Paramedic Care: Principles & Practice Volume 1 Introduction to Advanced Prehospital Care
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Transcript of Paramedic Care: Principles & Practice Volume 1 Introduction to Advanced Prehospital Care
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Paramedic Care:Principles & Practice
Volume 1Introduction to Advanced
Prehospital Care
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 9 General Principles of
Pharmacology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 9, Part 1Basic Pharmacology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Part 1 Topics
General AspectsLegal AspectsDrug Research and DevelopmentPatient Care Using MedicationsPharmacology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
IntroductionThe use of herbs and minerals to treat the sick and injured has been documented as long ago as 2000 BC. Presently, the Food and Drug Administration (FDA) is allowing many previously prescription-only drugs to become available over the counter. – Growing consumer awareness in health care – Consumer marketing by the pharmaceutical
industry
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Aspects
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Aspects
Drugs are chemicals used to diagnose, treat, or prevent disease. Pharmacology is the study of drugs and their actions on the body. Health care professionals have a systematic method for naming drugs.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug NamesChemical– States its chemical composition and molecular
structureGeneric– Usually suggested by the manufacturer
Official– As listed in the U.S. Pharmacopeia
Brand– The trade or proprietary name
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chemical Name 7-chloro-1, 3-dihydro-1, methyl-5-phenyl-2h-1
Generic Name diazepam
Official Name diazepam, USP
Brand Name Valium®
Drug Names
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Sources of Drug Products
Four main sources of drugs are: – Plants
The oldest source of medications Purple foxglove
– Animals Extracts of bovine (cow) and porcine (pig) pancreas
– MineralsInorganic sources of drugs such as calcium chloride
– SyntheticCreated in the laboratory
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Reference Material
United States Pharmacopeia (USP)Physician’s Desk Reference (PDR)Drug InformationMonthly Prescribing ReferenceAMA Drug EvaluationEMS field guides
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Components of a Drug Profile
Names– Most frequently include generic and trade
names
Classification– The broad group to which a drug belongs
Mechanism of Action– The way in which a drug causes its effects
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Components of a Drug Profile
Indications– Conditions that enable the appropriate
administration of the drug
Pharmacokinetics– How the drug is absorbed, distributed, and
eliminated
Side Effects/Adverse Reactions– The drug’s untoward or undesired effects
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Components of a Drug Profile
Routes of Administration– How the drug is given
Contraindications– Conditions that make it inappropriate to give the
drug
Dosage– Amount of the drug that should be given
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Components of a Drug Profile
How Supplied– Includes the common concentration of the
available preparations
Special Considerations– Pediatric, geriatric, or pregnant patients
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Legal Aspects
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Legal Aspects
It is important to know and obey the laws and regulations governing medications and their administration.These include federal, state, and agency regulations.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Federal
Pure Food and Drug Act of 1906Harrison Narcotic Act of 1914Federal Food, Drug, and CosmeticAct of 1938Comprehensive Drug AbusePrevention and Control Act of 1970
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
State and Local Standards
State– State laws vary widely.
