General Pharmacology

Combined Effort of:

TAaron Katz, AEMT-P
TYosef Simha, AEMT-P
TMike Murphy, RN, AEMT-P

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 What Is a Drug

T Chemical agents used in the diagnosis,

treatment, or prevention of disease
T Any substance that when taken into the
body changes one or more of the body’s
function
T The science of drugs including the study of
the origin, ingredients, uses and actions on
the body is pharmacology
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 Our Approach

T Lecture on General Pharmacology

T 3 lectures on Specific Emergency Drugs
S Mechanism of Action
S Indications
S Interactions
S Contraindications
S Precautions
S Dose
S How supplied
S Adverse Reactions
T Calculations
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 Information about Drugs

T Physicians Desk Reference (PDR)

T Merck Manual
T The Pill Book
T ePocrates
S Available for Palm and Windows OS.
T Many others
T
Very useful for patient assessment

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Pharmacology

S Branches include:
R Phamacokinetics – movement of drug in the body
with emphasis on its distribution, duration of action,
and method of excretion
R Pharmacodynamics – study of drugs and their actions
on body tissues
R Pharmacotherapy – use of drugs in treatment of
diseases
R Toxicology – study of poisons and adverse drug
effects
R Pharmacogenetics – study of influence of heredity
factors on the response to drugs
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History of Pharmacology

S Earliest written records from Egypt

S Greece-Hippocrates
S Renaissance
S Welsh “foxglove”
S Sulfa 1935
S PCN 1940

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History of Pharmacology
Important Discoveries

S 17th century
R Opium, coca, and ipecac
S 1785 – digitalis discovered
S 19th century
R Beginning of large scale manufacturing plants
S 1815 – morphine used to treat pain
S Early 1800’s – ether and chloroform allowing
surgical treatment

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History of Pharmacology
Important Discoveries

S 1922- insulin
S Mid-1940’s – antibiotics like PCN
S 1955 – polio vaccine
S Mid- 1970’s - antivirals

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 Sources of Medications

T Plant
• Alkaloids – group of organic substances that react with acids
to form salts (morphine, atropine)
• Glycosides – on hydrolysis, produce a sugar in addition to one
or more active substances (digoxin)
• Gums – plant exudates. When water added, forms gelatinous
mass (natural laxatives, tropical preparations to sooth skin)
• Oils – volatile or fixed
– Volatile – puts off a pleasant odor or taste and used as a
flavoring agent ( peppermint)
– Fixed – greasy (castor oil)

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Sources of Medications

T Animal and human

R Drugs used to replace insufficient glandular secretions
(ACTH, Insulin)
T Mineral
R Iron, iodine, and mineral salts (“bicarb”)
T Synthetic
R Laboratory-produced chemicals (lidocaine)

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Drug Legislation

T 1906-pure food and drug act

S Established the FDA
S United States Pharmacopoeia (USP)
T 1914-Harrison narcotic act
T 1938-food,drug and cosmetic act
T Durham/Humphrey Amendment
S Required verbal/written prescriptions
T 1970- controlled substance act
S Established the DEA
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 Drug Names

T Chemical
S Ethyl 1-methyl-4-phenylisonipecotate
hydrochloride
T Generic
S Meperidine hydrochloride
T Trade
S Demerol
T Official
S Meperidine hydrochloride, USP 12
 Drug Classifications

T Alpha Adrenergic Blockers

S Proscar, Hytrin
T Aminoglycosides
S “Mycin” antibiotics – Streptomycin, Tobramycin
T Amphetamines
S Diet “drugs”
T ACE Inhibitors
S Vasotec, Zestril, Lisinopril, Accupril, Altace, Diovan
T Antianginals – Nitroglycerine, Isosorbine (Isordil),
CC Blockers
T Antianxiety
S Valium, Xanax, Prozac, Thorazine 13
Drug Classifications

R Antiarrhythmic – correct dysrhythmias

• Group I – decrease rate of sodium during depolarization and
decrease rate of phase O of cardiac action potential
(lidocaine, phenytoin)
• Group II – block beta receptors and depress phase 4
depolarization ( atenolol)
• Group III – prolong duration of action potential (relative
refractory period) without changing phase of depolarization
(amiodarone)
• Group IV – calcium channel blockers and glycosides (digitalis,
verapmil)

