Routes of Drug Admin

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Mosbyitems and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.1

Chapter 11Chapter 11

Basic Principles of PharmacologyBasic Principles of Pharmacology


Learning ObjectivesLearning Objectives

Describe pharmacological historic trendsDescribe pharmacological historic trends

Differentiate chemical, generic, trade names ofDifferentiate chemical, generic, trade names of

drugdrug

List main sources of drug productsList main sources of drug products

Describe how drugs are classifiedDescribe how drugs are classified



List authoritative sources for drug informationList authoritative sources for drug information

List legislative acts controlling drug use,List legislative acts controlling drug use,

abuse in U.S.abuse in U.S.

Differentiate Schedule I, II, III, IV, VDifferentiate Schedule I, II, III, IV, V

substances; list examplessubstances; list examples

Discuss standardization of drugsDiscuss standardization of drugs

Aehlert: Paramedic Practice Today

PowerPoint Lecture Notes

Chapter 11: Basic Principles of Pharmacology

Mosby items and derived items 2010 by Mosby, Inc. an affiliate of Elsevier Inc.


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Discuss investigational drugs, including FoodDiscuss investigational drugs, including Food

& Drug Administration approval process and& Drug Administration approval process and

classifications for newly approved drugsclassifications for newly approved drugs

Discuss paramedicDiscuss paramedics responsibilities ands responsibilities and

scope of management pertinent toscope of management pertinent to

administration of medicationsadministration of medications



Review specific anatomy, physiologyReview specific anatomy, physiology

pertinent to pharmacology with attention topertinent to pharmacology with attention to

autonomic pharmacologyautonomic pharmacology

List and describe general drug propertiesList and describe general drug properties

List and describe liquid, solid drug formsList and describe liquid, solid drug forms



List and differentiate drug administrationList and differentiate drug administration

routes, includingroutes, including enteralenteral andand parenteralparenteral

routesroutes

Describe mechanisms of drug actionDescribe mechanisms of drug action

List and differentiate phases of drug activity,List and differentiate phases of drug activity,

including pharmaceutical, pharmacokinetic,including pharmaceutical, pharmacokinetic,

andand pharmacodynamicpharmacodynamic phasesphases



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Describe pharmacokinetics andDescribe pharmacokinetics and

pharmacodynamicspharmacodynamics, including theories of, including theories of

drug action, drug response relation, factorsdrug action, drug response relation, factors

altering drug responses, predictable drugaltering drug responses, predictable drug

responses, iatrogenic drug responses, andresponses, iatrogenic drug responses, and

unpredictable adverse drug responsesunpredictable adverse drug responses

Discuss special considerations in drugDiscuss special considerations in drug

treatment regarding pregnant, pediatric, andtreatment regarding pregnant, pediatric, and

geriatric patientsgeriatric patients



Differentiate drug interactionsDifferentiate drug interactions

Discuss considerations for storing andDiscuss considerations for storing and

securing medicationssecuring medications

List components of drug profile byList components of drug profile by

classificationclassification


IntroductionIntroduction

DrugDrug

Substance intended to diagnose, cure, relieve,Substance intended to diagnose, cure, relieve,

treat, prevent diseasetreat, prevent disease

Affects structure/function of bodyAffects structure/function of body

PharmacologyPharmacology

Study of drugsStudy of drugs



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Historic Trends in PharmacologyHistoric Trends in Pharmacology

Ancient health careAncient health care

Potions, religious rituals, crude surgeriesPotions, religious rituals, crude surgeries

GrecoGreco--RomansRomans

HippocratesHippocrates

Claudius GalenClaudius Galen



The RenaissanceThe Renaissance

After Roman Empire fall, many reverted to folklore,After Roman Empire fall, many reverted to folklore,

traditiontradition

Muslims, Greeks, Romans, Jews combinedMuslims, Greeks, Romans, Jews combined

knowledge of math, science, created formulariesknowledge of math, science, created formularies

MonasteriesMonasteries

Learning sites, pharmacy, medicineLearning sites, pharmacy, medicine



Modern health careModern health care

Pharmaceutical laws enacted late 19Pharmaceutical laws enacted late 19thth, early 20, early 20thth

century protecting publiccentury protecting public

Drugs developed improved chronic illnessDrugs developed improved chronic illness

treatmenttreatment

19501950--current, more changes in pharmacology thancurrent, more changes in pharmacology thanany other timeany other time



