Introduction to essential Pharmacology for Advanced EMT and Paramedic Students. A bit long but a good lecture. Does not goo into individual drugs, that is later. This is JUST the introduction.

1. Introduction to Pharmacology
Introduction to
Pharmacology
By: Robert S. Cole
CWI Paramedic Class 2014

2. Learning Objectives
 Describe pharmacological as a science and a
historical perspective
 Differentiate chemical, generic, trade names of drug
 List main sources of drug products
 Describe how drugs are classified
 List authoritative sources for drug information
 List legislative acts controlling drug use, abuse in U.S.
 Differentiate Schedule I, II, III, IV, V substances; list examples
 Discuss standardization of drugs
 Discuss paramedic’s s responsibilities and scope of
management pertinent to administration of
medications

3. Introduction
What is a drug?
What is
pharmacology?
Why is it important?

4. Introduction
 Drug :
 Substance (chemical agents) intended to diagnose,
cure, relieve, treat, prevent disease
 Affects structure/function of body
 Pharmacology : Study of drugs

5. Things that make you go hmmmmm
 Based on Greek:
 pharmakon: poison in classic Greek; drug in
modern Greek";
 - logia: "Study of"

6. Introduction
 Written records of drug use date back to the ancient
Egyptians
 Early writings on drugs were observational, and were not
based on science
 Early pharmacologists focused on natural substances,
mainly plant extracts.
 The theories of “Humors” were used for almost 2000
years.
 It wasn’t until the19th century that Pharmacology
developed as a biomedical science that applied the
principles of scientific experimentation to therapeutic
contexts.

7. Three Early Pharmacists
 Hippocrates
 Claudius Galen
 Pedanius Dioscorides

8. The Renaissance and Phamacology
 After Roman Empire fall, most European
cultures reverted to folklore, tradition,
superstition
 By contrast: Muslims, Greeks,
Italians/Romans, Jews combined knowledge
of math, science, created formularies
 Monasteries became some of the earliest
learning centers for pharmacy, medicine

9. “Modern” Pharmacology
 Pharmaceutical laws enacted late 19th, early 20th
century protecting public
 Drugs developed improved chronic illness
treatment 1950-current, more changes in
pharmacology than any other time

10. Introduction
 Subspecialties of Pharmacology
Pharmacokinetics
Pharmacodynamics
Pharmacogenetics
Pharmacogenomics
Pharmacogenosy

11. Pharmacokinetics vs.
Pharmacodynamics
 Pharmacokinetics describes the movement of the
drug throughout the body.
 The body’s effect on the drug (e.g. half-
life and volume of distribution),
 Pharmacodynamics described the effects of the
drug on the body, intentional or toxic
 Side effects, MOA, desired effects, etc

12. Pharmacokinetics
 When describing the pharmacokinetic properties of a
chemical, pharmacologists are often interested
in LADME:
 Liberation - disintegration (for solid oral forms {breaking down into
smaller particles}), dispersal and dissolution
 Absorption - How is the medication absorbed (through the skin,
the intestine, the oral mucosa)?
 Distribution - How does it spread through the organism?
 Metabolism - Is the medication converted chemically inside the
body, and into which substances. Are these active? Could they be
toxic?
 Excretion - How is the medication eliminated (through the bile,
urine, breath, skin)?

13. Pharmacokinetics
 This includes
 Active transport
 Facilitated diffusion
 Passive transport

14. Pharmacokinetics
 Active Transport
 Use of energy (typically ATP) across barrier (i.e.
membrane) into target tissue.
 Also may involve other ions
 Typically this is against a pressure gradient (or
else passive transport would work)

15. Pharmacokinetics
 Facilitated diffusion (also known
as facilitated transport or passive-mediated
transport)
 Passive transport “with a twist”
 Cell walls have specific properties that allow
passive transport of certain molecules and not
others.
 Polarity
 Size
 Protein assisted : “Channels”

16. Pharmacokinetics
 Pharmacokinetics considerations
 Molecule size and shape
 Solubility in water and lipids
 Ability to bind to tissue proteins
 Ionization

17. Pharmacodynamics
 Drugs may act in four different ways:
 Bind to a receptor site
 Change the physical properties of the cell
 Chemically combine with other chemicals
 Alter a normal metabolic pathway

18. Pharmacogenetics
and
pharmacogenomics
Pharmacogenetics and pharmacogenomics
Study unique genetic processes linked to DNA coding and genetics

19. Pharmacogenosy
 The study of natural drug sources
 Plants
 Animals
 Minerals
 What are some common examples of each drug
source?

