Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Paramedic Care:Principles & Practice

Volume 1Introduction to Advanced

Prehospital Care

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Chapter 9 General Principles of

Pharmacology

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Chapter 9, Part 2Drug Classifications

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Part 2 TopicsClassifying DrugsDrugs Used to Affect the Nervous SystemDrugs Used to Affect the Cardiovascular SystemDrugs Used to Affect the Respiratory SystemDrugs Used to Affect the Gastrointestinal SystemDrugs Used to Affect the EyesDrugs Used to Affect the EarsDrugs Used to Affect the Endocrine SystemDrugs Used to Treat CancerDrugs Used to Treat Infectious Diseases and InflammationDrugs Used to Affect the SkinDrugs Used to Supplement the DietDrugs Used to Treat Poisoning and Overdoses

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Classifying Drugs

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Classifying Drugs

Drugs can be classified many ways: – Body system they affect – Mechanism of action – Indications – Source or by chemical class

A prototype best demonstrates the class’s common properties and illustrates its particular characteristics.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Affect the Nervous System

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Nervous System

Two major divisions

Central Nervous System– Brain and spinal

cord

Peripheral nervous system– Outside of CNS

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Analgesics and antagonistsAnestheticsAnti-anxiety and sedative-hypnotic drugsAntiseizure or anti-epileptic drugs

Central nervous system stimulants

Psychotherapeutic medications

Parkinson’s medications

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Analgesics and Antagonists– Analgesia is removal of pain– Two basic subclasses of analgesics

OpioidMorphine is prototype

NonopioidAffects the production of prostaglandins and cyclooxygenase

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Analgesics and Antagonists (cont.)– Opioid antagonists

Competitively binds with opioid receptors

Naloxone is prototype

– Adjunct medicationsEnhancement of effect

Diazepam, lorazepam, phenergan

– Agonist-AntagonistTalwin, Stadol, and Nubain

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Anesthetics– Induces a state of anesthesia, or loss of

sensation to touch or pain – As a group tend to cause respiratory, central

nervous system (CNS), and cardiovascular depression

– Given either by inhalation or injection – Paramedics primarily use these agents to assist

with intubation in rapid sequence intubation

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Antianxiety and Sedative-Hypnotic Drugs– Used to decrease anxiety, induce amnesia, and

assist sleeping and as part of a balanced approach to anesthesia

Sedation

Hypnosis

– Two main pharmacologic classes are benzodiazepines and barbiturates

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Antianxiety and Sedative-Hypnotic Drugs– Benzodiazepines

Relatively safe and effective for treating general anxiety and insomnia Hyperpolarize the membrane of CNS neuronsBenzodiazepines only increase the effectiveness of GABA, therefore, the amount of GABA present limits their effects

Flumazenil is available as antidote

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Antiseizure or Antiepileptic Drugs– Seizures are treated through several general

mechanisms Direct action on the sodium and calcium ion channels

in the neural membranes Dilantin inhibits inflow of sodium

Interact with the GABA receptor-chloride ion channel complex

– Classes include benzodiazepines, barbiturates, hydantoins, succinimides, and miscellaneous medications such as valproic acid

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Benzodiazepine Receptors

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Central Nervous System Stimulants– Two techniques may accomplish this:

Increasing the release or effectiveness of excitatory neurotransmitters

Decreasing the release or effectiveness of inhibitory neurotransmitters

– Three pharmacologic classes: amphetamines, methylphenidates, and methylxanthines

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Central Nervous System Stimulants– Amphetamines

Most common uses are treating drowsiness and fatigue and suppressing the appetite

– Methylphenidate Commonly prescribed drug for attention deficit hyperactivity disorder (ADHD)

– Methylxanthines Caffeine, aminophylline, and theophylline

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Psychotherapeutic Medications

Treat mental dysfunction– Pathologies, seem to involve the monoamine

neurotransmitters Norepinephrine, dopamine, serotonin

Implicated in the control and regulation of emotions

– Extrapyramidal symptoms are common side effects of antipsychotic medications

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Psychotherapeutic Medications– The two chief pharmaceutical classes are

phenothiazines and butyrophenones.Therapeutic effects appear to come from blocking the dopamine receptors.

