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Chapter 17Chapter 17PharmacologyPharmacology

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

ObjectivesObjectivesExplain what a drug isExplain what a drug is

Identify four types of drug namesIdentify four types of drug names

Outline drug standards and legislationOutline drug standards and legislation

Describe the paramedicDescribe the paramedic’’s responsibilities in drug s responsibilities in drug administrationadministration

Distinguish among drug formsDistinguish among drug forms


ObjectivesObjectives

Outline autonomic nervous system functions Outline autonomic nervous system functions that may be changed with drug therapythat may be changed with drug therapy

Discuss factors that influence drug absorption, Discuss factors that influence drug absorption, distribution, eliminationdistribution, elimination

Describe how drugs react with receptors to Describe how drugs react with receptors to produce their desired effectsproduce their desired effects


Mosby, Inc. items and derived items © 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Sanders: Mosby's Paramedic Textbook, Revised 3rd Edition PowerPoint Lecture Notes

Chapter 17: Pharmacology

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ObjectivesObjectivesList variables that can influence drug interactionsList variables that can influence drug interactions

Identify considerations for drug administration to Identify considerations for drug administration to pregnant, pediatric, and older patientspregnant, pediatric, and older patients

Outline drug actions for patient who is given drugs that Outline drug actions for patient who is given drugs that affect body systemsaffect body systems

Explain meaning of drug terms used in drug referencesExplain meaning of drug terms used in drug references


ScenarioScenarioAn 80An 80--yearyear--old woman has fallen and is old woman has fallen and is experiencing severe pain. You observe experiencing severe pain. You observe obvious deformity of the hip. Her husband obvious deformity of the hip. Her husband hands you a sack that contains her pill hands you a sack that contains her pill bottles, but he is too upset to tell you what bottles, but he is too upset to tell you what she is being treated for.she is being treated for.


DiscussionDiscussionWhy is it important to understand the general Why is it important to understand the general actions of her home medications?actions of her home medications?

What additional information will you need to What additional information will you need to obtain prior to treating her pain?obtain prior to treating her pain?

How will the age of this patient affect your drug How will the age of this patient affect your drug administration?administration?



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Ancient Health CareAncient Health CarePharmacology dates to 10,000 to 7,000 B.C. Pharmacology dates to 10,000 to 7,000 B.C.

Medicinal herbsMedicinal herbs

Medications mentioned in BibleMedications mentioned in Bible

PlantPlant--derived drugs used in Middle Agesderived drugs used in Middle Ages


Historical Trends in PharmacologyHistorical Trends in Pharmacology

““Chemical medicineChemical medicine”” born in 17born in 17thth centurycentury

Studies of drug dosage in 19Studies of drug dosage in 19thth centurycenturyLed to development of manufacturing plants to Led to development of manufacturing plants to produce drugsproduce drugs


Modern Health CareModern Health CareExpansion of consumer health education Expansion of consumer health education

Increased researchIncreased research

Incentives to develop orphan drugs for Incentives to develop orphan drugs for treatment of rare, chronic diseasestreatment of rare, chronic diseases



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DrugsDrugsDefined as:Defined as:

Any substance taken by mouth; injected into a Any substance taken by mouth; injected into a muscle, blood vessel, or cavity of the body; muscle, blood vessel, or cavity of the body; inhaled; or applied topically to treat or prevent a inhaled; or applied topically to treat or prevent a disease or conditiondisease or condition


Sources of DrugsSources of DrugsFive major sourcesFive major sources

Plants (alkaloids, glycosides, gums, and oils)Plants (alkaloids, glycosides, gums, and oils)Animals and humansAnimals and humansMinerals or mineral productsMinerals or mineral productsMicroorganismsMicroorganismsChemical substances made in laboratoryChemical substances made in laboratory


Drug NamesDrug NamesChemical nameChemical name

Generic name Generic name Nonproprietary nameNonproprietary name

Trade name Trade name Brand or proprietary nameBrand or proprietary name

Official nameOfficial name



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Drug ReferencesDrug ReferencesAmerican Medical American Medical Association (AMA) Drug Association (AMA) Drug EvaluationEvaluation

American Hospital Formulary American Hospital Formulary Service (AHFS)Service (AHFS)

Medication package insertsMedication package inserts

MosbyMosby’’s Drug Consults Drug Consult

Physician's Desk ReferencePhysician's Desk Reference(PDR)(PDR)

Nursing Drug ReferenceNursing Drug Reference(NDR)(NDR)

Electronic data basesElectronic data basesFDA web pageFDA web pageMedlineMedlinePharmInfoNet web pagePharmInfoNet web pageToxlineToxline


Drug Standards and LegislationDrug Standards and Legislation

Before 1906: Little controlBefore 1906: Little controlPure Food and Drug Act, 1906Pure Food and Drug Act, 1906Shirley Amendment, 1912Shirley Amendment, 1912Harrison Narcotic Act, 1914Harrison Narcotic Act, 1914Federal Food, Drug, and Cosmetic Act, 1938Federal Food, Drug, and Cosmetic Act, 1938DurhamDurham--Humphrey Amendment, 1952Humphrey Amendment, 1952KefauverKefauver--Harris Amendment, 1962Harris Amendment, 1962


Comprehensive Drug Abuse Comprehensive Drug Abuse Prevention and Control Act, 1970Prevention and Control Act, 1970

Also called the Controlled Substances Act (CSA)Also called the Controlled Substances Act (CSA)Superseded Harrison Narcotic Act of 1914Superseded Harrison Narcotic Act of 1914

Classified drugs into five categories (schedules) Classified drugs into five categories (schedules) based on:based on:

Potential for abuse and physical and psychological Potential for abuse and physical and psychological dependencedependenceDefined terms Defined terms drug dependencydrug dependency and and drug addictiondrug addictionEstablished education and treatment programs for drug Established education and treatment programs for drug abuse abuse



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Drug SchedulesDrug SchedulesSchedule ISchedule I

High abuse potentialHigh abuse potentialNo accepted medical useNo accepted medical use

Schedule IISchedule IIHigh abuse potentialHigh abuse potentialAccepted medical usesAccepted medical uses

Schedule IIISchedule IIILess abuse potential than drugs in schedules I and IILess abuse potential than drugs in schedules I and IIAccepted medical uses; may lead to some physical Accepted medical uses; may lead to some physical dependence or high psychological dependencedependence or high psychological dependence


Drug SchedulesDrug Schedules

Schedule IVSchedule IVLower abuse potential than schedule III drugsLower abuse potential than schedule III drugsAccepted medical uses; may lead to limited physical or Accepted medical uses; may lead to limited physical or psychological dependencepsychological dependence

Schedule VSchedule VLow abuse potential compared to schedule IV drugsLow abuse potential compared to schedule IV drugsAccepted medical uses; may lead to limited physical or Accepted medical uses; may lead to limited physical or psychological dependencepsychological dependence


Drug Regulatory AgenciesDrug Regulatory AgenciesIn 1973 the Drug Enforcement Agency (DEA) In 1973 the Drug Enforcement Agency (DEA) became the sole drug enforcement organization in became the sole drug enforcement organization in the U.S.the U.S.

Other regulatory bodies or servicesOther regulatory bodies or servicesFood and Drug AdministrationFood and Drug AdministrationPublic Health ServicePublic Health ServiceFederal Trade CommissionFederal Trade CommissionCanadian drug controlCanadian drug controlInternational drug control International drug control



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General Properties of DrugsGeneral Properties of DrugsTherapeutic effectsTherapeutic effects

Desirable drug actionsDesirable drug actions

Side effectsSide effectsUndesirable or harmful drug actionsUndesirable or harmful drug actions

Drug interaction with other drugsDrug interaction with other drugsCan produce unpredictable effectsCan produce unpredictable effects

Drug actions are biochemical interaction between Drug actions are biochemical interaction between drug and tissue componentsdrug and tissue components


Pharmaceutical PhasePharmaceutical PhasePharmaceuticsPharmaceutics

Science of dispensing drugsScience of dispensing drugs

DissolutionDissolutionRate at which a solid drug goes into solution after Rate at which a solid drug goes into solution after ingestioningestionMore rapid rate of dissolution = more quickly drug More rapid rate of dissolution = more quickly drug is absorbedis absorbed


Pharmacokinetic PhasePharmacokinetic PhasePharmacokineticsPharmacokinetics

How the body handles a drug over a period of timeHow the body handles a drug over a period of time•• AbsorptionAbsorption•• DistributionDistribution•• BiotransformationBiotransformation•• ExcretionExcretion



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Drug AbsorptionDrug AbsorptionMovement of drug molecules from site of Movement of drug molecules from site of entry to general circulationentry to general circulation

Variables affecting drug absorptionVariables affecting drug absorptionAbsorbing surfaceAbsorbing surfaceBlood flow to the administration siteBlood flow to the administration siteDrug solubilityDrug solubilitypHpHDrug concentrationDrug concentrationDosage formDosage form


Routes of Medication AdministrationRoutes of Medication Administration

Mode affects the rate of onset of actionMode affects the rate of onset of actionMay affect the therapeutic response May affect the therapeutic response

Drugs are given for local or systemic effectsDrugs are given for local or systemic effects


Routes of Medication AdministrationRoutes of Medication Administration

TopicalTopical

Enteral Enteral

PulmonaryPulmonary

ParenteralParenteral



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Enteral RouteEnteral RouteDrugs administered along GI tractDrugs administered along GI tract

OralOralRectalRectalNasogastricNasogastric

Safe, convenient, economical Safe, convenient, economical

Least reliable and slowest route Least reliable and slowest route Food contentsFood contentsEmotional stateEmotional statePhysical activityPhysical activity


Oral AbsorptionOral AbsorptionRich blood supply, little absorption in mouthRich blood supply, little absorption in mouth

Nitroglycerin and some hormones Nitroglycerin and some hormones administered by sublingual or buccal routesadministered by sublingual or buccal routes

Rapidly dissolve in salivary secretionsRapidly dissolve in salivary secretions


Gastric AbsorptionGastric AbsorptionLength of time a drug remains in the stomach Length of time a drug remains in the stomach varies depending on:varies depending on:

pH of the environmentpH of the environmentGastric motilityGastric motility



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Absorption in the Small Intestine Absorption in the Small Intestine

Rich blood supply and large absorption areaRich blood supply and large absorption areaMost drug absorption occurs in the upper portion Most drug absorption occurs in the upper portion of the small intestineof the small intestine


