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Chapter 11 Chapter 11
Basic Principles of Pharmacology Basic Principles of Pharmacology
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Learning Objectives Learning Objectives
Describe pharmacological historic trends Describe pharmacological historic trends
Differentiate chemical, generic, trade names of Differentiate chemical, generic, trade names of
drug drug
List main sources of drug products List main sources of drug products
Describe how drugs are classified Describe how drugs are classified
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Learning Objectives Learning Objectives
List authoritative sources for drug information List authoritative sources for drug information
List legislative acts controlling drug use, List legislative acts controlling drug use,
abuse in U.S. abuse in U.S.
Differentiate Schedule I, II, III, IV, V Differentiate Schedule I, II, III, IV, V
substances; list examples substances; list examples
Discuss standardization of drugs Discuss standardization of drugs
Aehlert: Paramedic Practice Today
PowerPoint Lecture Notes
Chapter 11: Basic Principles of Pharmacology
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Learning Objectives Learning Objectives
Discuss investigational drugs, including Food Discuss investigational drugs, including Food
& Drug Administration approval process and & Drug Administration approval process and
classifications for newly approved drugs classifications for newly approved drugs
Discuss paramedic Discuss paramedic s responsibilities and s responsibilities and
scope of management pertinent to scope of management pertinent to
administration of medications administration of medications
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Learning Objectives Learning Objectives
Review specific anatomy, physiology Review specific anatomy, physiology
pertinent to pharmacology with attention to pertinent to pharmacology with attention to
autonomic pharmacology autonomic pharmacology
List and describe general drug properties List and describe general drug properties
List and describe liquid, solid drug forms List and describe liquid, solid drug forms
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Learning Objectives Learning Objectives
List and differentiate drug administration List and differentiate drug administration
routes, including routes, including enteral enteral and and parenteral parenteral
routes routes
Describe mechanisms of drug action Describe mechanisms of drug action
List and differentiate phases of drug activity, List and differentiate phases of drug activity,
including pharmaceutical, pharmacokinetic, including pharmaceutical, pharmacokinetic,
and and pharmacodynamic pharmacodynamic phases phases
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Learning Objectives Learning Objectives
Describe pharmacokinetics and Describe pharmacokinetics and
pharmacodynamics pharmacodynamics, including theories of , including theories of
drug action, drug response relation, factors drug action, drug response relation, factors
altering drug responses, predictable drug altering drug responses, predictable drug
responses, iatrogenic drug responses, and responses, iatrogenic drug responses, and
unpredictable adverse drug responses unpredictable adverse drug responses
Discuss special considerations in drug Discuss special considerations in drug
treatment regarding pregnant, pediatric, and treatment regarding pregnant, pediatric, and
geriatric patients geriatric patients
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Learning Objectives Learning Objectives
Differentiate drug interactions Differentiate drug interactions
Discuss considerations for storing and Discuss considerations for storing and
securing medications securing medications
List components of drug profile by List components of drug profile by
classification classification
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Introduction Introduction
Drug Drug
Substance intended to diagnose, cure, relieve, Substance intended to diagnose, cure, relieve,
treat, prevent disease treat, prevent disease
Affects structure/function of body Affects structure/function of body
Pharmacology Pharmacology
Study of drugs Study of drugs
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Historic Trends in Pharmacology Historic Trends in Pharmacology
Ancient health care Ancient health care
Potions, religious rituals, crude surgeries Potions, religious rituals, crude surgeries
Greco Greco- -Romans Romans
Hippocrates Hippocrates
Claudius Galen Claudius Galen
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Historic Trends in Pharmacology Historic Trends in Pharmacology
The Renaissance The Renaissance
After Roman Empire fall, many reverted to folklore, After Roman Empire fall, many reverted to folklore,
tradition tradition
Muslims, Greeks, Romans, Jews combined Muslims, Greeks, Romans, Jews combined
knowledge of math, science, created formularies knowledge of math, science, created formularies
Monasteries Monasteries
Learning sites, pharmacy, medicine Learning sites, pharmacy, medicine
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Historic Trends in Pharmacology Historic Trends in Pharmacology
Modern health care Modern health care