– Chlorpromazine (Thorazine) is the prototype phenothiazine.

– Haloperidol (Haldol) is the prototype of the butyrophenones.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Psychotherapeutic Medications– Antidepressants

Pharmaceutical interventions for this disease appear to increase the number of neurotransmitters released in the brain.

Tricyclic Anti-depressantsAct by blocking the reuptake of norepinephrine and serotonin

Selective serotonin reuptake inhibitors (SSRIs)

Selectively block the reuptake of serotonin

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Tricyclic Antidepressants

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

SSRI Antidepressants

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Psychotherapeutic Medications– Monoamine oxidase inhibitors (MAOIs)

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

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Monoamine Oxidase Inhibitors

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Drugs Used to Treat Parkinson’s Disease– Caused by the destruction of dopamine-

releasing neurons – Characterized by dyskinesia – Pharmacologic therapy for Parkinson’s disease

seeks to restore the balance of dopamine and acetylcholine.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Central Nervous System Medications

Drugs Used to Treat Parkinson’s Disease– Levadopa and Sinemet

Given concomitantly

– AmantadinePromotes the release of dopamine from those dopamine-releasing neurons that remain unaffected by the disease

– Anticholinergic drugsPrototype anticholinergic medication is benztropine (Cogentin)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Autonomic Nervous System

Two functional divisions of the autonomic nervous system– Sympathetic

Fight or flight

Responds to stress – Parasympathetic

Controls vegetative functions such as digestion of food

Work in constant opposition to control organ responses

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Autonomic Nervous System

Nerves of the autonomic nervous system exit the central nervous system.

Autonomic Ganglia– Preganglionic

nerves – Postganglionic

nerves Sympathetic Branch of the Autonomic Nervous System

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Autonomic Nervous SystemSynapse – No physical connection

Neurotransmitters – Acetylcholine – Norepinephrine

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Nervous System Synapse

Click here to view an animation on synapses.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Autonomic Nervous System Medications

Drugs affecting the parasympathetic system:– Cholinergics– Anticholinergics– Ganglionic blocking agents– Neuromuscular blocking agents– Ganglionic stimulating agents

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Parasympathetic NS Drugs

Stimulation of the parasympathetic nervous system results in the following conditions:– Pupillary constriction– Secretion by digestive glands– Reduction in heart rate and cardiac contractile

force– Bronchoconstriction– Increased smooth muscle activity along the

digestive tract

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Parasympathetic NS Drugs

Acetylcholine (ACh)– Two main types of ACh receptors

NicotinicMuscarinic“Cholinergic” receptors

Cholinergics (parasympathomimetics)Cholinergic blockers (parasympatholytics)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Parasympathetic NS Drugs

Cholinergics– Act either directly or indirectly

Direct-acting bind with ACh receptor sitesSLUDGE

Bethanechol (Urecholine)

Indirect-acting cholinergic drugs affect acetylcholinesterase

Neostigmine

Physostigmine

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Parasympathetic NS Drugs

Anticholinergics– Muscarinic cholinergic antagonists

Competitively bind with muscarinic receptors without stimulating them Prototype is Atropine

– Nicotinic cholinergic antagonistsBlock acetylcholine only at nicotinic sites

– Ganglionic Blocking Agents Trimethaphan (Arfonad) and mecamylamine (Inversine)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Parasympathetic NS Drugs

Neuromuscular Blockers– Produces a state of paralysis without affecting

consciousness By competitive antagonism of nicotinic receptors at the

neuromuscular junction

– Either depolarizing or non-depolarizing agents Succinylcholine (Anectine), a depolarizing agent, is

commonly used

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Parasympathetic NS Drugs

Ganglionic Stimulating Agents – Receptors reside at the ganglia of both the

parasympathetic and sympathetic nervous systems.