20. Did you know?
“Crude Drugs”:
 A crude drug is any naturally occurring, unrefined substance
derived from organic or inorganic sources such as plant, animal,
bacteria, organs or whole organisms intended for use in
the diagnosis, cure, mitigation, treatment, or prevention of
disease in man or other animals.
 Crude drugs are unrefined medications in their raw or natural forms.
 Prior to the 1950s, every pharmacy student learned about crude
drugs in pharmacognosy class.
 Pharmacognosy is the study of the
proper horticulture, harvesting and uses of the raw medications found
in nature.
 By the 1980’s, this practice was discontinued in most western
pharmacology programs, increasing the reliance of pharmacist on
drug companies.
 Raising, harvesting and selling crude drugs was how many large
pharmaceutical companies started out.
 Companies such as Eli Lilly and Company sold crude drugs to
pharmacists to save them time and money, but the early pharmacy
graduate would know how to raise their own crude drugs if need be.

21. Plant Sources of Drugs
 Oldest source of medications
 Drugs may consist of using the entire plant,
leaves, roots, bulbs, stems, seeds, buds, or
blossoms

22. Where do Drugs come from?

23. Animal Sources of Drugs
 Body fluids or glands from animals can act as
sources for drugs
 Hormones
 Oils and fats
 Enzymes

24. Mineral Sources of Drugs
 Metallic and nonmetallic minerals provide various
inorganic materials
 Occur naturally or are combined to form acids,
bases, or salts

25. Orphan Drugs
 An orphan drug is a pharmaceutical agent that has been
developed specifically to treat a rare medical condition, the
condition itself being referred to as an orphan disease.
 Development, production, and marketing of an orphan drug is
not considered profitable under traditional pharmaceutical
business models, and therefore would likely not occur without
incentives.
 The assignment of orphan status to a disease and to any drugs
developed to treat it is a matter of public policy in many countries and
the World Health Organization (WHO), and has resulted in medical
breakthroughs that may not have otherwise been achieved due to the
economics of drug research and development.
 In the US and EU it is easier to gain marketing approval for an
orphan drug, and there may be other financial incentives such as
extended exclusivity periods.

26. Introduction
 Laboratory-produced drug
sources
 New drugs may be a more
pure form of a naturally
occurring drug or they may
be a synthetic form
 Or a combination
 i.e. Morphine vs. Fentanyl

27. Routes of Administration

28. Routes of Administration
 Routes of Administration
 Enteral Route
 Parenteral Route
 Topical Route

29. Routes of
Administration
 Subroutes of
administration
 Ingestion
 Injection
 Absorption
 Inhalation

30. Route of Administration
 Depends of many factors
 Accessibility
 Rate of absorption
 Deactivation by enzymes or acids
 Toxicity to tissues

31. Routes of Administration
Enteral
Orally (PO)
Parenteral (just a few)
Intramuscular (IM)
Subcutaneous (SC or SQ)
Intravenous (IV)
Inhalation
Sublinqual

32. Local vs. systemic effects
 Local effect
 Affects specific body part
 Systemic effect
 Affects entire body

33. Common Routes
Oral (PO) Slow
Intra-Dermal (ID) Slow
Subcutaneous (SQ) Slow
Topical /Trans Dermal (TD) Moderate
Intramuscular (IM) Moderate
Rectal (PR) Rapid
Sublingual (SL) Rapid
Endotracheal (ET) Rapid
Inhalation Rapid
Intra-Nasal (IN) Rapid
Intraosseous (IO) Immediate
Intavenous (IV) Immediate

34. Drug Absorption
 Drug’s progress from
its pharmaceutical
dosage form to a
biologically available
substance
 Several factors affect
drug absorption

