Paramedic Care: Principles & Practice Volume 1

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Transcript Paramedic Care: Principles & Practice Volume 1

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.

Chapter 9 General Principles of Pharmacology

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Chapter 9, Part 2 Drug Classifications

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Part 2 Topics

Classifying Drugs Drugs Used to Affect the Nervous System Drugs Used to Affect the Cardiovascular System Drugs Used to Affect the Respiratory System Drugs Used to Affect the Gastrointestinal System Drugs Used to Affect the Eyes Drugs Used to Affect the Ears Drugs Used to Affect the Endocrine System Drugs Used to Treat Cancer Drugs Used to Treat Infectious Diseases and Inflammation Drugs Used to Affect the Skin Drugs Used to Supplement the Diet Drugs Used to Treat Poisoning and Overdoses Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Classifying Drugs

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Classifying Drugs

Drugs can be classified many ways: – Body system they affect – Mechanism of action – Indications – Source or by chemical class A prototype best demonstrates the class’s common properties and illustrates its particular characteristics. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Affect the Nervous System

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Nervous System

Two major divisions Central Nervous System – Brain and spinal cord Peripheral nervous system – Outside of CNS Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Analgesics and antagonists Anesthetics Anti-anxiety and sedative-hypnotic drugs Antiseizure or anti epileptic drugs Central nervous system stimulants Psychotherapeutic medications Parkinson’s medications Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Analgesics and Antagonists – Analgesia is removal of pain – Two basic subclasses of analgesics Opioid Morphine is prototype Nonopioid Affects the production of prostaglandins and cyclooxygenase Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Analgesics and Antagonists (cont.) – Opioid antagonists Competitively binds with opioid receptors Naloxone is prototype – Adjunct medications Enhancement of effect Diazepam, lorazepam, phenergan – Agonist-Antagonist Talwin, Stadol, and Nubain Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Anesthetics – Induces a state of anesthesia, or loss of sensation to touch or pain – As a group tend to cause respiratory, central nervous system (CNS), and cardiovascular depression – Given either by inhalation or injection – Paramedics primarily use these agents to assist with intubation in rapid sequence intubation Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Antianxiety and Sedative-Hypnotic Drugs – Used to decrease anxiety, induce amnesia, and assist sleeping and as part of a balanced approach to anesthesia Sedation Hypnosis – Two main pharmacologic classes are benzodiazepines and barbiturates Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Antianxiety and Sedative-Hypnotic Drugs – Benzodiazepines Relatively safe and effective for treating general anxiety and insomnia Hyperpolarize the membrane of CNS neurons Benzodiazepines only increase the effectiveness of GABA, therefore, the amount of GABA present limits their effects Flumazenil is available as antidote Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Antiseizure or Antiepileptic Drugs – Seizures are treated through several general mechanisms Direct action on the sodium and calcium ion channels in the neural membranes Dilantin inhibits inflow of sodium Interact with the GABA receptor-chloride ion channel complex – Classes include benzodiazepines, barbiturates, hydantoins, succinimides, and miscellaneous medications such as valproic acid Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Benzodiazepine Receptors

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Central Nervous System Stimulants – Two techniques may accomplish this: Increasing the release or effectiveness of excitatory neurotransmitters Decreasing the release or effectiveness of inhibitory neurotransmitters – Three pharmacologic classes: amphetamines, methylphenidates, and methylxanthines Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Central Nervous System Stimulants – Amphetamines Most common uses are treating drowsiness and fatigue and suppressing the appetite – Methylphenidate Commonly prescribed drug for attention deficit hyperactivity disorder (ADHD) – Methylxanthines Caffeine, aminophylline, and theophylline Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Psychotherapeutic Medications Treat mental dysfunction – Pathologies, seem to involve the monoamine neurotransmitters Norepinephrine, dopamine, serotonin Implicated in the control and regulation of emotions – Extrapyramidal symptoms are common side effects of antipsychotic medications Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Psychotherapeutic Medications – The two chief pharmaceutical classes are phenothiazines and butyrophenones.