Pharmaceutical laws enacted late 19 Pharmaceutical laws enacted late 19
th th
, early 20 , early 20
th th
century protecting public century protecting public
Drugs developed improved chronic illness Drugs developed improved chronic illness
treatment treatment
1950 1950- -current, more changes in pharmacology than current, more changes in pharmacology than
any other time any other time
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Historic Trends in Pharmacology Historic Trends in Pharmacology
Present period of change Present period of change
Pharmacology Pharmacology - - constant research, development constant research, development
Keep abreast of new medications, technology Keep abreast of new medications, technology
May be asked questions about patient medications May be asked questions about patient medications
Recognize side effects, adverse reactions Recognize side effects, adverse reactions
Orphan drugs Orphan drugs
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Drug Names Drug Names
Chemical name Chemical name
Description of drug Description of drug s chemical composition, s chemical composition,
molecular structure molecular structure
Official name Official name
Listed in Listed in U.S. Pharmacopoeia U.S. Pharmacopoeia
Generic (non Generic (non- -proprietary) name proprietary) name
First proposed by manufacturer when submitted to First proposed by manufacturer when submitted to
FDA for approval FDA for approval
Trade (brand/proprietary) name Trade (brand/proprietary) name
Patented name Patented name
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Sources of Drugs Sources of Drugs
Plants Plants
Animals, humans Animals, humans
Minerals/mineral products Minerals/mineral products
Synthetic chemical substances Synthetic chemical substances
Recombinant DNA technology Recombinant DNA technology
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Sources of Drugs Sources of Drugs
Plants Plants
Alkaloids Alkaloids
Glycoside Glycoside
Gums Gums
Oils Oils
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Sources of Drugs Sources of Drugs
Animals, humans Animals, humans
Hormones, vaccines, blood, plasma components Hormones, vaccines, blood, plasma components
Minerals/mineral products Minerals/mineral products
Chemical elements/compounds found in earth, soil Chemical elements/compounds found in earth, soil
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Sources of Drugs Sources of Drugs
Chemical substances Chemical substances
Developed by scientifically duplicating specific Developed by scientifically duplicating specific
compounds compounds
Called Called synthetic drugs synthetic drugs when developed in when developed in
laboratory laboratory
Recombinant DNA technology Recombinant DNA technology
Genetic engineering Genetic engineering
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Drug Classification Drug Classification
Anatomical Therapeutic Chemical Anatomical Therapeutic Chemical
Classification System Classification System
Body System Body System
Drug Drug s physiologic classification s physiologic classification
Mechanism of action Mechanism of action
Drug Drug s therapeutic classification s therapeutic classification
Class of agent Class of agent
Drug Drug s chemical classification s chemical classification
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Sources of Drug Information Sources of Drug Information
United States United States Pharmacopeia Pharmacopeia/Dispensing /Dispensing
Information Information
U.S. U.S. Pharmacopeia Pharmacopeia- -National Formulary (USP National Formulary (USP- -NF), NF),
official source for U.S manufactured drugs official source for U.S manufactured drugs
Physician Physician s Desk Reference s Desk Reference
Compilation of 4000+ drugs Compilation of 4000+ drugs
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Sources of Drug Information Sources of Drug Information
American Hospital Formulary Service American Hospital Formulary Service
Information about every U.S. drug available Information about every U.S. drug available
Uses for drugs included in labeling approved by Uses for drugs included in labeling approved by
FDA, off FDA, off- -label uses label uses
Package inserts Package inserts
Drug Drug s safety, effectiveness s safety, effectiveness
Other sources Other sources
Nurses, physicians, pharmacists, poison control Nurses, physicians, pharmacists, poison control
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U.S. Drug Legislation U.S. Drug Legislation
Laws govern purchase, distribution, Laws govern purchase, distribution,
dispensation, administration of drugs dispensation, administration of drugs
Must know laws Must know laws
Purpose of legislation Purpose of legislation
Protect public from adulterated, mislabeled drugs Protect public from adulterated, mislabeled drugs
History of legislation History of legislation
Pure Food and Drug Act Pure Food and Drug Act
Standardized name, strength, quality, purity of drugs Standardized name, strength, quality, purity of drugs
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U.S. Drug Legislation U.S. Drug Legislation
History of legislation History of legislation
Pure Food & Drug Act, early 20 Pure Food & Drug Act, early 20
th th
century century
Federal Food, Drug & Cosmetic Act, 1938 Federal Food, Drug & Cosmetic Act, 1938