35. Basic Principles of Pharmacology

36. Factors
1. Solubility
2. Concentration
3. pH
4. Site of absorption
5. Blood supply
6. Bioavailability

37. Bioavailability
 Bioavailability (BA) is a subcategory of
absorption and is used to describe the fraction
of an administered dose of unchanged drug
that reaches the systemic circulation
 By definition, when a medication is
administered intravenously, its bioavailability
is 100%.
 However, when a medication is administered via
other routes (such as orally), its bioavailability
generally decreases

38. Bioequivalence
 “The absence of a significant difference in the
rate and extent to which the active ingredient
or active moiety in pharmaceutical equivalents
or pharmaceutical alternatives becomes
available at the site of drug action when
administered at the same molar dose under
similar conditions in an appropriately designed
study” – The US FDA

39. Biotransformation
 Biotransformation has two effects:
 It can transform the drug into a more or less active
metabolite
 It can make the drug more water soluble (or less
lipid-soluble) to facilitate elimination

40. Biotransformation
 Can activate
metabolites to make
the drug active
(prodrugs)
 Many processes
occur in the liver
 First-pass effect
 Body detoxifies and
disposes of toxins and
excess drug by
increasing water
solubility

41. First Pass Metabolism
 The first-pass effect (AKA 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.
 It is the fraction of lost drug during the process of absorption which is
generally related to the liver and gut wall. Notable drugs that
experience a significant first-pass.
 After a drug is swallowed, it is absorbed by the digestive system and
enters the hepatic portal system through the portal vein to the liver.
 The liver metabolizes many drugs, sometimes to such an extent that
only a small amount of active drug emerges from the liver to the rest of
the circulatory system.
 This first pass through the liver thus greatly reduces the bioavailability of
the drug.
 Alternative routes administration like suppository , intravenous,
intramuscular, inhalational aerosol and sublingual avoid the first-pass
effect because they allow drugs to be absorbed directly into
the systemic circulation.

42. Distribution
 Several factors affect
distribution:
 Cardiovascular function
 Regional blood flow
 Drug storage reservoirs
 Physiological barriers

43. Physiologic Barriers
 Blood Brain Barrier/Placental barrier

44. BLOOD BRAIN BARRIER
 The blood- brain barrier is located in endothelial
cells of capillaries of the brain.
 The blood brain barrier is both a physical barrier
and a system of cellular transport mechanisms.
 It maintains homeostasis by restricting the
entrances of potentially harmful chemicals from
the blood, and by allowing the entrance of
essential nutrients.

45. BLOOD BRAIN BARRIER
 Lipid soluble molecules, (i.e.
ethanol , most opioids, and
caffeine) are able to penetrate
through the barrier relatively
easily via the lipid membranes
of the cells.
 In contrast, water soluble
molecules such as sodium and
potassium ions are unable to
transverse the barrier without
the use of specialized carrier-
mediated transport
mechanisms.

46. BLOOD BRAIN
BARRIER
 These endothelial cells of
capillaries in the brain are different
to those found in peripheral tissues
in various ways:
 Brain endothelial cells are joined by
tight junctions of high electrical
resistance providing an effective
barrier against molecules.
 In peripheral endothelial cells there
is good transcellular movement of
molecules. There is no such
movement in brain endothelial cells.
 Brain capillaries are in contact with
foot processes of astrocytes which
essentially separate the capillaries
from the neurones.

47. Astrocyte Feet?

48. 3 places w/ no
BBB
Incomplete
until 1-2 yrs
Hypothalamus/

49. Therapeutic Index
Medication must reach a certain concentration at the
target tissue to be effective
Therapeutic index
Therapeutic threshold

50. Therapeutic Index
 Dose calculation
 ED50
 LD50
 TD50

51. Elimination
 Can be affected by
 Drug half-life
 Accumulation
 Clearance
 Onset, peak, and
duration

52. Accumulation
 Accumulation: a drug that is not re-
administered is eliminated almost completely
over time, but a regularly administered
remains constant.
 When elimination is altered, accumulation
increases.
 In some cases this results in a drug exceeding
its therapeutic window.
 Tylonol is a common drug with this problem.
 Opioids as well.