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Drug Classifications
R Anticoagulants – affect blood clotting
• Anticoagulant – prevents or slows coagulation
– Coumadin, Heparin, Lovanox
• Thrombolytics - increase rate at which clot dissolves
– TPA, ASA, Streptokinase
• Hemostatics – prevent or stops internal bleeding
– Vitamin K
R Anticonvulsants – depress neuronal discharge in the CNS that may cause seizures
• Dilantin, Depakote, Valium, Lorazepam
R Antidepressants – cause adaptive changes in the serotonin and NE receptor
systems
• Elavil, Tofranil (“Tricyclic Antidepressants”)
R Antihistamines – blocks effect of histamine (H1)
• Benadryl (Diphenhydramine)
R Antihypertensive – lower B/P
• Beta Blockers, CC Blockers, Diuretics, ACE Inhibitors, Alpha Blockers
R Antipsychotic blocks dopamine receptors in brain
• Ziprasidone

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Drug Classifications
R Beta-adrenergic blockers – block response of sympathetic nerve
impulses
• Inderal (Propranalol), Lopressor, Tenormin (Atenalol)
R Bronchodilators – reverse bronchospasm
• Albuterol, Xopenex, Alupent, Terbutaline, Atrovent
R Calcium channel blockers – inhibit influx of ca through cell membrane
results in depression of automaticity and conduction velocity
• Verapamil, Cardizem, Procardia
R Cardiac glycosides – increase force and velocity of myocardial
contraction
• Digitalis (Digoxin, Lanoxin)
R Cholinergic agonist – strengthens, prolongs or prevents breakdown of
acetylcholine
• Physotigamine (Antilirium)
R Cholinergic blocker – prevents Ach from combining with receptors on the
postganglionic nerve terminal
• ATROPINE 16
Drug Classifications
R Corticosteroids – two functions
• regulation of metabolic pathways involving carbohydrates, protein
and fat
• electrolyte and water balance
– Solu-Medrol, Decadron
R Diuretics – inhibit reabsorption of sodium and chloride in
proximal and distal tubules and loop of Henle
• Lasix, HCTZ, Bumex
R Histamine (H2) blockers – block production of gastric acid
secretion
• Nexium, Prilosec, Protonix, Aciphex
R Inotropics – increase cardiac contractile force
• Dopamine**, Dobutamine, Epi
R Medicinal gases – maintain partial pressure of oxygen in arterial
blood
• Oxygen, General Anesthesia gasses
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Drug Classifications
R Narcotic analgesics – attach to specific receptors in CNS
• Morphine, Demerol (Meperidine), Fentanyl, Nubain
R Narcotic antagonists – block action of narcotic analgesics
• Narcan
R Sympathomimetics – mimic action of norepinephrine or
epinephrine
• Dopamine, Dobutamine
R Vasodilator- relaxes blood vessels
• Nitroglycerine, Isosorbide, Ismo, CC Blockers
R Vasopressor – causes contraction of muscles of capillaries and
arteries increasing Peripheral Vascular Resistance
• Epi, Vasopressin

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 Drug Preparations

T Local effects T Oral use

S Topical use S Liquids
R Solution
R Aerosol
R Suspension
R Colloid
R Spirits
R Liniment R Elixirs
R Lotion R Tinctures
R Ointment R Extract
R Paste S Solids
R Plaster R Capsule
R cream R Pill
R Powder
R Tablet
R Lozenge 19
 Drug Preparations

T Parenteral use T Oral preparations for

S Ampule systemic effects
S IV infusion S Inhalants
S Prefilled syringe S Suppositories
S Vial

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Drug Development

S Screening process required by FDA that needs

the following sequence
R Animal studies to determine
• Toxicity
– Acute toxicity – medial lethal dose (LD50) dose lethal to
50% of animals tested
– Subacute and chronic toxicity- speed at which toxicity
develops
• Therapeutic index – ratio of LD50 to median effective dose
• Modes of absorption, distribution, biotransformation, and
excretion

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Drug Development

S Human studies
R Phase I - initial pharmacologic evaluation. Goal to
prove drug’s safety and to identify tolerable dosages
R Phase II – limited controlled evaluation. Designed to
test drug’s effect on the specific illness it was designed
for. After completion of this phase, a new drug
application can be submitted to the FDA. If approved,
we move to phase III
R Phase III – extended clinical evaluation. Full-scale
evaluation on large number of subjects to determine
therapeutic effects, side effects and its tolerability and
to establish tolerable dose ranges 22
Pharmacological
Terminology

T Antagonism
S The opposition between two or more medications
T Bolus
S A single, often large dose of a medication
T Contraindications
S Medical or physiological conditions in a patient
that would make it harmful to administer a
medication
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 Terminology (Cont.)

T Cumulative action
S Occurs when a drug is administered in several
doses, causing an increased effect
T Habituation
S Act of becoming accustomed
T Hypersensitivity
S reaction to a substance that is normally more
profound than in the normal population
T Idiosyncrasy
S reaction to a drug that is unusually different 24
 Terminology (Cont.)

