1. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 9 General Principles of Pharmacology

2. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 9, Part 1 Basic Pharmacology

3. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Part 1 Topics Drug Names Sources of Drug Products Drug Classifications Food & Drug Administration Medication Administration Properties of Drugs

4. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Drugs are chemicals used to diagnose, treat, and prevent disease.

5. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pharmacology is the study of drugs and their actions on the body.

6. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Names of Drugs 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

7. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 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® Names of Drugs

8. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Sources of Drug Information United States Pharmacopeia (USP) Physician’s Desk Reference (PDR) Drug Information Monthly Prescribing Reference AMA Drug Evaluation EMS field guides

9. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Components of a Drug Profile Name Classification Mechanism of Action Indications Pharmacokinetics Side Effects Routes of Administration Contraindications Dosage How Supplied Special Considerations

10. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Names Most frequently include generic and trade names

11. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Classification The broad group to which a drug belongs. Knowing classifications is essential to understanding the properties of drugs.

12. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Mechanism of Action The way in which a drug causes its effects; its pharmacodynamics.

13. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Indications Conditions that enable the appropriate administration of the drug (as approved by the FDA).

14. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pharmacokinetics How the drug is absorbed, distributed, and eliminated; typically includes onset and duration of action.

15. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Side Effects/Adverse Reactions The drug’s untoward or undesired effects

16. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Routes of Administration How the drug is given

17. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Contraindications Conditions that make it inappropriate to give the drug. A predictable harmful event will occur if the drug is given in this situation.

18. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Dosage The amount of the drug that should be given

19. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ How Supplied This typically includes the common concentration of the available preparations; many drugs come in different concentrations.

20. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Legal Knowing and obeying the laws and regulations governing medications and their administration is an important part of a paramedic’s career. These include federal, state, and agency regulations.

21. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Federal Pure Food & Drug Act of 1906 Harrison Narcotic Act of 1914 Federal Food, Drug, & Cosmetic Act of 1938 Comprehensive Drug Abuse Prevention & Control Act of 1970

22. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

23. State vs. Local Standards They vary widely. Always consult local protocols and with medical direction for guidance in securing and distributing controlled substances.

24. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ New Drug Development

25. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Providing Patient Care Using Medications (1 of 4) 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 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Providing Patient Care Using Medications (2 of 4) 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 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Providing Patient Care Using Medications (3 of 4) 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 © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Providing Patient Care Using Medications (4 of 4) 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 © 2006 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 © 2006 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 © 2006 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. Teratogenic drug…is a medication that may deform or kill the fetus.

32. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

34. Pharmacokinetics (1 of 2) Absorption –A drug must find its way to the site of action. Distribution –A drug must then be distributed throughout the body.

35. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pharmacokinetics (2 of 2) Biotransformation –The process of breaking down, or metabolizing, drugs. Elimination –Drugs must eventually be excreted from the body.

36. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Drug Routes (1 of 2) Enteral: –Delivers medications by absorption through the gastrointestinal tract –Includes oral, orogastric/nasogastric, sublingual, buccal, rectal

37. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Drug Routes (2 of 2) Parenteral: –Delivers medications via routes other than the GI tract –Includes intravenous, endotracheal, intraosseous, umbilical, intramuscular, subcutaneous, inhalation, topical

38. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Enteral – Examples (1 of 2) Oral (PO) –Good for self-administering drugs Orogastric (OG) / Nasogastric (NG) –Alternate method to providing PO medications Sublingual (SL) –Excellent absorption without problems of gastric acidity

39. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Enteral – Examples (2 of 2) Buccal –Between the cheek/gum –Similar to sublingual Rectal (PR) –Reserved for unconscious or vomiting patients

40. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral – Examples (1 of 3) Intravenous (IV) –Preferred route in emergencies Endotracheal (ET) –Alternate route in emergencies for select medications Intraosseous (IO) –Alternative use in emergencies, mostly in pediatrics

41. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral – Examples (2 of 3) Umbilical –Provides alternate access in newborns Intramuscular (IM) –Slower absorption than IV Subcutaneous (SQ) –Slower absorption than IM

42. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Parenteral – Examples (3 of 3) Inhalation –Very rapid absorption via the lungs Topical –Delivers drugs directly to the skin

43. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Most emergency medications are given intravenously to avoid drug degradation in the liver.

44. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 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

45. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 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

46. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Liquid Forms (1 of 2) 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

47. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Liquid Forms (2 of 2) Spirits –Solution of a volatile drug in alcohol Elixirs –Alcohol and water solvent, often with flavoring Syrups –Sugar, water, and drug solutions

48. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Actions of Drugs Drugs that act by binding to a receptor site Drugs that act by changing physical properties Drugs that act by chemically combining with other substances Drugs that act by altering a normal metabolic pathway

49. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Responses to Drug Administration (1 of 5) Side effect –Unintended response to a drug Allergic reaction –Hypersensitivity Idiosyncrasy –Drug effect unique to an individual

50. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Responses to Drug Administration (2 of 5) 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

51. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Responses to Drug Administration (3 of 5) 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.

52. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Responses to Drug Administration (4 of 5) 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.

53. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Responses to Drug Administration (5 of 5) Potentiation –One drug enhances the effect of another. Interference –The direct biochemical interaction between two drugs; one drug affects the pharmacology of another drug.

54. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Factors Affecting Drug Response Age Body mass Sex Environment Time of administration Pathology Genetics Psychology

55. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 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.

56. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Part 1 Summary Drug Names Sources of Drug Products Drug Classifications Food & Drug Administration Medication Administration Properties of Drugs