53. Half Life
 Technically a biological half life or elimination
half-life
 In a medical context, half-life may also
describe the time it takes for the blood plasma
concentration of a substance to halve
("plasma half-life") its steady-state.
 The relationship between the biological and
plasma half-lives of a substance can be
complex, due to factors including
accumulation in tissues, active metabolites,
and receptor interactions.

54. Question
 Is the Half Life of a drug is 6 hours, how long
does it take to eliminate 98% the drug from the
body?

55. KEY POINT
 IT TAKES SIX HALF LIVES TO REACH 98%
ELIMINATION
 So it would take 36 hours for the hypothetical
drug to be (mostly) eliminated

56. Basics
 Drugs are eliminated in either their original form
or as metabolites
 Drug excretion is the movement of a drug or its
metabolites from the tissues back into circulation
and from secretion into organs of excretion

57. Drug Forms

58. Drug Forms
 Usually consist of a powder
dissolved in a liquid
Solute: drug
Solvent: liquid in which it is dissolved,
typicaly water
 Primary difference between one
preparation and another is the
solvent
 What is a solution?

59. Drug Forms
 Liquids
 Solids
 Suppositories
 Inhalants
 Sprays
 Creams/lotions
 Patches
 Lozenges

60. Liquid Drugs
 Solutions: preparations that
contain a drug dissolved in a
solvent, usually water.
 Tinctures: drugs chemically
extracted from alcohol.
 Suspensions: drugs that do not
remain dissolved in a solution.
 Spirits: drugs that contain volatile
chemicals dissolved in alcohol.
• Solutions: preparations that contain a
drug dissolved in a solvent, usually
water.
• Tinctures: drugs chemically extracted
from alcohol.
• Suspensions: drugs that do not remain
dissolved in a solution.
• Spirits: drugs that contain volatile
chemicals dissolved in alcohol.

61. Liquid Drugs
 Emulsions: an oily
substance is mixed
with a solvent into
which it doesn’t
dissolve.
 Elixirs: a drug in an
alcohol solvent.
 Syrups: drugs
suspended in sugar
and water to improve
the taste.

62. Packaging
 Packaging and
preparations
 Vials
 Ampules
 Self-contained systems or
syringes
 Nebules

63. Solid Drugs
 Administered orally or rectally
 Pills: shaped into a form
 Powders: dry, particulate form of drug
 Capsules: gelatin container filled with powder
 Tablets: compressed powder covered with sugar coating
 Suppositories: carried in a solid base that melts at body
temperature
• Administered rectally or vaginally
• Produce local and systemic effects

64. Inhalants
Both powdered or liquid forms of a
drug given via the respiratory route
and absorbed by the capillaries in the
lungs.
Nebulizers
Metered-dose aerosols
Turbo inhalers
Vaporizers

65. Take a Break….

66. Receptors

67. Receptors
 Mechanism of
Action: how a
drug works
Drug action
Drug effect

68. Receptors
 Drug receptors: proteins present on cell
membrane to which a drug must bind in order to
elicit a desired response

69. Receptors
 Receptors are classified based on effects
 Agonist
 AKA “ –Memetic”
 Antagonist
 Competitive antagonist
 Noncompetitive antagonist
 AKA “ -lytic”
 A drug attached to a receptor site displays affinity

70. Receptors

71. Receptors
 Efficacy: the power of a drug to
produce a therapeutic effect
 Agonists have affinity and efficacy
 Antagonists have affinity but not efficacy
 Drug potency: relative amount of drug
required to produce the desired
response

72. Receptors
 How do drugs bind to receptor sites?
 Ionic bonds: chemical bonds in which ions are transferred from
one molecule to another so that one end is positive and the
other negative
 Hydrogen bonds: bonds that share a hydrogen ion between
molecules
 Hydrophobic bonds nonpolar bonds created between
molecules
 Van der Waals forces: transient, weak electrical attraction of
one atom for another that allows a molecule to change shape
 Covalent bonds: chemical bond between two atoms achieved
by sharing pairs of electrons

73. Receptors
 Receptor sites
 Several drugs may bind to the same receptor site,
thus creating different responses by the cells
 Two main functions
 Ligand binding
 Message propagation

74. Neurotransmitters

75. Neurotransmitters
 The nervous system is
the body’s control
system, regulating all
bodily function via
electrical impulses
 What are the two main
parts of the central
nervous system that
drugs can affect?