Harrison Narcotics Act, 1914 Harrison Narcotics Act, 1914
Durham Durham- -Humphrey Amendments, 1928, required Humphrey Amendments, 1928, required
prescriptions for certain drugs prescriptions for certain drugs
All new drugs tested for toxicity All new drugs tested for toxicity
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U.S. Drug Legislation U.S. Drug Legislation
History of legislation History of legislation
Durham Durham- -Humphrey Amendment, 1951 Humphrey Amendment, 1951
Kefauver Kefauver- -Harris Amendment, 1962, required proof Harris Amendment, 1962, required proof
of effectiveness, safety of new prescription, over of effectiveness, safety of new prescription, over- -
the the- -counter drugs before FDA approval counter drugs before FDA approval
Schedule of controlled substances Schedule of controlled substances
Classifications of substances based on their Classifications of substances based on their
accepted medical use in the U.S., abuse potential, accepted medical use in the U.S., abuse potential,
potential for addiction potential for addiction
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U.S. Drug Legislation U.S. Drug Legislation
Food & Drug Administration Food & Drug Administration
Governing body, oversees general safety Governing body, oversees general safety
standards in production of drugs, food, cosmetics standards in production of drugs, food, cosmetics
U.S. Department of Health & Human Services U.S. Department of Health & Human Services
Regulates medical devices, radiation Regulates medical devices, radiation- -emitting emitting
products products
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U.S. Drug Legislation U.S. Drug Legislation
Drug Enforcement Administration Drug Enforcement Administration
U.S. Department of Justice U.S. Department of Justice
Enforces controlled substance laws, monitors Enforces controlled substance laws, monitors
need for changing abused drug schedules need for changing abused drug schedules
Federal Trade Commission Federal Trade Commission
Bureau of Consumer Protection Bureau of Consumer Protection
Protects consumers, truth Protects consumers, truth- -in in- -advertising laws advertising laws
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Standardization of Drugs Standardization of Drugs
Assay Assay
Substance test, finds components Substance test, finds components
Amount, purity Amount, purity
Bioassay Bioassay
Effects on organism, compares results with Effects on organism, compares results with
agreed standard agreed standard
United States United States Pharmacopeia Pharmacopeia
Official standards Official standards- -setting authority setting authority
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Investigational Drugs Investigational Drugs
Prospective drugs & evaluation Prospective drugs & evaluation
Conceptual evidence drug has physiologic benefit Conceptual evidence drug has physiologic benefit
Toxicity, drug absorption, metabolism Toxicity, drug absorption, metabolism
Food & Drug Administration approval process Food & Drug Administration approval process
Phases of investigation Phases of investigation
Require specific information, effects on humans Require specific information, effects on humans
3 phases conducted before New Drug Application (NDA) 3 phases conducted before New Drug Application (NDA)
submitted by manufacturer submitted by manufacturer
4 4
th th
phase follows NDA approval, not closely monitored by phase follows NDA approval, not closely monitored by
FDA FDA
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Investigational Drugs Investigational Drugs
Food & Drug Administration approval process Food & Drug Administration approval process
New drug application New drug application
Sponsor goal, product safe for initial use, compound Sponsor goal, product safe for initial use, compound
shows pharmacologic activity justifies commercial shows pharmacologic activity justifies commercial
development development
Abbreviated NDA used for generic drugs Abbreviated NDA used for generic drugs
Preclinical, clinical data not required Preclinical, clinical data not required
Must demonstrate performance as original patented drug Must demonstrate performance as original patented drug
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Scope of Management Scope of Management
Responsibilities Responsibilities
Safe & effective administration Safe & effective administration
Assess scene, patient Assess scene, patient
Obtain history Obtain history
Know, understand medication patient takes Know, understand medication patient takes
Assess for indications, contraindications Assess for indications, contraindications
Patient pill bottles, copy information exactly Patient pill bottles, copy information exactly
Ask patient how administered, may not be correct Ask patient how administered, may not be correct
Check with partner Check with partner
Use drug references Use drug references
Recheck calculations, dosages Recheck calculations, dosages
Contact medical direction online if necessary Contact medical direction online if necessary
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Scope of Management Scope of Management
Responsibilities Responsibilities
Legal, moral, ethical obligations Legal, moral, ethical obligations
