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Группа авторов. Fundamentals of Pharmacology for Paramedics
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Fundamentals of Pharmacology for Paramedics
Contributors
Preface
Acknowledgements
Prefixes, suffixes and abbreviations
Abbreviations used in prescriptions
Chapter 1 Introduction to pharmacology
Aim
Learning outcomes
Test your knowledge
SAMPLE
Skills in practice
Episode of care
Naming and classifying drugs
Look‐alikes and sound‐alikes
How drugs bring about their actions
How are we able to manipulate physiological function using drugs?
Receptors as sites of drug action
Enzymes as sites of drug action
Ion channels
Transport molecules
Selectivity of binding and its effect
Clinical considerations
The drug–body interaction is a dynamic process
Clinical considerations
Episode of care
Skills in practice
Administering medication to children
Reflection
Conclusion
Glossary
References
Further reading
Multiple‐choice questions
Chapter 2 How to use pharmaceutical and prescribing reference guides
Aim
Learning outcomes
Test your knowledge
Introduction
HCPC Standards of conduct, performance and ethics
HCPC Standards of proficiency for paramedics
Clinical consideration
Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Clinical Practice Guidelines
JRCALC Update information
Clinical considerations
How to navigate the JRCALC Guidelines
Skills in practice: example of navigating the JRCALC Guidelines
General Guidance section (JRCALC Guidelines, section 1)
Clinical considerations
Resuscitation section (JRCALC Guidelines, section 2)
Medical Emergencies section (JRCALC Guidelines, section 3)
Clinical consideration
Trauma section (JRCALC Guidelines, section 4)
Maternity Care (JRCALC Guidelines, section 5)
Special Situations (JRCALC Guidelines, section 6)
Medicines (JRCALC Guidelines, section 7)
Skills in practice
Page for Age (JRCALC Guidelines, no section number allocated)
Reflection
JRCALC Pocket Book
Reflection
JRCALC Guidelines digital application (app)
Test your knowledge
Useful additional resources
British National Formulary (BNF)
Monthly Index of Medical Specialities
Electronic Medicines Compendium (EMC)
Conclusion
Associated medications
Disclaimer
References
Further reading
Multiple‐choice questions
Chapter 3 Legal and ethical issues
Aim
Learning outcomes
Test your knowledge
Introduction
The law
Clinical consideration: the Bolam test
Ethical principles and theories
Clinical consideration
Clinical considerations: consent to treatment (adults)
Clinical consideration: consent to treatment (children)
Regulatory bodies
Episode of care
Clinical consideration
Research
Skills in practice: how to use medical ethics
Episode of care
Episode of care
Conclusion
Glossary
References
Further reading
Multiple‐choice questions
Chapter 4 Medicines management and the role of the paramedic
Aim
Learning outcomes
Test your knowledge
Introduction
Clinical consideration 1
Medicines management
Manufacturing, marketing, procurement and sale
Selection
Clinical consideration 2
Supply
Clinical considerations 3
Patient‐specific directions
Prescriptions
Clinical consideration 4
Patient Group Directions
Exemptions
Skills in practice 1
Student paramedic exceptions
Prescribing
Handling and administration
Box 4.1 Example of a medicine administration procedure
Clinical consideration 5
Clinical consideration 6
Special consideration: Controlled Drugs and critical medications
Groups requiring special considerations
Pregnancy and breast feeding
Older people
Clinical consideration 7
Monitoring for side‐effects
Medicines optimisation
Box 4.2 Four principles of medicines management
Safety in medicines management