76. Neurotransmitters
 Two divisions:
 Central Nervous System (CNS)
 Peripheral Nervous System (PNS)

77. Neurotransmitters

78. Neurotransmitters
Organ Sympathetic stimulation Parasympathetic stimulation
Heart Increased rate,
force
Decreased rate,
force
Lungs Bronchodilation Bronchoconstriction
Kidneys Decreased output None
Systemic blood
vessels
Constricted – a
dilated – b
None
Liver Glucose release Glycogen synthesis
Blood glucose Increased None
Pupils Dilated Constricted
Basal metabolism Increased up to
100%
None
Skeletal muscle Increased strength None

79. Neurotransmitters
 Nerves of the
autonomic nervous
system exit the CNS
and enter autonomic
ganglia

80. Neurotransmitters
 No connection exists between two nerve cells or
a nerve cell and its target organ; instead there is
a space called a synapse
 Neurotransmitters are specialized chemicals that
conduct impulses between nerve cells or between
a nerve cell and an organ

81. Neurotransmitters
 Neurotransmitters of ANS:
 Acetylcholine (Ach)
 Norepinephrine (NE)
 Synapses:
 Cholinergic synapses: use acetylcholine
 Adrenergic synapses: use norepinephrine

84. Neurotransmitters
 What is the action of an adrenergic drugs?
 What is the action of a cholinergic drug?

85. Neurotransmitters
 Cholinergic receptors
 Acetylcholine Interacts with receptors, physiologic
response
 Sympathetic receptors (Adrenergic receptors)
 When sympathetic division stimulated, adrenal
medulla stimulated, releases epinephrine into
circulatory system
 Sympatho-mimetic
 Sympatho-lytics

86. Neurotransmitters
 Sympathetic Nervous System
 Arises from the thoracic and lumbar regions of the
spinal cord
 Results in direct stimulation of adrenal medulla and
release of norepinephrine (noradrenaline) and
epinephrine (adrenaline)

87. Neurotransmitters
 Sympathetic Nervous System
 Stimulation ultimately results in release of
norepinephrine from postganglionic nerves
 Sympathetic stimulation also results in release of
epinephrine and norepinephrine from the adrenal
medulla
 What is/are the chemical mediators of the SNS?

88. Neurotransmitters
 Types of sympathetic receptors
 What is the action of adrenergic receptors?
 Alpha1 (a1)
 Alpha2 (a2)
 Beta1 (b1)
 Beta2 (b2)
 Of dopaminergic receptors?

89. Neurotransmitters
alpha1 (a1) Peripheral vasoconstriction, increased
contractile force, decreased rate
alpha2 (a2) Peripheral vasoconstriction
beta1 (b1) Increased heart rate, contractile force and
automaticity
beta2 (b2) Peripheral vasodilation, bronchodilation,
uterine smooth muscle relaxation
dopaminergic Renal vasodilation and mesenteric
vasodilation
Receptor Actions

90. Neurotransmitters
 Sympathomimetics: medications that stimulate the
sympathetic nervous system
 Sympatholytics: medications that inhibit the
sympathetic nervous system

91. Neurotransmitters
 The Parasympathetic Nervous System
 Arises from the brain stem and sacral segments of the
spinal cord
 Synapse in parasympathetic ganglia
 What is/are the chemical mediators of the PNS?

92. Neurotransmitters
 Stimulation of the parasympathetic nervous
system results in:
 Pupillary constriction
 Secretion by digestive glands
 Increased smooth muscle activity along GI
tract
 Bronchoconstriction
 Reduction in heart rate and contractile force

93. Neurotransmitters
 Parasympatholytics: medications that block the
actions of the parasympathetic nervous system
 Parasympathomimetics: medications that stimulate
the parasympathetic nervous system

94. Homeostasis and Balance

95. Homeostasis and
Balance
 Our bodies require
constant regulation in
order to maintain
balance and control

96. Legal Concerns and
Drugs

97. Legal Concerns
 Legal regulations, standards, and legislation
 International controls
 United Nations World Health Organization provides technical
assistance and encourages new research for drug use
 US Controls
 The FDA and the DEA share responsibility and enforcement

