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Paramedic Inter FacilityTransfer
TrainingPHARMACOLOGY
Review
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PHARMACOLOGY
Review Quiz
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• Briefly review information that youhave already had in your paramedic
programs.
• The purpose of this program is not toteach new concepts of pharmacology
Goals of the Pharmacology Review
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Medication and Transport
• The most common reason that you willbe asked to transport a patient utilizing
the PIFT module will be because thepatient requires administration ormonitoring of a medication or
medications other than those normallycarried in the paramedic drug box.
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Medication and Transport
• The new PIFT module allows anappropriately trained paramedic to
administer or monitor 18 classes ofmedications, as well as OTCmedications
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Medication and Transport
Potentially, this could
involve as many as several hundred different medications .
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This is a significantresponsibility. – Safe, effective transport of patients
requires sound, fundamental knowledge of basic principles of
pharmacology.
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IMPORTANTPHARMACOLOGICAL 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 thesame drug. Caused by buildup in the blood.
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• Hypersensitivity
– A reaction to a drug that is more profound thanexpected and which often results in an exaggeratedimmune response
• Idiosyncrasy – A reaction to a drug that is significantly different from
what is expected
• Indication
– The medical condition for which the drug has proventherapeutic value
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• Parenteral
– Any route of administration other than the digestivetract
• Pharmacodynamics
– Study of the mechanisms by which drugs act to
produce biochemical or physiological changes in thebody
• Pharmacokinetics
– Study of how drugs enter the body, reach their site ofaction and are eliminated from the body
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• Potentiation – The enhancement of a drug’s effect by another drug
– Eg. promethazine may enhance the effect ofmorphine; 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 actingindependently
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• Therapeutic Action
– The intended action of a drug given in an appropriatemedical 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 andthe amount of the drug considered to be toxic
– Often referred to as Safe and Effective range
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• Tolerance – The decreased sensitivity or response to a
drug that occurs after repeated doses
– Increased doses are required to achieve thedesired effect
• Untoward Effect
– A side effect of a drug that is harmful to the
patient
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PHARMACOKINETICS
• Study of the metabolism and actionof drugs
•Particularly emphasizes thefollowing:
1. Absorption
2. Distribution
3. Biotransformation
4. Excretion
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ABSORPTION
• The movement of a drug from its
point of entry into the body intosystemic circulation
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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
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DISTRIBUTION
• The manner in which a drug is
transported from the site ofabsorption to the site of action
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DISTRIBUTION
• Influenced by several factors:
• Cardiovascular function
–HR, BP, EF
• Physical barriers
–Blood-brain and placenta barriers
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BIOTRANSFORMATION
• The process by which drugs areinactivated and transformed into a
form that can be eliminated fromthe body
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BIOTRANSFORMATION
• Inactive forms are called metabolites
• Rate of transformation will determinehow often a drug must be administered
– Eg. Epinephrine transforms in 3-5 minutes
• The liver is the most significant organin the transformation process
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EXCRETION
• The process of eliminatingdrugs from the body
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EXCRETION
• Primarily accomplished through thekidneys but may also involve the liver,
the lungs, intestines, sweat andmammary glands
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PHARMACODYNAMICS
How a drug works and how we
can expect the body torespond to the administration
of a drug
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PHARMACODYNAMICS
• Most drugs work through interactionswith 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.
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Some drugs work through theprinciple 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.
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AUTONOMIC NERVOUS SYSTEM
• The Peripheral nervous system is dividedinto afferent and efferent divisions.
• The section of the efferent division that
controls involuntary bodily functions isknown as the Autonomic Nervous System.
• These functions include cardiac function,body temperature, smooth muscle, glandfunction and arterial blood pressure.
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AUTONOMIC NERVOUS SYSTEM
• Sympathetic nervous system
• Parasympathetic nervous system
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SYMPATHETIC NERVOUS SYSTEM
• Prepares body to deal with stress
– Fight or flight response
• Neurotransmitters are epinephrine andnorepinephrine
– Chemical substances that facilitate excitation or inhibition of target cells
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• A drug that stimulates the sympatheticnervous system is known as asympathomimetic or adrenergic agent
• A drug that inhibits the sympatheticnervous system is called asympatholytic or anti-adrenergic agent
• Ex. Propanolol ( beta blocker )
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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 aParasympathomimetic or cholinergic drug – Eg. Prostigmine
• A drug that blocks or inhibits the system is
called a Parasympatholytic or anticholinergicdrug – Eg. Atropine
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Classifications of Medications
• Anticoagulants• Anticonvulsants
• Antidiabetics
• Antidysrhythmics
• Antihypertensives
• Anti-infectives
• Antipsychotics
• CardiacGlycosides
• Corticosteroids
• Drotrecogin
• GI Agents• IV fluids• Narcotics• Parenteral Nutrition
• Platelet AggregationInhibitors
• Respiratory Medications• Sedatives
• Vasoactive agents
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GENERAL CONCEPTS
• Check transfer order carefully to be surethat all medications ordered are permittedunder 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.
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• Ask the physician or RN to reviewmedication 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
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• Determine how long it will take toreach receiving facility and calculate
the amount of the drug you will needto reach your destination.
– Allow for unforeseen delays.
GENERAL CONCEPTS
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• Check to be sure that you have theright drug and the right concentration.
• Check expiration dates of allmedications.
GENERAL CONCEPTS
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• Be sure that you thoroughly
understand how to use the infusion
pump being supplied by the hospital – Are you able to troubleshoot potentialproblems?
• Check IV site for patency, redness,etc.
GENERAL CONCEPTS
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• Be sure to have a drug reference bookavailable 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 becomesnecessary to administer another drug toascertain possible interaction problems
GENERAL CONCEPTS
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• OK, let’s look at the drugclassifications in the PIFT program