Therapeutic effects appear to come from blocking the dopamine receptors. – Chlorpromazine (Thorazine) is the prototype phenothiazine. – Haloperidol (Haldol) is the prototype of the butyrophenones. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Psychotherapeutic Medications – Antidepressants Pharmaceutical interventions for this disease appear to increase the number of neurotransmitters released in the brain. Tricyclic Anti-depressants Act by blocking the reuptake of norepinephrine and serotonin Selective serotonin reuptake inhibitors (SSRIs) Selectively block the reuptake of serotonin Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Tricyclic Antidepressants

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

SSRI Antidepressants

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Psychotherapeutic Medications – Monoamine oxidase inhibitors (MAOIs) MAOIs inhibit monoamine oxidase and block the monoamines’ breakdown, thus increasing their availability. MAOIs are not commonly used anymore. The prototype of this class is phenelzine (Nardil).

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Monoamine Oxidase Inhibitors

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Drugs Used to Treat Parkinson’s Disease – Caused by the destruction of dopamine releasing neurons – Characterized by dyskinesia – Pharmacologic therapy for Parkinson’s disease seeks to restore the balance of dopamine and acetylcholine. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Central Nervous System Medications

Drugs Used to Treat Parkinson’s Disease – Levadopa and Sinemet Given concomitantly – Amantadine Promotes the release of dopamine from those dopamine-releasing neurons that remain unaffected by the disease – Anticholinergic drugs Prototype anticholinergic medication is benztropine (Cogentin) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Autonomic Nervous System

Two functional divisions of the autonomic nervous system – Sympathetic Fight or flight Responds to stress – Parasympathetic Controls vegetative functions such as digestion of food Work in constant opposition to control organ responses Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Autonomic Nervous System

Nerves of the autonomic nervous system exit the central nervous system. Autonomic Ganglia – Preganglionic nerves – Postganglionic nerves Sympathetic Branch of the Autonomic Nervous System Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Autonomic Nervous System

Synapse – No physical connection Neurotransmitters – Acetylcholine – Norepinephrine Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Nervous System Synapse

Click here to view an animation on synapses.

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Autonomic Nervous System Medications

Drugs affecting the parasympathetic system: – Cholinergics – Anticholinergics – Ganglionic blocking agents – Neuromuscular blocking agents – Ganglionic stimulating agents Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Parasympathetic NS Drugs

Stimulation of the parasympathetic nervous system results in the following conditions: – Pupillary constriction – Secretion by digestive glands – Reduction in heart rate and cardiac contractile force – Bronchoconstriction – Increased smooth muscle activity along the digestive tract Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Parasympathetic NS Drugs

Acetylcholine (ACh) – Two main types of ACh receptors Nicotinic Muscarinic “Cholinergic” receptors Cholinergics (parasympathomimetics) Cholinergic blockers (parasympatholytics) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Parasympathetic NS Drugs

Cholinergics – Act either directly or indirectly Direct-acting bind with ACh receptor sites SLUDGE Bethanechol (Urecholine) Indirect-acting cholinergic drugs affect acetylcholinesterase Neostigmine Physostigmine Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Parasympathetic NS Drugs

Anticholinergics – Muscarinic cholinergic antagonists Competitively bind with muscarinic receptors without stimulating them Prototype is Atropine – Nicotinic cholinergic antagonists Block acetylcholine only at nicotinic sites – Ganglionic Blocking Agents Trimethaphan (Arfonad) and mecamylamine (Inversine) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Parasympathetic NS Drugs

Neuromuscular Blockers – Produces a state of paralysis without affecting consciousness By competitive antagonism of nicotinic receptors at the neuromuscular junction – Either depolarizing or non-depolarizing agents Succinylcholine (Anectine), a depolarizing agent, is commonly used Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Parasympathetic NS Drugs

Ganglionic Stimulating Agents – Receptors reside at the ganglia of both the parasympathetic and sympathetic nervous systems.