Rectal AbsorptionRectal AbsorptionEffective for some medicationsEffective for some medications

Vascular surface area capable of drug absorptionVascular surface area capable of drug absorption

Erratic absorption may occur from:Erratic absorption may occur from:Rectal contentsRectal contentsLocal drug irritationLocal drug irritationUncertainty of drug retentionUncertainty of drug retention

No hepatic alteration on first pass through bodyNo hepatic alteration on first pass through body


Parenteral AdministrationParenteral Administration

SubcutaneousSubcutaneousIntramuscularIntramuscularIntravenousIntravenousIntradermalIntradermalIntraosseousIntraosseousEndotrachealEndotracheal



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Subcutaneous AdministrationSubcutaneous AdministrationAn injection beneath skin into connective An injection beneath skin into connective tissue or fat beneath dermistissue or fat beneath dermis

Used for small volumes of drugs (Used for small volumes of drugs (<<0.5 mL) that do 0.5 mL) that do not irritate tissuenot irritate tissueAbsorption rate is slow Absorption rate is slow Can provide sustained effect Can provide sustained effect


Intramuscular AdministrationIntramuscular AdministrationInjection given into skeletal muscleInjection given into skeletal muscle

Absorption occurs more rapidly than SC injection Absorption occurs more rapidly than SC injection Greater tissue blood flow Greater tissue blood flow


Intravenous AdministrationIntravenous AdministrationAn injection given directly into the bloodstreamAn injection given directly into the bloodstream

Bypasses absorption processBypasses absorption process

Almost immediate effectAlmost immediate effect

Most IV drugs are administered slowly to help Most IV drugs are administered slowly to help prevent adverse reactionsprevent adverse reactions



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Intradermal AdministrationIntradermal AdministrationInjection just below the epidermisInjection just below the epidermis

Primarily used for allergy testing and to Primarily used for allergy testing and to administer local anestheticsadminister local anesthetics


Intraosseous AdministrationIntraosseous AdministrationAn injection directly into the bone marrow An injection directly into the bone marrow cavity through an IO infusion systemcavity through an IO infusion system

Agents circulate via boneAgents circulate via bone’’s medullary cavitys medullary cavity

Time from injection to onset of action similar Time from injection to onset of action similar to venous routeto venous route


Endotracheal Administration Endotracheal Administration Generally through an ET tubeGenerally through an ET tube

Drug delivery into the pulmonary alveoli Drug delivery into the pulmonary alveoli

Systemic absorption via lung capillariesSystemic absorption via lung capillaries

Absorption almost as rapid as IV routeAbsorption almost as rapid as IV route

Usually reserved for situations in which an IV line Usually reserved for situations in which an IV line cannot be establishedcannot be established



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Endotracheal AdministrationEndotracheal AdministrationAdult ET medications include:Adult ET medications include:

Lidocaine (Xylocaine)Lidocaine (Xylocaine)Epinephrine (Adrenalin)Epinephrine (Adrenalin)AtropineAtropineNaloxone (Narcan)Naloxone (Narcan)


Pulmonary RoutePulmonary RouteDrugs given by gas or fine mist (aerosol)Drugs given by gas or fine mist (aerosol)

Absorption in blood is rapid due to:Absorption in blood is rapid due to:Large surface areaLarge surface areaRich alveolar capillary networkRich alveolar capillary network

Produces primarily local effectsProduces primarily local effects

Occasionally unwanted systemic effectsOccasionally unwanted systemic effects


Topical RouteTopical RouteDrugs applied topically to skin and mucous Drugs applied topically to skin and mucous membranesmembranes

Usually rapidly absorbed to produce a local Usually rapidly absorbed to produce a local effecteffect

Only intact skin surfaces used to prevent Only intact skin surfaces used to prevent systemic effectssystemic effects

Massaging skin promotes drug absorptionMassaging skin promotes drug absorption



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Drug DistributionDrug Distribution

Transport of a drug through the bloodstream Transport of a drug through the bloodstream to body tissues and site of actionto body tissues and site of action

Distribution rate depends on capillary Distribution rate depends on capillary permeability to drugpermeability to drug

Cardiac output and regional blood flow affect Cardiac output and regional blood flow affect rate and extent of distributionrate and extent of distribution


Drug ReservoirsDrug Reservoirs

Drugs accumulate at storage sites, form Drugs accumulate at storage sites, form reservoirs by binding to specific tissuesreservoirs by binding to specific tissues

Two types of drug reservoirs:Two types of drug reservoirs:Plasma protein bindingPlasma protein bindingTissue bindingTissue binding


BloodBlood--Brain BarrierBrain BarrierSingle layer of capillary endothelial cellsSingle layer of capillary endothelial cells

Line blood vessels entering the CNSLine blood vessels entering the CNSPermits only lipidPermits only lipid--soluble drugs to be distributed soluble drugs to be distributed into brain and CSF into brain and CSF

•• e.g., general anesthetics and barbituratese.g., general anesthetics and barbituratesDrugs poorly soluble in fat have trouble passing Drugs poorly soluble in fat have trouble passing this barrier this barrier Cannot enter the brainCannot enter the brain

•• e.g., many antibioticse.g., many antibiotics



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Placental BarrierPlacental BarrierMembrane layers separate blood vessels of Membrane layers separate blood vessels of mother and fetusmother and fetus

Not permeable to many lipidNot permeable to many lipid--insoluble drugsinsoluble drugs

Provides some protection to the fetusProvides some protection to the fetusAllows passage of certain nonAllows passage of certain non--lipidlipid--soluble drugssoluble drugs

•• Steroids, narcotics, anesthetics, and some antibioticsSteroids, narcotics, anesthetics, and some antibiotics

Can affect developing embryo or neonate if given Can affect developing embryo or neonate if given to pregnant motherto pregnant mother


BiotransformationBiotransformationProcess by which the drug is chemically Process by which the drug is chemically converted to a metaboliteconverted to a metabolite

Purpose is to "detoxify" a drug and render it less Purpose is to "detoxify" a drug and render it less activeactive

Liver is primary site of drug metabolismLiver is primary site of drug metabolism

If drug metabolism is delayed, drug accumulation If drug metabolism is delayed, drug accumulation and cumulative drug effects may occurand cumulative drug effects may occur


ExcretionExcretionElimination of toxic or inactive metabolitesElimination of toxic or inactive metabolites

Organs of excretionOrgans of excretionKidneysKidneysIntestineIntestineLungsLungsSweat and salivary glandsSweat and salivary glandsMammary glandsMammary glands



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Excretion by KidneysExcretion by KidneysCan be excreted in Can be excreted in urine unchanged or as urine unchanged or as metabolite of its metabolite of its previous formprevious form

Renal excretionRenal excretionPassive glomerular Passive glomerular filtrationfiltrationPartial reabsorptionPartial reabsorptionActive tubular secretionActive tubular secretion


HemodialysisHemodialysisSubstances completely or almost completely Substances completely or almost completely excreted by the normal kidney can be excreted by the normal kidney can be removed by this artificial processremoved by this artificial process

Not effective for highly tissueNot effective for highly tissue-- or proteinor protein--bound drugs bound drugs

Limited benefit with rapidly acting toxinsLimited benefit with rapidly acting toxins


Excretion by the IntestineExcretion by the IntestineDrugs eliminated by biliary excretionDrugs eliminated by biliary excretion

After liver metabolism, metabolites are carried in After liver metabolism, metabolites are carried in bile, passed into duodenum, and eliminated with bile, passed into duodenum, and eliminated with fecesfeces

Some drugs are reabsorbed by the bloodstream, Some drugs are reabsorbed by the bloodstream, returned to the liver, and later excreted by the returned to the liver, and later excreted by the kidneyskidneys



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Excretion by the LungsExcretion by the Lungs

Drugs that can be excreted by the lungs includeDrugs that can be excreted by the lungs includeGeneral anestheticsGeneral anestheticsVolatile alcoholsVolatile alcoholsInhaled bronchodilatorsInhaled bronchodilators

Factors that can alter elimination via the lungs Factors that can alter elimination via the lungs areare

Rate and depth of respirationRate and depth of respirationCardiac outputCardiac output


Secretion through Sweat Secretion through Sweat and Salivary Glandsand Salivary Glands

Sweat is unimportant means of drug excretionSweat is unimportant means of drug excretion

Drugs excreted in saliva are usually swallowed Drugs excreted in saliva are usually swallowed and eliminated in the same manner as other and eliminated in the same manner as other orally administered drugsorally administered drugs


Excretion through Mammary GlandsExcretion through Mammary Glands

Many drugs or their metabolites cross the Many drugs or their metabolites cross the epithelium of the mammary glandsepithelium of the mammary glands

Are excreted in breast milkAre excreted in breast milk

Breast milk is acidic (pH 6.5)Breast milk is acidic (pH 6.5)

Nursing mothers are cautioned against Nursing mothers are cautioned against medication usemedication use



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Factors that Influence Actions of DrugsFactors that Influence Actions of Drugs

AgeAge

Body massBody mass

GenderGender

EnvironmentEnvironment

Time of administrationTime of administration

Pathological statePathological state

Genetic factorsGenetic factors

Psychological factorsPsychological factors


Pharmacokinetic Phase ofPharmacokinetic Phase ofDrug ActionDrug Action


PharmacodynamicsPharmacodynamicsStudy of how a drug acts on a living organismStudy of how a drug acts on a living organism

Pharmacologic response relative to the Pharmacologic response relative to the concentration of a drug at an active site in the concentration of a drug at an active site in the organismorganism



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PharmacodynamicsPharmacodynamicsMost drugs produce effects by:Most drugs produce effects by:

DrugDrug--receptor interactionreceptor interaction•• AgonistsAgonists•• AntagonistsAntagonists•• AffinityAffinity•• EfficacyEfficacy•• Types of receptors Types of receptors

DrugDrug--enzyme interactionenzyme interactionNonspecific drug interactionNonspecific drug interaction


DrugDrug--Receptor InteractionReceptor Interaction


DrugDrug--Receptor InteractionReceptor InteractionAgonists Agonists

Drugs that bind to a receptor and cause a Drugs that bind to a receptor and cause a physiological responsephysiological response

AntagonistsAntagonistsDrugs that bind to a receptor and whose presence Drugs that bind to a receptor and whose presence prevents a physiological response or other drugs prevents a physiological response or other drugs from bindingfrom binding



