leslie pharmacology

8/8/2019 Leslie Pharmacology

http://slidepdf.com/reader/full/leslie-pharmacology 1/16

2005 EMT-Intermediate Curriculum

Bridge Course

Pharmac ology andPharmac ology and

Medica t ion Admin is t ra t ionMed ica t ion Admin is t ra t ion


Bridge Course

Goals for the c lassGoals for the c lass

• Build a broad foundation of knowledgeregarding the characteristics and actions ofmedications

– How the body responds to medications

– Major organs and systems impacted by mostprehospital medications

• Apply the concepts of pharmacology to thedevelopment of better skill in patientassessment and management


Bridge Course

Object ivesObject ives

• Discuss how drugs are classified. (1)

• Explain the special considerations indrug treatment with regard to pregnant,pediatric and geriatric patients. (4)

• Discuss the EMT-I’s responsibilities andscope of management pertinent to the

administration of medications.


Bridge Course

Object ivesObject ives

• Describe the mechanisms of drug

action… (9)

• Defend medication administration by anEMT-I to effect positive therapeuticeffect.


Bridge Course

DeDe --Myst i fy ing Pharmac ologyMyst i fy ing Pharmac ology

• Drugs do not do anything new.

– They can only alter functions that are

already occurring in the body.• Replace a function, enhance a function or

interrupt a function

• Drugs will always leave residual effects.

– Even selective-site drugs!

• Albuterol and muscle tremors


Bridge Course

DeDe --myst i fy ing Pharmacologymyst i fy ing Pharmacology

• Drugs usually have to bind to somethingbefore anything can occur.

– Antacids bind to receptors in the stomach – Morphine binds to euphoria receptors,

nausea and vessel control receptors in thebrain




Bridge Course

The EMTThe EMT --In te rmed ia teIn te rmed ia te ’’ssrespons ib i li t ies w i threspons ib il i t ies w i th

med ica t ion admin is t ra t ionmed ica t ion admin is t ra t ion


Bridge Course

EM TEM T --I Respons ib i l i t iesI Respons ib i l i t ies

• Understand how drugs in your scope ofpractice work in the body

– How they alter body functions

– Binding sites of drug classes and expected actions

– Residual effects of specific drug classes

• Keep your knowledge base current!

– New drugs are approved for use every day

– www.Rxlist.com

• Top 200 prescriptions per year


Bridge Course

EM TEM T --I Respons ib i l i t iesI Responsib i l i t ies

• Use drug reference literature to assist

with your understanding

– Indications, contraindications, precautions

– PDR, online resources, nursing drugguides, field guides

• Seek out information from other

professionals

– Supervising physician, pharmacists, etc.2005 EMT-Intermediate Curriculum

Bridge Course

EM TEM T --II Respons ib i l i tesRespons ib i l i tes inin

Pat ient CarePat ient Care

• Perform a comprehensive drug history

– Prescribed medications

– Over-the-counter medications

– Vitamins or herbal supplements

– Recreational/illicit substances and alcohol

– Drug interactions/reactions


Bridge Course

Impac t s on the EMTImpac t s on the EMT --I w i t hI w i t h

Pat ient CarePat ient Care

• Drug administration – Use the correct precautions and

administration rates – Observe for expected and unexpected

effects of the drug

– Document patient responses from the drug• Good and bad!

• Pertinent vital signs

• Use the Rights of Drug Administration


Bridge Course

The Rights of DrugThe Rights of Drug

Admins t ra t ionAdmins t ra t ion

• Right patient

• Right drug

• Right dose• Right route

• Right time

• Right documentation

• Right to refuse




Bridge Course

TheThe ““ 6 Rights6 Rights ”” In Ac t ion?In Ac t ion?

Four days after an alert conscious patient was admitted tothe hospital, he died after receiving the wrong medication.

A pharmacist ordered Librium (a sedative) instead of Lithium,a drug used to manage bipolar disease. The dose for lithiumwas 300mg. The patient instead received 300mg of theLibrium, which was 60 times the safe dose for themedication. Other sedatives, antidepressants and antibioticswere administered concurrently as part of his care plan.

For two days the patient’s blood pressure continued to dropuntil he became lethargic and unresponsive.

A hospital spokesman stated that the autopsy reportconcluded that the patient died from pneumonia.