– Nicotine stimulates receptors.Although, no medical use, it has helped understand the autonomic NS receptors

– Causes sympathetic and parasympathetic response

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Autonomic Nervous System Medications

Drugs Affecting the Sympathetic Nervous System– Adrenergic receptors– Adrenergic agonists– Adrenergic antagonists– Skeletal muscle relaxants

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Sympathetic NS Drugs

Arises from the thoracic and lumbar regions of the spinal cord

Sympathetic ganglia – Chain ganglia – Collateral ganglia

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Sympathetic NS Drugs

Adrenergic Receptors– Alpha Receptors– Beta Receptors

Sympathomimetics

Sympatholytics

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Sympathetic NS Drugs

Adrenergic Agonists– Direct-acting agents – Indirect-acting agents– Adrenergic agents are chemically and

functionally similar to the endogenous neurotransmitters

Norepinephrine, epinephrine, and dopamine

Dobutamine and isoproterenol

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Sympathetic NS Drugs

Adrenergic Antagonists (cont.)– Adrenergic antagonists are remarkably selective in which

receptor they affect Alpha adrenergic antagonists

Phenoxybenzamine (Dibenzyline), prazosin (Minipress)

Beta adrenergic antagonists Propranolol (Inderal), metoprolol (Lopressor), Atenolol (Tenormin)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Sympathetic NS Drugs

Skeletal Muscle Relaxants– Used to treat muscle spasm

Injury and disease causes

– Prototype centrally acting skeletal muscle relaxant is baclofen (Lioresal)

Treats spasticity

– Cyclobenzaprine (Flexeril) and carisoprodol (Soma) are commonly used for muscle spasms.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Affect the Cardiovascular System

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Review of A and P

Two-sided pump

4 chambers

Systemic circulation

Pulmonary circulation

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Conduction SystemSpecialized cardiac tissue that generates electrical impulses – Conducts them rapidly throughout the heart

Automaticity

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Action Potential of Cardiac Pacing Cells

Cyclic activity in the fast potentials has five phases The slow potentials

– Located in the dominant pacemakers

– They depolarize differently

– Result in self-depolarizing of SA and AV node

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmia Generation

Result from either abnormal impulse formation (automaticity) or abnormal conductivity – Tachycardia and bradycardia are most common

– An imbalance between the sympathetic and parasympathetic nervous systems

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Dysrhythmia GenerationAbnormal conduction– In pathologic conditions, a section of one of the

Purkinje fibers has what amounts to a one-way valve that allows impulses to travel in only one direction.

– Re-entrant rhythm

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Classes of Cardiovascular Drugs

Antidysrhythmics– Used to treat and prevent abnormal cardiac

rhythms

Antihypertensives– Used to treat hypertension

Hemostatic agents– Used to stop bleeding

Antihyperlipidemic agents– Used to treat high cholesterol

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Antidysrhythmics

Pharmacological classes of antidysrhythmics – Sodium Channel

Blockers– Beta Blockers– Potassium

Channel Blockers

– Calcium Channel Blockers

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Antidysrhythmics

Miscellaneous Antidysrhythmics– Adenosine

Acts on both potassium and calcium channels

Results in hyperpolarization that effectively slows the conduction of slow potentials

– DigoxinBoth an effective antidysrhythmic and a potent prodysrhythmic

Decreases the intrinsic firing rate in the SA node

– Magnesium is the drug of choice in torsades de pointes (polymorphic ventricular tachycardia.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Antihypertensives

Diuretics

Adrenergic Inhibiting Agents

Angiotensin Converting Enzyme Inhibitors

Angiotensin II Receptor Antagonists

Calcium Channel Blockers

Direct Vasodilators

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Diuretics

Reduce circulating blood volume by increasing the amount of urine

Loop diuretics, thiazides, and potassium sparing diuretics – All affect the reabsorption of sodium and chloride