Storage and disposal
Conclusion
References
Further reading
Multiple‐choice questions
Chapter 5 Pharmacodynamics and pharmacokinetics
Aim
Learning outcomes
Test your knowledge
Introduction
Professional regulatory council
Programmes of education and training
Pharmacokinetics
The pharmacokinetic processes
Phase 1: absorption
Reflection – route selection
Physiology of transport. Active transport
Passive transport
Enteral
Parenteral
Phase 2: distribution
Protein binding
Blood–brain barrier
Placental barrier
Phase 3: metabolism (biotransformation)
Rates of reaction
Zero‐order reaction
First‐order reaction
First‐pass metabolism
Hepatic first‐pass effect
Phase 4: elimination
Example: pharmacokinetics of paracetamol
Box 5.1 Pharmacokinetics of paracetamol
Clinical consideration: half‐life
Clinical consideration: steady state
Clinical consideration: termination of action
Clinical consideration: therapeutic range
Pharmacodynamics
Agonists and antagonists
Agonist
Antagonists
Clinical consideration: confidence in the drug
Episode of care: adult suffering an opiate overdose
Clinical considerations
Drug potency and efficacy
Therapeutic index
Adverse drug reactions
Box 5.2 Factors altering medication response
Conclusion
References
Further reading
Multiple‐choice questions
Chapter 6 Drug formulations
Aim
Learning outcomes
Test your knowledge
Introduction
Routes of drug administration
Parenteral administration
Intravenous administration
Episode of care
Subcutaneous administration
Intramuscular administration
Skills in practice: administration of adrenaline auto‐injector (e.g. EpiPen® or EpiPen Jr®) for anaphylaxis or severe allergic reaction
Clinical consideration: administration of adrenaline
Intraosseous administration
Intrathecal administration
Intradermal administration
Skills in practice
Formulations. Localised versus long‐acting injectable formulations. Localised injectables
Long‐acting injectables
Topical formulations
Ocular
Clinical consideration: topical beta‐blockers
Otic
Nasal
Clinical consideration: topical medications
Transdermal
Vaginal formulations
Inhaled formulations. Inhalation
Episode of care: methoxyflurane
Nebulisation
Episode of care
Enteral formulations
Oral
Tablets. Immediate release
Controlled release
Skills in practice: controlled‐release medications
Enteric coated
Enteric‐coated tablets and patients with swallowing difficulties
Dispersible (soluble/effervescent)
Chewable
Capsules. Immediate release
Controlled release
Enteric coated
Liquid formulations. Solutions/suspensions
Skills in practice
Sublingual and buccal formulations
Skills in practice: glyceryl trinitrate
Rectal formulations
Clinical consideration: dosage differences across formulations
Conclusion
Glossary
References
Further reading
Multiple‐choice questions
Chapter 7 Adverse drug reactions
Aim
Learning outcomes
Test your knowledge
What is an adverse drug reaction?
Classification of adverse drug reactions
How prevalent are adverse drug reactions?
Who is more likely to experience adverse drug reactions?
Recognising signs and symptoms of adverse drug reactions
Anaphylaxis
Clinical consideration
Rashes and skin eruptions
Serum sickness
Renal disorders
Geriatric syndrome
Idiosyncratic reactions
Preventing adverse drug reactions
Clinical consideration
Managing adverse drug reactions
Clinical consideration
Clinical consideration
Skills in practice: adrenaline dosing in anaphylaxis
Reporting adverse drug reactions
Skills in practice: completing a Yellow Card
Episode of care
Conclusion
References
Further reading
Multiple‐choice questions
Chapter 8 Analgesics
Aim
Learning outcomes
Pain and analgesia
Understanding and assessing pain
Why do we treat pain?
