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PHARMACOLOGY

EMERGENCY MEDICAL TECHNICIAN - Paramedic

 Overview
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 History
 Overview of general pharmacology
 Review of some drug classes
 Ancient Pharmacology
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 The science of pharmacology may date back to

10,000 to 7,000 B.C.
 Using chemicals in medicine started in the 17th
century
 Studying drug dosage and factories to make drugs
began in 19th century
 Modern Pharmacology
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 Modern health care and pharmaceutical

companies are continuing to change
 Research and education on drugs
 Developing drugs for “orphan diseases” (rare
diseases)
 Combining or modifying existing drugs
 Drugs
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 A drug is:
 Any substance taken by mouth; injected into a muscle, blood
vessel, or cavity of the body; inhaled, or applied topically to
treat or prevent a disease or condition
 Source of Drugs
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 Drugs come from 5 major sources:

 Plants
 Animals and humans
 Minerals and mineral products
 Microorganisms
 Chemical substances made in laboratory
 Drug Classification
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 Drugs are classified:

 By body system (physiologic classification)
 Class of agent (chemical classification)

 Mechanism of action (therapeutic classification)

 Drug Names
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 Chemical name
 Generic name (nonproprietary name)
 Trade name (brand or proprietary name)
 Official name

Drugs have several names usually. It is best to call them

by their generic name, so that it does not depend on
which company you buy them from
 Controlled Substances Act
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 The Controlled Substances Act (CSA, from 1970)

separated drugs into 5 categories, or “schedules”,
based on their potential to be abused or to become
addicted to
 This is to help limit using more dangerous drugs, and to
establish treatment programs for drug addiction
 Drug Schedules
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• Schedule I
• High abuse potential
• No currently accepted medical use
• Schedule II
• High abuse potential
• Accepted medical uses
• Schedule III
• Less abuse potential than
medications in Schedules I and II
• Accepted medical uses - may lead
to moderate/ low physical
dependence or high psychological
dependence
• Schedule IV
• Lower abuse potential
compared to Schedule III
• Accepted medical uses - may
lead to limited physical or
psychological dependence
• Schedule V
• Low abuse potential
compared to Schedule IV
• Accepted medical uses - may
lead to limited physical or
psychological dependence
 Investigational Drugs
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 Drugs need to be approved prior to general use in

humans
 In the US, the FDA (Food and Drug Administration)
requires a process:
 Experiments
with drug use have 4 phases
 New drug application needs approval

 Each country has its own agency to approve use of

certain drugs in its country
 Paramedic Responsibility
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 Paramedics are responsible to know how to safely

administer all drugs they give; make sure the patient is
not allergic
 They are responsible to know what each drug they
administer is used for, and the normal dosage, as well
as side effects
 They decide on the drugs to be given with the support
of physicians or previously reviewed treatment
algorithms
 Paramedic Responsibility
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 They should obtain from all patients their current drug

history, to include:
 Prescribed medications
 Name
 Strength
 Dailydosage
 Over-the-counter medications
 Vitamins
 Drug reactions
 Consult with medical direction
 Pharmacological Terminology
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 Drug actions may be ________

 Desirable: “therapeutic effect”
 Undesirable: “side effect”
 Antagonism: blocks the effects
 Contraindications: situations to avoid the use of the drug
 Cumulative action: drug effects add to previous ones
 Potentiation: drug effect is made stronger by the
presence of another drug
 Tolerance: drug effect decreases over time as the body
gets used to it
 Allergic Reactions
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 Cross-reactivity
 One drug can trigger an allergic reaction in a patient who has
never taken the drug, but has an allergy to a chemically similar
drug (uncommon)

 Type I (anaphylactic) reactions

 Occur soon after exposure to the drug
 Caused by a specific type of antibody (immunoglobulin E, or IgE)
attached to mast cells
 Drugs associated with Type I reactions include penicillins,
Cephalosporins, and iodides
 Allergic Reactions
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 Type II (cytotoxic) reactions

 Delayed reactions that involve certain cytotoxic (toxic to
cells) antibodies of the IgG class
 Capable of lysing (breaking) cells and commonly cause
hemolytic (destruction of red cells) reactions and destruction
of platelets
 Drugs associated with Type II reactions:
 Quinidine
 Procainamide
 Hydralazine
 Allergic Reactions
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 Type III reactions