Bridge Course

The Basic s of Drug ClassesThe Basic s of Drug Classes


Bridge Course

Drug Class i f icat ionsDrug Class i f icat ions

• Drugs are classified 3 different ways:

– By body system

– By the action of the agents

– By the drug’s mechanism of action


Bridge Course

Drug Class Exam plesDrug Class Exam ples

• Nitroglycerin

– Body system: “Cardiac drug”

– Action of the agent: “Anti-anginal”

– Mechanism of action: “Vasodilator”

• Indications for nitroglycerin

– Cardiac chest pain

– Pulmonary edema

– Hypertensive crisis

• Which drug class best describes this drug?


Bridge Course

Drug ClassesDrug Classes – – another ano ther

exampleexample• Action of Agent: Anti-hypertensive drugs

– Produces similar end-results• Metoprolol

• Lisinopril

• Prazosin

• Verapamil

– None of the above drugs work on the samereceptor site

• Each drug will have different side effects and adversereactions

– Difficult to predict

– Difficult to determine how this class will interact withprehospital medications


Bridge Course

A bet te r w ay to c lass i fy d rugsA be t te r w ay to c lass i fy d rugs

• Mechanism of Action – Drugs in each category work on similar sites in the

body and will have similar specific effects/sideeffects

• Beta blockers: metoprolol

• ACE inhibitors: lisinopril• Alpha blockers: prazosin

• Calcium-channel blockers: verapamil

• Example: beta blocker actions and impacts – Suppress the actions of the sympathetic nervous

system

– Prehospital administration of epinephrine may notproduce as dramatic effects with a patient taking adrug in this class




Bridge Course

Prehospi ta l exam ple:Prehospi ta l example:

Hyperg lycemicsHyperg lycemics

• Dextrose 50% and glucagon

– Both will raise blood glucose• Mechanism of action

– Glucagon: hormone that works in the liver toconvert stored chains of carbohydrate to glucose

– Dextrose 50%: ready-made simple sugar that isready to enter into the cell

• Which drug is considered first-line forhypoglycemia? Why?

• What are some limitations for glucagon in thepresence of severe hypoglycemia?


Bridge Course

Drugs in t he BodyDrugs in the Body

Anatomy and Physiology Review

Concepts of Drug Actions


Bridge Course

Nervous system rev iewNervous system rev iew


Bridge Course

Central Nervous System

Somatic Nervous SystemVoluntary control

Receptors:Alpha 1 and 2Beta 1 and 2

Neurotransmitters:Norepinephrine

Epinephrine

Sympathetic"Fight or Flight"

Neurotransmitter:Acetylcholine

Parasympathetic"Feed and Breed"

Autonomic Nervous System

Peripheral Nervous System

Nervous System


Bridge Course

The Sympathe t ic NSThe Sympathe t ic NS

• Which organs willrespond when you are

chased by a bear?• What signs and

symptoms will youhave as a result?


Bridge Course

Alpha-1Vessel Constriction:

ArteriolesVeins

Alpha-2Nerve-to-Nerve ConnectionsMinimal EMS Significance

Beta-1

Cardiac EffectsIncrease in HR, conductivity

Increase in contractions

Beta-2Dilation of bronchioles

Skeletal muscle tremorsInhibition of uterine contractions

Receptor Sites


Epinephrine

Sympathetic

Neurotransmitter:Acetylcholine (ACh)

Parasympathetic


Drug Classification Names:

• “Sympathomimetics”

• “Adrenergics”

• “Beta-2 Agonist”

• “Non-Specific Beta Agonist”

• “Beta Blocker”




Bridge Course

The Parasympat het ic NSThe Parasympat het ic NS

• What organs will help outthe typical couch potato?

– Digestion

– Slow heart rate

– Smaller bronchioles

– Pupil size

• Normal or constricted

• This system works best atrest

Couch Potato


Bridge Course

Over Over --s t imu la t ion of thes t im u la t ion of the

Parasympathe t ic NSParasympathe t ic NS

• A little is a good thing, but too muchstimulation of this system leads totrouble

– Very slow heart rates

– Bronchoconstriction

– Major gastrointestional actions

• Vomiting

• Diarrhea


Bridge Course

Receptor Sites:Alpha 1 and 2Beta 1 and 2


Epinephrine

Sympathetic

Heart:Decrease in HR and conduction

Lungs:Bronchoconstriction

Increase in mucus production

GI Tract:"SLUDGE"

Increase in motilityVomiting

Effects

Neurotransmitter:Acetylcholine (ACh)

Parasympathetic


Drug Classification Names

• “Parasympatholytics”

• “Anticholinergics”

• “Cholinergics”


