paramedic pharmacology

1. PHARMACOLOGY

2. RESPIRATORY MANAGEMENT

3. BETA- 2 AGONISTS
Albuterol can promote cellular
reuptake of potassium.
Xopenex is similar to albuterol but
without Beta-1 effects.

4. RACEMIC EPINEPHRINE:
Like epinephrine but without
the cardiovascular effects.
Commonly given for croup.

5. ANTICHOLINERGICS

6. CORTICOSTEROIDS:
Have immunosuppressant properties. Have many
special considerations and contra-indications.

7. CORTICOSTEROIDS WE USE AND RUN INTO

8. COMPLICATIONS OF STEROIDS LONG TERM

9. CORTISOL- NATURAL STEROID FROM
ADRENAL GLAND
Cushing Syndrome:
Increased Bgl
Weight gain
Water retention
Electrolyte imbalances
Moon face
Chicken head
Buffalo hump
Skinny legs/arms
Must be weaned off
prednisone

10. MAGNESIUM SULFATE

12. LEUKOTRIENE RECEPTOR ANTAGONISTS
Patients with asthma have an
increased number of leukotrienes
which cause bronchospasms.
Leukotrienes bind to receptors and
cause a release of histamines which
results in inflammation and edema.

13. LEUKOTRIENE RECEPTOR
ANTAGONISTS

14. METHYLXANTHINES

15. CENTRAL NERVOUS SYSTEM
STIMULANTS
• Amphetamines
• Methylphenidates
• Methylxanthines

16. AMPHETAMINES
Release dopamine and norepinephrine
Causes tachycardia, hypertension,
convulsions, and insomnia

17. METHYLXANTHINES
- NOT USED AS MUCH ANYMORE
•AMINOPHYLLINE
•THEOPHYLLINE
•CAFFEINE

18. AIRWAY MANAGEMENT MEDICATIONS

19. SEDATIVE HYPNOTIC AGENTS USED IN
AIRWAY MGMT.

21. KETAMINE DOSE- LEON / TFD
• SEDATION FOR VIOLENT PATIENT: 5 MG/KG IM
• PAIN: 0.1-0.5 MG/KG IV/IO
• INDUCTION FOR RSI: 1-2 MG/KG IV/IO

22. BENZOS AND BARBITUATES-
BUT FIRST

23. GAMMA-AMINOBUTYRIC ACID
GLUTAMATE

24. BARBITUATES-
HIGHLY ADDICTIVE
MAKE NEW GABBA

25. BENZODIAZEPINES

28. IT’S KIND OF LIKE THE NARCAN OF BENZOS BUT NOT
REALLY.

29. PARALYTICS
NEUROMUSCULAR BLOCKING AGENTS
• DEPOLARIZING
• NONDEPOLARIZING

30. DEPOLARIZING AGENT
ONSET: 1 MINUTE
DURATION: 5 – 10 MINUTES
DOSE: 1 – 2 MG / KG
CONTRAINDICATIONS:
HYPERKALEMIA, NARROW-ANGLE
GLAUCOMA, MALIGNANT
HYPERTHERMIA, & OLD BURNS

31. NON-DEPOLARIZING
ONSET:
1- 3 MINUTES
DURATION:
OVER 45 MINUTES

32. OPIATES
Opiate
receptors in
the brain

34. • Decreases preload
and afterload
• Decreases
myocardial oxygen
demand
• Duration 2 – 7 hours

35. • Duration 30 –
60 minutes
• Equivalent to
10 mg of
morphine
• May cause
decreased
chest wall
compliance

36. • Roxanol (morphine
sulfate) is a highly
concentrated
solution of
morphine sulfate.
• Used for oral
administration for
the treatment of
severe, chronic
pain.

37. NARCAN

38. SPEAKING OF PAIN MEDICATIONS…

40. • NSAID
• Do not give prior to
surgery
• Dose 15 – 30 mg IV

41. SPEAKING OF NSAIDS…
Acetylsalicylic Acid
Has antipyretic and
analgesic properties
Prevents formation of
thromboxane A2 which
causes platelets to
aggregate

43. ACETAMINOPHEN IS NOT AN NSAID
Not as useful as an anti-inflammatory
Given for mild pain and fever (not as
good as ibuprofen)
Overdose can cause acute liver
failure
Pediatric dose 10 – 15 mg/kg
200 mg/kg can cause toxicity

44. ANTIHISTAMINES

45. ANTIHISTAMINES
• First Generation
• Second Generation

46. FIRST GENERATION

47. Used to Treat:
Extrapyramidal
Symptoms (EPS)
(AKA) Extrapyramidal
Side Effects

48. Extrapyramidal Symptoms
(EPS):
• Drug induced side
effects
• D-2 receptors
• Dystonias (spasms)
• Acute dystonic reactions
• Bradykinesia
• Parkinsonism
• Tardive dyskinesia