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Drug Response AssessmentDrug Response AssessmentAssess by observing the physiological Assess by observing the physiological parametersparameters

e.g., BP, paine.g., BP, pain

Effects of some drugs cannot be monitored Effects of some drugs cannot be monitored solely by the patient's responsesolely by the patient's response


Plasma Level ProfilesPlasma Level ProfilesRelationship between plasma concentration Relationship between plasma concentration and level of therapeutic effectiveness over and level of therapeutic effectiveness over timetime

Depend on:Depend on:•• Rate of absorptionRate of absorption•• DistributionDistribution•• BiotransformationBiotransformation•• Excretion Excretion


Plasma Level ProfilesPlasma Level ProfilesTherapeutic rangeTherapeutic range

Concentration (dose) that provides highest Concentration (dose) that provides highest probability of responseprobability of response

Least risk of toxicityLeast risk of toxicitySome patients fail to respond to therapeutic dosesSome patients fail to respond to therapeutic dosesOthers may develop toxicityOthers may develop toxicity



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Plasma Level ProfilesPlasma Level Profiles


Biological HalfBiological Half--LifeLifeTime needed to metabolize or eliminate half Time needed to metabolize or eliminate half of total amount of drug in bodyof total amount of drug in body

A drug is considered gone from the body after A drug is considered gone from the body after five halffive half--lives have passedlives have passed

Affected by renal and hepatic functionAffected by renal and hepatic function


Therapeutic IndexTherapeutic IndexMeasures relative safety of a drugMeasures relative safety of a drug

Ratio between:Ratio between:Lethal dose 50 (LD 50)Lethal dose 50 (LD 50)

•• Dose of a drug lethal in 50% of laboratory animals testedDose of a drug lethal in 50% of laboratory animals testedEffectiveness dose (ED 50)Effectiveness dose (ED 50)

•• Dose that produces a therapeutic effect in 50% of a Dose that produces a therapeutic effect in 50% of a similar populationsimilar population

TI = LD 50/ED 50TI = LD 50/ED 50The closer the ratio to 1, the greater the danger in The closer the ratio to 1, the greater the danger in administering the drug to humansadministering the drug to humans



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DrugDrug--Receptor InteractionReceptor InteractionMost drug actionsMost drug actions

Chemical interaction between drug and various Chemical interaction between drug and various receptors in bodyreceptors in bodyMost common form of drug action is the drugMost common form of drug action is the drug--receptor interactionreceptor interaction

Most drugs are thought to bind to drug Most drugs are thought to bind to drug receptors to produce their desired effectreceptors to produce their desired effect


Drug InteractionsDrug InteractionsVariables influencing drug interaction:Variables influencing drug interaction:

Intestinal absorptionIntestinal absorptionCompetition for plasma protein bindingCompetition for plasma protein bindingDrug metabolism or biotransformationDrug metabolism or biotransformationAction at the receptor siteAction at the receptor siteRenal excretionRenal excretionAlteration of electrolyte balanceAlteration of electrolyte balance


DrugDrug--Drug InteractionsDrug InteractionsSome drugSome drug--drug interactions are dangerousdrug interactions are dangerous

Drugs associated with significant interactions:Drugs associated with significant interactions:Blood thinnersBlood thinnersTricyclic antidepressantsTricyclic antidepressantsMonoamine oxidase (MAO) inhibitorsMonoamine oxidase (MAO) inhibitorsAmphetaminesAmphetaminesDigitalis glycosidesDigitalis glycosidesDiureticsDiureticsAntihypertensivesAntihypertensives



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Drug InteractionsDrug InteractionsOther factors influencing drug interactions:Other factors influencing drug interactions:

DrugDrug--induced malabsorption of foods and induced malabsorption of foods and nutrientsnutrientsFoodFood--induced malabsorption of drugsinduced malabsorption of drugsEnzyme alterations that affect the metabolism of Enzyme alterations that affect the metabolism of foods or drugsfoods or drugsAlcohol consumptionAlcohol consumptionCigarette smokingCigarette smokingFoodFood--initiated alteration of drug excretioninitiated alteration of drug excretion


Drug StorageDrug StorageRefer to local protocolRefer to local protocol

Drug potency can be affected by:Drug potency can be affected by:TemperatureTemperatureLightLightMoistureMoistureShelf lifeShelf life

Controlled medications securityControlled medications security


Paramedic ResponsibilitiesParamedic Responsibilities

Use correct medications and techniquesUse correct medications and techniquesObserve and document the effects of drugsObserve and document the effects of drugsKeep current on changes in pharmacology Keep current on changes in pharmacology trendstrendsMaintain professional relationships with Maintain professional relationships with health care teamhealth care team



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Paramedic ResponsibilitiesParamedic Responsibilities

Understand pharmacodynamics of drugs Understand pharmacodynamics of drugs being administeredbeing administeredCarefully evaluate patients for drug Carefully evaluate patients for drug indications and contraindicationsindications and contraindicationsTake a thorough patient medication historyTake a thorough patient medication historyConsult with medical direction as neededConsult with medical direction as needed


Components of a Drug ProfileComponents of a Drug Profile

Drug namesDrug namesClassificationClassificationIndicationsIndicationsPharmacokineticsPharmacokineticsSide/adverse effectsSide/adverse effects


Components of a Drug ProfileComponents of a Drug Profile

DosagesDosagesRoutes of administrationRoutes of administrationContraindicationsContraindicationsSpecial considerationsSpecial considerationsStorage requirementsStorage requirements



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Special ConsiderationsSpecial ConsiderationsPregnant patientsPregnant patients

Pediatric patientsPediatric patients

Geriatric patientsGeriatric patients


Pregnancy Ratings for DrugsPregnancy Ratings for DrugsCategory ACategory A

Risk of fetal harm remoteRisk of fetal harm remoteCategory BCategory B

Inconclusive risk in first trimester, no risk in later trimesterInconclusive risk in first trimester, no risk in later trimesterssCategory CCategory C

Give only if potential benefit outweighs risk to fetusGive only if potential benefit outweighs risk to fetusCategory DCategory D

Evidence of fetal risk; may be acceptable if lifeEvidence of fetal risk; may be acceptable if life--threatening threatening situationsituation

Category XCategory XRisk outweighs any benefitRisk outweighs any benefit


PediatricsPediatricsEffects unpredictable in infantsEffects unpredictable in infants

Drug doses weight relatedDrug doses weight related

Higher doses of waterHigher doses of water--soluble drugs may be neededsoluble drugs may be needed

Less effective bloodLess effective blood--brain barrier in infantsbrain barrier in infants

Slow drug clearance, excretionSlow drug clearance, excretion

Longer halfLonger half--lifelife



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Elderly PatientElderly PatientCauses of noncompliance and medication Causes of noncompliance and medication errors:errors:

Expense Expense Forgetfulness or confusionForgetfulness or confusionSymptoms disappearSymptoms disappearErrors in taking medicationsErrors in taking medicationsNoncompliance may be deliberateNoncompliance may be deliberate


Drugs that Affect theDrugs that Affect theNervous SystemNervous System


Autonomic Nervous SystemAutonomic Nervous SystemEffects of many drugs depend on:Effects of many drugs depend on:

Which branch of ANS they act onWhich branch of ANS they act onWhether the ANS branch is stimulated or inhibited Whether the ANS branch is stimulated or inhibited by drug therapyby drug therapy



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Autonomic Nervous SystemAutonomic Nervous SystemCNSCNS

BrainBrainSpinal cordSpinal cord

PNSPNSCranial and spinal nerves and their branchesCranial and spinal nerves and their branchesConnects all parts of body to CNSConnects all parts of body to CNS


Types of Nerve FibersTypes of Nerve FibersVisceral afferent (sensory)Visceral afferent (sensory)

Convey impulses from internal organs to CNSConvey impulses from internal organs to CNS

Visceral efferent (motor)Visceral efferent (motor)Convey impulses from CNS to internal organs, glands, and Convey impulses from CNS to internal organs, glands, and smooth and cardiac musclesmooth and cardiac muscle

Somatic afferent (sensory)Somatic afferent (sensory)Convey impulses from head, body wall, and extremities to Convey impulses from head, body wall, and extremities to CNSCNS

Somatic efferent (motor)Somatic efferent (motor)Convey impulses from CNS to striated musclesConvey impulses from CNS to striated muscles


Autonomic Nervous SystemAutonomic Nervous SystemPeripheral nervous system provides a double Peripheral nervous system provides a double set of nerve fibers:set of nerve fibers:

Sympathetic (adrenergic)Sympathetic (adrenergic)•• Exit from thoracic and lumbar regions Exit from thoracic and lumbar regions

Parasympathetic (cholinergic)Parasympathetic (cholinergic)•• Exit from cranial and sacral portions Exit from cranial and sacral portions



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Autonomic Nervous SystemAutonomic Nervous SystemSympathetic nerve stimulationSympathetic nerve stimulation

Excitatory effects in some organs Excitatory effects in some organs Inhibits effects in othersInhibits effects in others

Parasympathetic stimulationParasympathetic stimulationExcitation in some organsExcitation in some organsInhibition in othersInhibition in others


Autonomic Nervous SystemAutonomic Nervous SystemBoth systems function continuouslyBoth systems function continuously

Occasionally react in reciprocal fashionOccasionally react in reciprocal fashion

Most organs are dominantly controlled by one Most organs are dominantly controlled by one systemsystem


Overview of Nervous SystemOverview of Nervous System



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PrePre-- and Postganglionic Neuronsand Postganglionic Neurons

A twoA two--neuron chain exists in a series neuron chain exists in a series between the CNS and effector organsbetween the CNS and effector organs

Preganglionic neuron located in the CNSPreganglionic neuron located in the CNS•• Passes between CNS and gangliaPasses between CNS and ganglia

Postganglionic neuron located in the peripheryPostganglionic neuron located in the periphery•• Passes between ganglia and effector organPasses between ganglia and effector organ

SynapseSynapseJunction between two neuronsJunction between two neurons


Autonomic Conduction PathwaysAutonomic Conduction Pathways


Acetylcholine (ACh)Acetylcholine (ACh)NeurotransmitterNeurotransmitter

At junction between preganglionic fiber and At junction between preganglionic fiber and synapsesynapseAt junction between postganglionic fiber and At junction between postganglionic fiber and effector celleffector cellFibers that release ACh are known as Fibers that release ACh are known as cholinergic cholinergic fibersfibers