Bridge Course

Autonom ic Nervous SystemAutonom ic Nervous System

Sympathe t ic Receptor S i teSympathe t ic Receptor Si te

Ac t ionAc t ion


Bridge Course

1) Brain sends out the response via nerve paths

2) Nerve moves the response: depolarization

3) Depolarization stimulates norepinephrine sacks

• Sacks move to the end of the nerve anddump out their contents

23


Bridge Course

4) Norepinephrine travels across the synapse

• Attaches to a receptor on the organ, organresponds to the signal

5) Norepineprhine detaches and is deactivated

• 2 options: destroy it or move it back into its sack

2

3

4

5




Bridge Course

Nervous System ReviewNervous System Review

• You are to give a dose of a parasympatholytic.What is it expected to do?

– Bronchodilation

– Increase GI motility

– Stimulate vomiting

– Increase HR

• Is a parasympatholytic the same as asympathomimetic?


Bridge Course


5 minutes after you gave a non-specificbeta agonist, you notice that thepatient is complaining of palpitations.

This effect is considered to be:

a) A desired effect of the drug

b) An expected side effect of the drug

c) An unpredictable, adverse effect of thedrug


Bridge Course


• What other side effects or adverse

reactions would you expect to see in apatient after giving them an adrenergicdrug?

– Muscle tremors

– Tachycardia

– Elevated BP

– Chest discomfort2005 EMT-Intermediate Curriculum

Bridge Course


• A patient is taking atenolol, a Beta-1specific blocker. What is the expectedeffects of this drug? – Lowered HR

– Decrease in contraction and conduction

• What would be an expected side effectof the drug? – Dizziness when standing


Bridge Course

EM TEM T --I Nervous System DrugsI Nervous System Drugs

• Epinephrine 1:1,000

– Catecholamine, adrenergic, non-specific beta agonist

• Epinephrine, USP, 1:10,000

– Same as above!• Albuterol

– Beta-2 agonist

• Atropine

– Parasympatholytic

• Ipatroproprium Bromide (Atrovent)

– Parasympatholytic bronchodilator2005 EMT-Intermediate Curriculum

Bridge Course

Drug Mechanism sDrug Mechanism s

of Ac t iono f Ac t ion




Bridge Course

Phases of Drug Act iv i tyPhases of Drug Act iv i t y

• Pharmaceutical – Disintegration and dissolution

• Pharmacokinetic

– How the drug gets in, how it reaches thetarget and how it gets out of the body

• Pharmacodynamic

– The response of the tissue to the drug


Bridge Course

Pharmac eut ic a l PhasePharmac eut ic a l Phase

• Disintegration – Breakdown of the solid form of the

medication

• Dissolution

– Drug goes into solution form and is able tobe absorbed

– The more rapid this step, the faster thedrug will be absorbed


Bridge Course

Pharmacok ine t icsPharmacok ine t ics

• Absorption

• Distribution

• Metabolism

• Excretion


Bridge Course

Absorpt ionAbsorpt ion

Drug Fact ors ThatDrug Fact ors That

Impac t Absorp t ionImpac t Absorp t ion

• Fast, efficient absorption is achieved withthe following:

– High surface area of the tissue – Rich blood supply at the tissue

– Thin membranes between the tissue and thebloodstream

• Drug solubility

– Lipid soluble drugs absorb faster in tissuesand cells than water soluble drugs


Bridge Course

Other Drug Fact ors ThatOt her Drug Fact ors That

Impac t Absorp t ionImpac t Absorp t ion

• Drug concentration

– High concentrations of the drug at the

tissue will achieve better absorption as well• pH of the drug

– Glucagon does not absorb into cells readily

• Requires very low or very high pH to break itdown




Bridge Course

Pat ien t Fac to rs Impac t ingPat ien t Fac to rs Impac t ing


• Decreased circulation – Hypothermia

– Shock

• Decreased cardiacoutput – CHF

– Significant MI

Absorpt ion RatesAbsorpt ion Rates

Intracardiac

Endotracheal,Inhalation, IO, IV

Sublingual

Rectal

Topical

Intramuscular

Oral

Subcutaneous


Bridge Course

Oral Absorpt ion SpeedsOral Absorpt ion Speeds

• Elixirs, syrups

• Suspensions

• Powders

• Capsules

• Tablets

• Coated tablets

• Enteric-coated tablets

Fast

Slow


Bridge Course

Pharmac ology StudyPharmac ology St udy

Guide, #4Guide, #4

• A patient with an exacerbation of hischronic herniated disks – Oral Percocet taken 1 hour before EMS

arrival• No change in pain

– Has there been enough time for thePercocet to be absorbed?