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Present period of changePresent period of change

PharmacologyPharmacology -- constant research, developmentconstant research, development

Keep abreast of new medications, technologyKeep abreast of new medications, technology

May be asked questions about patient medicationsMay be asked questions about patient medications

Recognize side effects, adverse reactionsRecognize side effects, adverse reactions

Orphan drugsOrphan drugs


Drug NamesDrug Names

Chemical nameChemical name Description of drugDescription of drugs chemical composition,s chemical composition,

molecular structuremolecular structure

Official nameOfficial name Listed inListed in U.S. PharmacopoeiaU.S. Pharmacopoeia

Generic (nonGeneric (non--proprietary) nameproprietary) name First proposed by manufacturer when submitted toFirst proposed by manufacturer when submitted to

FDA for approvalFDA for approval

Trade (brand/proprietary) nameTrade (brand/proprietary) name

Patented namePatented name


Sources of DrugsSources of Drugs

PlantsPlants

Animals, humansAnimals, humans

Minerals/mineral productsMinerals/mineral products

Synthetic chemical substancesSynthetic chemical substances

Recombinant DNA technologyRecombinant DNA technology



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PlantsPlants

AlkaloidsAlkaloids

GlycosideGlycoside

GumsGums

OilsOils



Animals, humansAnimals, humans

Hormones, vaccines, blood, plasma componentsHormones, vaccines, blood, plasma components

Minerals/mineral productsMinerals/mineral products

Chemical elements/compounds found in earth, soilChemical elements/compounds found in earth, soil



Chemical substancesChemical substances

Developed by scientifically duplicating specificDeveloped by scientifically duplicating specific

compoundscompounds

CalledCalled synthetic drugssynthetic drugs when developed inwhen developed in

laboratorylaboratory

Recombinant DNA technologyRecombinant DNA technology

Genetic engineeringGenetic engineering



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Drug ClassificationDrug Classification

Anatomical Therapeutic ChemicalAnatomical Therapeutic Chemical

Classification SystemClassification System

Body SystemBody System

DrugDrugs physiologic classifications physiologic classification

Mechanism of actionMechanism of action

DrugDrugs therapeutic classifications therapeutic classification

Class of agentClass of agent

DrugDrugs chemical classifications chemical classification


Sources of Drug InformationSources of Drug Information

United StatesUnited States PharmacopeiaPharmacopeia/Dispensing/Dispensing

InformationInformation

U.S.U.S. PharmacopeiaPharmacopeia--National Formulary (USPNational Formulary (USP--NF),NF),

official source for U.S manufactured drugsofficial source for U.S manufactured drugs

PhysicianPhysicians Desk References Desk Reference

Compilation of 4000+ drugsCompilation of 4000+ drugs


Sources of Drug InformationSources of Drug Information

American Hospital Formulary ServiceAmerican Hospital Formulary Service

Information about every U.S. drug availableInformation about every U.S. drug available

Uses for drugs included in labeling approved byUses for drugs included in labeling approved by

FDA, offFDA, off--label useslabel uses

Package insertsPackage inserts

DrugDrugs safety, effectivenesss safety, effectiveness

Other sourcesOther sources

Nurses, physicians, pharmacists, poison controlNurses, physicians, pharmacists, poison control



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U.S. Drug LegislationU.S. Drug Legislation

Laws govern purchase, distribution,Laws govern purchase, distribution,

dispensation, administration of drugsdispensation, administration of drugs

Must know lawsMust know laws

Purpose of legislationPurpose of legislation

Protect public from adulterated, mislabeled drugsProtect public from adulterated, mislabeled drugs

History of legislationHistory of legislation

Pure Food and Drug ActPure Food and Drug Act

Standardized name, strength, quality, purity of drugsStandardized name, strength, quality, purity of drugs




Pure Food & Drug Act, early 20Pure Food & Drug Act, early 20thth centurycentury

Federal Food, Drug & Cosmetic Act, 1938Federal Food, Drug & Cosmetic Act, 1938

Harrison Narcotics Act, 1914Harrison Narcotics Act, 1914

DurhamDurham--Humphrey Amendments, 1928, requiredHumphrey Amendments, 1928, required

prescriptions for certain drugsprescriptions for certain drugs

All new drugs tested for toxicityAll new drugs tested for toxicity




DurhamDurham--Humphrey Amendment, 1951Humphrey Amendment, 1951

KefauverKefauver--Harris Amendment, 1962, required proofHarris Amendment, 1962, required proof

of effectiveness, safety of new prescription, overof effectiveness, safety of new prescription, over--

thethe--counter drugs before FDA approvalcounter drugs before FDA approval

Schedule of controlled substancesSchedule of controlled substances

Classifications of substances based on theirClassifications of substances based on their

accepted medical use in the U.S., abuse potential,accepted medical use in the U.S., abuse potential,

potential for addictionpotential for addiction



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Food & Drug AdministrationFood & Drug Administration

