Paramedic Inter Facility Transfer Training

PHARMACOLOGY Review

PHARMACOLOGY Review Quiz

Goals of the Pharmacology Review

Briefly review information that you have already had in your paramedic programs. The purpose of this program is not to teach new concepts of pharmacology

Medication and Transport

The most common reason that you will be asked to transport a patient utilizing the PIFT module will be because the patient requires administration or monitoring of a medication or medications other than those normally carried in the paramedic drug box.

Medication and Transport

The new PIFT module allows an appropriately trained paramedic to administer or monitor 18 classes of medications, as well as OTC medications

Medication and Transport

Potentially, this could involve as many as several hundred different medications.

This is a significant responsibility.

Safe, effective transport of patients requires sound, fundamental knowledge of basic principles of pharmacology.

IMPORTANT PHARMACOLOGICAL TERMS

Antagonism
The opposition between 2 or more medications ex. narcotics and Naloxone

Bolus
A single, often large dose of a drug. Often the initial dose

Cumulative action
An increased effect caused by multiple doses of the same drug. Caused by buildup in the blood.

 Hypersensitivity
A reaction to a drug that is more profound than expected and which often results in an exaggerated immune response

Idiosyncrasy
A reaction to a drug that is significantly different from what is expected

Indication
The medical condition for which the drug has proven therapeutic value

 Parenteral
Any route of administration other than the digestive tract

Pharmacodynamics
Study of the mechanisms by which drugs act to produce biochemical or physiological changes in the body

Pharmacokinetics
Study of how drugs enter the body, reach their site of action and are eliminated from the body

 Potentiation
The enhancement of a drugs effect by another drug Eg. promethazine may enhance the effect of morphine; also alcohol and barbiturates

Refractory
The failure of a patient to respond as expected to a certain medication

Synergism
The combined action of 2 or more drugs that is greater than the sum of the 2 drugs acting independently

 Therapeutic Action
The intended action of a drug given in an appropriate medical setting

Therapeutic Threshold
The minimum amount of a drug that is required to cause the desired response

Therapeutic Index
The difference between the therapeutic threshold and the amount of the drug considered to be toxic Often referred to as Safe and Effective range

 Tolerance
The decreased sensitivity or response to a drug that occurs after repeated doses Increased doses are required to achieve the desired effect

Untoward Effect
A side effect of a drug that is harmful to the patient

PHARMACOKINETICS
Study of the metabolism and action of drugs Particularly emphasizes the following:
1. Absorption 2. Distribution 3. Biotransformation 4. Excretion

ABSORPTION
The movement of a drug from its point of entry into the body into systemic circulation

ABSORPTION
Factors influencing rate of absorption:
Drug concentration Site of absorption pH of the drug
Acids into acids, etc.

Status of circulation Solubility

Water based vs. oil based

DISTRIBUTION
The manner in which a drug is transported from the site of absorption to the site of action

DISTRIBUTION
Influenced by several factors:
Cardiovascular function
HR, BP, EF

Physical barriers
Blood-brain and placenta barriers

BIOTRANSFORMATION
The process by which drugs are inactivated and transformed into a form that can be eliminated from the body

BIOTRANSFORMATION
Inactive forms are called metabolites Rate of transformation will determine how often a drug must be administered
Eg. Epinephrine transforms in 3-5 minutes

The liver is the most significant organ in the transformation process

EXCRETION
The process of eliminating drugs from the body

EXCRETION
Primarily accomplished through the kidneys but may also involve the liver, the lungs, intestines, sweat and mammary glands

PHARMACODYNAMICS
How a drug works and how we can expect the body to respond to the administration of a drug

PHARMACODYNAMICS
Most drugs work through interactions with receptor sites.
These are protein coatings found on the outer surface of the cell membrane. Generally, when a drug binds or attaches to a receptor site, a chemical reaction occurs that initiates the desired physiological or therapeutic response. Such drugs are called agonists.

Some drugs work through the principle of antagonism

In such cases, a drug competes with another drug or chemical for position at a receptor site. We see this with Naloxone which competes with narcotic drugs
In this case Naloxone would be an antagonist.

AUTONOMIC NERVOUS SYSTEM

The Peripheral nervous system is divided into afferent and efferent divisions. The section of the efferent division that controls involuntary bodily functions is known as the Autonomic Nervous System. These functions include cardiac function, body temperature, smooth muscle, gland function and arterial blood pressure.

AUTONOMIC NERVOUS SYSTEM

Sympathetic nervous system Parasympathetic nervous system

SYMPATHETIC NERVOUS SYSTEM

Prepares body to deal with stress
Fight or flight response

Neurotransmitters are epinephrine and norepinephrine

Chemical substances that facilitate excitation or inhibition of target cells

 A drug that stimulates the sympathetic nervous system is known as a sympathomimetic or adrenergic agent A drug that inhibits the sympathetic nervous system is called a sympatholytic or anti-adrenergic agent Ex. Propanolol ( beta blocker )

PARASYMPATHETIC NERVOUS SYSTEM

Controls vegetative functions
Constriction of pupils, slowing of heart rate, constriction of bronchioles, etc.

Neurotransmitter is Acetylcholine A drug that stimulates the system is called a Parasympathomimetic or cholinergic drug
Eg. Prostigmine

A drug that blocks or inhibits the system is called a Parasympatholytic or anticholinergic drug
Eg. Atropine

Classifications of Medications
Anticoagulants Anticonvulsants Antidiabetics Antidysrhythmics Antihypertensives Anti-infectives Antipsychotics Cardiac Glycosides Corticosteroids Drotrecogin GI Agents IV fluids Narcotics Parenteral Nutrition Platelet Aggregation Inhibitors Respiratory Medications Sedatives Vasoactive agents

GENERAL CONCEPTS
Check transfer order carefully to be sure that all medications ordered are permitted under the PIFT program. Be sure that order specifies:
Dosage information Times of administration (where applicable) Indications for changes or discontinuance. Eg. Nitroglycerin dosage is often altered based on pain and/or BP.

GENERAL CONCEPTS
Ask the physician or RN to review medication if it is one that you are not familiar with.
Discuss potential adverse reactions and how to deal with them. Use resources to double check

GENERAL CONCEPTS
Determine how long it will take to reach receiving facility and calculate the amount of the drug you will need to reach your destination.
Allow for unforeseen delays.

GENERAL CONCEPTS
Check to be sure that you have the right drug and the right concentration. Check expiration dates of all medications.

GENERAL CONCEPTS
Be sure that you thoroughly understand how to use the infusion pump being supplied by the hospital
Are you able to troubleshoot potential problems?

Check IV site for patency, redness, etc.

GENERAL CONCEPTS
Be sure to have a drug reference book available in your ambulance Review drug reference for detailed information about the drug.
Review side effects, adverse reactions, dosing, interactions, etc.

Contact medical control if it becomes necessary to administer another drug to ascertain possible interaction problems

 OK, lets look at the drug classifications in the PIFT program