Furosemide, Hydrochlorothiazide, and Spironolactone

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Adrenergic Inhibitors

Beta Adrenergic Antagonists  – Selective beta1 blockade is useful

– The prototype selective beta1 blocker is metropolol (Lopressor)

Centrally Acting Adrenergic Inhibitors – Inhibit CNS stimulation of adrenergic receptors– The prototype drug in this category is clonidine

(Catapres)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Adrenergic Inhibitors

Peripheral Adrenergic Neuron Blocking Agents   – Work indirectly to decrease stimulation of

adrenergic receptors– The prototype of this class is reserpine

(Serpalan)

Alpha1 Antagonists  – The prototype selective alpha1 antagonist is

prazosin (Minipress)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Adrenergic Inhibitors

Combined Alpha/Beta Antagonists– Competitively bind with both alpha1 and beta1

receptors Alpha1 blockade causes vasodilation

Beta1 blockade decreases heart rate, contractility, and

renin release from kidneys – Labetalol (Normodyne) and carvedilol (Coreg)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Angiotensin Converting Enzyme (ACE) Inhibitors

Interrupts the renin-angiotensin-aldosterone system (RAAS) – Prevents the conversion of angiotensin I to

angiotensin II– Very effective in treating hypertension, CHF, and

renal failure– The prototype ACE inhibitor is captopril

(Capoten)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Renin-Angiotensin-Aldosterone

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Angiotensin II Receptor Antagonists  

Recently developed classification

Achieves the same effects as the ACE inhibitors – Diminished side effects

The prototype of this new class is losartan (Cozaar)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Calcium Channel Blocking Agents  

The prototype dihydropyridine is nifedipine (Procardia, Adalat)– Acts only on the vascular smooth muscle of the

arterioles– Does not affect heart

It is effective in dilating the coronary arteries and arterioles

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Direct Vasodilators  

Selective dilation of arterioles causes a decrease in peripheral vascular resistance or afterload.

Hydralazine (Apresoline) is the prototype for the selective arteriole dilators.

Sodium nitroprusside (Nipride) acts on both arterioles and veins.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Ganglionic Blocking Agents  

NicotinicN antagonists – Exist at the ganglia of both the sympathetic and

the parasympathetic nervous systems

The prototype is trimethaphan (Arfonad)

Reduces preload and afterload

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Cardiac Glycosides  

Indicated for heart failure and some types of dysrhythmias

Digoxin is the prototype – Digoxin’s mechanism of action is complex

Elevated levels of intracellular calcium increase the strength of muscle contraction

Toxicity– Therapeutic index is very small

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Other Vasodilators and Anti-anginals  

Calcium channel blockers have a role in the treatment of angina– Verapamil (Calan, Isoptin), diltiazem (Cardizem),

and nifedipine (Procardia)

Organic nitrates are potent vasodilators – Nitroglycerin (Nitrostat) is the oldest of these

drugs and is the category’s prototype

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Hemostatic Agents

Antiplatelets– Drugs that decrease the formation of platelet

plugs

Anticoagulants– Drugs that disrupt the clotting cascade

Thrombolytics– Drugs that act directly on thrombi to break them

down

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Anti-Platelet Agents

The prototype anti-platelet drug is aspirin

Aspirin decreases the formation of platelet plugs and potential thrombi

Primary side effect is bleeding

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Anticoagulants

Prototype for this class is Heparin– Primary mechanism of action is to enhance

antithrombin III’s ability to inhibit the clotting cascade

– Low-molecular-weight heparinHas greater bioavailability, is easier to dose, and has fewer effects on platelet function

The prototype oral anticoagulant is warfarin (Coumadin)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Fibrinolytics

Act directly on thrombi to break them up

The prototype drug of this class is streptokinase (Streptase)– Alteplase (tPA), reteplase (Retavase), and

anistreplase (Eminase) – Mechanism of action is to promote plasminogen’s

conversion to plasmin Dissolves the fibrin mesh of clots

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Antihyperlipidemics

Drugs used to treat high blood cholesterol– These agents are also known as statins

Examples– Lovastatin (Mevacor)– Simvastatin (Zocor)