98. The FDA
 In the United States, the Food and Drug Administration (FDA) is
responsible for creating guidelines for the approval and use of
drugs. The FDA requires that all approved drugs fulfill two
requirements:
 The drug must be found to be effective against the disease for which
it is seeking approval.
 The drug must meet safety criteria by being subject to extensive
animal and controlled human testing.
 Gaining FDA approval usually takes several years to attain.
Testing done on animals must be extensive and must include
several species to help in the evaluation of both the
effectiveness and toxicity of the drug. The dosage of any drug
approved for use is intended to fall within a range in which the
drug produces a therapeutic effect or desired outcome.
 The safety and effectiveness of prescription drugs in the U.S. is
regulated by the federal Prescription Drug Marketing Act of 1987.

99. Legal Concerns
 Legal regulations, standards, and
legislation
Controls in the U.S.
 Testing (animals studies and clinical patient trials)
 Legislative control

100. Legal Concerns
 Legal regulations, standards, and legislation
 “Truth in labeling”
 Why might “truth in labeling” be important?

101. Legal Concerns
 Legal regulations, standards, and legislation
 Narcotics
 Harrison Narcotic Act, 1914
 Comprehensive Drug Abuse Prevention and Control Act, 1970

102. Schedule of Controlled Drugs
Category Examples
Schedule I
No recognized medical use;
high abuse potential
Opiates (heroin), hallucinogens (LSD),
depressants (methaqualone)
Schedule II
Written prescriptions required;
no telephone renewals
Opiates (codeine, morphine,
meperidine), stimulants
(amphetamines), depressants
Schedule III
Prescriptions rewritten after six months
or five refills
Opiates (codeine <1.8 g/dl), stimulants,
depressants, anabolic steroids
Schedule IV
Prescriptions rewritten after six months
or five refills
Opiates (propoxyphene), stimulants,
depressants (chloral hydrate)
Schedule V
Any non-
narcotic medication, OTC
Small amounts of opiates when uses as
antitussives or antidiarrheals

103. Legal Concerns
 Legal regulations, standards, and legislation
 Controlled Substances Act, 1970

104. KEY NOTEs
 The US scheduling system and the WHO
scheduling system is very similar, but still slightly
different.
 The scheduling does not include distilled spirits,
wine, malt beverages, or tobacco


105. Split Schedule Drugs
 gamma-Hydroxybutyric acid (GHB), which has
been used as a general anaesthetic and for
the treatment of narcolepsy and alcohol
withdrawal and controlled action but a limited
safe dosage range.
 It was placed in Schedule I in March 2000
after widespread recreational use led to
increased emergency room visits,
hospitalizations, and deaths.
 Uniquely, this drug is also listed in Schedule
III for limited uses, under the
trademark Xyrem;

106. Legal Concerns
 Legal regulations, standards, and legislation
 Canadian drug legislation
 Under direct control of Department of National Health and Welfare
 Food and Drug Act, 1941
 Canadian Food and Drugs Act, 1953

107. Legal Concerns
 Legal regulations, standards, and legislation
 Canadian Narcotic Control Act and Regulations
 Canadian Narcotic Control Act, 1965
 Restricts sale, possession, and use of narcotics
 Restricts narcotic distribution to authorized personnel

109. Drug Names and References

110. Need to Know
 Legal regulations, standards, and legislation
 Drug Standards
 United States Pharmacopeia (USP) is official standard to maintain
uniformity

111. Drug Names and References
 Drug Classification
Prescription (Rx)
Over-the-counter (OTC)
 Herbal
Dietary Suppliments

112. Drug Names and References
 Drug Names
 Official: generally same as generic name
 meperidine hydrochloride, USP
 Chemical: anatomic and molecular structure
 Ethyl 1-methyl-4-phenylisonipecotate hydrochloride
 Generic: abbreviated version of chemical name
 meperidine hydrochloride
 Trade: name based on chemical name or problem used
to treat
 Demerol hydrochloride
 What is another term for a drug’s trade name?
 Brand Name

113. Drug Approval by the FDA
 A process must be approved by the FDA
 Studies take place in four phases
 Preclinical testing, research, and development
 Clinical research and development
 NDA Review
 Postmarketing surveillance