Some states have legislated which medications are appropriate Others have left those decisions to local control
– The medical director can delegate to paramedics the authority to administer medications.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
State and Local Standards
Local– Local leaders are responsible for ensuring public
safety. – EMS agencies have the responsibility to create
local policies and procedures to ensure the public well-being.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug Standards
Standardization of drugs is a necessityAssay – Determines the amount and purity of a given
chemical in a preparation in the laboratory
Bioequivalence– Relative therapeutic effectiveness of chemically
equivalent drugs
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug Research and Development
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug Research and Development
Initial drug testing begins with the study of both male and female mammals. Pharmacokinetics tested in animalsProgresses to human testing
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Patient Care Using Medications
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Patient Care Using Medications
Know the precautions and contraindications for all medications you administerPractice proper techniqueKnow how to observe and document drug effects
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Patient Care Using Medications
Maintain a current knowledge inpharmacologyEstablish and maintain professionalrelationships with other health care providersUnderstand pharmacokinetics andpharmacodynamics
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Patient Care Using Medications
Have current medication referencesavailableTake careful drug histories including:– Name, strength, dose of prescribed medications– Over-the-counter drugs– Vitamins– Herbal medications– Allergies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Patient Care Using Medications
Evaluate the patient’s compliance, dosage, and adverse reactionsConsult with medical direction as needed
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The 6 Rights of Medication Administration
Right medicationRight dosageRight timeRight routeRight patientRight documentation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Considerations
Pregnant patientsPediatric patientsGeriatric patients
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pregnant Patients
Ask the patient if there is a possibility that she could be pregnant.Some drugs may have an adverse effect on the fetus of a pregnant female.– A drug’s possible benefits to the mother must
clearly outweigh its potential risks to the fetus.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pregnant Patients
The FDA has developed the classification system for the administration of drugs to a pregnant patient.Consult medical direction.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pediatric Patients
Several physiological factors affect pharmacokinetics in newborns and young children. Children up to one year old have diminished plasma protein concentrations. – Drugs that bind to proteins have higher free drug
availability.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pediatric Patients
A higher amount of total body water means a greater volume and may require higher drug doses.The newborn’s metabolic rates may be much lower than an adult’s– Rise rapidly in the first few years.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pediatric Patients
Pediatric drug dosages must be individualized to minimize the risks of toxicity. The Broselow tape
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Geriatric Patients
Significant changes in pharmacokinetics may also occur in patients older than about 60 years. – Decreased gastrointestinal motility – Decreased plasma proteins– Body fat increases and muscle mass decreases
with age – Multiple medications or to have multiple
underlying disease processes
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pharmacology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pharmacology
The study of drugs and their interactions with the body. Drugs may be given for their local action or for systemic action.
Two major divisions: – Pharmacokinetics – Pharmacodynamics
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pharmacokinetics
Review of Transport– Active transport
Requires energy or ATP
– Facilitated diffusionCarrier-mediated protein
– Passive transportOsmosis and diffusion
– Filtration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug Absorption
Several factors affect a drug’s absorption: – Route given– Perfusion of tissue– Solubility– Ionization and Ph– Absorbing surface– Concentration of drug
Bioavailability refers to drug available at tissue level
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Distribution
Most drugs will pass from bloodstream to target tissues.Some proteins bind drugs for a prolonged time.– Only unbound drugs can cross the cell
membrane.– Changing the pH of blood may affect protein
binding.Increasing pH enhances TCA binding.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Distribution
Certain organs exclude some drugs from distribution. – Blood-brain barrier
Only non-protein bound, lipid-soluble drugs may exit CNS vasculature.
– Placental barrierRestricts drug delivery to fetus
Other stores– Fats– Specific tissues
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Biotransformation
The metabolism of drugs is called biotransformation.Effects of biotransformation:– Can transform the drug into a more or less
active metabolite – Can make the drug more water soluble (or less
lipid soluble) to facilitate elimination
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Biotransformation
Many biotransformation processes occur in the liver. – First-pass effect
The first pass through the liver may partially or completely inactivate many drugs.
– Microsomal enzymesPhase IPhase II
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug Elimination
Most drugs (toxins and metabolites) are excreted in the urine. Renal excretion methods– Glomuler filtration
Function of glomerular filtration pressure
Results from blood pressure and blood flow – Tubular secretion
Active transport pumps in proximal tubule
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug Routes
How a drug is given has an impact on absorption and distribution.Routes – Enteral
Absorption through the gastrointestinal tract
– ParenteralAny area outside of the gastrointestinal tract
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Enteral Drug Administration
Oral (PO)Oro/nasogastric (OG/NG)Sublingual (SL)BuccalRectal (PR)
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Parenteral Drug Administration
Intravenous (IV)Endotracheal (ET)Intraosseous (IO)UmbilicalIntramuscular (IM)Subcutaneous (SC)
Inhalation/NebulizedTopicalTransdermalNasalInstillationIntradermal
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug Forms
Solid forms:– Pills, powders, suppositories, capsules
Liquid forms:– Solutions, tinctures, suspensions, emulsions,
spirits, elixirs, syrups
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Solid FormsPills– Drugs shaped spherically to be swallowed
Powders– Not as popular as they once were
Tablets– Powders compressed into disk-like form
Suppositories– Drugs mixed with a waxlike base that melts at
body temperatureCapsules– Gelatin containers filled with powders or tiny pills
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Liquid Forms
Solutions– Water or oil-based
Tinctures– Prepared using an alcohol extraction process
Suspensions– Preparations in which the solid does not dissolve
in the solventEmulsions– Suspensions with an oily substance in the
solvent
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Liquid Forms
Spirits– Solution of a volatile drug in alcohol
Elixirs– Alcohol and water solvent, often with flavoring
Syrups– Sugar, water, and drug solutions
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug Storage
Drug properties may be altered by the environment in which they are stored. – Changes in temperature, light, and moisture.