Governing body, oversees general safetyGoverning body, oversees general safety

standards in production of drugs, food, cosmeticsstandards in production of drugs, food, cosmetics

U.S. Department of Health & Human ServicesU.S. Department of Health & Human Services

Regulates medical devices, radiationRegulates medical devices, radiation--emittingemitting

productsproducts



Drug Enforcement AdministrationDrug Enforcement Administration

U.S. Department of JusticeU.S. Department of Justice

Enforces controlled substance laws, monitorsEnforces controlled substance laws, monitors

need for changing abused drug schedulesneed for changing abused drug schedules

Federal Trade CommissionFederal Trade Commission

Bureau of Consumer ProtectionBureau of Consumer Protection

Protects consumers, truthProtects consumers, truth--inin--advertising lawsadvertising laws


Standardization of DrugsStandardization of Drugs

AssayAssay

Substance test, finds componentsSubstance test, finds components

Amount, purityAmount, purity

BioassayBioassay Effects on organism, compares results withEffects on organism, compares results with

agreed standardagreed standard

United StatesUnited States PharmacopeiaPharmacopeia

Official standardsOfficial standards--setting authoritysetting authority



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Investigational DrugsInvestigational Drugs

Prospective drugs & evaluationProspective drugs & evaluation

Conceptual evidence drug has physiologic benefitConceptual evidence drug has physiologic benefit

Toxicity, drug absorption, metabolismToxicity, drug absorption, metabolism

Food & Drug Administration approval processFood & Drug Administration approval process

Phases of investigationPhases of investigation

Require specific information, effects on humansRequire specific information, effects on humans

3 phases conducted before New Drug Application (NDA)3 phases conducted before New Drug Application (NDA)submitted by manufacturersubmitted by manufacturer

44thth phase follows NDA approval, not closely monitored byphase follows NDA approval, not closely monitored byFDAFDA


Investigational DrugsInvestigational Drugs

Food & Drug Administration approval processFood & Drug Administration approval process

New drug applicationNew drug application

Sponsor goal, product safe for initial use, compoundSponsor goal, product safe for initial use, compoundshows pharmacologic activity justifies commercialshows pharmacologic activity justifies commercial

developmentdevelopment

Abbreviated NDA used for generic drugsAbbreviated NDA used for generic drugs Preclinical, clinical data not requiredPreclinical, clinical data not required

Must demonstrate performance as original patented drugMust demonstrate performance as original patented drug


Scope of ManagementScope of Management

ResponsibilitiesResponsibilities

Safe & effective administrationSafe & effective administration

Assess scene, patientAssess scene, patient

Obtain historyObtain history

Know, understand medication patient takesKnow, understand medication patient takes

Assess for indications, contraindicationsAssess for indications, contraindications Patient pill bottles, copy information exactlyPatient pill bottles, copy information exactly

Ask patient how administered, may not be correctAsk patient how administered, may not be correct

Check with partnerCheck with partner

Use drug referencesUse drug references

Recheck calculations, dosagesRecheck calculations, dosages

Contact medical direction online if necessaryContact medical direction online if necessary



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Scope of ManagementScope of Management

ResponsibilitiesResponsibilities

Legal, moral, ethical obligationsLegal, moral, ethical obligations

Give substance according to intended use, indication,Give substance according to intended use, indication,written protocolswritten protocols

Maintain patient confidentialityMaintain patient confidentiality

Use professionalismUse professionalism


Autonomic PharmacologyAutonomic Pharmacology

Nervous system organization & functionNervous system organization & function

Central nervous systemCentral nervous system

Brain, spinal cordBrain, spinal cord

Electrical impulses sent, received, coordinatedElectrical impulses sent, received, coordinated

Motor, temperature, vibration, sensation transmissionMotor, temperature, vibration, sensation transmission

