Emergency Pharmacology

Intramuscular (IM)

(IM) The intramuscular route allows a slower absorption than IV administration, as the drug passes into the capillaries.

Intravenous

(IV) With it's rapid onset, this is the preferred route in most emergencies.

Mechanism of Action

(MOA) refers to the specific biochemical interaction through which a drug substance produces its pharmacological effect. A mechanism of action usually includes mention of the specific molecular targets to which the drug binds, such as an enzyme or receptor.

Rectal

(PR) This route is usually reserved for unconscious or vomiting patients or patients who cannot cooperate with oral or IV administration (small children).

Subcutaneous

(SC, SQ, SubQ) This route is slower than IM route, because the subcutaneous tissue is less vascular than the muscular tissue.

Caplet

A coated oral medicinal tablet.

Desired Reaction

A drug's correct reaction in the body.

Active Transport

A mechanism that requires the use of energy to move a substance. This energy is achieved by the breakdown of high-energy chemical bonds found in chemicals such as ATP (adenosine triphosphate). An example of this is the sodium-potassium ATP pump.

Pill

A small round mass of solid medicine to be swallowed whole.

Receptor

A specialized protein that combines with a medication resulting in a biochemical effect.

Review the specific anatomy and physiology pertinent to pharmacology with additional attention to autonomic pharmacology

Autonomic nervous system consists of two divisions - sympathetic and parasympathetic.

Half-life

Biologic half-life: time body takes to clear one-half of drug.

Trade Name

Brand name: manufacturer gives name (Trade or Proprietary name)

Explain what a drug is

Drugs are foreign substances placed into the body. Drugs used to diagnose, treat, or prevent disease are called medications. Pharmacology is the study of drugs and their actions on the body.

Official Name

List in United States Pharmacopeia (USP)

Distribution

Once a drug is in the bloodstream, it must be moved throughout (distributed) the body. Most drugs will pass easily from the bloodstream, through the interstitial spaces, into the target cells. Some drugs however, will bind to proteins found in the blood, most commonly albumin, and remain in the body for a prolonged time.

Oral

Oral (PO). The oral route is good for self-administered drugs. Most home medications are administered by this route. The drug must be able to tolerate the acidic gastric environment and be absorbed. Few emergency drugs are administered through this route.

Median Lethal Dose

Otherwise know as, LD50 (abbreviation for "lethal dose, 50%"), LC50 (lethal concentration, 50%) or LCt50 is a measure of the lethal dose of a toxin, radiation, or pathogen. The value of LD50 for a substance is the dose required to kill half the members of a tested population after a specified test duration. LD50 figures are frequently used as a general indicator of a substance's acute toxicity.

Parenteral

Parenteral routes: needles to inject medications into circulatory system or tissues: IV, ET, IO, Umbilical, IM. subcutaneous (SC,SQ, SubQ), inhalation/nebulized, topical, transdermal, nasal, instillation, intradermal

Cholinergic

Pertaining to the neurotransmitter acetylcholine.

List the main sources of drug products

Plants, animals, minerals, laboratory (synthetic)

Tablets

Powders compresses into a dislike form.

Suspension

Preparations in which the solid does not dissolve in the solvent; if left alone, the solid portion will precipitate out.

Nasogastric

Reaching or supplying the stomach via the nose.

Formulary

Relating to or using officially prescribed formulas.

List the six rights of medication administration

Right Medication Right Dose Right Time Right Route Right Patient Right Documentation

Side Effect

Side Effects / Adverse Reactions are a drug's untoward or undesired effects.

Distinguish among drug forms

Solid - powders, tablets, suppositories, capsules Gaseous - (02) & (N20) - nitrous oxide Liquid - solutions, tinctures, suspensions, emulsions, spirits, elixirs, syrups

List and describe liquid and solid drug forms

Solid drug forms - Powders Tablets Suppositories Capsules Liquid drug forms - Solutions Tinctures Suspensions Emulsions Spirits Elixirs Syrups

Spirit

Solution of a volatile drug in alcohol.

Pharmacology

Study of drugs; interactions with body

Sublingual

Sublingual (SL). This is a good route for self-administration and excellent absorption from the sublingual capillary bed without the problems of gastric acidity or absorption. (ODT)?

Syrup

Sugar, water, and drug solutions.

Generic Name

Suggested by the manufacturer.

Pharmacokinetics

The body's ability to move substances in and out of cells and membranes. Two primary mechanisms: Passive transport (no energy required) - Osmosis, Diffusion, Filtration.