– Nicotine stimulates receptors.

Although, no medical use, it has helped understand the autonomic NS receptors – Causes sympathetic and parasympathetic response Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Autonomic Nervous System Medications

Drugs Affecting the Sympathetic Nervous System – Adrenergic receptors – Adrenergic agonists – Adrenergic antagonists – Skeletal muscle relaxants Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Sympathetic NS Drugs

Arises from the thoracic and lumbar regions of the spinal cord Sympathetic ganglia – Chain ganglia – Collateral ganglia Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Sympathetic NS Drugs

Adrenergic Receptors – Alpha Receptors – Beta Receptors Sympathomimetics Sympatholytics Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Sympathetic NS Drugs

Adrenergic Agonists – Direct-acting agents – Indirect-acting agents – Adrenergic agents are chemically and functionally similar to the endogenous neurotransmitters Norepinephrine, epinephrine, and dopamine Dobutamine and isoproterenol Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Sympathetic NS Drugs

Adrenergic Antagonists (cont.) – Adrenergic antagonists are remarkably selective in which receptor they affect Alpha adrenergic antagonists Phenoxybenzamine (Dibenzyline), prazosin (Minipress) Beta adrenergic antagonists Propranolol (Inderal), metoprolol (Lopressor), Atenolol (Tenormin) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Sympathetic NS Drugs

Skeletal Muscle Relaxants – Used to treat muscle spasm Injury and disease causes – Prototype centrally acting skeletal muscle relaxant is baclofen (Lioresal) Treats spasticity – Cyclobenzaprine (Flexeril) and carisoprodol (Soma) are commonly used for muscle spasms.

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Affect the Cardiovascular System

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Review of A and P

Two-sided pump 4 chambers Systemic circulation Pulmonary circulation Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Cardiac Conduction System

Specialized cardiac tissue that generates electrical impulses – Conducts them rapidly throughout the heart Automaticity Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Action Potential of Cardiac Pacing Cells

Cyclic activity in the fast potentials has five phases The slow potentials – Located in the dominant pacemakers – They depolarize differently – Result in self depolarizing of SA and AV node Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Dysrhythmia Generation

Result from either abnormal impulse formation (automaticity) or abnormal conductivity – Tachycardia and bradycardia are most common – An imbalance between the sympathetic and parasympathetic nervous systems Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Dysrhythmia Generation

Abnormal conduction – In pathologic conditions, a section of one of the Purkinje fibers has what amounts to a one-way valve that allows impulses to travel in only one direction. – Re-entrant rhythm Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Classes of Cardiovascular Drugs

Antidysrhythmics – Used to treat and prevent abnormal cardiac rhythms Antihypertensives – Used to treat hypertension Hemostatic agents – Used to stop bleeding Antihyperlipidemic agents – Used to treat high cholesterol Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Antidysrhythmics

Pharmacological classes of antidysrhythmics – Sodium Channel Blockers – Beta Blockers – Potassium Channel Blockers – Calcium Channel Blockers Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Antidysrhythmics

Miscellaneous Antidysrhythmics – Adenosine Acts on both potassium and calcium channels Results in hyperpolarization that effectively slows the conduction of slow potentials – Digoxin Both an effective antidysrhythmic and a potent prodysrhythmic Decreases the intrinsic firing rate in the SA node – Magnesium is the drug of choice in

torsades de pointes

(polymorphic ventricular tachycardia.