Potency of most medications is altered if they are not stored in proper conditions. EMS must consider the storage requirements of all drugs and diluents.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pharmacodynamics
Pharmacodynamics studies the effects of a drug on the body.– Mechanism of action– Relationship between dose and effect
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pharmacodynamics
Actions of Drugs – Binding to a receptor site– Changing physical properties– Chemically combining with other substances– Altering a normal metabolic pathway
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Receptor Site Binding
Most drugs bind with protein receptorsAffinity and EfficacyAgonist/Antagonist effects– Competitive antagonism– Non-competitive antagonism– Irreversible antagonism
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Receptor Site Binding
Click here to view an animation on antagonists.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Changing Physical Properties
Some drugs change the physical properties of a part of the body. – Drugs that change the osmotic balance across
membranes are examples.Mannitol
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drugs that Chemically Combine With Other Substances
Cause chemical reactions that change the chemical nature of their substrates– Alcohol denatures proteins on the skin– Sodium Bicarbonate neutralizes acids in the
bloodstream– Antacids neutralize stomach acid
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Altering a Normal Metabolic Pathway
Anticancer and antiviral drugs are chemical analogs of normal metabolic substrates. – Counterfeit incorporation mechanism
These drugs can be incorporated into the products of metabolism of cancer cells. – The anticipated product either will not form or be
substantially changed.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Responses to Drug Administration
Side effect– Unintended response to a drug
Allergic reaction– Hypersensitivity
Idiosyncrasy– Drug effect unique to an individual
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Responses to Drug Administration
Tolerance– Decreased response to the same amount
Cross tolerance– Tolerance for a drug that develops after
administration of a different drug
Tachyphylaxis– Rapidly occurring tolerance to a drug
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Responses to Drug Administration
Cumulative effect– Increased effectiveness when a drug is given in
several dosesDrug dependence– The patient becomes accustomed to the drug’s
presence in his bodyDrug interaction– The effects of one drug alter the response to
another drugDrug antagonism– The effects of one drug block the response to
another drug
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Responses to Drug Administration
Summation– Also known as additive effect. Two drugs with
the same effect are given together—similar to 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—similar to 1+1=3.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Responses to Drug Administration
Potentiation– One drug enhances the effect of another
Interference– The direct biochemical interaction between two
drugs; one drug affects the pharmacology of another drug
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug-Response Relationship
A drug-response relationship correlates different amounts of drug to the resultant clinical response. Factors affecting relationship:– Pharmaceutical– Pharmacokinetic– Pharmacodynamic
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug-Response Relationship
Plasma Profile– Onset of action
Time from administration to minimum effective dose– Termination of action– Therapeutic index
Represents the margin of safety– Biologic Half-life
The time the body takes to clear one half of the drug
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Factors Affecting Drug Response
AgeBody massSexEnvironment
Time of administrationPathologyGeneticsPsychology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Drug Interactions
Drug interactions occur whenever two or more drugs are available in the same patient.– The interaction can increase, decrease, or have
no effect on their combined actions.
Nutritional effectsEffects of AlcoholIncompatibility– Precipitation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Part 1 Summary
General AspectsLegal AspectsDrug Research and DevelopmentPatient Care Using MedicationsPharmacology