1 Chapter 6, Part 2 General Principles of Pharmacology 2 Drug Classifications There are numerous drug classifications in the medical field Most EMS medications are: medications medications Respiratory medications Gastrointestinal system medications Medications 3 Central Nervous System Medications & Antagonists Anesthetics Anti-anxiety & Sedative-Hypnotic Drugs Antiseizure or Anti-epileptic Drugs Central Nervous System Psychotherapeutic Medications Parkinson s Medications 4 Analgesics : the absence of the sensation of pain Aneshesia: the absence of all sensation Agonists: decrease the sensory neuron s ability to propagate pain impulses Derived from poppy plant or sinthetic Nonopioid Analgesics: have opioid characteristics but are not opioid based NSAIDS, Aspirin Also used as 5 Analgesics (2 of 2) Opioid Antagonists: Reverse the effects of (Naloxone) Adjunct Medications: given concurrently with other drugs to enhance the effect antihistamines and caffeine Opioid Agonist-Antagonists: displays both agonist and antagonist properties (kills pain but does not depress breathing) 6 Anesthetics Creates a loss of Provide Used in EMS for sedation for cardioversion, RSI, and chemical restraint, Versed 7 Anti-anxiety & Sedative-Hypnotic Drugs 1
Used to decrease anxiety, induce, and assist in sleeping Sedation: a state of decreased anxiety : the instigation of sleep 3 main types Alcohol Barbiturates 8 Autonomic Nervous System Medications : space between cells The two neurotransmitters of the ANS are: and Acetylcholine: main neurotransmitter of the parasympathetic nervous system Norepinephrine: main neurotransmitter of the sympathetic nervous system 9 Benzodiazepines and Barbiturates Both the membrane of the CNS neurons which decrease their response to stimuli Benzodiazepines are frequently prescribed for oral use and are relatively safe Barbiturates have general depressant activities and a larger potential for abuse 10 Drugs that Affect the Parasympathetic Nervous System The parasympathetic system uses (ACh) as a neurotransmitter. Receptors that are specialized for acetylcholine are termed cholinergic receptors Medications that stimulate these are called Medications that block these are called 11 Cholinergics Cholinergics stimulate the effect a ACh by binding with the cholinergic receptors Parasympathetic effects create Salivation - Lacrimation -Gastric motility Urination - Limited medical use for glaucoma and specific poisonings are cholernergics 12 Anticholinergics the parasympathetic nervous system Multiple types and classes Prototype anticholinergic is Reverses the effects of SLUDGE Also used to the heart 13 Neuromuscular Blocking Agents 2
Produces paralysis without affecting consciousness Most often used by EMS for Non-depolarizing agents: allows electrical charge in neurons to continue Vecuronium Bromide ( ) agents: causes loss of electrical charge in neurons Succinylvholine (Anectine) 14 Drugs That Affect the Sympathetic Nervous System Sympathomimetics: drugs that the SNS Sympatholytics: drugs that the SNS Work on receptors of the SNS 15 Alpha and Beta Receptors of the SNS : cause peripheral vasodilation, mild bronchoconstriction, and stimulate metabolism : prevent overrelease of norepinephrine : increase heart rate and increases cardiac contractility, automaticity, and conduction : vasodilation and bronchodilation 16 Effects of Adrenergic Receptors (Page 340) 17 Receptor Specific Drugs (Page 342) 18 Classifications of Cardiovascular Drugs (1 of 2) : Used to treat and prevent abnormal cardiac rhythms. : Drugs used to treat hypertension. 19 Classifications of Cardiovascular Drugs (2 of 2) Agents: Drugs used to stop bleeding. Agents: Drugs used to treat high cholesterol. 20 Antidysrhythmics Channel Blockers: affects the sodium influx of the conduction system of the heart Quinidine blockers: beta adrenergic antagonist. Blocks the beta 1 receptors Propranolol 21 Antidysrhythmics Channel blockers (antiadrenergics): blocks the efflux of potassium 3
Bretylium, Amiodarone channel blockers: blocks the efflux of potassium Verapamil, Adenosine, Digoxin 22 Antihypertensives =Cardiac Output X Peripheral Vascular Resistance Output=Heart Rate X Stroke Volume Antihypertensives manipulate one or more of these factors : reduce circulating blood volume 23 Drugs Used to Affect the Respiratory System 24 Antiasthmatic Medications Beta 1 specific agents: smooth muscles Albuterol is the prototype Bronchodilators: the bronchioles Epinephrine Anti-Inflammatory (Corticosteroids), Prednisone 25 Drugs Used to Affect the Gastrointestinal System 26 Main Indications for GI Drug Therapy Ulcers Constipation Diarrhea and Emesis 27 Drugs Affecting the Pancreas Diabetes mellitus is the most important disease involving the. a substance that decreases blood glucose level. a substance that increases blood glucose level. 28 Oral Hypoglycemics Orinase (chlorpropamide) (glipizide) (glyburide) 29 Hypoglycemic Agents is a 50%sugar solution given intravenously for acute hypoglycemia. is indicated for emergency treatment when an IV is unobtainable. 30 Classifications of Drugs for Other Body Systems 4