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Antihypertensives

Diuretics Adrenergic Inhibiting Agents Angiotensin Converting Enzyme Inhibitors Angiotensin II Receptor Antagonists Calcium Channel Blockers Direct Vasodilators Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Diuretics

Reduce circulating blood volume by increasing the amount of urine Loop diuretics, thiazides, and potassium sparing diuretics – All affect the reabsorption of sodium and chloride Furosemide, Hydrochlorothiazide, and Spironolactone Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Adrenergic Inhibitors

Beta Adrenergic Antagonists – Selective beta 1 blockade is useful – The prototype selective beta 1 metropolol (Lopressor) blocker is Centrally Acting Adrenergic Inhibitors – Inhibit CNS stimulation of adrenergic receptors – The prototype drug in this category is clonidine (Catapres) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Adrenergic Inhibitors

Peripheral Adrenergic Neuron Blocking Agents – Work indirectly to decrease stimulation of adrenergic receptors – The prototype of this class is reserpine (Serpalan) Alpha 1 Antagonists – The prototype selective alpha 1 prazosin (Minipress) antagonist is Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Adrenergic Inhibitors

Combined Alpha/Beta Antagonists – Competitively bind with both alpha 1 receptors and beta 1 Alpha 1 blockade causes vasodilation Beta 1 blockade decreases heart rate, contractility, and renin release from kidneys – Labetalol (Normodyne) and carvedilol (Coreg) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Angiotensin Converting Enzyme (ACE) Inhibitors

Interrupts the renin-angiotensin-aldosterone system (RAAS) – Prevents the conversion of angiotensin I to angiotensin II – Very effective in treating hypertension, CHF, and renal failure – The prototype ACE inhibitor is captopril (Capoten) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Renin-Angiotensin-Aldosterone

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Angiotensin II Receptor Antagonists

Recently developed classification Achieves the same effects as the ACE inhibitors – Diminished side effects The prototype of this new class is losartan (Cozaar) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Calcium Channel Blocking Agents

The prototype dihydropyridine is nifedipine (Procardia, Adalat) – Acts only on the vascular smooth muscle of the arterioles – Does not affect heart It is effective in dilating the coronary arteries and arterioles Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Direct Vasodilators

Selective dilation of arterioles causes a decrease in peripheral vascular resistance or afterload. Hydralazine (Apresoline) is the prototype for the selective arteriole dilators. Sodium nitroprusside (Nipride) acts on both arterioles and veins. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Ganglionic Blocking Agents

Nicotinic N antagonists – Exist at the ganglia of both the sympathetic and the parasympathetic nervous systems The prototype is trimethaphan (Arfonad) Reduces preload and afterload Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Cardiac Glycosides

Indicated for heart failure and some types of dysrhythmias Digoxin is the prototype – Digoxin’s mechanism of action is complex Elevated levels of intracellular calcium increase the strength of muscle contraction Toxicity – Therapeutic index is very small Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Other Vasodilators and Anti-anginals

Calcium channel blockers have a role in the treatment of angina – Verapamil (Calan, Isoptin), diltiazem (Cardizem), and nifedipine (Procardia) Organic nitrates are potent vasodilators – Nitroglycerin (Nitrostat) is the oldest of these drugs and is the category’s prototype Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Hemostatic Agents

Antiplatelets – Drugs that decrease the formation of platelet plugs Anticoagulants – Drugs that disrupt the clotting cascade Thrombolytics – Drugs that act directly on thrombi to break them down Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Anti-Platelet Agents

The prototype anti-platelet drug is aspirin Aspirin decreases the formation of platelet plugs and potential thrombi Primary side effect is bleeding Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Anticoagulants

Prototype for this class is Heparin – Primary mechanism of action is to enhance antithrombin III’s ability to inhibit the clotting cascade – Low-molecular-weight heparin Has greater bioavailability, is easier to dose, and has fewer effects on platelet function The prototype oral anticoagulant is warfarin (Coumadin) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Fibrinolytics

Act directly on thrombi to break them up The prototype drug of this class is streptokinase (Streptase) – Alteplase (tPA), reteplase (Retavase), and anistreplase (Eminase) – Mechanism of action is to promote plasminogen’s conversion to plasmin Dissolves the fibrin mesh of clots Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Antihyperlipidemics

Drugs used to treat high blood cholesterol – These agents are also known as statins Examples – Lovastatin (Mevacor) – Simvastatin (Zocor) Bile acid-binding resins can also reduce LDL levels – Cholestyramine (Questran) is the prototype Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Affect the Respiratory System

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Anti-Asthmatic Medications

Drug treatment of asthma aims to relieve bronchospasm and decrease inflammation.