– Should morphine be given to the patient?• Explain the rationale for the decision

Absorpt ion Pr inc ip les for theAbsorpt ion Pr inc ip les for the

EM TEM T --II

• IV is used as the primary route

– IV drugs already in solution form

– Achieving drug levels are predictable• Everything that is administered is already in the

circulation

– Higher chance of toxicity

• Absorption and delivery is immediate


Bridge Course

Absorpt ion Pr inc ip les for Absorpt ion Pr inc ip les for

the EMTthe EMT --II

• Intramuscular (IM) – “second line” route – Highly vascular, but not as direct a route

for administration – IM routes are utilized as a back-up when IV

access is unobtainable

• SQ – Limited #s of BV and slower absorption

– Drugs must have a higher concentration in orderto be given in this route




Bridge Course

More Appl icat i ons of More Appl icat ions of



Bridge Course

Ni t rog lycer inNi t rog lycer in

• How does the drug come packaged? – As a tablet

• Nitroglycerin forms and absorption rates

– SL: 1-3 minutes

– Ointment/transdermal: 30 minutes

– Oral/tablet: 15-40 minutes

– IV: immediate!


Bridge Course

Epinephr ine Absorpt ionEpinephr ine Absorpt ion• What is the concentration and dosing time for

subcutaneous and IV epinephrine? – SQ - 1:1000 with repeat doses every 3-5 minutes

– IV - 1:10,000 with repeat doses every 3-5 minutes

• Why is there a need for 2 differentconcentrations? – Epinephrine is a short-lived drug and will break down

quickly

– SQ absorption is significantly slower than IV

– A higher concentration of the drug will assure thatenough of the active drug will still be available after it isabsorbed


Bridge Course

Absorpt ion at t he Cel lAbsorpt ion at t he Cel l


Bridge Course

Four Pat hs of Cel lu lar Four Pat hs of Cel lu lar


• Membrane pores

– Drug must be very, very small in order to enter

– Rare site of absorption• Diffusion

– Movement through the membrane with aconcentration gradient

– No energy required to move the drug

– Most common route of entry for drugs (lipidsoluble)


Bridge Course

DiffusionDiffusion




Bridge Course

Four Pat hs of Cel lu lar Four Pat hs of Cel lu lar


• Facilitated Diffusion – Commonly used for moderate-sized drugs and

water soluble drugs• Morphine, dextrose, amiodarone, diphenhydramine

– Drug forms a complex with a protein in themembrane, which allows the gates of themembrane to open

• Active Transport – Movement of a drug against a concentration

gradient

– Requires the use of energy to let the drug in


Bridge Course

Fac i l i ta tedFac i l i ta tedDiffusionDiffusion


Bridge Course

Distr ibut ionDis tr ibut ion

Pharmacok ine t ics :Pharmacok ine t ics :

Dis t r ibut ionDis tr ibut ion

• Definition: how the drug gets from the bloodto the target cell or tissue

• Plight of the drug bolus

– Some of the drug will seek out and bind with cellreceptors

• There may not be enough cell receptors for the drug

– The rest of the drug will go to staging andutilized as replacements

• Drug reservoirs


Bridge Course


Dis t r ibut ionDis tr ibut ion

• Types of drug reservoirs

– Fat cells (for fat soluble drugs)

• Longer storage time

• Marijuana THC can stay in the body up to 6 months with

just one dose

– Plasma proteins (all other drugs)

• “Mobile storage”

• Release of the drug is more immediate and replacement

at cell receptors is more rapid

Barr iers to Dis t r i but ionBarr iers to Dis t r ibut ion

• Blood-Brain Barrier

– Selective site for drugs

– Capillary cells packed tightly

together

– Only allows fat-soluble drugs andsmall molecules through

• Placental Barrier

– Only lipid soluble or free-formdrugs can get through




Bridge Course

Bio t rans fo rmat ionBio t rans fo rmat ion

(Drug Met abol ism)(Drug Met abol ism)


B io t rans fo rmat ionB io t rans fo rmat ion

• Drugs must be in an active form before

they can work at a cell receptor

– Most prehospital drugs are packaged in anactive form and result in a faster onset of thedrug

• “Active metabolite”

– Other drugs must be transported to the liverto be “de-activated” before elimination


Bridge Course

Fact ors Al ter ing DrugFact ors Al ter ing Drug

Metabol ismMetabol ism

• Age

– Pediatric “growth spurts” may increasedrug metabolism

– The very young and very old havediminished liver function and may developdrug toxicity