31 Drugs Used to Affect the Eyes drugs are used to treat conditions involving the eyes, primarily glaucoma and trauma. 32 Drugs Used to Affect the Ears Most drugs used to treat conditions involving the ear are aimed at eliminating underlying or fungal infections or at breaking up impacted ear wax. 33 Drugs Affecting Sexual Behavior L-dopa (Levodopa) has demonstrated increased libido as a side effect. Sildenafil ( ), Vardenafil ( ) and Tadalafil ( ) increase blood flow to the penis by relaxing vascular smooth muscle NOTE: If you treat a patient with chest pain who has taken Viagra recently, do NOT give or any other nitrate. 34 Drugs Used to Treat Infectious Diseases and Inflammation (1 of 3). An antibiotic agent may either kill the offending bacteria or so decrease the bacteria s growth that the patient s immune system can effectively fight the infection. Agents. Fungi are parasitic microorganisms that cannot synthesize their own food. 35 Drugs Used to Treat Infectious Diseases and Inflammation (2 of 3) Antimicrobial and Drugs. Although most diseases treated with these drugs are uncommon in developed countries, they are leading causes of death in third-world countries. They include, leprosy, and helminthiasis. 36 Drugs Used to Treat Infectious Diseases and Inflammation (3 of 3) Tuberculosis, caused by bacteria, is increasing in the United States. (non-steroidal anti-inflammatory drugs) Commonly used as analgesics and antipyretics. Uricosuric drugs Used to treat gout. Serums, vaccines, and other immunizing agents. 37 Drugs Used to Treat Poisoning and Overdoses The treatment for poisoning and overdose depends greatly on the substance involved. Syrup of Activated Mucomyst Pralidoxime 38 Specific Drugs for EMT-Is 1:1,000 5
(Narcan) Glucagon Benadryl Lidocaine 39 Epinephrine 1:1,000 (1 of 3) Agonist Stimulates sympathetic nervous system Primary drug for reactions Actions: - heart rate -Increases strength of cardiac contractions -Peripheral -Bronchiodilator -Reverses effects of 40 Epinephrine 1:1,000 (2 of 3) Adult Dosage: - mg SC (may be given IV or IM) must be used with elderly and those with cardiac history May be given via Auto-Injector May be as directed by medical control 41 Epinephrine 1:1,000 (3 of 3) Pediatric Dosage: - mg SC (may be given IV or IM) May be given via Auto-Injector May be repeated as directed by medical 42 Naloxone (Narcan) (1 of 3) Antagonist Reverses the effects of narcotic (opioid) overdoses depression Seizures Used for known overdoses and unconsciousness due to unknown cause 43 Naloxone (Narcan) (2 of 3) Can produce Be prepared for. Restraints should be applied prior to administration Has no ill effects if not an overdose 44 Naloxone (Narcan) (2 of 3) 6
Adult Dosage: IV Push Repeated prn to titrate to LOC and Can also be given via ET Tube Pediatric Dosage: /kg up to 2mg IV Narcan has very short half-life. Be prepared to repeat as needed 45 D50W (1 of 3) D50 is a 50% dextrose (sugar solution) Solution Used to increase sugar levels in hypoglycemic patients Works very rapidly Indicated in patients with altered LOC due to 46 D50W (2 of 3) Must have a IV line Will cause of the skin if IV infiltrates Use as large an IV catheter as possible Watch for infiltration as drug is being administered 47 D50W (3 of 3) Adult Dosage: grams slow IV push Pediatric Dosage: /kg of D25W to a max of 100cc (25gm) D25W can be achieved by diluting D50W to 1 with normal saline 48 Glucagon (1 of 3) Polypeptide identical to human glucagon Increases blood glucose and relaxes smooth muscles of the GI tract Acts only on liver, converting it to glucose Indications: hypoglycemia where patient cannot take oral glucose and an is unobtainable 49 Glucagon (2 of 3) Contraindications: Allergic Dosage: - mg IV, IM, or SC Short half life if given IV (8-13 minutes) Takes approximately - minutes to reach full effects given IM and slightly longer if given SC Side Effects: N/V Repeat X 1 if patient does not regain however repeat doses are not normally needed since oral glucose can then be given and 7
the repeat dosage may not work if liver glycogen is depleted 50 Glucagon (3 of 3) Special Notes: After patient responds, watch Supplemental required after Glucagon to restore liver glycogen Comes in a dry powder and must be constituted Normally does not contraindicate D50W is ALWAYS the drug of choice SPEMS Protocol dosage is: Adult mg IM Pediatric mg IM 51 Benadryl Blocks the production of histamine release during an allergic reaction No contraindications except for allergy Adult Dosage: mg IV or IM Pediatric Dosage: mg/kg up to mg 52 Lidocaine Used to correct ventricular arrhythmias Also used for pain management (numbing effect) in intraosseous infusions Numbs the space in bone Contraindicated if allergic (Novacain) Dosage (Adult and Pedi): mg/kg up to mg 8