 Delayed reactions ("serum sickness")
 Like Type II reactions, specific antibodies are usually involved
(usually IgG)
 Symptoms include urticaria (itching), joint pain, swollen lymph
nodes, and fever
 Drugs associated with Type III reactions:
 Penicillins
 Iodides
 Sulfonamides
 Phenytoin (Dilantin)
 Some antitoxins that use horse serum
 Allergic Reactions
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 Type IV reactions
 Those in which contact dermatitis is produced by a topical
application of a drug
 Produced by T lymphocytes, not by the antibodies
 Usually require more than 24 hours to become evident
 Drugs associated with Type IV reactions:
 Sunscreens
 Acne preparations
 Anti-inflammatory agents
 Antibiotic powders and ointments
 Drugs and the Nervous System
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 Neurotransmitters
(chemicals used by neurons to communicate)
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 The autonomic nervous system is divided into the

sympathetic and parasympathetic.
 Sympathetic leave from thoracic and lumbar regions of spinal
cord
 Parasympathetic leave from cranial and sacral portions of
spinal cord
 Neurotransmitters
(chemicals used by neurons to communicate)
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 The neurons leave the CNS and send a message to a

2nd neuron grouped in ganglia (collection of neurons)
 The chemical used to transmit signals from the 1st to the
2nd neuron is acetylcholine
 The chemical used from the second neuron to the organ
is acetylcholine for parasympathetic nerves, and
norepinephrine for sympathetic nerves
 Neurotransmitters
(chemicals used by neurons to communicate)
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 Nerves that release acetylcholine to communicate are

“cholinergic” neurons
 Acetylcholine can bind muscarinic or nicotinic receptors
 Nerves that release norepinephrine to communicate are
“adrenergic” neurons
 Norepinephrine can bind alpha (more strongly) and beta
receptors
 Adrenergic Hormone
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 Another adrenergic substance in addition to

norepinephrine is epinephrine
 Epinephrine is produced in the adrenal medulla
 Epinephrine binds both alpha and beta receptors
equally
 Nerve Impulses
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 General Drug Properties
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 Drugs have an effect on the body usually by

interacting on certain tissues in particular receptors
 The effect of drugs on the body are separated into 2
classes:
 Pharmacokinetic: How does the body handle the drug
(metabolism…)
 Pharmacodynamic: What effect does the drug have on
the body
 Pharmacokinetic Phase
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 How does the body handle the drug includes all the
following steps:
 Absorption (how does the drug get into the body)
 Distribution (where does the drug go in the body)
 Biotransformation (what changes happen to the drug)
 Excretion (how is the drug or its metabolites eliminated)
 Factors that Influence Actions of
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Drugs
 Age
 Body mass
 Gender
 Environment
 Time of administration
 Pathological state
 Genetic factors
 Psychological factors
 Pharmacodynamic Phase
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 How the drug affects the

organs and body
 Most drugs work in one of the
following ways:
 Drug-receptor interaction
 Drug-enzyme interaction
 Nonspecific drug interaction
 Drug Receptor Interaction
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 Agonists: drugs bind a receptor and cause a

physiological response
 Antagonists: drugs bind a receptor and prevent a
response or another drug from binding
 Therapeutic Range
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 For most drugs, the therapeutic range is based on the

concentration (dose) of drug that gives the best
chance for a good response with the least toxicity
 We aim to give just enough drug to have the effect we
want in most patients, but few side effects
 Biological Half-life
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 The biological half-life is the amount of time it takes

for the concentration of the drug in the body to reach
½ of its original level
 It depends on the biotransformation as well as the
excretion of the drug
 It takes about 5 half-lives for the drug to be
considered gone from the body
 Special Considerations
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 Elderly patients
 May not have the money to buy medications needed
 Forget or get confused with when and how much to take
 May not take medications on purpose

 Pediatric patients
 Drugs may have different effects than on adults
 Dose is often weight dependent

 Pregnant patients
 Drugs can cross the placenta to the fetus
 Dose may be different than for nonpregnant women
 Narcotics
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 Drugs that come from opium (opioids)

 Morphine is a common narcotic
 They work to relieve pain by binding opioid receptors in
the brain and other organs
 Possible side effects:
 Nausea and vomiting
 Constipation and urinary retention
 Orthostatic hypotension (BP decreases when standing)
 CNS depression (get sleepy, lethargic…)
 Narcotics
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 Morphine (morphine sulfate)