114. Typical Trials (FDA)
 Pre-Clinical
 Animal and lab studies
 Phase 0
 Optional, Studying basic pharmokenetics/dynamics in humans
 Phase 1
 Studied in healthy volunteers
 Phase 2
 To determine efficacy on patients , small groups limits study of
safety
 Phase 3
 Final studies prior to FDA approval and marketing
 Studied in real patients vs. control group
 Primarily for safety
 Phase 4
 Long Term studies on real patients

115. Drug Names and References
 Bringing a drug to market is a process that takes
several years and must be approved by the U.S.
Food and Drug Administration (FDA)

116. Drug Names and References
 Studies take place in four phases
 Preclinical testing, research and development
 Clinical research and development
 NDA Review
 Postmarketing surveillance

117. Drug Names and References
 New Drug Development
 Phase I
 Testing to determine the drug’s pharmacokinetics, toxicity, and
safe dosing in humans
 Phase II
 Determination of the therapeutic drug level and observation for
toxicity and side effects
 Phase III
 Refinement of the usual therapeutic dose and collection of relevant
data on side effects
 Phase IV
 Post marketing analysis during conditional approval
 Drug’s manufacturer is required to monitor its performance
 Expedited Drug Approval

118. Unlabeled uses of drugs
 Unlabeled uses of drugs
 AKA “Off Label”
 FDA recognizes that a drug’s labeling does not always
contain the most current information on usage

119. Classifying of Medications for
Therapies

120. Classifying Medications
 Classified with other similar medications with
the same effects
 Anatomical/Body system/disease used to treat
 cardiac, respiratory, GI
 Anti-arrhythmic, Anti-emetic
 Chemical group
 benzodiazepines, xanthine derivatives, nitrates, opioids,
TCA’s, SSRI’s
 Receptor binding site
 parasympathetic blocker, adrenergic, dopaminergic

121. AHA Classes of Recommendations
for Drug Therapies
 Class I
Benefit >>> Risk
Procedure/treatment or diagnostic
test/assessment should be
performed/administered
Table 15-7

122. Classes of Recommendations
• Most previous classes retained with better clarifications and descriptions.
•“Class Indeterminate” recommendations, which were used in 2005, are not
included in the 2010 AHA Guidelines for CPR and ECC. The elimination of the
term “Class Indeterminate” is consistent with the ACCF–AHA Classes of
Recommendation.
•When the AHA writing groups felt that the evidence was insufficient to offer a
recommendation either for or against the use of a drug or intervention, no
recommendation was given.

123. Levels of Evidence

124. KEY POINT:
“ A recommendation with Level of Evidence B or C does not imply
that the recommendation is weak. Many important clinical
questions addressed in the guidelines do not lend themselves to
clinical trials. Even though randomized trials are not available,
there may be a very clear clinical consensus that a particular test
or therapy is useful or effective.”
-2010 AHA ECC Guidelines
Circulation 2010;122;S657-S664

126. Patient Medication
Rights

127. Patient Medication Rights
 What are the six “rights” of patient medication
administration that ensure safe, proper, and
effective administration?

128. Patient Medication Rights
1. Right patient
2. Right medication
3. Right dose
4. Right route
5. Right time
6. Right documentation

129. Street Smart Medic Tip
 Be Very Careful with multiple patients, Mutiple
providers, and Multiple Drugs
 The complexity of ANY situation increases the
chance of a critical error in medication
administration.
 In otherwords:
 KEEP YOUR SH*T TIGHT!
Street Smart Medic Tip
• Be Very Careful with multiple patients,
Multiple providers, and Multiple Drugs
• The complexity of ANY situation
increases the chance of a critical error
in medication administration.
• In other words:
– KEEP YOUR SH*T TIGHT!