Cumulative Action

The condition in which repeated administration of a drug may produce effects that are more pronounced than those produced by the first dose.

First-pass Effect

The first-pass effect (also known as first-pass metabolism or presystemic metabolism) is a phenomenon of drug metabolism whereby the concentration of a drug is greatly reduced before it reaches the systemic circulation.

Affinity

The force of attraction between a medication and a receptor. The stronger the affinity, the stronger the bond.

Solution

The most common liquid preparations. Generally water based; some may be oil based.

Therapeutic Index (TI)

The ratio of a medication's lethal dose for 50% of the population to its effective dose for 50% of the population. (A drug's margin of safety)

Polypharmacy

The simultaneous use of multiple drugs to treat a single ailment or condition.

Dose

The specific amount of a drug given at one time.

Synergism

Two drugs that both have the same effect are given together and produce a response greater than the sum of their individual responses, analogous 1 + 1 = 3

Intranasal

Used for delivering drugs directly to the nasal mucosa, the nasal route has an expanding role in delivering systemically acting drugs.

Drug Interaction

When two or more drugs are available in the same patient. The interaction can increase, decrease, or have no effect on their combined actions.

Transdermal

absorbed through the skin

Chemical Name

chemical composition and molecular structure

Systemic Effect

Effect throughout the body.

Gel Cap

A capsule-shaped tablet coated with gelatin for easy swallowing.

Drug Antagonist

A drug that blocks the response of another drug.

Desired Action

A drug's correct action on the body.

Parasympatholytics

A parasympatholytic agent is a substance or activity that reduces the activity of the parasympathetic nervous system. (The parasympathetic nervous system is often colloquially described as the "Feed and Breed" or "Rest and Digest" portion of the autonomic nervous system.

Parasympathomimetics

A parasympathomimetic drug, sometimes called a cholinomimetic drug, is a substance that stimulates the parasympathetic nervous system. These chemicals are also called cholinergic drugs because acetylcholine is the neurotransmitter used by the PSNS.

Dosage

A quantity of a medicine or drug taken or recommended to be taken at a particular time or over a given time period.

Nonproprietary Name

A short name (often called a generic name) of a chemical, drug, or other substance that is not subject to trademark (proprietary) rights but is, in contrast to a trivial name, recognized or recommended by government agencies

Discuss factors that influence a drugs pharmacokinetics; absorption, distribution, and elimination

Absorption - The body absorbs most drugs faster when they are given IM than when they are given SUBq because muscles are more vascular. Anything that slows blood flow (shock or hypothermia) will delay absorption. Conversely, process such as fever and hyperthermia increase peripheral blood flow and speed up absorption. Also, if a drug is not soluble in water, it will have difficulty being absorbed. Some drugs become ionized (electronically charged) following administration, which can slow the absorption process. A drug's PH also affects the extent to which it oiizes. For example, aspirin (an acidic drug) does not dissociate well in the stomach (an acidic environment) and is therefore readily absorbed there. Surface area can effect absorption. The greater the area the faster the absorption. The greater the blood flow to a particular area, the faster the absorption. The greater the vascularity the quicker the absorption by way of diffusion. A drugs concentration also can effect it's absorption. The higher the concentration, the quicker the absorption. Distribution - changing the bloodstream's pH can affect the protein-binding action of the drug giving them sustained release from the bloodstream and prolonged period of action. The presence of other serum protein-binding drugs can also affect drug-protein binding. Hypoalbuminemia, which occurs in malnutrition, can cause drugs that are normally protein bound to rise to much greater blood levels than anticipated. The blood-brain barrier or so-called placental barrier will only allow non-protein bound, highly lipid-soluble drugs cross into the CNS. Elimination - conditions that affect blood flow and blood pressure can affect renal elimination.

Buccal

Absorption through this route between the cheek and gum is similar to sublingual absorption.

Potentiation

Adverse responses to drugs. eg. OJ and percocet.

List variables that can influence drug interactions

Age, body mass, sex, environment, time of administration, pathology, genetics; psychology

Elixir

Alcohol and water solvent, often with flavorings added to improve the taste.

Summation

Also known as an additive effect. Two drugs that both have the same effect are given together, analogous to 1 + 1 = 2

Drug-food Interaction

Alterations of pharmacokinetics or pharmacodynamics of a drug or nutritional element or a compromise in nutritional status as a result of the addition of a drug.

Powder

Although they are not as popular as they once were, some powdered drugs are still in use.