 Codeine (Methyl morphine)

 Hydromorphone (Dilaudid, Dilaudid HP)

 Meperidine (Demerol)

 Methadone (Dolophine, Methadose)

 Oxycodone (Percodan, Tylox, Percocet)

 Hydrocodone (Lortab)

 Propoxyphene (Darvon, Dolene)

 Opioid Antagonists
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 Opioid antagonists block the effects of narcotics at the

receptor site
 Examples:
 Naloxone (Narcan)
 Naltrexone (Trexan)

 Nalmefene (Revex)
 Non-narcotic Analgesics
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 These drugs relieve pain by acting on mediators

(proteins that send messages) released by tissue
damage or pain
 They do not work at the opioid receptor as do narcotics
 Examples:
 Tylenol
 Aspirin
 NSAIDS
 Antianxiety, Sedative-Hypnotic
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Agents, and Alcohol

Antianxiety and sedative- Antianxiety agents:

hypnotic agents and alcohol Reduce feelings of apprehension
have similarities in Nervousness
pharmacological action Worry
Fearfulness
Sedatives and hypnotics:
Depress the CNS
Produce a calming effect
Help induce sleep
 Alcohol
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 A general CNS depressant that can produce sedation,

sleep, and anesthesia
 Enhances sedative-hypnotic effects of other drug
classes
 Bloodalcohol is measured in milligrams per deciliter
(mg/dL)
 Behavioral effects can be predicted based on blood alcohol
levels
 Benzodiazepines
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 Thought to work by binding to specific receptors in the

cerebral cortex and limbic system
 Four actions:
 Anxiety reducing
 Sedative-hypnotic
 Muscle relaxing
 Anticonvulsant

 All benzodiazepines are schedule IV drugs because of

their potential for abuse
 Benzodiazepines
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 Commonly prescribed benzodiazepines:

 Alprazolam (Xanax)
 Chlordiazepoxide (Librium)

 Clorazepate (Tranxene)

 Diazepam (Valium)

 Flurazepam (Dalmane)

 Prazepam (Centrax)

 Midazolam (Versed)

 Lorazepam (Ativan)

 Triazolam (Halcion)
 Barbiturates
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 Divided into four classes according to their duration of

action:
 Ultra-shortacting
 Short-acting

 Intermediate-acting

 Long-acting
 Psychotherapeutic Drugs
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 Neurotransmitters in the CNS that have major effects on

emotion:
 Acetylcholine
 Norepinephrine

 Dopamine

 Serotonin

 Monoamine oxidase

 Changes in these neurotransmitters affect mood

 Antipsychotic Drugs
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 Used in treating Schizophrenia, dementia

 Drugs block the dopamine receptor in certain
areas of the brain
 Classifications
 Phenothiazine derivatives
 Butyrophenone derivatives

 Dihydroindolone derivatives

 Dibenzoxapine derivatives

 Thienbenzodiazepine derivatives

 Atypical agents
 Antidepressants
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 Antidepressants are used to treat affective disorders

(mood disturbances):
 Depression
 Mania

 Elation

 Tricyclic antidepressants and MAO inhibitors are

prescribed for depression
 Lithium (an antimanic drug) is the preferred treatment for
mania
 Newer drugs such as bupropion, fluoxetine, sertraline
 Drugs Affecting the Autonomic
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Nervous System
 Autonomic drugs mimic or block the effects of the
sympathetic and parasympathetic divisions of the
autonomic nervous system
 These drugs can be classified into four groups
 Drugs Affecting the Autonomic
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Nervous System
1. Cholinergic (parasympathomimetic) drugs
Mimic actions of parasympathetic nervous system
2. Cholinergic blocking (parasympatholytic) drugs
Block actions of parasympathetic nervous system
3. Adrenergic (sympathomimetic) drugs
Mimic the actions of the sympathetic nervous system or the
adrenal medulla
4. Adrenergic blocking (sympatholytic) drugs
Block the actions of the sympathetic nervous system or adrenal
medulla
 Drugs Affecting the Autonomic
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Nervous System
 Catecholamines depend on their ability to act directly
with alpha and beta receptors
 Alpha-1
 Alpha-2
 Beta-1
 Beta-2