Bile acid-binding resins can also reduce LDL levels – Cholestyramine (Questran) is the prototype

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Affect the Respiratory System

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Anti-Asthmatic Medications

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

Approaches are categorized according to actions.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Anti-Asthmatic Medications

Beta2 Specific Agents– Albuterol (Proventil, Ventolin) is the prototype of

this class – These agents relax bronchial smooth muscle

Nonselective Sympathomimetics– Stimulate both beta1 and beta2 receptors, as well

as alpha receptors  – Epinephrine is the only nonselective

sympathomimetic in common use today

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Anti-Asthmatic Medications

Methylxanthines– CNS stimulants that have additional

bronchodilatory properties

– The prototype methylxanthine is theophylline

Anticholinergics – Ipratropium (Atrovent)—an atropine derivative

given by nebulizer – A muscarinic antagonist that causes

bronchodilation

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Anti-Asthmatic Medications

Glucocorticoids– Have anti-inflammatory properties.– The prototype inhaled glucocorticoid is

beclomethasone.– An injectable glucocorticoid

(methylprednisolone) is available for use secondary to beta2 agonists.

Leukotriene Antagonists  – Leukotriene antagonists can either block the

synthesis of leukotrienes or block their receptors.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used for Rhinitis and Cough

Nasal decongestants

Antihistamines

Antitussives

Expectorants

Mucolytic

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used for Rhinitis and Cough

Nasal Decongestants– The main pharmacologic classification in this

functional category is alpha1 agonists.

– Examples of these agents are phenylephrine, pseudoephedrine, and phenylpropanolamine.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used for Rhinitis and Cough

Antihistamines– The first-generation antihistamines comprise

several chemical sub-classes. Differ in the degree of sedation they cause

– The second-generation antihistamines include terfenadine (Seldane), loratadine (Claritin), and cetirizine (Zyrtec).

Do not cross blood-brain barrierDecreased sedation

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used for Rhinitis and Cough

Cough Suppressants– Antitussive medications suppress the stimulus to

cough in the central nervous system.Opioids and non-opioids

Most common opioid antitussives are codeine and hydrocodone

Dextromethorphan is non-opioid

– Expectorants are intended to increase the productivity of cough.

– Mucolytics make mucus more watery.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Affect the Gastrointestinal System

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Main Indications for GI Drug Therapy

Peptic ulcers

Constipation

Diarrhea and emesis

Digestion

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Peptic Ulcer Disease

H2 receptor antagonists– Cimetidine (Tagamet), ranitidine (Zantac),

Famotidine (Pepcid), Nizatidine (Axid)

Proton pump inhibitors– Omeprazole (Prilosec), Lansoprazole (Prevacid)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Peptic Ulcer Disease

Antacids– Aluminum, magnesium, or sodium compounds

Anticholinergics– Pirenzepine (Gastrozepine)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Constipation

Categories of laxatives– Bulk-forming (methylcellulose or Citrucel)

– Stimulant (phenolphthalein or Ex-Lax)– Osmotic (Milk of Magnesia)– Surfactant (Colace)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Diarrhea

Although a nuisance, diarrhea is often a helpful process– Usually self-correcting and does not need to be

treated

Specific or non-specific agents may be used

Antibiotics are frequently used

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Emesis

Antiemetics– Medications used to prevent vomiting– This functional class includes several

pharmacologic subclasses: Serotonin antagonists

Dopamine antagonists

Cannabinoids

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Emesis

Serotonin Antagonists– Prototype serotonin antagonist is ondansetron

(Zofran)– Blocks the serotonin receptors in the CTZ, the

stomach, and the small intestines

Dopamine Antagonists – Phenothiazines and butyrophenones effectively

block dopamine receptors in the CTZ Phenothiazines include prochlorperazine (Compazine) and promethazine (Phenergan)Butyrophenones include haloperidol (Haldol) and droperidol (Inapsine)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Emesis

Cannabinoids  – Derivatives of tetrahydrocannabinol (THC)– Effective antiemetics used to treat

chemotherapy-induced nausea and vomiting – Available agents are dronabinol (Marinol) and

nabilone (Cesamet)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Aid Digestion

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

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

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Affect the Eyes

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Affect the Eyes

These drugs are used to treat conditions involving the eyes, primarily glaucoma and trauma.Medications used to treat glaucoma are all aimed at reducing intraocular pressure (IOP). – Beta-blockers and cholinergics are the most

commonly used drugs.