•• All preganglionic fibers of autonomic divisionAll preganglionic fibers of autonomic division•• All postganglionic fibers of parasympathetic divisionAll postganglionic fibers of parasympathetic division



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NorepinephrineNorepinephrineNeurotransmitter between sympathetic Neurotransmitter between sympathetic postganglionic fiber and effector cellpostganglionic fiber and effector cell

Adrenergic fibersAdrenergic fibersRelease norepinephrine Release norepinephrine Most postganglionic neurons of the sympathetic Most postganglionic neurons of the sympathetic division are adrenergicdivision are adrenergic


Nerve Impulse TransmissionNerve Impulse TransmissionAcetylcholine combines with cholinergic Acetylcholine combines with cholinergic receptorsreceptors

NicotinicNicotinic•• Excitatory responseExcitatory response

MuscarinicMuscarinic•• Excites or inhibitsExcites or inhibits


Nerve Impulse TransmissionNerve Impulse TransmissionNorepinephrine combines with alpha and Norepinephrine combines with alpha and beta receptors in effector organsbeta receptors in effector organs

Binds to and activates both types of receptor Binds to and activates both types of receptor moleculesmolecules

•• More affinity for alpha receptorsMore affinity for alpha receptors



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Nerve Impulse TransmissionNerve Impulse TransmissionEpinephrine is an adrenergic substance:Epinephrine is an adrenergic substance:

Produced by adrenal medullaProduced by adrenal medullaNearly equal affinity for both receptorsNearly equal affinity for both receptorsIn tissues containing alphaIn tissues containing alpha-- and betaand beta--receptor receptor cells, one type is more abundantcells, one type is more abundantHas a dominating effectHas a dominating effect


Nerve Impulse TransmissionNerve Impulse Transmission


Drugs that Affect the ANSDrugs that Affect the ANS



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ClassificationsClassificationsCholinergic (parasympathomimetic)Cholinergic (parasympathomimetic)

Cholinergic blocking (parasympatholytic)Cholinergic blocking (parasympatholytic)

Adrenergic (sympathomimetic)Adrenergic (sympathomimetic)

Adrenergic blocking (sympatholytic)Adrenergic blocking (sympatholytic)


Narcotic Analgesics and AntagonistsNarcotic Analgesics and Antagonists

Narcotic analgesics relieve painNarcotic analgesics relieve pain

Narcotic antagonists reverse the narcotic Narcotic antagonists reverse the narcotic effects of some narcotic analgesicseffects of some narcotic analgesics


Pain ComponentsPain ComponentsSensation of painSensation of pain

•• Involves the nerve pathways and the brainInvolves the nerve pathways and the brain

Emotional response to painEmotional response to pain•• Anxiety levelAnxiety level•• Previous pain experience Previous pain experience •• AgeAge•• GenderGender•• CultureCulture



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NarcoticsNarcoticsContain or abstracted from opiumContain or abstracted from opium

Morphine: Chief alkaloid of opiumMorphine: Chief alkaloid of opium

Bind with opioid receptors in brain and other Bind with opioid receptors in brain and other body organsbody organs

Alters pain perception and emotional response to Alters pain perception and emotional response to painpain


NarcoticsNarcoticsUndesirable effectsUndesirable effects

Nausea and vomitingNausea and vomitingConstipationConstipationUrinary retentionUrinary retentionCough reflex suppressionCough reflex suppressionOrthostatic hypotensionOrthostatic hypotensionCNS depressionCNS depression


Opioid AnalgesicsOpioid AnalgesicsMorphine (morphine sulfate)Morphine (morphine sulfate)Codeine (methylmorphine)Codeine (methylmorphine)Hydromorphone (Dilaudid, DilaudidHydromorphone (Dilaudid, Dilaudid--HP)HP)Meperidine (Demerol)Meperidine (Demerol)Methadone (Dolophine, Methadose)Methadone (Dolophine, Methadose)Oxycodone (Percodan, Tylox, Percocet)Oxycodone (Percodan, Tylox, Percocet)Hydrocodone (Lortab)Hydrocodone (Lortab)Propoxyphene (Darvon, Dolene)Propoxyphene (Darvon, Dolene)



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Opioid AntagonistsOpioid Antagonists““BlockBlock”” opioid analgesics opioid analgesics

Displace analgesics from receptor sitesDisplace analgesics from receptor sites

Examples:Examples:Naloxone (Narcan)Naloxone (Narcan)Naltrexone (Trexan)Naltrexone (Trexan)Nalmefene (Revex)Nalmefene (Revex)


Opioid AgonistOpioid Agonist--AntagonistsAntagonistsAnalgesic and antagonist effectsAnalgesic and antagonist effects

Pharmacokinetic and adverse effects similar to Pharmacokinetic and adverse effects similar to morphinemorphine

Lower dependency risk than opioidsLower dependency risk than opioidsLess severe withdrawal symptomsLess severe withdrawal symptomsMay cause withdrawal symptoms in addictsMay cause withdrawal symptoms in addicts


Nonnarcotic AnalgesicsNonnarcotic AnalgesicsPeripheral mechanism Peripheral mechanism

Interferes with local mediators released when Interferes with local mediators released when tissue is damagedtissue is damaged

Mediators stimulate nerve endingsMediators stimulate nerve endingsCause pain Cause pain

Nonnarcotic analgesics decrease nerve ending Nonnarcotic analgesics decrease nerve ending stimulationstimulation



35

AnestheticsAnestheticsCNS depressants CNS depressants

Reversible action on nervous tissueReversible action on nervous tissue

Major categories of anesthesia:Major categories of anesthesia:GeneralGeneralRegionalRegionalLocalLocal


Antianxiety Agents and AlcoholAntianxiety Agents and Alcohol

Antianxiety agentsAntianxiety agentsReduce feelings of apprehensionReduce feelings of apprehensionNervousnessNervousnessWorryWorryFearfulnessFearfulness


SedativeSedative--Hypnotic AgentsHypnotic AgentsDepress CNSDepress CNS

Calming effectCalming effect

Sedatives and hypnotics differ by degree of Sedatives and hypnotics differ by degree of CNS depressionCNS depression

Agent may be sedative Agent may be sedative andand hypnotichypnoticDepends on dose usedDepends on dose used



36

AlcoholAlcoholCNS depressantCNS depressant

Can produce sedation, sleep, and anesthesiaCan produce sedation, sleep, and anesthesia

Enhances sedativeEnhances sedative--hypnotic effects of other hypnotic effects of other drugsdrugs

Blood alcohol measured (mg/dL)Blood alcohol measured (mg/dL)Behavioral effects based on blood alcohol levelsBehavioral effects based on blood alcohol levels


BenzodiazepinesBenzodiazepinesBind to receptors in cerebral cortex and limbic Bind to receptors in cerebral cortex and limbic system system

ActionsActionsAnxiety reducingAnxiety reducingSedativeSedative--hypnotichypnoticMuscle relaxingMuscle relaxingAnticonvulsantAnticonvulsant

Schedule IV drugs Schedule IV drugs


BenzodiazepinesBenzodiazepinesCommonly prescribed benzodiazepinesCommonly prescribed benzodiazepines

Alprazolam (Xanax)Alprazolam (Xanax)Chlordiazepoxide (Librium)Chlordiazepoxide (Librium)Clorazepate (Tranxene)Clorazepate (Tranxene)Diazepam (Valium)Diazepam (Valium)Flurazepam (Dalmane)Flurazepam (Dalmane)Prazepam (Centrax)Prazepam (Centrax)Midazolam (Versed)Midazolam (Versed)Lorazepam (Ativan)Lorazepam (Ativan)Triazolam (Halcion)Triazolam (Halcion)



37

BarbituratesBarbituratesDuration of action Duration of action

UltraUltra--short actingshort actingShort actingShort actingIntermediate actingIntermediate actingLong actingLong acting


Miscellaneous Miscellaneous SedativeSedative--Hypnotic DrugsHypnotic Drugs

Not benzodiazepines or barbituratesNot benzodiazepines or barbiturates

More like barbiturates than benzodiazepinesMore like barbiturates than benzodiazepines

ExamplesExamplesChloral hydrate (Noctec)Chloral hydrate (Noctec)Ethchlorvynol (Placidyl)Ethchlorvynol (Placidyl)Meprobamate (Equanil, Meprospan)Meprobamate (Equanil, Meprospan)

Some antihistamines have sedative effectsSome antihistamines have sedative effectsHydroxyzine hydrochloride (Vistaril, Atarax)Hydroxyzine hydrochloride (Vistaril, Atarax)


AnticonvulsantsAnticonvulsantsTreat seizure disordersTreat seizure disorders

Mode of action not understoodMode of action not understood

Choice of drug depends on:Choice of drug depends on:Type of seizure disorder Type of seizure disorder Patient's drug tolerance Patient's drug tolerance Medication noncompliance commonMedication noncompliance common



38

CNS StimulantsCNS StimulantsClassified by site of actionClassified by site of action

CerebrumCerebrumMedulla and brainstemMedulla and brainstemHypothalamic limbic regionsHypothalamic limbic regions

Common CNS stimulant drugsCommon CNS stimulant drugsAnorexiantsAnorexiantsAmphetaminesAmphetamines


Psychotherapeutic DrugsPsychotherapeutic DrugsPsychotherapeutic drugs includePsychotherapeutic drugs include

Antipsychotic agentsAntipsychotic agentsAntidepressantsAntidepressantsLithiumLithium

Treat psychoses and affective disordersTreat psychoses and affective disordersSchizophrenia, depression, and maniaSchizophrenia, depression, and mania


Psychotherapeutic DrugsPsychotherapeutic Drugs

Neurotransmitters in Neurotransmitters in CNS affecting emotion:CNS affecting emotion:

AcetylcholineAcetylcholineNorepinephrineNorepinephrineDopamineDopamineSerotoninSerotoninMonoamine oxidaseMonoamine oxidase



39

CNS and EmotionsCNS and EmotionsAlterations in neurotransmitter levels Alterations in neurotransmitter levels associated with changes in mood and associated with changes in mood and behaviorbehavior

Drug therapy alleviates symptoms Drug therapy alleviates symptoms Temporarily modifies unwanted behaviorTemporarily modifies unwanted behavior


Antipsychotic AgentsAntipsychotic AgentsSchizophrenia (primary use)Schizophrenia (primary use)