Peripheral nervous systemPeripheral nervous system

All nerves outside of CNSAll nerves outside of CNS

Somatic nervous systemSomatic nervous system Cranial, spinal nerves carry messages to skeletal musclesCranial, spinal nerves carry messages to skeletal muscles

Controlled voluntarily, consciouslyControlled voluntarily, consciously





Autonomic nervous systemAutonomic nervous system Involuntary controlInvoluntary control

ANS nerves message to heart,ANS nerves message to heart, secretorysecretory glands, GI tractglands, GI tract

smooth muscles, blood vessels, bronchi, genitourinarysmooth muscles, blood vessels, bronchi, genitourinary

systemsystem



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Somatic nervous systemSomatic nervous system

Autonomic nervous systemAutonomic nervous system SympatheticSympathetic

ParasympatheticParasympathetic



Parasympathetic & Sympathetic Nervous Systems



Sympathetic Division of Autonomic Nervous System



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Sympathetic divisionSympathetic division Fight or FlightFight or Flight syndromesyndrome





Parasympathetic divisionParasympathetic division Feed and breedFeed and breed

Resting and digestingResting and digesting



NeurochemicalNeurochemical transmissiontransmission

Synaptic transmissionSynaptic transmission

PreganglionicPreganglionic neuronneuron

Postganglionic neuronPostganglionic neuron

GanglionGanglion

Synaptic junctionSynaptic junction NeurotransmitterNeurotransmitter

ReceptorReceptor

NeurotransmittersNeurotransmitters

CholinergicCholinergic

AdrenergicAdrenergic



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Neurotransmitters at Synapse



Neurotransmitters of Peripheral Nervous System



ReceptorsReceptors

Cholinergic receptorsCholinergic receptors

AcetylcholineAcetylcholine Interacts with receptors, physiologic responseInteracts with receptors, physiologic response



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ReceptorsReceptors

Sympathetic receptorsSympathetic receptors

Adrenergic receptorsAdrenergic receptors

When sympathetic division stimulated, adrenal medullaWhen sympathetic division stimulated, adrenal medullastimulated, releases epinephrine into circulatory systemstimulated, releases epinephrine into circulatory system

SympathomimetricSympathomimetric

SympatholyticsSympatholytics



ReceptorsReceptors

Other neurotransmitters & receptorsOther neurotransmitters & receptors

SerotoninSerotonin

EndorphinsEndorphins

NeuropeptidesNeuropeptides



EffectorEffectorcell responsecell response

Receptor structureReceptor structure

Agonist gated ion channel receptorsAgonist gated ion channel receptors

Selected pathway when membrane allows transfer ofSelected pathway when membrane allows transfer ofspecific channels across its concentration gradientspecific channels across its concentration gradient



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EffectorEffector

cell responsecell response

G proteinG protein--coupled receptorscoupled receptors

Adrenergic, cholinergic receptorsAdrenergic, cholinergic receptors

Protein chains wind back, forth through cell membrane 7Protein chains wind back, forth through cell membrane 7timestimes

Receptor siteReceptor site

G proteinG protein

EffectorEffector

Second messengersSecond messengers

Biochemical messengerBiochemical messenger

Molecule relays signals from receptor on cell surface toMolecule relays signals from receptor on cell surface totarget molecules in celltarget molecules in cells nucleus, internal fluids nucleus, internal fluid



Receptor regulationReceptor regulation

DownregulationDownregulation

UpregulationUpregulation

Altering neurotransmission with drugsAltering neurotransmission with drugs

Produce biologic effects necessary to minimizeProduce biologic effects necessary to minimize

disease/injury effectsdisease/injury effects


General Properties of DrugsGeneral Properties of Drugs

Generally do not give body new functionGenerally do not give body new function

Use existing body function, change for particularUse existing body function, change for particular

advantageadvantage

Exert multiple actions rather than single effectExert multiple actions rather than single effect Must consider all actions when choosingMust consider all actions when choosing

Physiochemical interaction between drug,Physiochemical interaction between drug,

body moleculebody molecule



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Drug FormsDrug Forms

Liquid drug formsLiquid drug forms

ElixirElixir

EmulsionEmulsion

ExtractExtract

SolutionSolution

SpiritSpirit

SuspensionSuspension

SyrupSyrup

TinctureTincture



Solid drug formsSolid drug forms

CapletCaplet

CapsuleCapsule

EntericEnteric--coated tabletscoated tablets

Gel capGel cap

PillPill

PowderPowder

SuppositorySuppository

TabletTablet



Gas drug formsGas drug forms

Inhaled, absorbed through respiratory tractInhaled, absorbed through respiratory tract