• Body mass and gender

– Fat distribution and percentage differences


Bridge Course

Fact ors Al ter ing DrugFact ors Al ter ing Drug

Metabol ismMetabol ism

• Pathologic state

– Circulatory problems, CHF may slow drugdistribution

• Genetic factors

– Enzyme systems in some may be slower

– More susceptibility to adverse reactions ortoxic effects


Bridge Course

Excre t ionExcre t ion

Pharmacok ine t ics : Excre t ionPharmacok ine t ics : Excre t ion

• Bile

– Drugs turned intoinactive metabolitesby the liver

– Dumped into theduodenum andexcreted by the feces

• Expired air

– Alcohol andvolatilegases

• Breast milk

– Narcotics

Routes o f El iminat ionRoutes o f El iminat ion




Bridge Course

Routes of E l iminat ionRoutes of E l iminat ion

• Urine

– Drugs must be in a “deactivated” formbefore they are eliminated by the kidneys

– Water-soluble drugs are removed easily

– Fat soluble drugs must be more “water-friendly” if the kidneys are going to get ridof them

• This transformation occurs in the liver


Bridge Course

Pharmacodynamics:Pharmacodynamics:

How the tissues and cellsHow the tissues and cells

respond to a drugrespond to a drug


Bridge Course

Theor ies of Drug Act ionTheor ies of Drug Act ion


Bridge Course

DrugDrug --Receptor In te rac t ionReceptor In te rac t ion

Drug classes are sometimes named by

the type of cell receptor with which theyinteract

• “Beta blockers”

• “Opiate drugs”

• “Anticholinergics”


Bridge Course

DrugDrug --Receptor In te rac t ionReceptor In te rac t ion

Drug classes are sometimes named by theiractions on a cell receptor

• “Agonist” drugs – after binding, the drug willstimulate a response – Albuterol: “Beta-2 agonist”

• “Antagonist” drugs – after binding, the drugwill prevent a response – Narcan: “narcotic antagonist”

– Benadryl: anti-histamine


Bridge Course

Pharmac ology StudyPharmac ology St udy

Guide, #4Guide, #4

• Back pain guy – Does Percocet work on the same receptors

as morphine?• How could these impact the patient (sideeffects)?

– New medication options• Nubain and Toradol

– Do these work differently?

– How will these impact the patient’sconditions?




Bridge Course

MorphineMorphine

versusversus

NubainNubain

• Morphine binding to2 receptors

– Activates both

• Nubain binds to both

– Activates only one

– Sits in the other andblocks agonists fromstimulating it MS

Morphine

Nubain

- Decrease pain,sedate and dropconsciousness- Drop RR

- Decrease pain,sedate and dropconsciousness

- Decrease pain,sedate and dropconsciousness

NoResponse


Bridge Course

DrugDrug --ResponseResponse

Relat ionshipRelat ionship

• Drugs are studied for the following: – Plasma levels

• How fast they reach active levels

– Biologic half-life

• How long it takes to break down half of the drug

– Minimum effective concentration

• How much of the drug it takes to create a response

– Therapeutic threshold

• How much of the drug is too much, or toxic


Bridge Course

MinimumEffectiveConcentration

TherapeuticThreshold

PlasmaLevels

DrugDrug --

Response:Response:

L idoca ineL idoca ine

• Graph: single bolus of lidocaine

• Relatively rapid breakdown of the drug to sub-therapeutic levels – Half-life is 7-30 minutes

• Dosing regimen is every 3-5 minutes in order to

keep the drug at or near therapeutic levels


Bridge Course

Lidoca ineL idoca ine

Top Graph

• Multiple bolusescreate variedtherapeutic levels – Blue line

Lower Graph

• Bolus with a drip: – Smaller constant

level of infusionwill provide justenough lidocaineto replaceelements of thebolus that wasbroken down


Bridge Course

DrugDrug --

Response:Response:

L idoca ineL idoca ine

• Lidocaine is broken down by the liver

• What will happen if the same dosing regimen for thedrug is used in patients with liver failure?