Tourette syndromeTourette syndrome

Senile dementia associated with Alzheimer Senile dementia associated with Alzheimer diseasedisease

Antipsychotic (neuroleptic) drugs block CNS Antipsychotic (neuroleptic) drugs block CNS dopamine receptorsdopamine receptors


Antipsychotic AgentsAntipsychotic AgentsClassificationsClassifications

Phenothiazine derivativesPhenothiazine derivativesButyrophenone derivativesButyrophenone derivativesDihydroindolone derivativesDihydroindolone derivativesDibenzoxapine derivativesDibenzoxapine derivativesThienbenzodiazepine derivativesThienbenzodiazepine derivativesAtypical agentsAtypical agents



40

AntidepressantsAntidepressantsTreatment of affective disorders (mood Treatment of affective disorders (mood disturbances)disturbances)

DepressionDepressionManiaManiaElationElation

Tricyclic antidepressants and MAO inhibitors Tricyclic antidepressants and MAO inhibitors are prescribed for depressionare prescribed for depression

Lithium is preferred treatment for maniaLithium is preferred treatment for mania


AntidepressantsAntidepressantsNewer classes of antidepressants (secondNewer classes of antidepressants (second--generation drugs) have been developedgeneration drugs) have been developed

ExamplesExamplesBupropion (Wellbutrin)Bupropion (Wellbutrin)Fluoxetine (Prozac)Fluoxetine (Prozac)Trazodone (Desyrel)Trazodone (Desyrel)Sertraline (Zoloft)Sertraline (Zoloft)Paroxetine (Paxil)Paroxetine (Paxil)


Tricyclic AntidepressantsTricyclic AntidepressantsIncrease levels (block reuptake) of Increase levels (block reuptake) of norepinephrine and serotoninnorepinephrine and serotonin

ExamplesExamplesImipramine (Tofranil) Imipramine (Tofranil) Amitriptyline (Elavil)Amitriptyline (Elavil)



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MAO InhibitorsMAO InhibitorsCentralCentral--acting monoamines, especially acting monoamines, especially norepinephrine and serotonin are thought to norepinephrine and serotonin are thought to cause depression and maniacause depression and mania

Monoamine oxidase is responsible for Monoamine oxidase is responsible for metabolizing norepinephrine within nervemetabolizing norepinephrine within nerveMAO inhibitors block this enzyme, leading to MAO inhibitors block this enzyme, leading to increased norepinephrine levelsincreased norepinephrine levels


LithiumLithiumAlters sodium transport in nerve and muscle Alters sodium transport in nerve and muscle cellscells

Affects norepinephrine and serotoninAffects norepinephrine and serotonin

Antimanic effects are thought to result from:Antimanic effects are thought to result from:Increased norepinephrine uptakeIncreased norepinephrine uptakeIncreased serotonin receptor sensitivityIncreased serotonin receptor sensitivity


Drugs for Specific Drugs for Specific CNSCNS--Peripheral DysfunctionPeripheral Dysfunction

Parkinson diseaseParkinson diseaseMuscle rigidityMuscle rigidityTremorsTremorsSuspected cause: Low dopamine levelsSuspected cause: Low dopamine levels

Huntington diseaseHuntington diseaseProgressive dementiaProgressive dementiaInvoluntary muscle twitchingInvoluntary muscle twitchingDopamine, acetylcholine imbalanceDopamine, acetylcholine imbalance



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Drugs with Drugs with Central Anticholinergic ActivityCentral Anticholinergic Activity

Inhibit or block acetylcholineInhibit or block acetylcholineAnticholinergicAnticholinergic

Restore brainRestore brain’’s dopamines dopamine--acetylcholine acetylcholine balance balance

ExamplesExamplesBenztropine (tablets and injections)Benztropine (tablets and injections)Ethopropazine hydrochlorideEthopropazine hydrochloride


Drugs Affecting Brain DopamineDrugs Affecting Brain Dopamine

Three classificationsThree classificationsThose that release dopamineThose that release dopamineThose that increase brain levels of dopamineThose that increase brain levels of dopamineDopaminergic agonistsDopaminergic agonists


Skeletal Muscle RelaxantsSkeletal Muscle RelaxantsCentral actingCentral acting

Baclofen (lioresal)Baclofen (lioresal)Cyclobenzaprine (flexeril)Cyclobenzaprine (flexeril)Diazepam (valium)Diazepam (valium)

Direct actingDirect actingDantrolene (Dantrium)Dantrolene (Dantrium)

Neuromuscular blockersNeuromuscular blockersCan cause paralysisCan cause paralysisPancuronium (Pavulon), vecuronium (Norcuron)Pancuronium (Pavulon), vecuronium (Norcuron)Succinylcholine (Anectine)Succinylcholine (Anectine)



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Drugs Affecting the ANSDrugs Affecting the ANSAutonomic drugsAutonomic drugs

Mimic or block effects of sympathetic and Mimic or block effects of sympathetic and parasympathetic divisions of autonomic parasympathetic divisions of autonomic nervous systemnervous system


Autonomic DrugsAutonomic DrugsCholinergic drugsCholinergic drugs

ParasympathomimeticParasympathomimeticMimic parasympathetic nervous systemMimic parasympathetic nervous system

CholinergicCholinergic--blocking drugsblocking drugsParasympatholyticParasympatholyticBlock parasympathetic nervous systemBlock parasympathetic nervous system


Autonomic DrugsAutonomic DrugsAdrenergic drugsAdrenergic drugs

SympathomimeticSympathomimeticMimic sympathetic nervous system (adrenal Mimic sympathetic nervous system (adrenal medulla)medulla)

AdrenergicAdrenergic--blocking drugsblocking drugsSympatholyticSympatholyticBlock actions of sympathetic nervous system Block actions of sympathetic nervous system (adrenal medulla)(adrenal medulla)



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ReceptorsReceptorsCatecholamines act on alpha and beta receptorsCatecholamines act on alpha and beta receptors

Alpha 1Alpha 1Alpha 2Alpha 2Beta 1Beta 1Beta 2Beta 2

NorepinephrineNorepinephrineActs mainly on alpha receptorsActs mainly on alpha receptors

EpinephrineEpinephrineActs on alpha and beta receptorsActs on alpha and beta receptors


Alpha and Beta ActivitiesAlpha and Beta ActivitiesAlpha activitiesAlpha activities

VasoconstrictionVasoconstriction•• Arterioles in the skin and splanchnic areaArterioles in the skin and splanchnic area•• Pupil dilationPupil dilation

Relaxation of the gutRelaxation of the gut

Beta activitiesBeta activitiesCardiac acceleration and increased contractilityCardiac acceleration and increased contractilityVasodilation of skeletal muscle arteriolesVasodilation of skeletal muscle arteriolesBronchial relaxationBronchial relaxationUterine relaxationUterine relaxation


AlphaAlpha--Blocking DrugsBlocking DrugsBlock the vasoconstricting effect of Block the vasoconstricting effect of catecholaminescatecholamines

Used in certain cases of hypertensionUsed in certain cases of hypertensionPrevent necrosis after norepinephrine (Levophed) Prevent necrosis after norepinephrine (Levophed) or dopamine (Intropin) extravasation into tissuesor dopamine (Intropin) extravasation into tissuesLimited use in prehospital settingLimited use in prehospital setting



45

BetaBeta--Blocking AgentsBlocking AgentsBlock beta receptorsBlock beta receptors

Selective beta 1 blockersSelective beta 1 blockersMetoprolol, atenololMetoprolol, atenololTreatment of hypertension, anginaTreatment of hypertension, angina

Nonselective beta blockersNonselective beta blockersNadolol, propranolol, labetalolNadolol, propranolol, labetalolAntianginal, antihypertensivesAntianginal, antihypertensives


Cardiac Drug TerminologyCardiac Drug TerminologyChronotropic drugsChronotropic drugs

Affect heart rateAffect heart rate

Dromotropic drugsDromotropic drugsAffect conduction velocity through the conducting Affect conduction velocity through the conducting tissues of the hearttissues of the heart

Inotropic drugsInotropic drugsAffect force of contractionAffect force of contraction


Cardiac GlycosidesCardiac GlycosidesPositive inotropic effectPositive inotropic effect

Increase contractilityIncrease contractility

Negative chronotropic effectNegative chronotropic effectSlow heart rateSlow heart rate

Negative dromotropic effectNegative dromotropic effectSlow conduction velocitySlow conduction velocity

Digoxin (Lanoxin)Digoxin (Lanoxin)

Small therapeutic indexSmall therapeutic index

Side effects commonSide effects common



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AntidysrhythmicsAntidysrhythmicsTreat and prevent disorders of cardiac rhythmTreat and prevent disorders of cardiac rhythm

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


AntidysrhythmicsAntidysrhythmics——ClassificationsClassifications

Based on mode of action on cardiac muscleBased on mode of action on cardiac muscle

Drugs that belong to the same class do not Drugs that belong to the same class do not produce identical actionsproduce identical actions

All antidysrhythmics can suppress All antidysrhythmics can suppress automaticityautomaticity


Class I Sodium Channel BlockersClass I Sodium Channel BlockersClass IClass I--AA

Decrease conduction velocityDecrease conduction velocityProlong electrical potential of cardiac tissueProlong electrical potential of cardiac tissueProcainamide (Pronestyl)Procainamide (Pronestyl)

Class IClass I--BBDecrease or have no effect on conduction velocityDecrease or have no effect on conduction velocityLidocaine (Xylocaine)Lidocaine (Xylocaine)

Class IClass I--CCProfoundly slow conductionProfoundly slow conductionControl lifeControl life--threatening ventricular dysrhythmiasthreatening ventricular dysrhythmiasFlecainide (Tambocor)Flecainide (Tambocor)



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Class IIClass IIBetaBeta--blocking agents blocking agents

Reduce adrenergic stimulation of the heartReduce adrenergic stimulation of the heartNegative chronotropeNegative chronotrope

•• Propranolol (Inderal)Propranolol (Inderal)


Class IIIClass IIIPotassium channel blockersPotassium channel blockers

Increase contractilityIncrease contractilityDo not suppress automaticity Do not suppress automaticity Have no effect on conduction velocityHave no effect on conduction velocity

Terminate dysrhythmias that result from Terminate dysrhythmias that result from reentry of blocked impulsesreentry of blocked impulses

Amiodarone (Cordarone)Amiodarone (Cordarone)