Delayed Reaction

An allergic or immune response that begins 24 to 48 hours after exposure to an antigen to which the individual has been sensitized.

Additive Effect

An effect wherein two or more substances or actions used in combination produce a total effect, the same as the arithmetic sum of the individual effects.

Hypersensitivity

An exaggerated and harmful immune response; an umbrella term for allergy, autoimmunity, and isoimmunity.

Enteric-coated tablets

An oral dosage form in which a tablet is coated with a material to prevent or minimize dissolution in the stomach but allow dissolution in the small intestine (alkaline environment). This form of tablet is also know as a time released medication.

Adverse Effect (reaction)

An undesired harmful effect resulting from a medication or other intervention such as surgery. An adverse effect may be termed a "side effect" when judged to be secondary to a main or therapeutic effect. Eg. Allergic reaction, idiosyncrasy, tolerance, cross tolerance (opiates), tachyphylaxis, cumulative effect, drug dependence (withdrawals). Drug interaction - oral contraceptive/antibiotics; coumadin, drug antagonism, summation, synergism, potentiation - OJ and percocet, interference.

Identify the four types of drug names

Chemical name Generic Name Official Name Brand Name

Suppository

Drugs mixed with a waxlike base that melts at body temperature, allowing absorption be rectal or vaginal tissue.

Synthetic Drugs

Drugs produced by chemical or biochemical synthesis; Produced or artificially devised, arranged, or fabricated for special situations to imitate or replace usual realities

Discuss the paramedic's responsibilities and scope of management pertinent to the administration of medications

EMS providers are empowered to administer many different controlled substances such as: Fentanyl, Morphine, Versed, Diazepam, Lorazepam

List and differentiate routes of drug administration, including the enteral and parenteral routes

Enteral Routes - delivers medications by absorption through the gastrointestinal tract, which goes from the mouth to the stomach and on through the intestines to the rectum *Oral (Po) *Orogastric/Nasogastric (OG/NG) *Sublingual (SL) *Buccal *Rectal (PR) Parenteral Routes - an area outside the gastrointestinal tract; however, these routes typically use needles to inject medications into the circulatory system or tissues. (most rapid delivery and absorption) *IV *ET *IO *Umbilical *IM *SC, SQ, SubQ *Inhalation/Nebulized *Topical *Transdermal *Nasal *Instillation *Intradermal

Enteral

Enteral routes deliver deliver medications by absorption through the gastrointestinal tract, which goes from the mouth to the stomach and on through the intestines to the rectum. They may be oral (PO), orogastric/nasogastric (OG/NG), sublingual (SL), buccal, or rectal (PR).

Intradermal

For allergy testing, intradermal administration delivers a drug or biological agent between the dermal layers.

Drug

Foreign substance placed into the human body.

Capsule

Gelatin containers, filled with powders or tiny pills; the gelatin dissolves, releasing the drug into the gastrointestinal tract.

Discuss consideration for storing and securing medications

Guidelines dictate manner in which drugs stored; properties may be altered by environment in which they are stored. eg. Temperature, light, moisture, and shelf life.

Inhalation

Inhalation/Nebulized: This route, which offers very rapid absorption, is especially useful for delivering drugs whose target tissues are the lungs.

Describe the paramedic's responsibilities to understand drug profiles

Know precautions and contraindications for medications you administer. Practice proper techniques. Know how to observe and document drug effects. Maintain knowledge in pharmacology. Establish and maintain professional relationships with health care providers.

Pharmacodynamics

Mechanism of action. A drugs effect once they reach their target issues.

Sympathomimetics

Medication of other substance that causes effects like those of the sympathetic nervous system (also called adrenergic)

Sympatholytics

Medication or other substance that blocks the actions of the sympathetic nervous system (also called antiadrenergic)

Therapeutic Threshold

Minimum amount of drug required to produce the desired response.

Describe how drugs react with receptors to produce their desired effects i.e. pharmacodynamics

Most drugs operate by binding to a receptor. Almost all drug receptors are protein molecules on the surface of cells. They are past of the body's normal regulatory stimulation/inhibition function, and can be stimulated or inhibited by chemicals. Receptor-mediated drug actions work like a lock (the receptor) and key (the agonist). The agonist will hypothetically unlock the door, where as the antagonist will put the key into the lock, but will get stuck and not be able to open the door (receptor).