Give substance according to intended use, indication, Give substance according to intended use, indication,
written protocols written protocols
Maintain patient confidentiality Maintain patient confidentiality
Use professionalism Use professionalism
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Autonomic Pharmacology Autonomic Pharmacology
Nervous system organization & function Nervous system organization & function
Central nervous system Central nervous system
Brain, spinal cord Brain, spinal cord
Electrical impulses sent, received, coordinated Electrical impulses sent, received, coordinated
Motor, temperature, vibration, sensation transmission Motor, temperature, vibration, sensation transmission
Peripheral nervous system Peripheral nervous system
All nerves outside of CNS All nerves outside of CNS
Somatic nervous system Somatic nervous system
Cranial, spinal nerves carry messages to skeletal muscles Cranial, spinal nerves carry messages to skeletal muscles
Controlled voluntarily, consciously Controlled voluntarily, consciously
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Autonomic Pharmacology Autonomic Pharmacology
Nervous system organization & function Nervous system organization & function
Peripheral nervous system Peripheral nervous system
Autonomic nervous system Autonomic nervous system
Involuntary control Involuntary control
ANS nerves message to heart, ANS nerves message to heart, secretory secretory glands, GI tract glands, GI tract
smooth muscles, blood vessels, bronchi, genitourinary smooth muscles, blood vessels, bronchi, genitourinary
system system
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Autonomic Pharmacology Autonomic Pharmacology
Nervous system organization & function Nervous system organization & function
Peripheral nervous system Peripheral nervous system
Somatic nervous system Somatic nervous system
Autonomic nervous system Autonomic nervous system
Sympathetic Sympathetic
Parasympathetic Parasympathetic
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Autonomic Pharmacology Autonomic Pharmacology
Parasympathetic & Sympathetic Nervous Systems
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Autonomic Pharmacology Autonomic Pharmacology
Sympathetic Division of Autonomic Nervous System
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Autonomic Pharmacology Autonomic Pharmacology
Nervous system organization & function Nervous system organization & function
Peripheral nervous system Peripheral nervous system
Sympathetic division Sympathetic division
Fight or Flight Fight or Flight syndrome syndrome
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Autonomic Pharmacology Autonomic Pharmacology
Nervous system organization & function Nervous system organization & function
Peripheral nervous system Peripheral nervous system
Parasympathetic division Parasympathetic division
Feed and breed Feed and breed
Resting and digesting Resting and digesting
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Autonomic Pharmacology Autonomic Pharmacology
Neurochemical Neurochemical transmission transmission
Synaptic transmission Synaptic transmission
Preganglionic Preganglionic neuron neuron
Postganglionic neuron Postganglionic neuron
Ganglion Ganglion
Synaptic junction Synaptic junction
Neurotransmitter Neurotransmitter
Receptor Receptor
Neurotransmitters Neurotransmitters
Cholinergic Cholinergic
Adrenergic Adrenergic
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Autonomic Pharmacology Autonomic Pharmacology
Neurotransmitters at Synapse
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Autonomic Pharmacology Autonomic Pharmacology
Neurotransmitters of Peripheral Nervous System
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Autonomic Pharmacology Autonomic Pharmacology
Receptors Receptors
Cholinergic receptors Cholinergic receptors
Acetylcholine Acetylcholine
Interacts with receptors, physiologic response Interacts with receptors, physiologic response
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Autonomic Pharmacology Autonomic Pharmacology
Receptors Receptors
Sympathetic receptors Sympathetic receptors
Adrenergic receptors Adrenergic receptors
When sympathetic division stimulated, adrenal medulla When sympathetic division stimulated, adrenal medulla
stimulated, releases epinephrine into circulatory system stimulated, releases epinephrine into circulatory system
Sympathomimetric Sympathomimetric
Sympatholytics Sympatholytics
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Autonomic Pharmacology Autonomic Pharmacology
Receptors Receptors
Other neurotransmitters & receptors Other neurotransmitters & receptors
Serotonin Serotonin
Endorphins Endorphins
Neuropeptides Neuropeptides
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Autonomic Pharmacology Autonomic Pharmacology
Effector Effector cell response cell response
Receptor structure Receptor structure
Agonist gated ion channel receptors Agonist gated ion channel receptors
Selected pathway when membrane allows transfer of Selected pathway when membrane allows transfer of
specific channels across its concentration gradient specific channels across its concentration gradient
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Autonomic Pharmacology Autonomic Pharmacology
