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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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.

9. 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).

10. 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.

11. 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

12. 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

13. 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.

14. 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

15. 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.

16. 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.

17. 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

18. Bledsoe et al., Paramedic Care Principles & Practice Volume 1: Introduction © 2006 by Pearson Education, Inc. Upper Saddle River, NJ State vs. Local Standards They vary widely. Always consult local protocols and with medical direction for guidance in securing and distributing controlled substances.

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

20. 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.

21. 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

22. 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

23. 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.

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

25. 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.

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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.

32. 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.

33. 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.

34. 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