Paramedic Interfacility Transfer PHARMACOLOGY New Hampshire

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Paramedic Interfacility Transfer PHARMACOLOGY

• New Hampshire Department of Safety,
• Division of Fire Standards and Training
• Emergency Medical Service

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Terminal Objective

• At the completion of this section the student
  will have a review of pharmacology, learned in
  full, at a previous time

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Enabling Objectives

• At the conclusion of this section the student
  will be able to
• Define important pharmacological terms
• Discuss pharmacokinetics
• Discuss pharmacodynamics
• Discuss the autonomic nerve system

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Enabling Objective continued

• At the conclusion of this section the student
  will be able to
• Describe the general concepts of medication
  orders during interfacilty transfers
• Defend the need for having a general knowledge of
  the commonly used pharmacologic agents for
  interfacility transfer
• Given a scenario, defend the need to question
  medication orders

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Goals of the Pharmacology Review

• Briefly review information that you have already
  had in your paramedic programs.
• The purpose of this program is not to teach new
  concepts of pharmacology

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Medication and Transport

• The most common reason that you will be asked to
  transport a patient utilizing the PIFT module
  will be because the patient requires
  administration or monitoring of a medication or
  medications other than those normally carried in
  the paramedic drug box.

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Medication and Transport

• The new PIFT module allows an appropriately
  trained paramedic to administer or monitor 20
  classes of medications, including over the
  counter (OTC) medications

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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 significant responsibility.
• Safe, effective transport of patients requires
  sound, fundamental knowledge of basic principles
  of pharmacology.

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IMPORTANT PHARMACOLOGICAL 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
  the same drug. Caused by buildup in the blood.

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• Hypersensitivity
• A reaction to a drug that is more profound than
  expected and which often results in an
  exaggerated immune response
• Idiosyncrasy
• A reaction to a drug that is significantly
  different from what is expected
• Indication
• The medical condition for which the drug has
  proven therapeutic value

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• Parenteral
• Any route of administration other than the
  digestive tract
• Pharmacodynamics
• Study of the mechanisms by which drugs act to
  produce biochemical or physiological changes in
  the body
• Pharmacokinetics
• Study of how drugs enter the body, reach their
  site of action and are eliminated from the body

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• Potentiation
• The enhancement of a drugs effect by another
  drug
• Eg. promethazine may enhance the effect of
  morphine 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 acting
  independently

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• Therapeutic Action
• The intended action of a drug given in an
  appropriate medical 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
  and the 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 the
  desired 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 action of drugs
• Particularly emphasizes the following
• Absorption
• Distribution
• Biotransformation
• Excretion

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ABSORPTION

• The movement of a drug from its point of entry
  into the body into systemic 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 of absorption 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 are inactivated and
  transformed into a form that can be eliminated
  from the body

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BIOTRANSFORMATION

• Inactive forms are called metabolites
• Rate of transformation will determine how often a
  drug must be administered
• Eg. Epinephrine transforms in 3-5 minutes
• The liver is the most significant organ in the
  transformation process

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EXCRETION

• The process of eliminating drugs from the body

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EXCRETION

• Primarily accomplished through the kidneys but
  may also involve the liver, the lungs,
  intestines, sweat and mammary glands

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PHARMACODYNAMICS

• How a drug works and how we can expect the body
  to respond to the administration of a drug

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PHARMACODYNAMICS

• Most drugs work through interactions with
  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 the principle 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 divided into
  afferent and efferent divisions.
• The section of the efferent division that
  controls involuntary bodily functions is known as
  the Autonomic Nervous System.
• These functions include cardiac function, body
  temperature, smooth muscle, gland function 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 and
  norepinephrine
• Chemical substances that facilitate excitation or
  inhibition of target cells

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• A drug that stimulates the sympathetic nervous
  system is known as a sympathomimetic or
  adrenergic agent
• A drug that inhibits the sympathetic nervous
  system is called a sympatholytic 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 a
  Parasympathomimetic or cholinergic drug
• Eg. Prostigmine
• A drug that blocks or inhibits the system is
  called a Parasympatholytic or anticholinergic
  drug
• Eg. Atropine

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Classifications of Medications

• Anticoagulants
• Anticonvulsants
• Antidiabetics
• Antidysrhythmics
• Antihypertensives
• Anti-infectives
• Antipsychotics
• Cardiac Glycosides
• Corticosteroids
• Drotrecogin

• GI Agents
• IV fluids
• Narcotics
• Parenteral Nutrition
• Platelet Aggregation Inhibitors
• Respiratory Medications
• Sedatives
• Thrombolytics
• Vasoactive agents
• Paralytics
• Blood Products

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GENERAL CONCEPTS

• Check transfer order carefully to be sure that
  all medications ordered are permitted under 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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GENERAL CONCEPTS

• Ask the physician or RN to review medication 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

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GENERAL CONCEPTS

• Determine how long it will take to reach
  receiving facility and calculate the amount of
  the drug you will need to reach your destination.
  
• Allow for unforeseen delays.

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GENERAL CONCEPTS

• Check to be sure that you have the right drug and
  the right concentration.
• Check expiration dates of all medications.

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GENERAL CONCEPTS

• Be sure that you thoroughly understand how to use
  the infusion pump being supplied by the hospital
• Are you able to troubleshoot potential problems?
• Check IV site for patency, redness, etc.

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GENERAL CONCEPTS

• Be sure to have a drug reference book available
  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 becomes necessary
  to administer another drug to ascertain possible
  interaction problems

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• OK, lets look at the drug classifications in the
  PIFT program