Effector Effector cell response cell response
G protein G protein- -coupled receptors coupled receptors
Adrenergic, cholinergic receptors Adrenergic, cholinergic receptors
Protein chains wind back, forth through cell membrane 7 Protein chains wind back, forth through cell membrane 7
times times
Receptor site Receptor site
G protein G protein
Effector Effector
Second messengers Second messengers
Biochemical messenger Biochemical messenger
Molecule relays signals from receptor on cell surface to Molecule relays signals from receptor on cell surface to
target molecules in cell target molecules in cell s nucleus, internal fluid s nucleus, internal fluid
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Autonomic Pharmacology Autonomic Pharmacology
Receptor regulation Receptor regulation
Downregulation Downregulation
Upregulation Upregulation
Altering neurotransmission with drugs Altering neurotransmission with drugs
Produce biologic effects necessary to minimize Produce biologic effects necessary to minimize
disease/injury effects disease/injury effects
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General Properties of Drugs General Properties of Drugs
Generally do not give body new function Generally do not give body new function
Use existing body function, change for particular Use existing body function, change for particular
advantage advantage
Exert multiple actions rather than single effect Exert multiple actions rather than single effect
Must consider all actions when choosing Must consider all actions when choosing
Physiochemical interaction between drug, Physiochemical interaction between drug,
body molecule body molecule
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Drug Forms Drug Forms
Liquid drug forms Liquid drug forms
Elixir Elixir
Emulsion Emulsion
Extract Extract
Solution Solution
Spirit Spirit
Suspension Suspension
Syrup Syrup
Tincture Tincture
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Drug Forms Drug Forms
Solid drug forms Solid drug forms
Caplet Caplet
Capsule Capsule
Enteric Enteric- -coated tablets coated tablets
Gel cap Gel cap
Pill Pill
Powder Powder
Suppository Suppository
Tablet Tablet
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Drug Forms Drug Forms
Gas drug forms Gas drug forms
Inhaled, absorbed through respiratory tract Inhaled, absorbed through respiratory tract
Commonly used for anesthesia Commonly used for anesthesia
Not common for EMS Not common for EMS
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Routes of Medication Administration Routes of Medication Administration
Local vs. systemic effects Local vs. systemic effects
Local effect Local effect
Affects specific body part Affects specific body part
Systemic effect Systemic effect
Affects entire body Affects entire body
Enteral Enteral routes routes
Passes through any portion of digestive tract Passes through any portion of digestive tract
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Routes of Medication Administration Routes of Medication Administration
Enteral Enteral routes routes
Oral Oral
First First- -pass effect pass effect
Drug breakdown in liver, intestine walls before reaching Drug breakdown in liver, intestine walls before reaching
systemic circulation systemic circulation
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Routes of Medication Administration Routes of Medication Administration
Enteral Enteral
Sublingual Sublingual
Under tongue Under tongue
Absorbed through mucus membrane, into blood vessels Absorbed through mucus membrane, into blood vessels
Advantages Advantages
Accessibility Accessibility
Rapid onset Rapid onset
Patient must be adequately hydrated for drug absorption Patient must be adequately hydrated for drug absorption
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Routes of Medication Administration Routes of Medication Administration
Enteral Enteral
Buccal Buccal
Mouth, between gum, cheek mucous membrane, Mouth, between gum, cheek mucous membrane,
absorbed into blood stream absorbed into blood stream
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Routes of Medication Administration Routes of Medication Administration
Enteral Enteral
Rectal Rectal
Suppository Suppository
Eliminates some of Eliminates some of first pass first pass effect effect
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Routes of Medication Administration Routes of Medication Administration
Enteral Enteral
Gastric Gastric
Tube placed in digestive tract Tube placed in digestive tract
Nasogastric Nasogastric
Orogastric Orogastric
Gastrostomy Gastrostomy
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Medication does not pass through digestive tract Medication does not pass through digestive tract
Avoid first Avoid first- -pass effect pass effect
Rapid, complete absorption Rapid, complete absorption
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Intravenous Intravenous
Directly into venous circulation Directly into venous circulation
Instantaneous Instantaneous
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Intraosseous Intraosseous
Needle passed through bone cortex, infused into Needle passed through bone cortex, infused into
capillary network capillary network
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Intracardiac Intracardiac