130. Additional stuff you
HAVE to know

131. What Paramedics Need to Know
About Drugs
 Comprehensive drug list based on protocol
 Be familiar with AHA Guidelines for treating cardiac
patients
 Know local protocol and drugs used in your region

132. Some
thoughts on
protocols

133. Pediatric
Dosages
 Know the pediatric
doses, adult doses, and
all approved routes for
administration

134. Street Smart Medic:
 Before giving any drug, several actions must
performed:
 Oxygen and monitor should be started as
appropriate
 Establish IV access with appropriate fluids started

135. Need to Know
 Components of a drug
profile
 Names
 Classification
 Mechanism of action
 Indications
 Pharmacokinetics

136. What Paramedics Need to Know About
Drugs
 Components of a drug profile
 Side effects/adverse reactions
 Contraindications
 Dosage
 How supplied
 Special considerations

137. Need to Know
 Special considerations in drug
therapy
 Pediatric patients
 Geriatric patients
 Pregnant and lactating patients

138. Need to Know
 Use care administering
medications
 Follow the medication
order

139. What Paramedics Need to Know
About Drugs
 Preparation involves selecting the appropriate
sized needle and syringe
 No compensation for dead space is necessary
when drawing up medications

140. What Paramedics Need to Know
About Drugs
 Use different needles when reconstituting
medication to be drawn up
 Use caution when mixing drugs in one syringe
 ALWAYS use sterile technique

141. Need to Know
 Medical control
 As a paramedic, you operate under the licensure of a
medical director who is responsible for all of your
actions
 The medical director determines which drugs you will
administer and the routes by which they are given

142. Need to Know
 Reduce the potential for contamination
 Identify allergies prior to contacting hospital
 Obtain vital signs
 Obtain and confirm/repeat order
 Write the order and the time

143. Need to Know
 Select the proper medication
 Inspect the medication
 Confirm the order and medication
 Six rights of administration
 Record drug, dose, volume, route, and time, and
obtain vital signs and effects

144. What Paramedics Need to Know
About Drugs
 Storage and handling considerations
 USP28-NF23, PF30 (6), p. 2118
 “Storage of Drugs in Emergency Medical Services (EMS)
Vehicles”
 Narcotics and controlled substances should be
secured according to local protocols

145. Need to Know
 Important pharmacological terminology
 What is antagonism?
 What is cumulative action?
 What is potentiation?
 What is synergism?

146. Need to Know
 Important
pharmacological
terminology
 Contraindications
 Hypersensitivity
 Idiosyncrasy
 Side effects
 Untoward effects

147. Need to Know
 Important pharmacological terminology
 Bolus
 Indication
 Therapeutic action
 Tolerance

148. Need to Know
 Important pharmacological
terminology
 Depressant
 Habituation
 Refractory
 Stimulant

149. Administration
Procedures

150. Preparation
 Before starting each shift, make sure all medications
are
 Stocked in the proper amount
 Not expired
 In good condition
 Stored properly

151. Preparation
 Make sure you have adequate supplies to administer
them
 Including syringes, needles, or needleless systems

152. Narcotic Drugs
 Follow local, state, and
federal regulations when
it comes to usage and
storage

153. Administration Procedures
 Premedication procedures
 Obtain a complete SAMPLE history
 Obtain a full set of vital signs
 Complete a detailed exam
 Contact medical control for authorization

154. Consider the whole patient…
 Complete a thorough
assessment
 Look for medication bottles
and herbal preparations
 Determine if the patient
has been compliant with
his or her medication
 Consider the medications
the patient already has on
board before you give any
more….

155. Get Good Data
 Get a FULL set of RELIABLE vitals before you
administer a medication
 Be Prepared for adverse reactions
 Know your situation…

156. Administration Procedures
 Prior to administration
 Make sure you have all necessary equipment

157. Medical Asepsis During Medication
Administration
 Medical asepsis is
keeping the environment
free of pathogens
 Several ways to keep the
environment clean
include:
 Sterilization
 Medically clean
 Disinfectants
 Antiseptics

158. Disposal of Contaminated Material
 Use sharps container
to dispose of anything
capable of piercing
the skin
 Dispose of all
contaminated material
in the proper
biohazard container

159. Administration Procedures
 Post-medication procedures
 Document
 Obtain a full set of vital signs
 Complete a detailed exam
 Ongoing assessment

160. Summary

161. Summary
 In order to deliver exceptional patient care,
the paramedic must have a basic
understanding of the responsibilities and
scope of management prior to administration
of any drug

162. The
END