1. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 1 Introduction to Advanced Prehospital Care

2. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 9 General Principles of Pharmacology

3. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 9, Part 1 Basic Pharmacology

4. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Part 1 Topics General Aspects Legal Aspects Drug Research and Development Patient Care Using Medications Pharmacology

5. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction The use of herbs and minerals to treat the sick and injured has been documented as long ago as 2000 BC. Presently, the Food and Drug Administration (FDA) is allowing many previously prescription-only drugs to become available over the counter. –Growing consumer awareness in health care –Consumer marketing by the pharmaceutical industry

6. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Aspects

7. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Aspects Drugs are chemicals used to diagnose, treat, or prevent disease. Pharmacology is the study of drugs and their actions on the body. Health care professionals have a systematic method for naming drugs.

8. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug Names Chemical –States its chemical composition and molecular structure Generic –Usually suggested by the manufacturer Official –As listed in the U.S. Pharmacopeia Brand –The trade or proprietary name

9. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chemical Name 7-chloro-1, 3-dihydro-1, methyl-5-phenyl-2h-1 Generic Namediazepam Official Namediazepam, USP Brand Name Valium® Drug Names

10. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Sources of Drug Products Four main sources of drugs are: –Plants The oldest source of medications Purple foxglove –Animals Extracts of bovine (cow) and porcine (pig) pancreas –Minerals Inorganic sources of drugs such as calcium chloride –Synthetic Created in the laboratory

11. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Reference Material United States Pharmacopeia (USP) Physician’s Desk Reference (PDR) Drug Information Monthly Prescribing Reference AMA Drug Evaluation EMS field guides

12. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Components of a Drug Profile Names –Most frequently include generic and trade names Classification –The broad group to which a drug belongs Mechanism of Action –The way in which a drug causes its effects

13. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Components of a Drug Profile Indications –Conditions that enable the appropriate administration of the drug Pharmacokinetics –How the drug is absorbed, distributed, and eliminated Side Effects/Adverse Reactions –The drug’s untoward or undesired effects

14. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Components of a Drug Profile Routes of Administration –How the drug is given Contraindications –Conditions that make it inappropriate to give the drug Dosage –Amount of the drug that should be given

15. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Components of a Drug Profile How Supplied –Includes the common concentration of the available preparations Special Considerations –Pediatric, geriatric, or pregnant patients

16. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Aspects

17. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Aspects It is important to know and obey the laws and regulations governing medications and their administration. These include federal, state, and agency regulations.

18. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Federal Pure Food and Drug Act of 1906 Harrison Narcotic Act of 1914 Federal Food, Drug, and Cosmetic Act of 1938 Comprehensive Drug Abuse Prevention and Control Act of 1970

19. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ State and Local Standards State –State laws vary widely. Some states have legislated which medications are appropriate Others have left those decisions to local control –The medical director can delegate to paramedics the authority to administer medications.

20. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ State and Local Standards Local –Local leaders are responsible for ensuring public safety. –EMS agencies have the responsibility to create local policies and procedures to ensure the public well-being.

21. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug Standards Standardization of drugs is a necessity Assay –Determines the amount and purity of a given chemical in a preparation in the laboratory Bioequivalence –Relative therapeutic effectiveness of chemically equivalent drugs

22. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug Research and Development

23. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug Research and Development Initial drug testing begins with the study of both male and female mammals. Pharmacokinetics tested in animals Progresses to human testing

24. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Patient Care Using Medications

25. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Patient Care Using Medications Know the precautions and contraindications for all medications you administer Practice proper technique Know how to observe and document drug effects

26. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Patient Care Using Medications Maintain a current knowledge in pharmacology Establish and maintain professional relationships with other health care providers Understand pharmacokinetics and pharmacodynamics

27. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Patient Care Using Medications Have current medication references available Take careful drug histories including: –Name, strength, dose of prescribed medications –Over-the-counter drugs –Vitamins –Herbal medications –Allergies

28. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Patient Care Using Medications Evaluate the patient’s compliance, dosage, and adverse reactions Consult with medical direction as needed

29. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The 6 Rights of Medication Administration Right medication Right dosage Right time Right route Right patient Right documentation

30. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Special Considerations Pregnant patients Pediatric patients Geriatric patients

31. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pregnant Patients Ask the patient if there is a possibility that she could be pregnant. Some drugs may have an adverse effect on the fetus of a pregnant female. –A drug’s possible benefits to the mother must clearly outweigh its potential risks to the fetus.

32. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pregnant Patients The FDA has developed the classification system for the administration of drugs to a pregnant patient. Consult medical direction.

33. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pediatric Patients Several physiological factors affect pharmacokinetics in newborns and young children. Children up to one year old have diminished plasma protein concentrations. –Drugs that bind to proteins have higher free drug availability.

34. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pediatric Patients A higher amount of total body water means a greater volume and may require higher drug doses. The newborn’s metabolic rates may be much lower than an adult’s –Rise rapidly in the first few years.

35. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pediatric Patients Pediatric drug dosages must be individualized to minimize the risks of toxicity. The Broselow tape

36. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Geriatric Patients Significant changes in pharmacokinetics may also occur in patients older than about 60 years. –Decreased gastrointestinal motility –Decreased plasma proteins –Body fat increases and muscle mass decreases with age –Multiple medications or to have multiple underlying disease processes

37. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pharmacology

38. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pharmacology The study of drugs and their interactions with the body. Drugs may be given for their local action or for systemic action. Two major divisions: –Pharmacokinetics –Pharmacodynamics

39. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pharmacokinetics Review of Transport –Active transport Requires energy or ATP –Facilitated diffusion Carrier-mediated protein –Passive transport Osmosis and diffusion –Filtration

40. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug Absorption Several factors affect a drug’s absorption: –Route given –Perfusion of tissue –Solubility –Ionization and Ph –Absorbing surface –Concentration of drug Bioavailability refers to drug available at tissue level

41. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Distribution Most drugs will pass from bloodstream to target tissues. Some proteins bind drugs for a prolonged time. –Only unbound drugs can cross the cell membrane. –Changing the pH of blood may affect protein binding. Increasing pH enhances TCA binding.

42. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Distribution Certain organs exclude some drugs from distribution. –Blood-brain barrier Only non-protein bound, lipid-soluble drugs may exit CNS vasculature. –Placental barrier Restricts drug delivery to fetus Other stores –Fats –Specific tissues

43. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Biotransformation The metabolism of drugs is called biotransformation. Effects of biotransformation: –Can transform the drug into a more or less active metabolite –Can make the drug more water soluble (or less lipid soluble) to facilitate elimination

44. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Biotransformation Many biotransformation processes occur in the liver. –First-pass effect The first pass through the liver may partially or completely inactivate many drugs. –Microsomal enzymes Phase I Phase II

45. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug Elimination Most drugs (toxins and metabolites) are excreted in the urine. Renal excretion methods –Glomuler filtration Function of glomerular filtration pressure Results from blood pressure and blood flow –Tubular secretion Active transport pumps in proximal tubule

46. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug Routes How a drug is given has an impact on absorption and distribution. Routes –Enteral Absorption through the gastrointestinal tract –Parenteral Any area outside of the gastrointestinal tract

47. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Enteral Drug Administration Oral (PO) Oro/nasogastric (OG/NG) Sublingual (SL) Buccal Rectal (PR)

48. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral Drug Administration Intravenous (IV) Endotracheal (ET) Intraosseous (IO) Umbilical Intramuscular (IM) Subcutaneous (SC) Inhalation/Nebulized Topical Transdermal Nasal Instillation Intradermal

49. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug Forms Solid forms: –Pills, powders, suppositories, capsules Liquid forms: –Solutions, tinctures, suspensions, emulsions, spirits, elixirs, syrups

50. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Solid Forms Pills –Drugs shaped spherically to be swallowed Powders –Not as popular as they once were Tablets –Powders compressed into disk-like form Suppositories –Drugs mixed with a waxlike base that melts at body temperature Capsules –Gelatin containers filled with powders or tiny pills

51. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Liquid Forms Solutions –Water or oil-based Tinctures –Prepared using an alcohol extraction process Suspensions –Preparations in which the solid does not dissolve in the solvent Emulsions –Suspensions with an oily substance in the solvent

52. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Liquid Forms Spirits –Solution of a volatile drug in alcohol Elixirs –Alcohol and water solvent, often with flavoring Syrups –Sugar, water, and drug solutions

53. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug Storage Drug properties may be altered by the environment in which they are stored. –Changes in temperature, light, and moisture. Potency of most medications is altered if they are not stored in proper conditions. EMS must consider the storage requirements of all drugs and diluents.

54. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pharmacodynamics Pharmacodynamics studies the effects of a drug on the body. –Mechanism of action –Relationship between dose and effect

55. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pharmacodynamics Actions of Drugs –Binding to a receptor site –Changing physical properties –Chemically combining with other substances –Altering a normal metabolic pathway

56. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Receptor Site Binding Most drugs bind with protein receptors Affinity and Efficacy Agonist/Antagonist effects –Competitive antagonism –Non-competitive antagonism –Irreversible antagonism

57. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Receptor Site Binding Click here to view an animation on antagonists.here

58. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Changing Physical Properties Some drugs change the physical properties of a part of the body. –Drugs that change the osmotic balance across membranes are examples. Mannitol

59. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drugs that Chemically Combine With Other Substances Cause chemical reactions that change the chemical nature of their substrates –Alcohol denatures proteins on the skin –Sodium Bicarbonate neutralizes acids in the bloodstream –Antacids neutralize stomach acid

60. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Altering a Normal Metabolic Pathway Anticancer and antiviral drugs are chemical analogs of normal metabolic substrates. –Counterfeit incorporation mechanism These drugs can be incorporated into the products of metabolism of cancer cells. –The anticipated product either will not form or be substantially changed.

61. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Responses to Drug Administration Side effect –Unintended response to a drug Allergic reaction –Hypersensitivity Idiosyncrasy –Drug effect unique to an individual

62. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Responses to Drug Administration Tolerance –Decreased response to the same amount Cross tolerance –Tolerance for a drug that develops after administration of a different drug Tachyphylaxis –Rapidly occurring tolerance to a drug

63. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Responses to Drug Administration Cumulative effect –Increased effectiveness when a drug is given in several doses Drug dependence –The patient becomes accustomed to the drug’s presence in his body Drug interaction –The effects of one drug alter the response to another drug Drug antagonism –The effects of one drug block the response to another drug

64. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Responses to Drug Administration Summation –Also known as additive effect. Two drugs with the same effect are given together—similar to 1+1=2. Synergism –Two drugs with the same effect are given together and produce a response greater than the sum of their individual responses—similar to 1+1=3.

65. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Responses to Drug Administration Potentiation –One drug enhances the effect of another Interference –The direct biochemical interaction between two drugs; one drug affects the pharmacology of another drug

66. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug-Response Relationship A drug-response relationship correlates different amounts of drug to the resultant clinical response. Factors affecting relationship: –Pharmaceutical –Pharmacokinetic –Pharmacodynamic

67. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug-Response Relationship Plasma Profile –Onset of action Time from administration to minimum effective dose –Termination of action –Therapeutic index Represents the margin of safety –Biologic Half-life The time the body takes to clear one half of the drug

68. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Factors Affecting Drug Response Age Body mass Sex Environment Time of administration Pathology Genetics Psychology

69. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Drug Interactions Drug interactions occur whenever two or more drugs are available in the same patient. –The interaction can increase, decrease, or have no effect on their combined actions. Nutritional effects Effects of Alcohol Incompatibility –Precipitation

70. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Part 1 Summary General Aspects Legal Aspects Drug Research and Development Patient Care Using Medications Pharmacology