Injection directly into heart ventricle during cardiac arrest Injection directly into heart ventricle during cardiac arrest
Coronary artery laceration Coronary artery laceration
Heart muscle injection, instead of heart chamber, Heart muscle injection, instead of heart chamber,
pneumothorax pneumothorax, cardiac , cardiac tamponade tamponade
Not paramedic skill Not paramedic skill
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Endotracheal Endotracheal
Tracheal tube Tracheal tube
Unpredictable Unpredictable
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Inhalation Inhalation
Humidified, Humidified, nebulized nebulized
Directly to respiratory tract Directly to respiratory tract
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Intralingual Intralingual
Direct injection into underside of tongue Direct injection into underside of tongue
Naloxone Naloxone, narcotic overdose , narcotic overdose
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Intranasal Intranasal
Nasal passages, sinuses Nasal passages, sinuses
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Intramuscular Intramuscular
Injection directly into skeletal muscle Injection directly into skeletal muscle
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Subcutaneous Subcutaneous
Liquid form injection placed underneath skin into Liquid form injection placed underneath skin into
subcutaneous tissue subcutaneous tissue
Slower Slower
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Transdermal Transdermal
Absorption through skin barrier Absorption through skin barrier
Slow absorption Slow absorption
Look for patches when assessing patient Look for patches when assessing patient
Nitroglycerin Nitroglycerin - - upper chest upper chest
Nicotine Nicotine - - upper arms, buttocks upper arms, buttocks
Nausea Nausea - - vomiting, dizziness, behind ear vomiting, dizziness, behind ear
Estrogen Estrogen - - buttocks, thighs buttocks, thighs
Pain relief Pain relief - - anywhere anywhere
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Intrathecal Intrathecal
Into spinal canal Into spinal canal
Child birth, chronic back pain Child birth, chronic back pain
Not paramedic skill Not paramedic skill
Umbilical Umbilical
Used in newborns Used in newborns
Requires special training, approval from medical Requires special training, approval from medical
direction direction
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Routes of Medication Administration Routes of Medication Administration
Parenteral Parenteral routes routes
Intradermal Intradermal
Between dermal skin layers Between dermal skin layers
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Mechanisms of Drug Action Mechanisms of Drug Action
Pharmaceutical phase Pharmaceutical phase
Broken down into solution in body for absorption Broken down into solution in body for absorption
Pharmacokinetics Pharmacokinetics
Modes of transport Modes of transport
Passive transport Passive transport
Diffusion Diffusion
Osmosis Osmosis
Facilitated transport Facilitated transport
Active transport Active transport
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Mechanisms of Drug Action Mechanisms of Drug Action
Pharmacokinetics Pharmacokinetics
Stages of drug function Stages of drug function
Absorption Absorption
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Mechanisms of Drug Action Mechanisms of Drug Action
Pharmacokinetics Pharmacokinetics
Stages of drug function Stages of drug function
Enteric absorption Enteric absorption
Parenteral Parenteral absorption absorption
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Mechanisms of Drug Action Mechanisms of Drug Action
Pharmacokinetics Pharmacokinetics
Stages of drug function Stages of drug function
Distribution Distribution
Blood Blood- -brain barrier brain barrier
Placental barrier Placental barrier
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Mechanisms of Drug Action Mechanisms of Drug Action
Pharmacokinetics Pharmacokinetics
Stages of drug function Stages of drug function
Metabolism Metabolism
Chemical reactions Chemical reactions
Change active drug into inactive Change active drug into inactive
Change less Change less- -active/inactive into more active active/inactive into more active
Excretion/elimination Excretion/elimination
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Mechanisms of Drug Action Mechanisms of Drug Action
Pharmacodynamics Pharmacodynamics
Theories of drug action Theories of drug action
Drug Drug- -receptor interaction receptor interaction
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Mechanisms of Drug Action Mechanisms of Drug Action
Pharmacodynamics Pharmacodynamics
Theories of drug action Theories of drug action
Affinity Affinity
Efficacy Efficacy
Agonist Agonist
Partial agonist Partial agonist
Antagonist Antagonist
Acetylation Acetylation
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Mechanisms of Drug Action Mechanisms of Drug Action
Pharmacodynamics Pharmacodynamics
Drug response relation Drug response relation
Plasma level profile Plasma level profile
Half Half- -life life
Therapeutic threshold Therapeutic threshold
Therapeutic index Therapeutic index
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Mechanisms of Drug Action Mechanisms of Drug Action
Pharmacodynamics Pharmacodynamics