– Takes longer to break down the drug (increase in its half life)

– Toxic levels can occur in lidocaine’s target organs

• Heart – asystole

• Brain – altered levels of consciousness




Bridge Course

Drug In terac t ion Var iab lesDrug In terac t ion Var iab les

• Intestinal absorption

• Competition for plasmaprotein binding

• Drug metabolism

– “Biotransformation”

• Action at the receptorsite

• Renal excretion

• Alteration of electrolytebalance

• Drug-druginteractions

• Other druginteractions

– Alcohol consumption

– Cigarette smoking


Bridge Course

Pharmac ology Case StudyPharmac ology Case St udy


Bridge Course

Case Stu dyCase Stu dy

You respond to “Jan,” a 45 year-old female who wasstung by a bee while at a family picnic. She is lying inthe grass field. She is conscious but shaking. She hashives on her arms, chest and legs.

A family member tells you that they administered herEpi-Pen 5 minutes ago.

She is conscious. Her vital signs include a respiratoryrate of 24, heart rate of 110 and a blood pressure of 156/70.


Bridge Course

More Pat ient In form at ion

Jan has a history of “severe” reactions to bee stings.Her lips appear swollen but her family members statethat “her whole face was swollen before we gave her theEpi-Pen.”

Her lung sounds are clear.


Bridge Course

Embel l ishment !

• Would you expect a change in Jan’sresponse to epinephrine if she… – Was 5 years old?

– Was 20 and pregnant?

– Was 65 (and not pregnant)?

– Was old, pregnant, and acted like she was 5?

Just Kidding!!


Bridge Course

A New EMTA New EMT--I T rea tmentI T rea tment

Opt ion for Anaphy lax isOpt ion for Anaphy lax is

• Benadryl – Class: “Antihistamine”

– Antagonist to histamine• Competes for the same receptor sites as

histamine

• Does not directly control the release ofhistamine

• Effectiveness is dependent on concentration

– Higher levels of histamine will be more likelyto bind to the receptor than Benadryl




Bridge Course

Benadryl v. Epinephr ineBenadryl v. Epinephri ne

• When should you give one medicationover the other? Why? – Benadryl not as effective with massive

histamine release

– Epinephrine binds to other cell receptors incritical areas

• Beta receptors

• More potent response and will override thehistamine response


Bridge Course

Benadry l Act ionsBenadry l Ac t ions

• Half-l ife

– 2.5 - 7 hours

• Drug effects

– Rapid onset with widedistribution

– Extensively broken down

by the liver

– Excreted extensively by

the kidneys

– Also has anticholinergic

activity

• How will this drug

act differently inchildren?

• How will it impactthe elderly?

• With which medicalconditions will itcause more trouble?

Drugs in K idsDrugs in K ids

• Less than one year

– Lower levels of plasma protein

• Increased likelihood for drugs to be in a free-form state

– More potent effects of the drug

– Kidneys and liver are less developed

• Potentially slower activation and eliminationof drugs


Bridge Course

Kids and DrugsKids and Drugs

• Over 1 year

– Liver enzymes more active than an adult

– Faster work in the kidneys than an adult

• Later childhood causes a faster elimination of drugs

– Dosing for drugs are based on the child’s weight

• More proportional response

PregnancyPregnancy

Considerat ionsConsiderat ions

• 1st trimester – Lipid soluble drugs can cross into the placenta

– Immature fetal liver and kidneys may store drugs longer

• Later pregnancy – Higher HR, CO = faster absorption and onset of drugs

– Increased fatty tissue may cause more storage of lipid-solubledrugs

– Drug dependency by the fetus if the mother is addicted to opiatedrugs

• During labor – May depress respirations in the neonate

The ElderlyThe Elderly

• Decreased cardiac output and metabolism

– Longer drug effects (pain medications)

– Less filtration through the kidneys – keepsdrugs in circulation longer

• More body fat and less total body water

– Stores more fat-soluble drugs

– Higher concentration of drugs in the body

• Decreased plasma proteins

– More drugs circulating in their free-form state




Bridge Course

The hal f -l i fe o f Val ium in a 20

year-o ld las ts approx im ate ly 20

hours .

For a person in the i r 80s, th is

hal f -l i fe ex t ends to 90 hours !


Bridge Course

Managing Contro l ledManaging Cont ro l led

SubstancesSubstances

• Ensuring the security of them• Requirements for locking a controlled

substance

• Accounting of drug inventory

• Wasting a controlled substance

• DEA forms

• Violation reporting


Bridge Course

Pharmaco logy Ac t iv i tyPharmaco logy Ac t iv i t y

Find a partner and grab one medication out of thegrab bag. Create a singles ad-style of profile for

your medication, including indications,contraindications, precautions and how the drug

works in the body.

Be prepared to share your “singles ad” to the class.

leslie pharmacology

Documents