Tetracaine (Pontocaine) is a local anesthetic.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Affect the Ears

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Affect the Ears

Most drugs used to treat conditions involving the ear are aimed at eliminating underlying bacterial or fungal infections or at breaking up impacted ear wax.– Chloramphenicol (Chloromycetin Otic)– Gentamicin sulfate (Garamycin)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Affect the Endocrine System

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Hormonal Regulation

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

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting the Pituitary Gland

Anterior pituitary drugs– The only conditions treated with these drugs are

those associated with abnormal growth such as dwarfism

– Somatrem (Protropin) and somatropin (Humatrope)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting the Pituitary Gland

Posterior pituitary drugs– The two drugs in this category are oxytocin and

antidiuretic hormoneAntidiuretic hormone (ADH) increases water reabsorption ADH—a key component in regulating blood volume, blood pressure, and electrolyte balance Vasopressin (Pitressin), desmopressin (Stimate), and lypressin (Diapid)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting the Parathyroid and Thyroid Glands

Parathyroid glands—primarily responsible for regulating calcium levels– Treatment is with calcium and Vitamin D

supplements

Thyroid – Hypothyroid

Levothyroxine (Synthroid)

– HyperthyroidRadioactive iodine

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting the Adrenal Cortex

Glucocorticoids, mineralocorticoids, and androgens – Glucocorticoids increase the production of

glucose. – Mineralocorticoids regulate salt and water

balance. – Androgens are important hormones in regulating

sexual maturation.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting the Adrenal Cortex

Two diseases typify the disorders associated with the adrenal cortex: – Cushing’s disease and Addison’s disease

Treatment of Cushing’s disease is typically surgical Symptomatic pharmacologic intervention with an antihypertensive may be necessary

Treatment of Addison’s disease is aimed at replacement therapy

Cortisone (Cortistan) and hydrocortisone (SoluCortef)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting the Pancreas

Diabetes mellitus is the most important disease involving the pancreas.– Insulin

A substance that decreases blood glucose level

– GlucagonA substance that increases blood glucose level

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting the Pancreas

Oral Hypoglycemics – Stimulates insulin secretion from the pancreas – Examples

Orinase (chlorpropamide)

Glucotrol (glipizide)

Micronase (glyburide)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Hyperglycemic Agents

Hyperglycemic Agents – Two hyperglycemic agents, glucagon and

diazoxide (Proglycem), act to increase blood glucose levels.

Glucagon can be given IM when IV access is unavailable.

– D50W is a sugar solution given intravenously for acute hypoglycemia.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting the Female Reproductive System

Estrogens and Progestins– The principal indication for estrogen is

replacement therapy in postmenopausal women. Alleviates menopausal symptoms and reverses the increased risk for osteoporosisIncreases chances of breast cancer and stroke

– Progestins help balance the untoward effects of estrogen on the endometrium.

Oral Contraceptives– The primary mechanism of action is the

prevention of ovulation.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting the Female Reproductive System

Uterine Stimulants and Relaxants – Drugs that increase uterine contraction (uterine

stimulants) are oxytocics Indications are to induce labor and to treat severe postpartum hemorrhage Pitocin and Syntocinon

– Drugs that relax the uterus or inhibit uterine contraction are tocolytics.