Psychology of pain
Physiology of pain
Pain transmission
Pain modulation
Clinical consideration
Types of pain
Clinical considerations
Assessment of pain
Approach to analgesia
Find out more
Paracetamol
Paracetamol overdose
Non‐steroidal anti‐inflammatory drugs
Salicylates
Find out more
Propionic acid derivatives
Acetic acid derivatives
Enolic acid derivatives
Selective COX‐2 inhibitors
Find out more
Episode of care
Inhalational analgesia. Nitrous oxide
Methoxyflurane
Box 8.1 Contraindications to nitrous oxide:oxygen (50:50 mix) administration
Box 8.2 Contraindications to methoxyflurane administration
Skills in practice: Penthrox preparation and administration
Opioids. Agonists
Morphine
Codeine
Diamorphine (heroin)
Fentanyl
Episode of care
Find out more
Skills in practice: intranasal diamorphine administration
Antagonists
Reflection
Atypical analgesics. Ketamine
Find out more
Antidepressants and antiepileptics
Nefopam
Adjuncts to analgesia. Magnesium sulfate
Local anaesthetics
Conclusion
Reflection choice of analgesia
Glossary
References
Further reading
Multiple‐choice questions
Chapter 9 Antibacterials
Aim
Learning outcomes
Test your knowledge
Introduction
Language and terminology
Antibacterial mechanisms of action
Disruption of bacterial cell wall synthesis: beta‐lactams
Interference in folate metabolism: sulfonamides, trimethoprim
Inhibition of bacterial DNA synthesis: quinolones
Inhibition of bacterial protein synthesis: tetracyclines, aminoglycosides, macrolides, chloramphenicol, lincosamides
Choosing the right treatment
Antimicrobial resistance
Preventing antimicrobial resistance
Clinical consideration: Summary of the paramedic’s role in the principles of good assessment, combating microbial resistance and prescribing practice considerations
Antimicrobial stewardship (AMS)
Antibacterials by clinical use
Beta‐lactams. Penicillins
Contraindication, cautions and adverse effects
Drug interactions
Considerations in the administration of penicillins
Episode of care
Cephalosporins
Contraindications, cautions and adverse effects
Drug interactions
Considerations in the administration of cephalosporins
Episode of care
Carbapenems
Contraindications, cautions and adverse effects
Drug interactions
Considerations in the administration of carbapenems
Clinical consideration: medication consideration during adulthood
Tetracyclines
Contraindications, cautions and adverse effects
Drug interactions
Considerations in the administration of tetracyclines
Chloramphenicol
Contraindications, cautions and adverse effects
Drug interactions
Considerations in the administration of chloramphenicol
When administered in combination with phenytoin, monitor seizure pattern. Aminoglycosides
Contraindications, cautions and adverse effects
Drug interactions
Considerations in the administration of aminoglycosides
Clinical consideration: medication administration in the older adult
Macrolides
Contraindications, cautions and adverse effects
Drug interactions
Considerations in the administration of macrolides
Lincosamides
Contraindications, cautions and adverse effects
Drug interactions
Considerations in the administration of lincosamides
Conclusion
References
Further reading
Multiple‐choice questions
Chapter 10 Medications used in the cardiovascular system
Aim
Learning outcomes
Cardiovascular diseases
Hypertension and heart failure
Management of hypertension and heart failure
Beta‐adrenoceptor antagonists (beta‐blockers)
Renin‐angiotensin‐aldosterone‐system
Angiotensin‐converting enzyme (ACE) inhibitors
Angiotensin receptor blockers (ARBs)
Angiotensin receptor‐neprilysin inhibitor (ARNI)
Mineralocorticoid receptor antagonists
Calcium channel blockers (CCBs)
Diuretics
Positive inotropes for patients with decompensated heart failure
Acute coronary Syndrome (ACS)
Management of acute coronary syndrome. Fibrinolytic therapy
Aspirin and dual antiplatelet therapy
Glyceryl trinitrate (nitroglycerin)
Lipid‐lowering therapies
HMG‐CoA reductase inhibitors (statins)
Ezetimibe
PCSK9 inhibitors
Episode of care: chest pain
Reflection
Skills in practice: electrode placement for a 12‐lead ECG
Conclusion
Glossary
References
Further reading
Multiple‐choice questions
Chapter 11 Medications used in the renal system
Aim