Class IVClass IVCalcium channel blockersCalcium channel blockers

Block inflow of calcium through cell membranes of Block inflow of calcium through cell membranes of cardiac and smooth muscle cellscardiac and smooth muscle cells

•• Depresses the myocardial and smooth muscle Depresses the myocardial and smooth muscle contractioncontraction

•• Decreases automaticity and in some cases decreases Decreases automaticity and in some cases decreases conduction velocityconduction velocity

Diltiazem (Cardizem)Diltiazem (Cardizem)



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AntihypertensivesAntihypertensivesDiureticsDiuretics

Sympathetic blocking agents (sympatholytic drugs)Sympathetic blocking agents (sympatholytic drugs)

VasodilatorsVasodilators

AngiotensinAngiotensin--converting enzyme (ACE) inhibitorsconverting enzyme (ACE) inhibitors

Calcium channel blockersCalcium channel blockers

Angiotensin II receptor antagonistsAngiotensin II receptor antagonists


DiureticsDiureticsRenal excretion of excess salt and water Renal excretion of excess salt and water

Thiazide diureticsThiazide diureticsModerately effective in lowering blood pressureModerately effective in lowering blood pressureHydrochlorothiazide (HCTZ)Hydrochlorothiazide (HCTZ)

Loop diureticsLoop diureticsShortShort--acting agents that inhibit sodium and chloride reabsorption in acting agents that inhibit sodium and chloride reabsorption in loop of Henleloop of HenleFurosemide (Lasix)Furosemide (Lasix)

PotassiumPotassium--sparing diureticssparing diureticsLess potassium loss than other diureticsLess potassium loss than other diureticsSpironolactone (Aldactone)Spironolactone (Aldactone)


Sympathetic Blocking AgentsSympathetic Blocking AgentsBetaBeta--blocking agents and adrenergicblocking agents and adrenergic--inhibiting agentsinhibiting agents

BetaBeta--blocking agentsblocking agentsTreatment of suspected myocardial infarction, Treatment of suspected myocardial infarction,

highhigh--risk unstable angina, and hypertensionrisk unstable angina, and hypertension•• Atenolol (Tenormin), metoprolol (Lopressor)Atenolol (Tenormin), metoprolol (Lopressor)•• Labetalol (Normodyne, trandate), nadolol (Corgard)Labetalol (Normodyne, trandate), nadolol (Corgard)



49

Adrenergic Inhibiting AgentsAdrenergic Inhibiting AgentsCentrally acting adrenergic inhibitorsCentrally acting adrenergic inhibitors

Clonidine hydrochloride (Catapres)Clonidine hydrochloride (Catapres)

Peripheral adrenergic inhibitorsPeripheral adrenergic inhibitorsDoxazosin (Cardura)Doxazosin (Cardura)

Mechanism by which many of these agents Mechanism by which many of these agents work is unknownwork is unknown


Vasodilator DrugsVasodilator DrugsAct directly on the smooth muscle walls of Act directly on the smooth muscle walls of arterioles, veins, or botharterioles, veins, or both

Lower peripheral resistance and blood Lower peripheral resistance and blood pressurepressure

Arteriolar dilator drugsArteriolar dilator drugs•• Hydralazine (Apresoline)Hydralazine (Apresoline)

Arteriolar and venous dilator drugsArteriolar and venous dilator drugs•• Nitroglycerin sublingual tablet (Nitrostat)Nitroglycerin sublingual tablet (Nitrostat)


AngiotensinAngiotensin--Converting Enzyme (ACE) Converting Enzyme (ACE) InhibitorsInhibitors

Angiotensin II is a powerful vasoconstrictor:Angiotensin II is a powerful vasoconstrictor:Raises blood pressureRaises blood pressureCauses the release of aldosteroneCauses the release of aldosterone

•• Contributes to sodium and water retentionContributes to sodium and water retentionInhibits conversion of angiotensin I to angiotensin Inhibits conversion of angiotensin I to angiotensin II (brought about through ACE)II (brought about through ACE)ReninRenin--angiotensinangiotensin--aldosterone system is aldosterone system is suppressedsuppressedBlood pressure is loweredBlood pressure is lowered

•• Captopril (Capoten)Captopril (Capoten)



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Calcium Channel BlockersCalcium Channel BlockersInhibit contractility of vascular smooth muscleInhibit contractility of vascular smooth muscle

Reduce peripheral vascular resistance Reduce peripheral vascular resistance

Dilate coronary vessels Dilate coronary vessels Verapamil (Isoptin)Verapamil (Isoptin)Diltiazem (Cardizem)Diltiazem (Cardizem)


Angiotensin II Receptor AntagonistsAngiotensin II Receptor Antagonists

Selectively inhibit angiotensin II receptorsSelectively inhibit angiotensin II receptors

Lower systolic and diastolic BPLower systolic and diastolic BPCandesartan (Atacand)Candesartan (Atacand)Irbesartan (Avapro)Irbesartan (Avapro)Losartan (Cozaar, Hyzaar)Losartan (Cozaar, Hyzaar)


Monoamine Oxidase (MAO) InhibitorsMonoamine Oxidase (MAO) InhibitorsBlock release of norepinephrine at the sympathetic Block release of norepinephrine at the sympathetic junctionjunction

Interfere with vasoconstrictionInterfere with vasoconstriction

Reduce peripheral vascular resistanceReduce peripheral vascular resistance

Decrease blood pressureDecrease blood pressure

Not widely used to treat hypertensionNot widely used to treat hypertension



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Antihemorrheological AgentsAntihemorrheological AgentsUsed to treat peripheral vascular disorders Used to treat peripheral vascular disorders caused by pathological or physiological caused by pathological or physiological obstruction obstruction


Antihemophilic AgentsAntihemophilic AgentsHemophiliaHemophilia

Hemophilia A (classic hemophilia) is caused by a Hemophilia A (classic hemophilia) is caused by a deficiency of factor VIIIdeficiency of factor VIIIHemophilia B (the Hemophilia B (the ““Christmas diseaseChristmas disease””) results ) results from a deficiency in factor IX complexfrom a deficiency in factor IX complexReplacement therapy of the missing clotting factor Replacement therapy of the missing clotting factor can be effective in the management of hemophiliacan be effective in the management of hemophilia

•• Factor VIII (Factorate)Factor VIII (Factorate)•• Factor IX (Konyne)Factor IX (Konyne)•• Antiinhibitor coagulant complex (Autoplex)Antiinhibitor coagulant complex (Autoplex)


Drugs that Affect the BloodDrugs that Affect the BloodDrugs that affect blood coagulation may be Drugs that affect blood coagulation may be classified as:classified as:

Antiplatelet agentsAntiplatelet agentsAnticoagulant agentsAnticoagulant agentsFibrinolytic agentsFibrinolytic agents



52

Antiplatelet AgentsAntiplatelet AgentsInterfere with platelet aggregationInterfere with platelet aggregation

Prevention of clots, MI, strokePrevention of clots, MI, stroke

Treatment of valvular disease, shuntsTreatment of valvular disease, shunts

Include:Include:Aspirin Aspirin Dipyridamole (Persantin)Dipyridamole (Persantin)Abciximab (ReoPro)Abciximab (ReoPro)


AnticoagulantsAnticoagulantsUsed to prevent intravascular thrombosisUsed to prevent intravascular thrombosis

Decreases blood coagulabilityDecreases blood coagulability

ExamplesExamplesHeparin (Liquaemin)Heparin (Liquaemin)Coumadin (Warfarin)Coumadin (Warfarin)


Fibrinolytic AgentsFibrinolytic AgentsUsed to dissolve clots after formationUsed to dissolve clots after formation

Used for some acute myocardial infarctsUsed for some acute myocardial infarcts

Used in some stroke patientsUsed in some stroke patients

ExamplesExamplesStreptokinaseStreptokinaseTissue plasminogen activator (tTissue plasminogen activator (t--PA)PA)Reteplase (Retavase)Reteplase (Retavase)Alteplase (Activase)Alteplase (Activase)Tenecteplase (TNKase)Tenecteplase (TNKase)



53

Hemostatic AgentsHemostatic AgentsHasten clot formation to reduce bleedingHasten clot formation to reduce bleeding

Systemic hemostatic agents Systemic hemostatic agents •• Control rapid blood loss after surgery by inhibiting Control rapid blood loss after surgery by inhibiting

fibrinolysisfibrinolysis

Topical hemostatic agents Topical hemostatic agents •• Control capillary bleeding during surgical and dental Control capillary bleeding during surgical and dental

proceduresprocedures


Blood and Blood ComponentsBlood and Blood ComponentsReplacement therapiesReplacement therapies

Whole blood (rarely used)Whole blood (rarely used)Packed red blood cellsPacked red blood cellsFreshFresh--frozen plasmafrozen plasmaPlasma expanders (Dextran)Plasma expanders (Dextran)PlateletsPlateletsCoagulation factorsCoagulation factorsFibrinogenFibrinogenAlbuminAlbuminGamma globulinsGamma globulins


Antihyperlipidemic DrugsAntihyperlipidemic DrugsHyperlipidemia: Excess Hyperlipidemia: Excess lipids in plasmalipids in plasma

Used in conjunction Used in conjunction with diet and exercise to with diet and exercise to control serum lipid control serum lipid levelslevels

ExamplesExamplesAtorvastatin (Lipitor)Atorvastatin (Lipitor)Cholestyramine Cholestyramine (Questran)(Questran)Niacin (Nicobid)Niacin (Nicobid)Pravastatin (Pravachol) Pravastatin (Pravachol) Lovastatin (Mevacor)Lovastatin (Mevacor)Simvastatin (Zocor)Simvastatin (Zocor)



54

BronchodilatorsBronchodilatorsPrimary treatment for obstructive pulmonary Primary treatment for obstructive pulmonary diseasedisease

Asthma, chronic bronchitis, and emphysemaAsthma, chronic bronchitis, and emphysema

Classified as:Classified as:Sympathomimetic drugsSympathomimetic drugsXanthine derivativesXanthine derivatives

Many agents are administered by inhalation Many agents are administered by inhalation via a nebulizer or pressure cartridgevia a nebulizer or pressure cartridge


Sympathomimetic DrugsSympathomimetic DrugsNonselective adrenergic drugsNonselective adrenergic drugs