 Norepinephrine
 Acts mainly on alpha receptors
 Epinephrine
 Acts on alpha and beta receptors
 Drugs Affecting the Autonomic
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Nervous System
 Alpha activities
 Vasoconstriction
 Of arterioles in the skin and splanchnic area
 Pupil dilation
 Relaxation of the gut
 Beta activities
 Cardiac acceleration and increased contractility
 Vasodilation of arterioles supplying skeletal muscle
 Bronchial relaxation
 Uterine relaxation
 Cardiac Drugs
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 Chronotropic drugs
 Affect heart rate
 Dromotropic drugs
 Affect conduction velocity through the conducting tissues
of the heart
 Inotropic drugs
 Affect force of contraction
 Antiarrhythmic Drugs
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 Used to treat and prevent disorders of cardiac rhythm

 Work by:
 Direct action on the cardiac cell membrane (lidocaine)
 Indirect action that affects the cell (propranolol)

 Or both

 Divided into classes based on mode of action

 Antiarrhythmic Drugs
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 Class I (IA, IB, IC)

 Affect conduction velocity
 Class II
 Beta-blockers (block beta receptor)
 Class III
 Increase contractility; antiadrenergic
 Class IV
 Calcium channel blockers
 Antihypertensive Drugs
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 Four major categories:

 Diuretics

 Sympathetic blocking agents (such as beta-blockers)

 Vasodilators

 Angiotensin-converting-enzyme (ACE) inhibitors

 Vasodilator Drugs
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 Act on the smooth muscle walls of blood vessels

 Angiotensin converting enzyme (ACE) inhibitors block
formation of angiotensin II; blocks renin-angiotensin-
aldosterone system and decreases blood pressure
 Calcium channel blockers dilate smooth muscle in the
coronary and peripheral blood vessel walls
 Drugs that Affect Blood
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 Can affect blood coagulation in 3 ways:

 Antiplatelet drugs
 Anticoagulant drugs

 Fibrinolytic drugs
 Respiratory Drugs
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 Bronchodilator drugs help treat obstructive pulmonary disease

such as asthma, chronic bronchitis, and emphysema
 May be classified as:
 Sympathomimetic drugs (beta 2 receptor in lung dilates
bronchi)
 Xanthine derivatives (such as caffeine, theophylline,
theobromine)
 Anticholinergic

 Steroids
 Antihistamines
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 Histamine is a chemical mediator found in almost all

body tissues
 Concentration is highest in the skin, lungs, and GI tract
 Body releases histamine when exposed to an antigen
such as pollen or insect stings
 Antihistamines compete with histamine for receptor
sites, thereby preventing physiological action of
histamine
 GI Drugs
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 Drugs affecting the GI tract:

 Antacids (block acid in stomach)
 Antiflatulents (decrease gas in intestines)
 Digestants (help digest)
 Emetics (help vomit)
 Antiemetics (prevent vomiting and nausea)
 Cytoprotective agents

 H2 receptor antagonists

 Laxatives (help excrete stool)

 Antidiarrheals (decrease diarrhea)

 Drugs Affecting Endocrine Organs
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 Thyroid: affect thyroglobulin

 Parathyroid: affect calcium and vitamin D
 Adrenal: affect cortisol, aldosterone
 Pancreas: affect insulin and glucagon
 Ovaries: affect estrogen and progesterone
 Testes: affect testosterone
 Antibiotics
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 Used to treat bacterial infection

 Kill or suppress growth of microorganisms by:
 Breaking the bacterial cell wall
 Disturbing the functions of the cell membrane
 Interfering with the cell’s metabolism

 Includes:
 Penicillins
 Cephalosporins and related products
 Macrolide antibiotics
 Tetracyclines
 Miscellaneous antibiotic agents
 Other Antimicrobials
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 Antifungal drugs
 Antiviral drugs
 Other Immunologic Drugs
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 Immunosuppressants
 Immunomodulating agents
 Serums
 Vaccines
 Analgesics, Antipyretics
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 Antipyretics reduce fever by blocking the effect of

pyrogen on the hypothalamus
 Aspirin, Tylenol…
 Analgesics act on peripheral pain receptors to block
pain
 NSAID’s (nonsteroidal anti-inflammatory drugs) are a
major class of these drugs. They block prostaglandin
formation or effect