Factors that influence drug action Factors that influence drug action
Age Age
Gender Gender
Body weight Body weight
Environment Environment
General health General health
Genetics Genetics
Culture Culture
Emotional, Emotional,
psychological state psychological state
Time of Time of
administration administration
Administration route Administration route
Medication history Medication history
Diet Diet
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Mechanisms of Drug Action Mechanisms of Drug Action
Pharmacodynamics Pharmacodynamics
Predictable, iatrogenic, & unpredictable drug Predictable, iatrogenic, & unpredictable drug
responses responses
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Special Considerations Special Considerations
Pregnant patients Pregnant patients
Physiologic changes affect metabolism Physiologic changes affect metabolism
Teratogen Teratogen
Drug/agent harmful to embryo/fetus development Drug/agent harmful to embryo/fetus development
FDA pregnancy risk categories FDA pregnancy risk categories
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Special Considerations Special Considerations
Pediatric patients Pediatric patients
Changes from birth to Changes from birth to
adolescence adolescence
Doses based on weight, Doses based on weight,
body surface area body surface area
Broselow Broselow tape used tape used
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Special Considerations Special Considerations
Geriatric patients Geriatric patients
Bone mass loss, lean muscle mass, body water Bone mass loss, lean muscle mass, body water
changes changes
Body fat decreases Body fat decreases
Organ degeneration Organ degeneration
Polypharmacy Polypharmacy
Self Self- -medication errors medication errors
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Drug Interactions Drug Interactions
Factors influencing drug action Factors influencing drug action
Intestinal absorption Intestinal absorption
Drug metabolism/biotransformation Drug metabolism/biotransformation
Action at receptor site Action at receptor site
Renal excretion Renal excretion
Alteration of electrolyte balance Alteration of electrolyte balance
Drug Drug- -drug interactions drug interactions
Competition for plasma protein binding Competition for plasma protein binding
Other drug interactions Other drug interactions
Drug incompatibilities Drug incompatibilities
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Drug Interactions Drug Interactions
Drug Drug- -drug interactions drug interactions
Drug Drug- -food interactions food interactions
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Drug Storage Drug Storage
Some volatile/possible abuse Some volatile/possible abuse
Follow protocols Follow protocols
Check contents before/after shift Check contents before/after shift
Expiration dates Expiration dates
Quantity Quantity
Locking mechanisms Locking mechanisms
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Components of a Drug Profile Components of a Drug Profile
Components Components
Generic, trade name Generic, trade name
Classification Classification
How supplied How supplied
Mechanism of action Mechanism of action
Pharmacokinetics Pharmacokinetics
Indications Indications
Dosage Dosage
Contraindications Contraindications
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Components of a Drug Profile Components of a Drug Profile
Components Components
Precautions Precautions
Side effects/adverse effects Side effects/adverse effects
Route(s) of administration Route(s) of administration
Drug interactions Drug interactions
Pregnancy risk category Pregnancy risk category
Antidotes Antidotes
Special considerations Special considerations
Pediatric, geriatric, pregnant Pediatric, geriatric, pregnant
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Summary Summary
Drug trade name is brand name, generic is Drug trade name is brand name, generic is
chemical name, chemical name is structure of chemical name, chemical name is structure of
compound compound
Orphan drugs treat rare diseases, conditions Orphan drugs treat rare diseases, conditions
Sources of drugs include plants, Sources of drugs include plants,
animal/human products, minerals, synthetic animal/human products, minerals, synthetic
chemicals, recombinant DNA technology chemicals, recombinant DNA technology
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Summary Summary
Three drug class systems include body Three drug class systems include body
system, class of agent, mechanism of action system, class of agent, mechanism of action
Sources of information include Physician Sources of information include Physician s s
Desk Reference, hospital formularies, people, Desk Reference, hospital formularies, people,
pocket references, package inserts pocket references, package inserts
1970 Comprehensive Drug Abuse Prevention 1970 Comprehensive Drug Abuse Prevention
& Control Act established schedule of & Control Act established schedule of
controlled substances controlled substances
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Summary Summary
U.S. Pharmacopoeia, official public U.S. Pharmacopoeia, official public
standards standards- -setting authority for prescription, setting authority for prescription,
OTC, dietary supplements sold in U.S. OTC, dietary supplements sold in U.S.