Approaches are categorized according to actions.

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Anti-Asthmatic Medications

Beta 2 Specific Agents – Albuterol (Proventil, Ventolin) is the prototype of this class – These agents relax bronchial smooth muscle Nonselective Sympathomimetics – Stimulate both beta 1 and beta 2 well as alpha receptors receptors, as – Epinephrine is the only nonselective sympathomimetic in common use today Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Anti-Asthmatic Medications

Methylxanthines – CNS stimulants that have additional bronchodilatory properties – The prototype methylxanthine is theophylline Anticholinergics – Ipratropium (Atrovent)—an atropine derivative given by nebulizer – A muscarinic antagonist that causes bronchodilation Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Anti-Asthmatic Medications

Glucocorticoids – Have anti-inflammatory properties.

– The prototype inhaled glucocorticoid is beclomethasone.

– An injectable glucocorticoid (methylprednisolone) is available for use secondary to beta 2 agonists.

Leukotriene Antagonists – Leukotriene antagonists can either block the synthesis of leukotrienes or block their receptors. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used for Rhinitis and Cough

Nasal decongestants Antihistamines Antitussives Expectorants Mucolytic Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used for Rhinitis and Cough

Nasal Decongestants – The main pharmacologic classification in this functional category is alpha 1 agonists. – Examples of these agents are phenylephrine, pseudoephedrine, and phenylpropanolamine.

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used for Rhinitis and Cough

Antihistamines – The first-generation antihistamines comprise several chemical sub-classes. Differ in the degree of sedation they cause – The second-generation antihistamines include terfenadine (Seldane), loratadine (Claritin), and cetirizine (Zyrtec). Do not cross blood-brain barrier Decreased sedation Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used for Rhinitis and Cough

Cough Suppressants – Antitussive medications suppress the stimulus to cough in the central nervous system.

Opioids and non-opioids Most common opioid antitussives are codeine and hydrocodone Dextromethorphan is non-opioid – Expectorants are intended to increase the productivity of cough. – Mucolytics make mucus more watery. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Affect the Gastrointestinal System

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Main Indications for GI Drug Therapy

Peptic ulcers Constipation Diarrhea and emesis Digestion Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Peptic Ulcer Disease

H 2 receptor antagonists – Cimetidine (Tagamet), ranitidine (Zantac), Famotidine (Pepcid), Nizatidine (Axid) Proton pump inhibitors – Omeprazole (Prilosec), Lansoprazole (Prevacid) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Peptic Ulcer Disease

Antacids – Aluminum, magnesium, or sodium compounds Anticholinergics – Pirenzepine (Gastrozepine) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Constipation

Categories of laxatives – Bulk-forming (methylcellulose or Citrucel) – Stimulant (phenolphthalein or Ex-Lax) – Osmotic (Milk of Magnesia) – Surfactant (Colace) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Diarrhea

Although a nuisance, diarrhea is often a helpful process – Usually self-correcting and does not need to be treated Specific or non-specific agents may be used Antibiotics are frequently used Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Emesis

Antiemetics – Medications used to prevent vomiting – This functional class includes several pharmacologic subclasses: Serotonin antagonists Dopamine antagonists Cannabinoids Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Emesis

Serotonin Antagonists – Prototype serotonin antagonist is ondansetron (Zofran) – Blocks the serotonin receptors in the CTZ, the stomach, and the small intestines Dopamine Antagonists – Phenothiazines and butyrophenones effectively block dopamine receptors in the CTZ Phenothiazines include prochlorperazine (Compazine) and promethazine (Phenergan) Butyrophenones include haloperidol (Haldol) and droperidol (Inapsine) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Emesis

Cannabinoids – Derivatives of tetrahydrocannabinol (THC) – Effective antiemetics used to treat chemotherapy-induced nausea and vomiting – Available agents are dronabinol (Marinol) and nabilone (Cesamet) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Aid Digestion

Several drugs are available to aid digestion of carboyhydrates and fats.