Learning outcomes
Test your knowledge
Introduction
Acute kidney injury
Box 11.1 Drugs known to be nephrotoxic
Chronic kidney disease
Management of CKD
Electrolyte abnormalities resulting from poor renal function. Hyponatraemia (low serum sodium)
Box 11.2 Levels of hyponatraemia
Hypokalaemia (low serum potassium) and hyperkalaemia (high serum potassium)
Urinary retention and incontinence. Clinical consideration
Drug‐induced renal damage
Drugs that act on the renal system. Diuretics
Clinical consideration
Loop diuretics
Clinical consideration
Thiazide diuretics
Osmotic diuretics
Drugs used to treat urinary retention and urinary incontinence
Conclusion
Skills in practice: identifying the need for furosemide use
Episode of care
Glossary
References
Further reading
Multiple‐choice questions
Chapter 12 Medications and diabetes mellitus
Aim
Learning outcomes
Test your knowledge
Introduction
Hormonal control of blood glucose
Box 12.1 Major actions of insulin and glucagon in the body
Monitoring diabetes
Measuring blood glucose
Skills in practice: Tips for measuring blood glucose levels
Clinical consideration: Factors that may interfere with the accuracy of blood glucose measurements
Measuring ketones
Drug use in diabetes
Insulin replacement therapy
Insulin administration
Clinical consideration: insulin administration
Insulin preparations
Clinical consideration: Dosing insulin in certain situations
Adverse effects of insulin
Metformin
Sulfonylureas
Incretin mimetics
DPP‐4 inhibitors
GLP1 receptor agonists
SGLT‐2 inhibitors
Thiazolidinediones
Alpha‐glucosidase inhibitors
Drug use in diabetic emergencies. Hypoglycaemic emergency
Box 12.2 Medications most likely to cause iatrogenic hypoglycaemia
Clinical consideration: Important medication interactions
Box 12.3 Hypoglycaemia risk factors
Management of severe hypoglycaemia. Glucagon
Skills in practice: preparation and administration of glucagon
Intravenous glucose
Clinical consideration: hypoglycaemia unawareness
Episode of care: hypoglycaemia
Hyperglycaemic emergency. Diabetic ketoacidosis
Clinical consideration: Hyperosmolar hyperglycaemia
Signs and symptoms
Clinical consideration: euglycaemic ketoacidosis
Management of hyperglycaemia
Fluid replacement
Electrolyte replacement
Insulin therapy
Episode of care: Hyperglycaemia
Conclusion
Glossary
References
Multiple‐choice questions
Chapter 13 Medications used in the respiratory system
Aim
Learning outcomes
Test your knowledge
Introduction
Anatomy and physiology
Nervous system control
Reflection
Common respiratory emergencies. Asthma
Skills in practice: obtaining a peak flow reading (DeVrieze et al., 2020)
Chronic obstructive pulmonary disease
Croup
Pneumonia
Pneumothorax
Pulmonary oedema
Reflection
Classes of medications
Bronchodilators
Beta‐2 adrenergic receptor agonists (B2‐agonists)
Muscarinic receptor antagonists (anticholinergics)
Short‐acting muscarinic antagonists
Skills in practice: preparing and administering nebulised medications
Clinical consideration: inhalation therapy
Sympathomimetics: epinephrine (adrenaline)
Electrolytes and minerals: magnesium sulfate
Diuretics
Nitrates
Steroids
Clinical consideration: corticosteroids
Episode of care: COPD exacerbation
Medical gases
Oxygen devices
Conclusion
Find out more
References
Further reading
Multiple‐choice questions
Chapter 14 Medications used in the gastrointestinal system
Aim
Learning outcomes
Test your knowledge
Introduction
Anatomy and physiology of the gastrointestinal system
Nausea and vomiting
Clinical consideration: management of vomiting in the patient receiving palliative care
H1 receptor antagonists (antihistamines)
Dopamine (D2) receptor antagonists
Metoclopramide
Serotonin (5‐HT3) receptor antagonists
Peptic ulcers
Helicobacter pylori infections
Non‐steroidal anti‐inflammatory drugs
Symptoms of peptic ulcer
Clinical consideration: Presentation of haematemesis
Constipation
Laxatives
Bulk‐forming laxatives
Osmotic laxatives
Stimulant laxatives
Softener laxatives
Episode of care: constipation
Episode of care: suspected bowel perforation
Gastro‐oesophageal reflux disease
Drug interventions (patients with confirmed endoscope diagnosis) Proton pump inhibitor
Prokinetic/promotility/gastrointestinal stimulants (GIS)