Adrenergic

Pertaining to the neurotransmitter norepinephrine

Describe the process of pharmacokinetics and pharmacodynamics, including theories of drug action, drug response relation, factors altering drug responses, predictable drug responses, iatrogenic drug responses, and unpredictable adverse drug responses

Pharmacokinetics is the study of the basic processes that determine the duration and intensity of a drugs effect. These four processes include - absorption, distribution, biotransformation, and elimination. Pharmacodynamics is study of a drugs effect(s) on the body. Specifically its mechanisms of action and the relationship between its concentration and its effect. Iatrogenic drug responses - (from the Greek for "brought forth by the healer") refers to any effect on a person, resulting from any activity of one or more persons acting as healthcare professionals or promoting products or services as beneficial to health, that does not support a goal of the person affected.

List and describe general properties of drugs

Plants - Oldest source of medication. "herbal medications" Animals - Minerals - Synthetics -

Describe how drugs are classified

Schedule I - High abuse potential; may leas to severe dependence; no accepted medical indictions; used for research, analysis, or instruction only. (Heroin, LSD, Mescaline) Schedule II - High abuse potential; may lead to severe dependence; accepted medical indication (opium, cocaine, morphine, codeine, oxycodone, methadone, secobarbital) Schedule III - Less abuse potential tan schedule I and II; may lead to moderate or low physical dependence or high psychological dependence; accepted medical indications (limited opioid amounts or combined with noncontrolled substances: Vicodin, Tylenol with codeine) Schedule IV - Low abuse potential compared to Schedule III; limited psychological and/or physical dependence; accepted medical indications. (Diazepam, lorazepam, phenobarbital) Schedule V - Lower abuse potential compared to Schedule IV; may lead to limited physical or psychological dependence; accepted medical indications. (Limited amounts of opioids; often for cough or diarrhea)

Emulsion

Suspensions with an oily substance in the solvent; even when well mixed, globules of oil separate out of the solution.

Drug Allergy

The abnormal reaction of your immune system to a medication. Any medication — over-the-counter, prescription or herbal — is capable of inducing a drug allergy. However, a drug allergy is more likely with certain medications. The most common signs and symptoms of drug allergy are hives, rash or fever.

Local Effect

The action of a chemical, biological or physical agent at the site of contact such as the skin, mucous membranes of eyes, nose, mouth, throat or respiratory or gastro intestinal tract.

Adsorb

The adhesion of atoms, ions, or molecules from a gas, liquid, or dissolved solid to a surface.[1] This process creates a film of the adsorbate on the surface of the adsorbent. This process differs from absorption, in which a fluid (the absorbate) is dissolved by or permeates a liquid or solid (the absorbent), respectively.

Intraosseous

The intraosseous route delivers drugs to the medullary space of bones. Most often used as an alternative to IV administration in pediatric emergencies, it also is used in adults.

Describe the mechanism of drug addiction

The patient becomes accustomed to the drug's presence in his body and will suffer from withdrawal symptoms upon its absence. The dependence may be physical or psychological.

Drug Dependence

The patient becomes accustomed to the drug's presence in his body and will suffer from withdrawal symptoms upon its absence. The dependence may be physical or psychological.

Absorption

The process or action by which one thing absorbs or is absorbed by another. If a drug is given orally or injected into and place except the bloodstream, its absorption into the bloodstream is the first step in the process. IM is the fastest way of absorption.

Solubility

The quality or property of being soluble; relative capability of being dissolved.

Therapeutic Dose

The quantity of any substance required to effect the cure of a disease or to correct the manifestations of a deficiency

Metabolism

The total changes that take place during physiological processes; the body's breaking down of chemicals into different chemicals.

Cross Tolerance

Tolerance for a drug that develops after administration of a different drug. Morphine and other opioid agents are common examples. Tolerance for one agent implies tolerance for others as well. Moreover, the resistance to the effects of a substance because of exposure to a pharmacologically similar substance.

Tincture

a medicine made by dissolving a drug in alcohol. "the remedies can be administered in the form of tinctures" synonyms: solution, suspension, infusion, elixir "tincture of iodine"

Tolerance

a person's diminished response to a drug, which occurs when the drug is used repeatedly and the body adapts to the continued presence of the drug.

Topical

material applied to and absorbed through the skin or mucous membranes.

Agonist

medication that binds to a receptor and causes it to initiate the expected response. (opioid)

Antagonist

medication that binds to a receptor but does not cause it to initiate the expected response. (narcan) Blocks agonist.

Elimination

most drugs (toxins and metabolites) are excreted in the urine. Some are excreted in the feces or in expired air.

Bioavailability

the measure of the amount of a drug that is still active after it reaches its target tissue. This is the bottom line as far as absorption is concerned.