Have alpha, betaHave alpha, beta--1 (cardiac), and beta1 (cardiac), and beta--2 (respiratory) 2 (respiratory) activitiesactivitiesEpinephrine (Adrenalin, Asmolin)Epinephrine (Adrenalin, Asmolin)

Nonselective betaNonselective beta--adrenergic drugsadrenergic drugsHave both betaHave both beta--1 and beta1 and beta--2 effects2 effectsIsoproterenol inhalation aerosol (Isuprel)Isoproterenol inhalation aerosol (Isuprel)

Selective betaSelective beta--2 receptor drugs2 receptor drugsAct primarily on betaAct primarily on beta--2 receptors in the lungs 2 receptors in the lungs Albuterol (Proventil, Ventolin)Albuterol (Proventil, Ventolin)


Xanthine DerivativesXanthine DerivativesXanthine drugs include caffeine, theophylline, Xanthine drugs include caffeine, theophylline, and theobromineand theobromine

ActionsActionsRelax smooth muscle (particularly bronchial Relax smooth muscle (particularly bronchial smooth muscle)smooth muscle)Stimulate cardiac muscle and CNSStimulate cardiac muscle and CNSIncrease diaphragmatic contractilityIncrease diaphragmatic contractilityPromote diuresis through increased renal Promote diuresis through increased renal perfusionperfusion



55

Other Respiratory DrugsOther Respiratory DrugsProphylactic asthmatic agentsProphylactic asthmatic agents

Cromolyn sodium (Intal)Cromolyn sodium (Intal)

Aerosol corticosteroid agentsAerosol corticosteroid agentsBeclomethasone dipropionate (Vanceril inhaler, Beclovent)Beclomethasone dipropionate (Vanceril inhaler, Beclovent)

Muscarinic antagonistsMuscarinic antagonistsIpratropium (Atrovent)Ipratropium (Atrovent)

AntileukotrienesAntileukotrienesMontelukast (Singulair)Montelukast (Singulair)


Mucokinetic DrugsMucokinetic Drugs

Move respiratory secretions and sputum along Move respiratory secretions and sputum along tracheobronchial treetracheobronchial tree

Alter consistency of secretions so that they can Alter consistency of secretions so that they can more easily be removed from the bodymore easily be removed from the body

Diluents (water, saline)Diluents (water, saline)Expectorants (Mucomyst)Expectorants (Mucomyst)


OxygenOxygenTreatment of hypoxia and hypoxemiaTreatment of hypoxia and hypoxemia

Colorless, odorless, and tasteless gas Colorless, odorless, and tasteless gas essential for sustaining lifeessential for sustaining life



56

Respiratory StimulantsRespiratory StimulantsDirect stimulants (analeptics)Direct stimulants (analeptics)

Act on medullary center of brainAct on medullary center of brainIncrease rate and depth of respirationsIncrease rate and depth of respirations

Reflex respiratory stimulantsReflex respiratory stimulantsSpirits of ammonia only inhalation drug given as a Spirits of ammonia only inhalation drug given as a reflex respiratory stimulantreflex respiratory stimulantAdministered during cases of faintingAdministered during cases of fainting


Respiratory DepressantsRespiratory DepressantsIncludes opium and barbiturate groupsIncludes opium and barbiturate groups

Respiratory depression is a common side Respiratory depression is a common side effect effect

Seldom given to intentionally inhibit rate and Seldom given to intentionally inhibit rate and depth of respirationdepth of respiration


Cough SuppressantsCough Suppressants

Cough is a protective reflex to expel harmful irritantsCough is a protective reflex to expel harmful irritants

It may be:It may be:Productive (removes airway secretions)Productive (removes airway secretions)Nonproductive (dry and irritating)Nonproductive (dry and irritating)

Antitussive agentsAntitussive agentsNarcotic agents (codeine)Narcotic agents (codeine)Nonnarcotic agents Nonnarcotic agents

•• Benzonatate (Tessalon)Benzonatate (Tessalon)



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AntihistaminesAntihistaminesChemical mediator in most body tissuesChemical mediator in most body tissues

Highest in the skin, lungs, and GI tractHighest in the skin, lungs, and GI tract

Body releases histamine if exposed to antigen Body releases histamine if exposed to antigen

Antihistamines compete with histamine for receptor Antihistamines compete with histamine for receptor sitessites

Prevent action of histaminePrevent action of histamine


AntihistaminesAntihistaminesH 1 receptorsH 1 receptors

Act primarily on blood vessels and bronchiolesAct primarily on blood vessels and bronchioles

H 2 receptorsH 2 receptorsAct mainly on GI tractAct mainly on GI tract

Anticholinergic or atropineAnticholinergic or atropine--like actionlike action


AntihistaminesAntihistaminesPrimary clinical use is for allergic reactionsPrimary clinical use is for allergic reactions

Also for motion sickness, sedative, antiemeticAlso for motion sickness, sedative, antiemetic

ExamplesExamplesDimenhydrinate (Dramamine) Dimenhydrinate (Dramamine) Diphenhydramine (Benadryl)Diphenhydramine (Benadryl)Promethazine (Phenergan)Promethazine (Phenergan)



58

SerotoninSerotoninNaturally occurring vasoconstrictorNaturally occurring vasoconstrictor

In platelets and in cells of brain and intestineIn platelets and in cells of brain and intestineSerotonin is not administered as a drugSerotonin is not administered as a drugHas a major influence on other drugs and some Has a major influence on other drugs and some disease statesdisease states

•• Helpful in repairing damaged blood vesselsHelpful in repairing damaged blood vessels•• Stimulates smooth muscle contractionStimulates smooth muscle contraction•• Acts as a neurotransmitter in the CNSActs as a neurotransmitter in the CNS


AntiserotoninsAntiserotoninsAntiserotonins (serotonin antagonists) work Antiserotonins (serotonin antagonists) work to inhibit responses to serotonin and its to inhibit responses to serotonin and its influence on other drugs and disease statesinfluence on other drugs and disease states

Vascular headache, allergic disorder Vascular headache, allergic disorder treatmenttreatment

Cyproheptadine (Periactin)Cyproheptadine (Periactin)Methysergide maleate (Sansert)Methysergide maleate (Sansert)


Drugs Affecting the GI SystemDrugs Affecting the GI SystemAntacids (AlkaAntacids (Alka--Seltzer)Seltzer)

Antiflatulents (Mylicon)Antiflatulents (Mylicon)

Digestants (Pancrease)Digestants (Pancrease)

Emetics (syrup of ipecac)Emetics (syrup of ipecac)



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Drugs Affecting the GI SystemDrugs Affecting the GI System

Antiemetics Antiemetics Compazine, PhenerganCompazine, Phenergan

Cytoprotective agentsCytoprotective agentsProtect cells from damageProtect cells from damageCytotec, CarafateCytotec, Carafate


Drugs Affecting the GI SystemDrugs Affecting the GI System

H2 receptor antagonists H2 receptor antagonists Reduce volume and acidity of gastric acidReduce volume and acidity of gastric acidZantac, Tagamet, PepcidZantac, Tagamet, Pepcid

Proton pump inhibitorsProton pump inhibitorsTreat symptomatic gastroesophageal reflux Treat symptomatic gastroesophageal reflux disease, esophagitisdisease, esophagitisNexium, Prevacid, Prilosec, AciphexNexium, Prevacid, Prilosec, Aciphex


Drugs Affecting the Lower GI TractDrugs Affecting the Lower GI Tract

LaxativesLaxativesConstipation causes: Neurological disease, Constipation causes: Neurological disease, pregnancy, rectal disorders, surgery, drug pregnancy, rectal disorders, surgery, drug poisoningpoisoningEpsom salt, Dulcolax, ColaceEpsom salt, Dulcolax, Colace

AntidiarrhealsAntidiarrhealsAdsorbents (PeptoAdsorbents (Pepto--Bismol)Bismol)Anticholinergics (Donnatal)Anticholinergics (Donnatal)Opiates (paregoric)Opiates (paregoric)Other (Lomotil, Imodium)Other (Lomotil, Imodium)



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Drugs Affecting the EyeDrugs Affecting the Eye

Antiglaucoma agentsAntiglaucoma agentsPilocarpine, acetazolamidePilocarpine, acetazolamide

Mydriatic and cycloplegic agentsMydriatic and cycloplegic agentsTreat inflammation, relieve painTreat inflammation, relieve painAtropine, homatropine opthalmic solutionAtropine, homatropine opthalmic solution


Drugs Affecting the EyeDrugs Affecting the Eye

Antiinfective/antiinflammatory agentsAntiinfective/antiinflammatory agentsTreat conjunctivitis, sty, keratitisTreat conjunctivitis, sty, keratitis

Topical anesthetic agentsTopical anesthetic agentsPrevent pain, rapid onsetPrevent pain, rapid onsetProparacaine HCl, tetracaine HClProparacaine HCl, tetracaine HCl


Drugs Affecting the EarDrugs Affecting the EarAntibiotics for infectionAntibiotics for infection

ChloramphenicolChloramphenicol

Steroid/antibiotic combinationsSteroid/antibiotic combinationsSuperficial bacterial infectionsSuperficial bacterial infectionsCortisporin OticCortisporin Otic

Miscellaneous preparationsMiscellaneous preparationsTreat ear wax, fungal infections, inflammationTreat ear wax, fungal infections, inflammation



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Drugs Affecting the Endocrine SystemDrugs Affecting the Endocrine System

Endocrine system works to control and Endocrine system works to control and integrate body functionsintegrate body functions

Natural chemicals (hormones) are produced Natural chemicals (hormones) are produced by endocrine glandsby endocrine glands


Drugs Affecting the PituitaryDrugs Affecting the Pituitary

Anterior and posterior pituitary gland hormones Anterior and posterior pituitary gland hormones regulate secretion of other hormonesregulate secretion of other hormones

Anterior pituitary drugsAnterior pituitary drugsTreat growth failure in children caused by growth Treat growth failure in children caused by growth hormone deficiencyhormone deficiency

Posterior pituitary drugsPosterior pituitary drugsTreat symptoms of diabetes insipidus due to Treat symptoms of diabetes insipidus due to antidiuretic hormone deficiencyantidiuretic hormone deficiency


Drugs Affecting the Thyroid Drugs Affecting the Thyroid

Thyroid hormone controls rate of metabolic Thyroid hormone controls rate of metabolic processesprocesses

Required for normal growth and developmentRequired for normal growth and development