T Indication
S the medical condition in which the drug has proven of
therapeutic value
T Physiologic action
S Effect on body function
T Potentiation
S The enhancement of one drug’s effects by another
R E.g. Alcolhol and Barbiturates
T Refractory
S When there is no response to a drug
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 Terminology (Cont.)

T Side effects
S Known, unavoidable, undesired effects seen in a
drug
T Synergism
S The combined action of two drugs – generally for
the same purpose
R E.g. HCTZ and Accupril
T Therapeutic action
S The desired, intended action of a drug given in
the appropriate medical condition
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Terminology (Cont.)

T Tolerance
S Progressive decrease in effectiveness or response
to drug
T Untoward reaction
S Harmful side effect

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 Mechanism of Action

T The biochemical events that take place

resulting in the desired physiological actions
T The study of these actions are termed
pharmacodynamics

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Drug Absorption

T The process of movement of a drug from the

site of application to the extracellular
compartment of the body

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 Factors Affecting Drug
Absorption

T Solubility of the drug

T Concentration of the drug
T Body pH
S Most drugs are weak acids or bases
S Acidic vs. Alkaline Drugs
T Site of absorption
S E.g. skin vs. IV vs. IM…
T Absorbing surface area
S E.g. lungs
T Blood supply to the site of absorption
T Bioavailability
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Drug Distribution

T The process whereby a drug is transported

from the site of absorption to the site of
action
R A certain amount of drug may become bound to blood
proteins rendering it unavailable for further distribution
until released
S Amount that binds to protein is called bound
protein
S Amount not bound is called free drug
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 Factors Affecting Drug
Distribution

T Cardiovascular function
S E.g. in cardiogenic shock, kidneys are not well perfused –
drugs for kidneys (e.g. ????) are less effective
T Regional blood flow
T Drug storage reservoirs
S Plasma/tissue reservoirs – Delay onset, BUT, prolong the
action of drugs
T Physiological barriers
S E.g. Blood/Brain Barrier
R Excludes ionize (water-based drugs) such as Dopamine
R Allows nonionized drugs such as barbiturates to enter the brain
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Biotransformation

T Active drugs are converted to inactive form

T Usually occurs in the liver
T Converted to water soluble metabolites
S if slow, can cause cumulative drug effects
S Consider the “aging” liver and biotransformation
R Lidocaine dosage variations

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 Elimination

T Drugs are eliminated in original form or as a

metabolite
T Kidneys (urine)
T Liver(bile)
T Intestines (feces)
T Lungs(air)

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 Pharmacodynamics

T Time from administration to production of

therapeutic response called onset of drug action
T Drugs must bind to receptors
S Affinity – attraction to receptor
S Efficacy – capacity to produce pharmacological response
S Affinity & Efficacy need not be directly “proportional”
T Proteins present on the cell membrane
T Lock & Key theory
S Agonist vs. Anagonists
S Partial Agonists (Nubain)
S Classic Example: Epinephrine and Inderal 35
Special Considerations

T Pediatrics
T Geriatrics
T Pregnancy & Lactation

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Pregnancy & Lactation

T FDA assigned categories

R A controlled studies show no risk
R B no evidence of risk in humans
R C risk cannot be ruled out
R D positive evidence of risk
R X contraindicated in pregnancy

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 Drug Administration

T Medication
T Dose
T Route
T Rate

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 Six Rights of Med.
Administration

T Right Patient
T Right Medication
T Right Dose
T Right Route
T Right Time (rate)
T Right Documentation

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 Administration Routes

T Enteral (Alimentary) vs. Parenteral

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Enteral Routes

T Oral
T Sublingual
T Rectal

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 Parenteral Routes

T Topical
T Intradermal
T Subcutaneous
T Intramuscular
T Intravenous
T Endotracheal
T Intaosseous
T Intranasal
T Inhalation
T Vaginal 42
 Cardiac Output

T Stroke Volume x Heart Rate

T CO = SV x HR
T Typical adult SV = 70ml/beat
T Typical adult HR: 60-100 beats/minute
T Therefore, typical adult CO = ?

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Tropic Agents

T Chronotropic = Rate
T Inotropic = Contractile force
T Dromotropic = Rate of nerve impulse
conduction (electrical conduction)
T Positive Tropic Agents
S Epi/Norepi
T Negative Tropic Agents
S Beta Blockers (e.g. Inderal)
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Blood Pressure

T Blood Pressure = Cardiac Output x Peripheral

Vascular Resistance
T BP = CO x PVR
T What might increase PVR?

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 Shock
(Hypoperfusion)

T BP= SV x HR x PVR

T What is my first and most reliable vital sign?

T What is my least reliable sign?

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 Tonight’s Scenario

You come to the scene and find a

semiconscious 51 YO male lying
prone on the floor. There is a
small cut on the forehead that
looks a few days old.

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