in dependent patients.
Drug stem '-triptan' → class, prototype, mechanism?
Answer: Serotonin 5-HT1 receptor agonists (migraine abortive agents); prototype sumatriptan; cause vasoconstriction of cranial blood vessels and inhibit neuropeptide release
Nursing consideration: contraindicated in coronary artery disease or uncontrolled hypertension due to vasoconstrictive effects.
Drug stem '-parin' → class, prototype, mechanism?
Answer: Heparins/anticoagulants; prototype enoxaparin (a low-molecular-weight heparin); bind antithrombin III, enhancing inactivation of factor Xa (and thrombin for unfractionated heparin)
Nursing consideration: monitor for bleeding and platelet counts (heparin-induced thrombocytopenia, HIT); protamine sulfate is the antidote.
Drug stem '-gliptin' → class, prototype, mechanism?
Answer: DPP-4 inhibitors; prototype sitagliptin; inhibit dipeptidyl peptidase-4, prolonging incretin (GLP-1) activity to enhance glucose-dependent insulin secretion
Nursing consideration: monitor for pancreatitis symptoms; low hypoglycemia risk when used alone and generally weight neutral.
Drug stem '-glutide' → class, prototype, mechanism?
Answer: GLP-1 receptor agonists; prototype semaglutide; mimic glucagon-like peptide-1, enhancing glucose-dependent insulin secretion, slowing gastric emptying, and promoting satiety
Nursing consideration: monitor for GI upset (nausea, vomiting) and pancreatitis; carries a black box warning for thyroid C-cell tumors.
Drug stem '-flozin' → class, prototype, mechanism?
Answer: SGLT2 inhibitors; prototype empagliflozin; inhibit sodium-glucose cotransporter 2 in the renal proximal tubule, decreasing glucose reabsorption and promoting glucosuria
Nursing consideration: monitor for genital mycotic infections, UTIs, and euglycemic diabetic ketoacidosis.
Drug stem '-lukast' → class, prototype, mechanism?
Answer: Leukotriene receptor antagonists; prototype montelukast; block leukotriene receptors, reducing bronchoconstriction and airway inflammation
Nursing consideration: used for asthma/allergy prophylaxis, not acute attacks; monitor for neuropsychiatric effects such as mood changes.
Drug stem '-terol' → class, prototype, mechanism?
Answer: Beta2-adrenergic agonists (bronchodilators); prototype albuterol; stimulate beta2 receptors, causing bronchial smooth muscle relaxation
Nursing consideration: monitor for tachycardia and tremor; distinguish short-acting (rescue, e.g., albuterol) from long-acting (maintenance, e.g., salmeterol) agents.
Drug stem '-asone' / '-olone' → class, prototype, mechanism?
Answer: Corticosteroids; prototype prednisone or fluticasone; bind glucocorticoid receptors to suppress inflammatory and immune responses via altered gene transcription
Nursing consideration: taper gradually to avoid adrenal insufficiency; monitor blood glucose and for increased infection risk.
Drug stem '-semide' → class, prototype, mechanism?
Answer: Loop diuretics; prototype furosemide; inhibit the Na-K-2Cl cotransporter in the thick ascending limb of the loop of Henle, promoting diuresis
Nursing consideration: monitor for hypokalemia, ototoxicity, and hypotension; administer IV doses slowly.
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