FDA approval process for investigational FDA approval process for investigational
drugs has 4 phases drugs has 4 phases
Safe, effective drug administration Safe, effective drug administration
responsibility of paramedic responsibility of paramedic
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Summary Summary
Nervous system contains central, peripheral Nervous system contains central, peripheral
nervous system nervous system
CNS CNS - - brain, spinal cord brain, spinal cord
Peripheral Peripheral - - all nerves outside of CNS all nerves outside of CNS
Somatic nervous system, voluntary nerves Somatic nervous system, voluntary nerves
Autonomic nervous system Autonomic nervous system
Sympathetic, parasympathetic Sympathetic, parasympathetic
Sympathetic/adrenergic division, Sympathetic/adrenergic division, fight fight- -or or- -flight flight
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Summary Summary
Parasympathetic/cholinergic division, Parasympathetic/cholinergic division, resting resting
& digesting & digesting
Synaptic transmission at synaptic junction Synaptic transmission at synaptic junction
Pre/postganglionic nerves connect at ganglion Pre/postganglionic nerves connect at ganglion
Drugs come in liquid, solid, gas forms Drugs come in liquid, solid, gas forms
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Summary Summary
Drug route administration affects type of Drug route administration affects type of
effect, onset of action effect, onset of action
Enteral Enteral drugs enter systemic circulation by GI tract drugs enter systemic circulation by GI tract
Parenteral Parenteral drugs enter systemic circulation by drugs enter systemic circulation by
bypassing digestive tract bypassing digestive tract
Medications alter normal body response Medications alter normal body response
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Summary Summary
Pharmocokinetics Pharmocokinetics - - process of how drugs process of how drugs
process in body process in body
Absorbed, distributed, metabolized, excreted Absorbed, distributed, metabolized, excreted
Agonist stimulated receptor, causes Agonist stimulated receptor, causes
physiologic response physiologic response
Partial agonist/antagonist may cause physiologic Partial agonist/antagonist may cause physiologic
response response
Antagonist binds with receptor, does not elicit Antagonist binds with receptor, does not elicit
response response
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Summary Summary
Biologic half Biologic half- -life, time required to eliminate life, time required to eliminate
50% from bloodstream 50% from bloodstream
FDA regulates drugs for safety in pregnancy, FDA regulates drugs for safety in pregnancy,
pediatric & geriatric patients may have pediatric & geriatric patients may have
different responses different responses
Side effects may/may not be harmful Side effects may/may not be harmful
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Summary Summary
Iatrogenic drug response, unintentional Iatrogenic drug response, unintentional
disease/effect produced by physician disease/effect produced by physician s s
prescribed therapy prescribed therapy
Drug action factors include intestinal Drug action factors include intestinal
absorption, drug metabolism, excretion, absorption, drug metabolism, excretion,
electrolytes, drug electrolytes, drug- -drug interactions, drug interactions,
incompatibilities incompatibilities
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Summary Summary
Drug storage important Drug storage important
Drug profile, complete description of drug, its Drug profile, complete description of drug, its
characteristics characteristics
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Questions? Questions?
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