Commonly used for anesthesiaCommonly used for anesthesia

Not common for EMSNot common for EMS



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Routes of Medication AdministrationRoutes of Medication Administration

Local vs. systemic effectsLocal vs. systemic effects

Local effectLocal effect

Affects specific body partAffects specific body part

Systemic effectSystemic effect

Affects entire bodyAffects entire body

EnteralEnteral routesroutes

Passes through any portion of digestive tractPasses through any portion of digestive tract



EnteralEnteral routesroutes

OralOral

FirstFirst--pass effectpass effect Drug breakdown in liver, intestine walls before reachingDrug breakdown in liver, intestine walls before reaching

systemic circulationsystemic circulation



EnteralEnteral

SublingualSublingual

Under tongueUnder tongue

Absorbed through mucus membrane, into blood vesselsAbsorbed through mucus membrane, into blood vessels

AdvantagesAdvantages

AccessibilityAccessibility Rapid onsetRapid onset

Patient must be adequately hydrated for drug absorptionPatient must be adequately hydrated for drug absorption



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EnteralEnteral

BuccalBuccal

Mouth, between gum, cheek mucous membrane,Mouth, between gum, cheek mucous membrane,absorbed into blood streamabsorbed into blood stream



EnteralEnteral

RectalRectal

SuppositorySuppository

Eliminates some ofEliminates some of first passfirst pass effecteffect



EnteralEnteral

GastricGastric

Tube placed in digestive tractTube placed in digestive tract NasogastricNasogastric

OrogastricOrogastric

GastrostomyGastrostomy



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ParenteralParenteral

routesroutes

Medication does not pass through digestive tractMedication does not pass through digestive tract

Avoid firstAvoid first--pass effectpass effect

Rapid, complete absorptionRapid, complete absorption



ParenteralParenteral routesroutes

IntravenousIntravenous

Directly into venous circulationDirectly into venous circulation

InstantaneousInstantaneous




IntraosseousIntraosseous

Needle passed through bone cortex, infused intoNeedle passed through bone cortex, infused intocapillary networkcapillary network



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routesroutes

IntracardiacIntracardiac

Injection directly into heart ventricle during cardiac arrestInjection directly into heart ventricle during cardiac arrest

Coronary artery lacerationCoronary artery laceration

Heart muscle injection, instead of heart chamber,Heart muscle injection, instead of heart chamber,pneumothoraxpneumothorax, cardiac, cardiac tamponadetamponade

Not paramedic skillNot paramedic skill




EndotrachealEndotracheal

Tracheal tubeTracheal tube

UnpredictableUnpredictable




InhalationInhalation

Humidified,Humidified, nebulizednebulized

Directly to respiratory tractDirectly to respiratory tract



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routesroutes

IntralingualIntralingual

Direct injection into underside of tongueDirect injection into underside of tongue

NaloxoneNaloxone, narcotic overdose, narcotic overdose




IntranasalIntranasal

Nasal passages, sinusesNasal passages, sinuses




IntramuscularIntramuscular

Injection directly into skeletal muscleInjection directly into skeletal muscle



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routesroutes

SubcutaneousSubcutaneous

Liquid form injection placed underneath skin intoLiquid form injection placed underneath skin intosubcutaneous tissuesubcutaneous tissue

SlowerSlower




TransdermalTransdermal

Absorption through skin barrierAbsorption through skin barrier

Slow absorptionSlow absorption

Look for patches when assessing patientLook for patches when assessing patient NitroglycerinNitroglycerin -- upper chestupper chest

NicotineNicotine -- upper arms, buttocksupper arms, buttocks

NauseaNausea -- vomiting, dizziness, behind earvomiting, dizziness, behind ear

EstrogenEstrogen -- buttocks, thighsbuttocks, thighs

Pain reliefPain relief -- anywhereanywhere




IntrathecalIntrathecal

Into spinal canalInto spinal canal Child birth, chronic back painChild birth, chronic back pain

Not paramedic skillNot paramedic skill

UmbilicalUmbilical Used in newbornsUsed in newborns

Requires special training, approval from medicalRequires special training, approval from medicaldirectiondirection



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routesroutes

IntradermalIntradermal

Between dermal skin layersBetween dermal skin layers


Mechanisms of Drug ActionMechanisms of Drug Action

Pharmaceutical phasePharmaceutical phase

Broken down into solution in body for absorptionBroken down into solution in body for absorption