Two such drugs are pancreatin (Entozyme) and pancrelipase (Viokase).

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Affect the Eyes

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Affect the Eyes

These drugs are used to treat conditions involving the eyes, primarily glaucoma and trauma.

Medications used to treat glaucoma are all aimed at reducing intraocular pressure (IOP). – Beta-blockers and cholinergics are the most commonly used drugs. Tetracaine (Pontocaine) is a local anesthetic.

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Affect the Ears

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Affect the Ears

Most drugs used to treat conditions involving the ear are aimed at eliminating underlying bacterial or fungal infections or at breaking up impacted ear wax.

– Chloramphenicol (Chloromycetin Otic) – Gentamicin sulfate (Garamycin) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Affect the Endocrine System

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Hormonal Regulation

The endocrine system and nervous system together are chiefly responsible for the regulatory activities that maintain homeostasis. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting the Pituitary Gland

Anterior pituitary drugs – The only conditions treated with these drugs are those associated with abnormal growth such as dwarfism – Somatrem (Protropin) and somatropin (Humatrope) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting the Pituitary Gland

Posterior pituitary drugs – The two drugs in this category are oxytocin and antidiuretic hormone Antidiuretic hormone (ADH) increases water reabsorption ADH —a key component in regulating blood volume, blood pressure, and electrolyte balance Vasopressin (Pitressin), desmopressin (Stimate), and lypressin (Diapid) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting the Parathyroid and Thyroid Glands

Parathyroid glands —primarily responsible for regulating calcium levels – Treatment is with calcium and Vitamin D supplements Thyroid – Hypothyroid Levothyroxine (Synthroid) – Hyperthyroid Radioactive iodine Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting the Adrenal Cortex

Glucocorticoids, mineralocorticoids, and androgens – Glucocorticoids increase the production of glucose. – Mineralocorticoids regulate salt and water balance. – Androgens are important hormones in regulating sexual maturation. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting the Adrenal Cortex

Two diseases typify the disorders associated with the adrenal cortex: – Cushing’s disease and Addison’s disease Treatment of Cushing’s disease is typically surgical Symptomatic pharmacologic intervention with an antihypertensive may be necessary Treatment of Addison’s disease is aimed at replacement therapy Cortisone (Cortistan) and hydrocortisone (SoluCortef) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting the Pancreas

Diabetes mellitus is the most important disease involving the pancreas.

– Insulin A substance that decreases blood glucose level – Glucagon A substance that increases blood glucose level Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting the Pancreas

Oral Hypoglycemics – Stimulates insulin secretion from the pancreas – Examples Orinase (chlorpropamide) Glucotrol (glipizide) Micronase (glyburide) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Hyperglycemic Agents

Hyperglycemic Agents – Two hyperglycemic agents, glucagon and diazoxide (Proglycem), act to increase blood glucose levels. Glucagon can be given IM when IV access is unavailable.

– D50W is a sugar solution given intravenously for acute hypoglycemia. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting the Female Reproductive System

Estrogens and Progestins – The principal indication for estrogen is replacement therapy in postmenopausal women. Alleviates menopausal symptoms and reverses the increased risk for osteoporosis Increases chances of breast cancer and stroke – Progestins help balance the untoward effects of estrogen on the endometrium. Oral Contraceptives – The primary mechanism of action is the prevention of ovulation.

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting the Female Reproductive System

Uterine Stimulants and Relaxants – Drugs that increase uterine contraction (uterine stimulants) are oxytocics Indications are to induce labor and to treat severe postpartum hemorrhage Pitocin and Syntocinon – Drugs that relax the uterus or inhibit uterine contraction are tocolytics.