Relax uterine smooth muscle by stimulating the beta2 receptors in the uterus Terbutaline (Brethine) and ritodrine (Yutopar)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting the Female Reproductive System

Infertility Agents– Most infertility drugs are developed for women

and promote maturation of ovarian follicles.   – Clomiphene (Clomid), urofollitropin (Metrodin),

and menotropins (Pergonal)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting the Male Reproductive System

Testosterone deficiency– Metandren

Benign prostatic hypertrophy (BPH)– Proscar

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Affecting Sexual Behavior

Many drugs decrease libido.– Anti-hypertensives, antianxiety, and

antipsychotic medications

Drugs that aid in erectile dysfunction increase blood supply to the penis.

– Viagra, vardenafil (Levitra), and tadalafil (Cialis) – These drugs greatly decrease preload when

used with nitrates, creating a dangerous situation.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Cancer

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Cancer

Drugs used to treat cancer are called antineoplastic agents– Most antineoplastic agents have their greatest

effect on cancer cells during mitosis

Examples include:– Fluorouracil (Adrucil)– Mechlorethamine (Mustargen)– Vinblastine (Velban)– Vincristine (Oncovin)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Infectious Diseases and Inflammation

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Infectious Diseases and Inflammation

Antibiotics– An antibiotic agent may either kill the offending

bacteria or decrease the bacteria’s growth so that the patient’s immune system can effectively fight the infection.

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

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Infectious Diseases and Inflammation

Antifungal agents– Fungi are parasitic microorganisms that cannot

synthesize their own food.– The azole antifungals inhibit fungal growth.

Anti-viral agents– Drugs used to treat viruses work by a variety of

mechanisms. – Acyclovir (Zovirax) and zidovudine (Retrovir)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Infectious Diseases and Inflammation

Non-steroidal Anti-Inflammatory Drugs– Commonly used as analgesics and antipyretics – These agents interfere with the production of

prostaglandins– Acetaminophen and ibuprofen – Ketorolac (Toradol), piroxicam (Feldene), and

naproxen (Naprosyn)

Uricosuric Drugs– Used to treat and prevent acute episodes of

gout – Colchicine and allopurinol (Zyloprim)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Infectious Diseases and Inflammation

Serums, Vaccines, and Other Immunizing Agents– Immunity may be acquired passively or actively. – A serum is a solution containing whole

antibodies for a specific pathogen. – A vaccine contains a modified pathogen.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Infectious Diseases and Inflammation

Immune Suppressing and Enhancing Agents  

– Suppressing the immune system is indicated to prevent the rejection of transplanted organs and grafted skin.

Azathioprine (Imuran)

– Immunomodulating agents enhance the natural immune reaction in immunosuppressed patients.

Zidovudine (Retrovir), ritonavir (Norvir) and saquinavir (Invirase)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Affect the Skin

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Affect the Skin

Dermatologic drugs are used to treat skin irritations.

These are common over-the-counter medications.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Supplement the Diet

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Supplementthe Diet

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

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

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Supplementthe Diet

Vitamins and Minerals– Vitamins are organic compounds – Must be obtained in our diet– Indicated for special populations

Pregnant and nursing women, patients with absorption disorders, the chronically ill, surgery patients, alcoholics, and the malnourished

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Supplementthe Diet

Vitamins– Fat Soluble

Stored

– Water SolubleMust be routinely ingested

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Poisoning and Overdoses

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Drugs Used to Treat Poisoning and Overdoses

The treatment for poisoning andoverdose depends greatly on the substance involved.– Syrup of ipecac– Activated charcoal– Mucomyst– Atropine – Pralidoxime

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Part 2 SummaryClassifying DrugsDrugs Used to Affect the Nervous SystemDrugs Used to Affect the Cardiovascular SystemDrugs Used to Affect the Respiratory SystemDrugs Used to Affect the Gastrointestinal SystemDrugs Used to Affect the EyesDrugs Used to Affect the EarsDrugs Used to Affect the Endocrine SystemDrugs Used to Treat CancerDrugs Used to Treat Infectious Diseases and InflammationDrugs Used to Affect the SkinDrugs Used to Supplement the DietDrugs Used to Treat Poisoning and Overdoses