PharmacokineticsPharmacokinetics

Modes of transportModes of transport

Passive transportPassive transport

DiffusionDiffusion

OsmosisOsmosis

Facilitated transportFacilitated transport

Active transportActive transport




Stages of drug functionStages of drug function

AbsorptionAbsorption



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Enteric absorptionEnteric absorption

ParenteralParenteral absorptionabsorption





DistributionDistribution BloodBlood--brain barrierbrain barrier

Placental barrierPlacental barrier





MetabolismMetabolism Chemical reactionsChemical reactions

Change active drug into inactiveChange active drug into inactive

Change lessChange less--active/inactive into more activeactive/inactive into more active

Excretion/eliminationExcretion/elimination



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PharmacodynamicsPharmacodynamics

Theories of drug actionTheories of drug action

DrugDrug--receptor interactionreceptor interaction




Theories of drug actionTheories of drug action

AffinityAffinity

EfficacyEfficacy

AgonistAgonist

Partial agonistPartial agonist

AntagonistAntagonist

AcetylationAcetylation




Drug response relationDrug response relation

Plasma level profilePlasma level profile

HalfHalf--lifelife

Therapeutic thresholdTherapeutic threshold

Therapeutic indexTherapeutic index



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Factors that influence drug actionFactors that influence drug action

AgeAge

GenderGender

Body weightBody weight

EnvironmentEnvironment

General healthGeneral health

GeneticsGenetics

CultureCulture

Emotional,Emotional,psychological statepsychological state

Time ofTime ofadministrationadministration

Administration routeAdministration route

Medication historyMedication history

DietDiet




Predictable, iatrogenic, & unpredictable drugPredictable, iatrogenic, & unpredictable drug

responsesresponses


Special ConsiderationsSpecial Considerations

Pregnant patientsPregnant patients

Physiologic changes affect metabolismPhysiologic changes affect metabolism

TeratogenTeratogen

Drug/agent harmful to embryo/fetus developmentDrug/agent harmful to embryo/fetus development

FDA pregnancy risk categoriesFDA pregnancy risk categories



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Pediatric patientsPediatric patients

Changes from birth toChanges from birth to

adolescenceadolescence

Doses based on weight,Doses based on weight,

body surface areabody surface area

BroselowBroselow tape usedtape used



Geriatric patientsGeriatric patients

Bone mass loss, lean muscle mass, body waterBone mass loss, lean muscle mass, body water

changeschanges

Body fat decreasesBody fat decreases

Organ degenerationOrgan degeneration

PolypharmacyPolypharmacy

SelfSelf--medication errorsmedication errors


Drug InteractionsDrug Interactions

Factors influencing drug actionFactors influencing drug action

Intestinal absorptionIntestinal absorption

Drug metabolism/biotransformationDrug metabolism/biotransformation

Action at receptor siteAction at receptor site

Renal excretionRenal excretion

Alteration of electrolyte balanceAlteration of electrolyte balance

DrugDrug--drug interactionsdrug interactions

Competition for plasma protein bindingCompetition for plasma protein binding

Other drug interactionsOther drug interactions

Drug incompatibilitiesDrug incompatibilities



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Drug InteractionsDrug Interactions

DrugDrug

--drug interactionsdrug interactions

DrugDrug--food interactionsfood interactions


Drug StorageDrug Storage

Some volatile/possible abuseSome volatile/possible abuse

Follow protocolsFollow protocols

Check contents before/after shiftCheck contents before/after shift

Expiration datesExpiration dates

QuantityQuantity

Locking mechanismsLocking mechanisms


Components of a Drug ProfileComponents of a Drug Profile

ComponentsComponents

Generic, trade nameGeneric, trade name

ClassificationClassification

How suppliedHow supplied

Mechanism of actionMechanism of action


IndicationsIndications

DosageDosage

ContraindicationsContraindications



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Components of a Drug ProfileComponents of a Drug Profile

ComponentsComponents

PrecautionsPrecautions

Side effects/adverse effectsSide effects/adverse effects

Route(s) of administrationRoute(s) of administration

Drug interactionsDrug interactions

Pregnancy risk categoryPregnancy risk category

AntidotesAntidotes

Special considerationsSpecial considerations

Pediatric, geriatric, pregnantPediatric, geriatric, pregnant


SummarySummary

Drug trade name is brand name, generic isDrug trade name is brand name, generic is

chemical name, chemical name is structure ofchemical name, chemical name is structure of

compoundcompound

Orphan drugs treat rare diseases, conditionsOrphan drugs treat rare diseases, conditions