51. SECOND GENERATION
DON’T CROSS THE BLOOD/BRAIN BARRIER

52. ANTIUSSIVES
• OPIOIDS- CODEINE AND HYDROCODONE
• NONOPIOIDS-

53. COUGH SUPPRESSANTS
DEXTROMORPHAN

54. EXPECTORANTS- LOOSENS MUCUS
MUCOLYTICS- THINS MUCUS

55. ANTIEMETICS

56. ZOFRAN
5-HT3 Receptor
antagonist
Blocks serotonin
Dose 4 – 8 mg

57. H-1 Antagonist
Weak Dopamine Antagonist

58. Compazine
Antiemetic/antipsychotic
Blocks dopamine
May cause EPS: Extrapyramidal Syndrome

59. BLOCKS SERATONIN AND DOPAMINE

60. DOPAMINE ANTAGONISTS MAY CAUSE EPS !
GIVE BENADRYL FOR ACUTE DYSTONIC
REACTIONS !

61. PROTON PUMP INHIBITORS

65. DIABETIC MEDICATIONS Functions
Biguanides
Metformin (Glucophage), Metformin liquid (Riomet), Metformin
extended release (Glucophage XR, Fortamet, Glumetza)
Decreases amount of glucose released from liver
Sulfonylureas
Glimepiride (Amaryl), Glyburide (Diabeta, Micronase), Glipizide
(Glucotrol, Glucotrol XL), Micronized glyburide (Glynase)
Stimulates the pancreas to release more insulin,
both right after a meal and then over several
hours
Meglitinides- Repaglinide (Prandin)
D-Phenylalanine Derivatives- Nateglinide (Starlix)
Stimulates the pancreas to release more insulin
right after a meal
Thiazolidinediones Pioglitazone (TZDs)
Pioglitazone (Actos)
Makes the body more sensitive to the effects of
insulin
DPP-4 Inhibitors
Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin ( Tradjenta)
Improves insulin level after a meal and lowers the
amount of glucose made by the body
Alpha-glucosidase Inhibitors
Acarbose (Precose), Miglitol (Glyset)
Slows the absorption of carbohydrate into the
bloodstream after eating
Combo Platters:
Pioglitazone & metformin) (Actoplus Met) Glyburide & metformin (Glucovance) Glipizide & metformin (Metaglip)
Sitagliptin & metformin (Janumet) Saxagliptin & metformin (kombiglyze ) Repaglinide & metformin (Prandimet)
Pioglitazone & glimepiride (Duetact)

68. Treatments for
hypoglycemia

69. Given for hypoglycemia
Also used for beta blocker overdose and
calcium channel blocker overdose

70. DIURETICS

76. ANTIHYPERTENSIVES
• Diuretics
• Adrenergic Inhibiting
• ACE Inhibitors
• Vasodilators
• Cardiac Glycosides

77. ADRENERGIC INHIBITING
• Alpha 1 antagonist
• Alpha 2 agonist
• Beta antagonist

78. ACE INHIBITORS AND THE

79. BLOOD PRODUCTS
AND MEDICATIONS THAT
AFFECT BLOOD CLOTTING

80. BLOOD PRODUCTS

81. HEMATOCRIT

83. PACKED RED BLOOD CELLS

84. BLOOD TRANSFUSIONS
• Can cause hypocalcemia
• Citrate-based solution combines with
Calcium
• Must be given Calcium
• May also cause hyperkalemia

85. BLOOD TYPING

86. TRANSFUSION REACTION

87. PLATELETS ARE GIVEN FOR
THROMBOCYTOPENIA.

88. PLASMA IS GIVEN TO REPLACE
CLOTTING FACTORS… NOT VOLUME.

90. LIVER PATIENTS BLEED A LOT; THEY
CANNOT MAKE PROTEIN FOR CLOTTING
FACTORS.

91. TRANEXAMIC ACID (TXA)
PROMOTES BLOOD CLOTTING
1 GRAM OVER 10 MINUTES

92. CRASH-2 TRIAL

93. ANTICOAGULANT MEDICATIONS

94. ENHANCE ANTITHROMBIN III

95. FONDAPARINUX (ARIXA)

96. COUMADIN

97. COUMADIN
• Work on 4 clotting factors that use Vitamin K
• Vitamin K is the antidote
• Kcentra is another antidote
• Patient’s coumadin levels are inferred using
• PT (Prothombin Time) – Normal 11-13 seconds
• Patient’s on coumadin 2-3 times clotting time
• INR (International Normalized Ratio)- Normal 1-1.4
• Patient’s PT/ Normal PT

99. ANTIPLATELET AGGREGATES

102. CLOPIDOGREL (BETTER THAN ASA IN
THE HOSPITAL)

103. TICLOPIDINE (TRICLID)- ADVERSE
REACTIONS

104. XA INHIBITORS:
_____ + XA + BAN

106. GLYCOPROTIEN IIB/IIIA INHIBITOR
• Abciximab (ReoPro)
• Tirofiban (Aggrestat)
• Eptifibatide (Integrilin)
• Administered by IV infusion. May be encountered on
transport.
• 5-7% experience bleeding and thrombocytopenia

107. FIBRINOLYTICS