EMT – Pharmacology (Alberta, Canada)

Pharmacology
The study of meds and their effect or actions on the body
6 rights
D-documentation
T-time
R-route
A-amount/dosage
M-medications
P-person
Medication
A drug that has been approved by the government agency that regulates pharmaceuticals. In Canada, the agency is the Health Products and Food Branch (HPFB).
Chemical name
Describes the drug’s chemical makeup – that is, its composition and molecular structure
generic name
(nonproprietary name) – general name for a drug, usually created by the company that first manufactures the chemical (amiodarone)
Trade name
unique name under which the original manufacturer registers the new drug wit the HPFB and is capitalized. (Cordarone)
sources of drugs
plants, animals, minerals, synthetic
special considerations for pediatric, geriatric, and pregnant patients
Pediatric and geriatric patients often have slower absorption and elimination times, and pregnant patients are limited in meds they can take because of risk to the fetus
What is the nervous system made up of?
CNS (brain and spinal cord) and PNS
What are the peripheral nerves?
Afferent nerves, which carry sensory impulses from all parts of the body to the brain
Efferent nerves, which carry messages from the brain to the muscles and all other organs in the body
What does the CNS do?
It receives input from many receptors throughout the body, interprets the stimulus received via these sensory neurons, and makes decisions and directs actions to be carried out at target sites and organs throughout the body.
What does the PNS consists of?
It consists of all nervous tissues outside of the brain and spinal cord and is separated into two divisions; the somatic nervous system (voluntary functions) and the autonomic nervous system (involuntary functions).
What is the sympathetic nervous system?
Division of the ANS; is responsible for the fight or flight response; is the dominant system during periods of stress and activity; is a key player in the regulation of hypoglycemia, hypothermia, and trauma.
What is the primary chemical messengers of the sympathetic nervous system?
Noepinephrine and epinephrine.
How does epinephrine affect your body?
It activates a specific type of receptor in the heart known as beta-1 adrenergic receptor. It affects the heart by increasing the rate of contraction, the conduction velocity, and the force of contraction in the ventricular muscle, increasing the BP.
What is the parasympathetic nervous system?
It is the dominant system during periods of rest and relaxation; rest and digest response.
What are receptors?
They are specialized target molecules that are present on the surface of cells or within cells. They bind a medication and mediate its pharmacologic effect,
What is affinity?
The attraction between a medication and its receptors. The stronger the affinity, the stronger the bond.
What is an agonist?
A medication that stimulates a response in a receptor site.
What are percutaneous routes?
Medications that are absorbed through the skin or through a mucous membrane, such as transdermal routes, sublingual, buccal, pulmonary routes
What are enteral routes?
Medications that are absorbed by along the GI tract.
What are parental routes?
Medications that are absorbed without going through the GI tract.
How much medication can you give via IM injection into the deltoid?
1mL
How much medication can you give via SC route?
less than 2mL
Pharmacokinetics
The study of the metabolism and action of medications within the body: how the drug is absorbed, distributed, and eliminated, including the onset and duration of action.
What is a drug classification?
Broad group to which a drug belongs. Knowing classifications is essential to understanding e properties of a drug.
Mechanism of action
The way which a drug causes its effects; its pharmacodynamics
Indications
Conditions that enable the appropriate administration of the drug
Side effects/adverse actions
Drug’s untoward or undesired effects
Contraindications
Conditions that make it inappropriate to give the drug
Controlled substances in Canada (schedule I)
Morphine, fentanyl, ketamine
Controlled substances in Canada (schedule IV)
Barbiturates
Absorption
Process of movement of a medication from the site of application into the body and into the extra cellular compartment
Factors that affect absorption
Solubility, concentration, pH, site, surface area, blood supply to the site, bioavailability
Distribution
Process whereby a medication is transported from the site of absorption to the site of action
Factors that affect distribution
Cardiovascular function, regional blood flow, medication storage reservoirs, physiological barriers
Blood-brain barrier
Refers to the network of capillary endothelial cells in the brain
Biotransformation
Metabolism of medication
Can transform the medication into a more or less active metabolite, or it can make the medication more water soluble to facilitate elimination
Elimination
Refers to the movement of a medication or its metabolites from the tissues back in the circulation and from the circulation into the organs of excretion
What is idiosyncrasy?
A unique drug effect response to an individual
What Is tolerance?
Decreased response to the same amount
What is half-life?
The time required for the total amount of a medication in the body to diminish by one-half. Most medications have a half life of 5 hours.
Loading dose
Initial large dose
Clearance
Refers to the removal of a medication from the body
What is the mechanism of action of medications?
They may bind to receptor site, change the physical properties of cells, chemically combine with other chemicals, or alter a normal metabolic pathway
Efficacy
Medications ability to cause the expected response
Antagonists
Bind to a site but does not cause the receptor to initiate expected response
Medication potency
Refers to the relative amount of a medication required to produce desired response
Factors altering medication response
Age, body mass, gender, environment, time of administration, pathological state, genetic factors, psychological factors.
