Division 1 Introduction to Advanced Prehospital Care

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Division 1Introduction to AdvancedPrehospital
Care
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Chapter 6General Principles of PharmacologyPart
1Basic Pharmacology
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Topics

• Drug Names
• Sources of Drug Products
• Drug Classifications
• Food Drug Administration
• Medication Administration
• Properties of Drugs

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Drugs are chemicals used to diagnose, treat, and
prevent disease.
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Pharmacology is the study of drugs and their
actions on the body.
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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

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Names of Drugs
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Sources of Drug Information

• United States Pharmacopeia (USP)
• Physicians Desk Reference (PDR)
• Drug information
• Monthly prescribing reference
• AMA drug evaluation
• EMS field guides

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Components of a Drug Profile

• Name
• Classification
• Mechanism ofaction
• Indications
• Pharmacokinetics
• Side effects

• Routes of administration
• Contraindications
• Dosage
• How supplied
• Special considerations

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Names

• Most frequently include generic and trade names

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Classification

• The broad group to which a drug belongs. Knowing
  classifications is essential to understanding the
  properties of drugs.

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Mechanism of Action

• The way in which a drug causes its effects its
  pharmacodynamics

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Indications

• Conditions that enable the appropriate
  administration of the drug (as approved by the
  FDA)

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Pharmacokinetics

• How the drug is absorbed, distributed, and
  eliminated typically includes onset and duration
  of action

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Side Effects/Adverse Reactions

• The drugs untoward or undesired effects

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Routes of Administration

• How the drug is given

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Contraindications

• Conditions that make it inappropriate to give the
  drug
• A predictable harmful event will occur if the
  drug is given in this situation.

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Dosage

• The amount of the drug that should be given

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How Supplied

• This typically includes the common concentration
  of the available preparations many drugs come in
  different concentrations.

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Legal

• Knowing and obeying the laws and regulations
  governing medications and their administration is
  an important part of a paramedics career.
• These include federal, state, and agency
  regulations.

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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

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State vs. Local Standards

• They vary widely.
• Always consult local protocols and with medical
  direction for guidance in securing and
  distributing controlledsubstances.

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New Drug Development
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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.

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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.

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Providing Patient Care Using Medications (3 of 4)

• Have current medication referencesavailable.
• Take careful drug histories including
• Name, strength, dose of prescribed medications
• Over-the-counter drugs
• Vitamins
• Herbal medications
• Allergies

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Providing Patient Care Using Medications (4 of 4)

• Evaluate the patients compliance, dosage, and
  adverse reactions.
• Consult with medical direction as needed.

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The Six Rights of Medication Administration

• Right medication
• Right dosage
• Right time
• Right route
• Right patient
• Right documentation

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Special Considerations

• Pregnant patients
• Pediatric patients
• Geriatric patients

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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 drugs are medications that may deform
  or kill the fetus.

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FDA Pregnancy Categories
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A Broselow tape is useful for calculating drug
dosage for pediatric patients.
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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.

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Pharmacokinetics (2 of 2)

• Biotransformation
• The process of breaking down, or metabolizing,
  drugs.
• Elimination
• Drugs must eventually be excreted from the body.

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Drug Routes (1 of 2)

• Enteral
• Deliver medications by absorption through the
  gastrointestinal tract
• Oral, orogastric/nasogastric, sublingual, buccal,
  rectal

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Drug Routes (2 of 2)

• Parenteral
• Deliver medications via routes other than the GI
  tract
• Include intravenous, endotracheal, intraosseous,
  umbilical, intramuscular, subcutaneous,
  inhalation, topical

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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

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Enteral Examples (2 of 2)

• Buccal
• Between the cheek and gum
• Similar to sublingual
• Rectal (PR)
• Reserved for unconscious or vomiting patients

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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

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Parenteral Examples (2 of 3)

• Umbilical
• Provides alternate access in newborns
• Intramuscular (IM)
• Slower absorption than IVs
• Subcutaneous (SQ)
• Slower absorption than IM

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Parenteral Examples (3 of 3)

• Inhalation
• Very rapid absorption via the lungs
• Topical
• Delivers drugs directly to the skin

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Most emergency medicationsare given
intravenously to avoiddrug degradation in the
liver.
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Drug Forms

• Solid forms
• Pills, powders, suppositories, capsules, and so
  on
• Liquid forms
• Solutions, tinctures, suspensions, emulsions,
  spirits, elixirs, syrups, and so on

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Solid Forms

• Pills
• Drugs shaped spherically to be swallowed
• Powders
• Not as popular as they once were
• Tablets
• Powders compressed into disklike form
• Suppositories
• Drugs mixed with a waxlike base that melts at
  body temperature
• Capsules
• Gelatin containers filled with powders or tiny
  pills

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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

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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

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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

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Responses to Drug Administration (1 of 5)

• Side effect
• Unintended response to a drug
• Allergic reaction
• Hypersensitivity
• Idiosyncrasy
• Drug effect unique to an individual

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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

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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 drugs
  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

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Responses to Drug Administration (4 of 5)

• Summation
• Also known as additive effect two drugs with the
  same effect are given together
• Similar to 112
• Synergism
• Two drugs with the same effect are given together
  and produce a response greater than the sum of
  their individual responses
• Similar to 113

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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

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Factors AffectingDrug Response

• Age
• Body mass
• Sex
• Environment

• Time of administration
• Pathology
• Genetics
• Psychology

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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.

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Summary

• Drug Names
• Sources of Drug Products
• Drug Classifications
• Food Drug Administration
• Medication Administration
• Properties of Drugs