Parathyroid hormone regulates level of Parathyroid hormone regulates level of ionized calcium in blood through:ionized calcium in blood through:

Release of calcium from boneRelease of calcium from boneAbsorption of calcium from the intestineAbsorption of calcium from the intestineRate of excretion of calcium by the kidneysRate of excretion of calcium by the kidneys



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Thyroid Gland DisordersThyroid Gland DisordersGoiterGoiter

Enlargement of thyroidEnlargement of thyroid

HypothyroidismHypothyroidismThyroid hormone deficiencyThyroid hormone deficiency

HyperthyroidismHyperthyroidismThyroid hormone excessThyroid hormone excess

Drugs to treat Drugs to treat hypothyroidism and hypothyroidism and prevent goitersprevent goiters

Thyroid (Synthroid)Thyroid (Synthroid)Iodine products Iodine products LevothyroxineLevothyroxine


Parathyroid DisordersParathyroid DisordersHypoparathyroidism and hyperparathyroidismHypoparathyroidism and hyperparathyroidism

Drugs to treat hyperparathyroidismDrugs to treat hyperparathyroidismVitamin DVitamin DCalcium supplementsCalcium supplements


Drugs Affecting the Adrenal CortexDrugs Affecting the Adrenal Cortex

Adrenal cortex secretes steroid hormonesAdrenal cortex secretes steroid hormonesGlucocorticoids (cortisol)Glucocorticoids (cortisol)

•• Raise blood glucoseRaise blood glucose•• Deplete tissue proteinsDeplete tissue proteins•• Suppress the inflammatory reactionSuppress the inflammatory reaction

Mineralocorticoids (primarily aldosterone)Mineralocorticoids (primarily aldosterone)•• Regulate electrolyte and water balanceRegulate electrolyte and water balance

Sex hormones Sex hormones •• Little physiological effect under normal circumstancesLittle physiological effect under normal circumstances



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Drugs Affecting the PancreasDrugs Affecting the Pancreas

Hormones of the pancreasHormones of the pancreasInsulinInsulin

•• Primary hormone that regulates glucose metabolismPrimary hormone that regulates glucose metabolism

GlucagonGlucagon•• Stimulates liver to break down glycogen so that glucose Stimulates liver to break down glycogen so that glucose

is released into the bloodis released into the blood•• Also inhibits uptake of glucose by muscle and fat cellsAlso inhibits uptake of glucose by muscle and fat cells


Drugs Affecting the PancreasDrugs Affecting the PancreasInsulin PreparationsInsulin Preparations

Rapid actingRapid actingInsulin lisproInsulin lisproInsulum aspartInsulum aspart

Short actingShort actingRegularRegular

Intermediate actingIntermediate actingLente InsulinLente InsulinNPH InsulinNPH Insulin

Long actingLong actingUltralenteUltralenteInsulin glargineInsulin glargine

Oral Hypoglycemic AgentsOral Hypoglycemic AgentsAmarylAmarylGlucophageGlucophageGlucotrolGlucotrolMicronaseMicronase

Oral Combination AgentsOral Combination AgentsGlucovanceGlucovanceMetaglipMetaglipAvandametAvandamet


Drugs Affecting the PancreasDrugs Affecting the Pancreas

Hyperglycemic AgentsHyperglycemic AgentsGlucagonGlucagonDiazoxide (Proglycem)Diazoxide (Proglycem)DextroseDextroseOral glucose (Glutose, InstaOral glucose (Glutose, Insta--Glucose)Glucose)



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Drugs Affecting the Reproductive SystemDrugs Affecting the Reproductive System

Includes synthetic and natural substancesIncludes synthetic and natural substances

HormonesHormonesFemaleFemaleMaleMale


Female Sex HormonesFemale Sex HormonesTwo hormones secreted by ovary:Two hormones secreted by ovary:

EstrogenEstrogenProgesteroneProgesterone

Supplemental estrogen indicated for:Supplemental estrogen indicated for:Estrogen deficiency or replacementEstrogen deficiency or replacementTreatment of breast cancerTreatment of breast cancerProphylaxis for osteoporosis in postmenopausal womenProphylaxis for osteoporosis in postmenopausal women

Progesterone (and synthetic progestins) used to:Progesterone (and synthetic progestins) used to:Treat hormonal imbalanceTreat hormonal imbalanceTreat endometriosisTreat endometriosisTreat specific cancersTreat specific cancersPrevent pregnancy when properly usedPrevent pregnancy when properly used


Oral ContraceptivesOral ContraceptivesOral contraception most effective form of birth Oral contraception most effective form of birth controlcontrol

Commonly known as Commonly known as ““the pillthe pill””Combination of estrogen and progesterone that Combination of estrogen and progesterone that results in suppression of ovulationresults in suppression of ovulation

Available in several different formsAvailable in several different forms



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Ovulatory Stimulants and Infertility DrugsOvulatory Stimulants and Infertility Drugs

Absence of ovulation (anovulation) may be a Absence of ovulation (anovulation) may be a pathological condition in women with pathological condition in women with abnormal bleeding or infertilityabnormal bleeding or infertility

Sometimes treated with:Sometimes treated with:GonadotropinsGonadotropinsThyroid preparationsThyroid preparationsEstrogenEstrogenSynthetic agentsSynthetic agents


Drugs Affecting the Drugs Affecting the Male Reproductive SystemMale Reproductive System

Testosterone therapyTestosterone therapyIndicated for treatment of:Indicated for treatment of:

•• Hormone deficiency (e.g., testicular failure)Hormone deficiency (e.g., testicular failure)•• ImpotenceImpotence•• Delayed pubertyDelayed puberty•• Female breast cancerFemale breast cancer•• AnemiaAnemia


Drugs Affecting Sexual BehaviorDrugs Affecting Sexual Behavior

Drugs that impair libido and sexual Drugs that impair libido and sexual gratificationgratification

Includes some antihypertensives, antihistamines, Includes some antihypertensives, antihistamines, antispasmodics, sedatives, tranquilizersantispasmodics, sedatives, tranquilizers

Drugs that enhance libido and sexual Drugs that enhance libido and sexual gratificationgratification

Levodopa (LLevodopa (L--dopa)dopa)Sildenafil (Viagra)Sildenafil (Viagra)



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Drugs Used in Neoplastic DiseasesDrugs Used in Neoplastic Diseases

Antineoplastic agentsAntineoplastic agentsUsed in cancer chemotherapy to prevent Used in cancer chemotherapy to prevent proliferation of malignant cellsproliferation of malignant cells

•• Do not directly kill tumor cellsDo not directly kill tumor cells•• Interfere with cell reproduction or replication Interfere with cell reproduction or replication •• ExamplesExamples

AdrucilAdrucilMustargenMustargenAmethopterinAmethopterin


AntibioticsAntibioticsTreat local or systemic infectionTreat local or systemic infection

Kill or suppress growth of microorganisms Kill or suppress growth of microorganisms Disrupt bacterial cell wallDisrupt bacterial cell wallDisturb functions of cell membraneDisturb functions of cell membraneInterfere with cellInterfere with cell’’s metabolic functionss metabolic functions

Includes:Includes:PenicillinsPenicillinsCephalosporins and related productsCephalosporins and related productsMacrolide antibioticsMacrolide antibioticsTetracyclinesTetracyclinesMiscellaneous antibiotic agents Miscellaneous antibiotic agents


Antifungal DrugsAntifungal DrugsSome fungi are always present in bodySome fungi are always present in body

Mouth, skin, intestines, and vaginaMouth, skin, intestines, and vaginaPrevented from multiplying through competition Prevented from multiplying through competition from bacteria and from actions of the immune from bacteria and from actions of the immune systemsystemInfection occurs when person becomes Infection occurs when person becomes immunocompromisedimmunocompromisedTinactin, Diflucan, MycostatinTinactin, Diflucan, Mycostatin



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Antiviral DrugsAntiviral DrugsFew effective drugs to treat minor viral infectionsFew effective drugs to treat minor viral infections

Viral infections range from harmless (e.g., warts) to Viral infections range from harmless (e.g., warts) to serious diseasesserious diseases

Often have toxic effectsOften have toxic effects

Acyclovir (Zovirax)Acyclovir (Zovirax)Zidovudine (Retrovir)Zidovudine (Retrovir)Lamivudine; zidovudine (Combivir)Lamivudine; zidovudine (Combivir)


Protease InhibitorsProtease InhibitorsComplete mechanism of action not clearComplete mechanism of action not clear

Appear to inhibit replication of retroviruses (e.g., Appear to inhibit replication of retroviruses (e.g., HIV) in acute and chronically infected cellsHIV) in acute and chronically infected cells

Side effects and adverse reactionsSide effects and adverse reactions

Indinavir (Crixivan)Indinavir (Crixivan)

Ritonavir (Norvir)Ritonavir (Norvir)


AnalgesicAnalgesic--Antipyretic DrugsAntipyretic DrugsAntipyretics reduce feverAntipyretics reduce fever

AnalgesicAnalgesic--antipyretic drugs work by reversing the antipyretic drugs work by reversing the effect of the pyrogen on the hypothalamus effect of the pyrogen on the hypothalamus

Analgesics act on peripheral pain receptors to Analgesics act on peripheral pain receptors to block activationblock activation

AcetaminophenAcetaminophenAspirinAspirin



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Nonsteroidal Antiinflammatory DrugsNonsteroidal Antiinflammatory Drugs

Aspirin is the prototype of the NSAIDsAspirin is the prototype of the NSAIDsInhibit enzymes so that prostaglandins Inhibit enzymes so that prostaglandins (substances that promote inflammation and pain) (substances that promote inflammation and pain) are not formedare not formedAspirinAspirinIbuprofenIbuprofenNaproxenNaproxenKetorolacKetorolacCelecoxibCelecoxib


Drugs Affecting theDrugs Affecting theImmunological SystemImmunological System

ImmunosuppressantsImmunosuppressantsAntirejection, anticancer, Antirejection, anticancer, corticosteroid drugscorticosteroid drugs

Immunomodulating Immunomodulating agentsagents

SerumsSerumsVaccinesVaccines


ConclusionConclusionTo ensure maximum effectiveness and To ensure maximum effectiveness and

reduce the potential for harm, the paramedic reduce the potential for harm, the paramedic must have a thorough understanding of drugs must have a thorough understanding of drugs

and their actions before they are and their actions before they are administered.administered.



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Questions?Questions?



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