7 psychological effects of aging
Decreased cardiac output, renal function, brain mass, total body water, body fat, serum albumin, respiratory capacity
Tachyphylaxis
Rapidly occurring tolerance to a drug
Cumulative effect
Increased effectiveness when a drug is given in several doses
Drug dependence
Accustomed to the drug’s presence in the body
Drug interaction
Effects of one drug alter the response to another drug
Drug antagonism
Effects of one drug block the response of another drug
Summation
Also known as additive effect, two drugs with the same effect are given together (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 (1+1=3)
Potentiation
One drug enhances the effect of another
Interference
Direct biochemical interaction between two drugs; one drug affects the pharmacology of another drug
What is thalidomide?
Anti-anemic drug that was giving to pregnant women in the 50-60s in Europe that cause deformed limbs in babies
Pregnant women have anatomical and physiological changes
Increased cardiac output, heart rate, blood volume by up to 45%
Decreased protein binding, hepatic metabolism, BP
Active transport
Requires the use of energy to move a substance
Passive transport
Does not equine the use of energy to move a substance
Diffusion
Passive transport, involves the movement of a solute in the solution from an area of higher concentration to an area of lower concentration
Osmosis
Passive transport, involves the movement of solvent from a power concentration area to a higher concentration area
Carrier-mediated diffusion
Active process, molecule binds to carrier protein, causing the cell membrane to change and allow larger molecules to enter target cell
Facilitated diffusion
Passive process,
Filtration
Passive transport, involves the movement of molecules across a membrane down a pressure gradient from an aa of high pressure to an area of low pressure
What is the formula to calculate a drug dose?
Volume to de administered = (VOH x DD)/DOH
What is the formula for fluid volume over time?
Rate=volume x drip factor / time in minutes
What is Parkland formula?
Fluid requirements=TBSA burnt % X weight KG X 4mL
What are indications for an IV?
Fluid and blood replacement, drug administration, obtaining venous blood specimens for lab analysis
CNS medications
Analgestics and antagonists
Anesthetics
Anti-anxiety and sedative hypnotic drugs
Anti seizures or anti epileptic drugs
CNS stimulants
Psychotherapeutic meds
Parkinson’s meds
ANS medications (parasympathetic)
Anticholinergics
Neuromuscular blocking agents
Ganglionic blocking agents
Cholinergics
Ganglionic stimulating agents
ANS medications (sympathetic)
Adrenergic receptors
Adrenergic agonists
Adrenergic antagonists
Skeletal muscle relaxants
Nitrous oxide
Entonox, for pain management, 50% oxygen 50% nitrous oxide
Anxiolytics and analgesic
Euphoria
Acts on several receptors in the brain
Laughing gas
Beta 1
Increases heart rate, conductivity, automaticity, contractibility in the heart
Renin release in the kidneys
Alpha 2
Pre synaptic terminals inhibition
Alpha 1
Constriction in the arteriolar
Constriction in the veins
Mydriasis in the eyes
Ejaculation in the penis
Anaphylaxis signs and symptoms
Hypotensive
Bronchoconstriction
Release of histamine
Swelling of facial structures
CNS affected
SOB, wheezes, stridor
Skin hives, itchy, flushing
Pelvic pain
Loss of bladder control
Epinephrine
Adrenalin
Adrenergic agonist
1:1000 multi dose vial 30mg/30mL
1:1000 ampule 1mg/1mL
Epi pen 0.3mg
Epi pen Jr. 0.15mg 1:1000
Pharmacodynamics of epi
Directly stimulates alpha and beta adrenergic receptors in SNS
Bronchodilator beta 2 receptors
CV and vasopressor
Vasodilation beta2
Vasoconstriction alpha
Cardiovascular medications
Anti anginals
Antidysrhythmics
Anti hypertensives
Antihyperlipidemic
Amiodarone
Potassium channel blocker, prolonged QT
Verapamil
Calcium channel blocker, prolonged PR and brady
Adenosine
Half life 6 secs
Affects potassium channels/breaks rhythm
Works in AV node
-olol
Any meds ending in that are beta blockers
Anti hypertensives medications
Diuretics
Adrenergic inhibiting agents
Angiotensin converting enzymes (ACE) inhibitors
Angiotensin Ii receptor antagonists
Calcium channel blockers
Direct vasodilators
ASA contraindications
Anti platelet drug
Given to chest pain patients unless bleeding disorders, active ulcers, erecting dysfunction drugs, severe asthmatic patients
Nitroglycerin MOA
Coronary vasodilator
Opens up coronary arteries causing increased perfusion
Opens up peripheral arteries causing decreased BP
Withhold nitroglycerin if 12 lead states
STEMI
Acute MI suspected
ST elevation criteria met
Indications for GI drug therapy
Peptic ulcers
Constipation
Diarrhea and emetics
Digestion
Drugs used to treat peptic ulcer disease
Antibiotics
H2 receptor antagonists
Proton pump inhibitors
Antacids
Anticholinergics
H2 receptor antagonists drugs (OTC)
Tagamet, Zantac, Pepcid, Axid
Proton pump inhibitor drugs (OTC)
Prisolec, Prevacid, Losec
Peptic ulcer symptoms
Epigastic pain “burning”
Heartburn
Chest discomfort
Hematemesis or Melena
What colour is stool with lower GI bleed?
Bright red blood
Drugs used to treat constipation
Laxatives -bulk forming
Stimulant
Osmotic
Surfactant
Drugs used to treat emesis
Antiemetics
Serotonin antagonists
What are enteral routes?

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