Sources of drugs include plants,Sources of drugs include plants,

animal/human products, minerals, syntheticanimal/human products, minerals, synthetic

chemicals, recombinant DNA technologychemicals, recombinant DNA technology


SummarySummary

Three drug class systems include bodyThree drug class systems include body

system, class of agent, mechanism of actionsystem, class of agent, mechanism of action

Sources of information include PhysicianSources of information include Physicianss

Desk Reference, hospital formularies, people,Desk Reference, hospital formularies, people,pocket references, package insertspocket references, package inserts

1970 Comprehensive Drug Abuse Prevention1970 Comprehensive Drug Abuse Prevention

& Control Act established schedule of& Control Act established schedule of

controlled substancescontrolled substances



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SummarySummary

U.S. Pharmacopoeia, official publicU.S. Pharmacopoeia, official public

standardsstandards--setting authority for prescription,setting authority for prescription,

OTC, dietary supplements sold in U.S.OTC, dietary supplements sold in U.S.

FDA approval process for investigationalFDA approval process for investigational

drugs has 4 phasesdrugs has 4 phases

Safe, effective drug administrationSafe, effective drug administration

responsibility of paramedicresponsibility of paramedic


SummarySummary

Nervous system contains central, peripheralNervous system contains central, peripheral

nervous systemnervous system

CNSCNS -- brain, spinal cordbrain, spinal cord

PeripheralPeripheral -- all nerves outside of CNSall nerves outside of CNS

Somatic nervous system, voluntary nervesSomatic nervous system, voluntary nerves

Autonomic nervous systemAutonomic nervous system

Sympathetic, parasympatheticSympathetic, parasympathetic

Sympathetic/adrenergic division,Sympathetic/adrenergic division, fightfight--oror--flightflight


SummarySummary

Parasympathetic/cholinergic division,Parasympathetic/cholinergic division, restingresting

& digesting& digesting

Synaptic transmission at synaptic junctionSynaptic transmission at synaptic junction

Pre/postganglionic nerves connect at ganglionPre/postganglionic nerves connect at ganglion

Drugs come in liquid, solid, gas formsDrugs come in liquid, solid, gas forms



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SummarySummary

Drug route administration affects type ofDrug route administration affects type of

effect, onset of actioneffect, onset of action

EnteralEnteral drugs enter systemic circulation by GI tractdrugs enter systemic circulation by GI tract

ParenteralParenteral drugs enter systemic circulation bydrugs enter systemic circulation by

bypassing digestive tractbypassing digestive tract

Medications alter normal body responseMedications alter normal body response


SummarySummary

PharmocokineticsPharmocokinetics-- process of how drugsprocess of how drugs

process in bodyprocess in body

Absorbed, distributed, metabolized, excretedAbsorbed, distributed, metabolized, excreted

Agonist stimulated receptor, causesAgonist stimulated receptor, causes

physiologic responsephysiologic response

Partial agonist/antagonist may cause physiologicPartial agonist/antagonist may cause physiologic

responseresponse

Antagonist binds with receptor, does not elicitAntagonist binds with receptor, does not elicit

responseresponse


SummarySummary

Biologic halfBiologic half--life, time required to eliminatelife, time required to eliminate

50% from bloodstream50% from bloodstream

FDA regulates drugs for safety in pregnancy,FDA regulates drugs for safety in pregnancy,

pediatric & geriatric patients may havepediatric & geriatric patients may havedifferent responsesdifferent responses

Side effects may/may not be harmfulSide effects may/may not be harmful



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SummarySummary

Iatrogenic drug response, unintentionalIatrogenic drug response, unintentional

disease/effect produced by physiciandisease/effect produced by physicianss

prescribed therapyprescribed therapy

Drug action factors include intestinalDrug action factors include intestinal

absorption, drug metabolism, excretion,absorption, drug metabolism, excretion,

electrolytes, drugelectrolytes, drug--drug interactions,drug interactions,

incompatibilitiesincompatibilities


SummarySummary

Drug storage importantDrug storage important

Drug profile, complete description of drug, itsDrug profile, complete description of drug, its

characteristicscharacteristics


Questions?Questions?

Routes of Drug Admin

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