Relax uterine smooth muscle by stimulating the beta 2 receptors in the uterus Terbutaline (Brethine) and ritodrine (Yutopar) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting the Female Reproductive System

Infertility Agents – Most infertility drugs are developed for women and promote maturation of ovarian follicles. – Clomiphene (Clomid), urofollitropin (Metrodin), and menotropins (Pergonal) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting the Male Reproductive System

Testosterone deficiency – Metandren Benign prostatic hypertrophy (BPH) – Proscar Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Affecting Sexual Behavior

Many drugs decrease libido.

– Anti-hypertensives, antianxiety, and antipsychotic medications Drugs that aid in erectile dysfunction increase blood supply to the penis . – Viagra, vardenafil (Levitra), and tadalafil (Cialis) – These drugs greatly decrease preload when used with nitrates, creating a dangerous situation.

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Cancer

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Cancer

Drugs used to treat cancer are called antineoplastic agents – Most antineoplastic agents have their greatest effect on cancer cells during mitosis Examples include: – Fluorouracil (Adrucil) – Mechlorethamine (Mustargen) – Vinblastine (Velban) – Vincristine (Oncovin) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Infectious Diseases and Inflammation

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Infectious Diseases and Inflammation

Antibiotics – An antibiotic agent may either kill the offending bacteria or decrease the bacteria’s growth so that the patient’s immune system can effectively fight the infection.

Macrolide, aminoglycoside, and tetracycline antibiotics inhibit protein synthesis. The penicillin, cephalosporin classes, and vancomycin, are bactericidal and act by inhibiting cell wall synthesis. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Infectious Diseases and Inflammation

Antifungal agents – Fungi are parasitic microorganisms that cannot synthesize their own food.

– The

azole

antifungals inhibit fungal growth . Anti-viral agents – Drugs used to treat viruses work by a variety of mechanisms. – Acyclovir (Zovirax) and zidovudine (Retrovir) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Infectious Diseases and Inflammation

Non-steroidal Anti-Inflammatory Drugs – Commonly used as analgesics and antipyretics – These agents interfere with the production of prostaglandins – Acetaminophen and ibuprofen – Ketorolac (Toradol), piroxicam (Feldene), and naproxen (Naprosyn) Uricosuric Drugs – Used to treat and prevent acute episodes of gout – Colchicine and allopurinol (Zyloprim) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Infectious Diseases and Inflammation

Serums, Vaccines, and Other Immunizing Agents – Immunity may be acquired passively or actively. – A serum is a solution containing whole antibodies for a specific pathogen. – A vaccine contains a modified pathogen. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Infectious Diseases and Inflammation

Immune Suppressing and Enhancing Agents – Suppressing the immune system is indicated to prevent the rejection of transplanted organs and grafted skin. Azathioprine (Imuran) – Immunomodulating agents enhance the natural immune reaction in immunosuppressed patients. Zidovudine (Retrovir), ritonavir (Norvir) and saquinavir (Invirase) Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Affect the Skin

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Affect the Skin

Dermatologic drugs are used to treat skin irritations.

These are common over-the-counter medications.

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Supplement the Diet

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Supplement the Diet

Disease processes affect the production, distribution, and utilization of essential dietary nutrients.

The body’s intricate balance of fluid (including specific amounts of electrolytes) is a vital component of maintaining homeostasis. Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Supplement the Diet

Vitamins and Minerals – Vitamins are organic compounds – Must be obtained in our diet – Indicated for special populations Pregnant and nursing women, patients with absorption disorders, the chronically ill, surgery patients, alcoholics, and the malnourished Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Supplement the Diet

Vitamins – Fat Soluble Stored – Water Soluble Must be routinely ingested Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Poisoning and Overdoses

Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Drugs Used to Treat Poisoning and Overdoses

The treatment for poisoning and overdose depends greatly on the substance involved.

– Syrup of ipecac – Activated charcoal – Mucomyst – Atropine – Pralidoxime Bledsoe et al.,

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.

Part 2 Summary

Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.