Paramedic practice
Clinical consideration: chest pain mimics
Reflection
Clinical consideration: assessing diarrhoea
Antidiarrhoeals
Skills in practice: assessing bowel sounds
Inflammatory bowel disease (IBD)
Crohn’s disease
Ulcerative colitis
Drug treatment for inflammatory bowel disease
Aminosalicylates (5‐ASAS)
Immunosuppressants
Corticosteroids
Biologic medicines (infliximab, adalimumab, golimumab and vedolizumab)
Skills in practice: how to assess dehydration
Conclusion
References
Multiple‐choice questions
Chapter 15 Medication and the nervous system
Aim
Learning outcomes
Introduction
The nervous system
Parkinson disease and parkinsonism
Episode of care
Infections
Dementia
Drugs used in dementia
Cautions
Epilepsy
Antiepileptic medication
Psychogenic non‐epileptic seizures (PNES) versus bilateral tonic clonic seizures (BTCS)
Emergency medication in the prehospital setting
Administering buccal midazolam
Administering rectal diazepam
Strokes (including transient ischaemic attacks)
Definition of a stroke and a transient ischaemic attack
Assessment of a stroke
Treatment
Episode of care
Considerations
Conclusion
References
Further reading/resources
Multiple‐choice questions
Chapter 16 Medications used in mental health
Aim
Learning outcomes
Test your knowledge
Introduction
Neurotransmitters
Reflection
Antidepressants
Selective serotonin reuptake inhibitors
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors
Serotonin and noradrenaline reuptake inhibitors
Serotonin syndrome
Other atypical antidepressants
Clinical consideration: activated charcoal
Reflection
Anxiolytics
Pregabalin
Benzodiazepines
Buspirone
Beta‐blockers
Hypnotics
Benzodiazepines
Z‐drugs
Pharmaceutical drugs used for non‐medical purposes
Mood‐stabilising medications
Lithium
Valproate
Antipsychotics
Antipsychotic‐related side‐effects. Extrapyramidal symptoms
Cardiovascular side‐effects
Endocrine side‐effects
Neuroleptic malignant syndrome
Other side‐effects
Clinical consideration: acute behavioural disturbance
Skills in practice: intranasal medication administration
Episode of care TCA overdose
Dementia
Acetylcholinesterase inhibitors
Memantine
Attention deficit‐hyperactivity disorder
Stimulants
Non‐stimulants
Conclusion
Find out more about these conditions
Glossary
References
Further reading
Resources
Multiple‐choice questions
Chapter 17 Immunisations
Aim
Learning outcomes
Test your knowledge
Introduction
Being mindful of clinical terminology
Understanding the fundamental epidemiological concepts and theories in preventing infectious diseases
Essential ways of examining infectious diseases
Reflection: essential infectious diseases knowledge
Becoming familiar with vaccine design to underpin clinical practice knowledge
Vaccine design
Vaccine failure
Appreciating public concerns in the acceptability and uptake of immunisations
Vaccine acceptability
Clinical consideration: key points when assessing patients with vaccine hesitancy
Reflection: Immunisation information and advice opportunities
Recognising the role of the paramedic in health promotion and immunisation administration
Reflection: the role of the paramedic
Immunisations as prescription‐only medicines
Embedding immunisation history taking in clinical assessment
Clinical consideration: consent
Clinical consideration: anaphylaxis
Skills in practice: vaccination care
Episode of care
Conclusion
References
Further reading
Multiple‐choice questions
Normal Values
Answers. Chapter 1 Introduction to pharmacology
Chapter 2 How to use pharmaceutical and prescribing reference guides
Chapter 3 Legal and Ethical Issues
Chapter 4 Medicines management and the role of the Paramedic
Chapter 5 Pharmacodynamics and Pharmacokinetics
Chapter 6 Drug Formulations
Chapter 7 Adverse Drug Reactions
Chapter 8 Analgesics
Chapter 9 Antibacterials
Chapter 10 Medications used in the cardiovascular system
Chapter 11 Medications used in the renal system
Chapter 12 Medications and diabetes mellitus
Chapter 13 Medications used in the respiratory system
Chapter 14 Medications used in the gastrointestinal system
Chapter 15 Medication and the Nervous System
Chapter 16 Medications used in Mental Health
Chapter 17 Immunisations
Index
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