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Prehospital Pharmacology

Prehospital Pharmacology. 6. 5. Prehospital medicating. Prescribed by GP Standing Orders Protocols Transfer orders (should be written) EMS administered. Ace Inhibitors.

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Prehospital Pharmacology

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  1. Prehospital Pharmacology 6 5

  2. Prehospital medicating • Prescribed by GP • Standing Orders • Protocols • Transfer orders (should be written) • EMS administered

  3. Ace Inhibitors • Inhibits the effect of the Angiotensin Converting Enzyme (ACE) in the lungs, blocking the conversion of Angiotension I to Angiotension II thus inhibits the release of ADH and helps decrease blood pressure. • Captopril • Enalapril • Quinipril • Benazepril • Lisinopril

  4. Amoxicillin Azithromycin Bactrim Ceclor Ceftin Ciprofloxacin Clarithromycin Cloxicillin Dicloxicillin Erythromycin Keflex Metrodiazanole Nitrofurantoin Penicillin PenVee Rifampin Suprax Tetracycline Vancomycin Vantin Antibiotics • Kills or disrupts/stops the growth and development of bacteria

  5. Antidysrhythmics • Vaughn-Williams Classifications • Class I • Class II • Class III • Class IV

  6. Antidysrhythmics • Class I • Na Channel Blockers • Slow the maximum rate of Phase 0 depolarization • Slow conduction velocity • Slow rate and force of contraction refractory period effects • Mechanisms of Action • Blocks Na influx through fast Na channels

  7. Antidysrhythmics • Differential effects: • Ia • Increase duration of AP, prolonged repolarization, prolonged refractory period, decreased membrane responsiveness • Decreased depolarization of SA node thus decreased pacemaker activity • Also blocks K+ channels • Ib • Decreased duration of AP, decreased membrane responsiveness in ventricles • Blocks activated and inactivated Na+ channels, depresses damaged or depolarized cells (eg. post MI) • Does not block K+ channels • Ic • No effect or minimal increase in duration of AP & repolarization • Decreased membrane responsiveness • Decreased conduction velocity in atrial & ventricular cells • Also blocks K+ channels

  8. Antidysrhythmics • Class Ia • Quinidine • Procainamide • Disopyramide • Class Ib • Lidocaine • Tocainide (Mexilitine) • Phenytoin • Class Ic • Flecainide • Propanfenone • Moricizine

  9. Antidysrhythmics • Class II • Beta Blockers • Mechanisms of Action • Blockade of ß-receptors • Inhibition of norepinephrine release (bretylium) • Propranolol • Metoprolol • Atenolol

  10. Antidysrhythmics • Class III • K Channel blockers • Prolong action potential and affiliated refractory period • Mechanisms of Action • Do not alter normal fast Na conductance • Do not compete for ß-receptors • Bretylium • Amiodarone (Has effects of all classes) • Sotalol (no longer used – causes Torsades)

  11. Antidysrhythmics • Class IV • Ca Channel Blockers • Mechanisms of Action • Selectively block slow Ca channels • Inhibit slow inward Ca current during phase 2 • Decrease rate of phase 4 depolarization • Effect on the “pacemaker in charge” • Depress conduction velocity in purkinji system and AV node • Decrease contractility in myocardium • Vasodilatation (lower intracellular Ca in arterial muscle) • Verapamil (Isoptin) • Diltiazem • Cardizem • Nifedepine • Plendil

  12. Antihistamines • Compete with histamine for H1 and H2 receptors thus decreasing the histamines affect • Chlorpheniramine • Cyproheptidine • Diphenhydramine • Hydroxizine • Promethazine

  13. Antihypoglycemics • Treat diabetes by increasing the amount of sugar in the blood, and decreasing the amount transported into the tissues • Diabeta • Diabinese • Glypizide • Glyburide • Metformin • Tolinase

  14. Antifungals • Acts primarily by damaging the permeability barrier in the membrane of the fungi. This leads to the inability for the cell to construct an intact membrane and leads to the death of the fungus • Diflucan (Fluconazole) • Canesten (Clotrimazol) • Griseofluvin • Ketoconazole • Lamisil • Nizoral • Monostat • Sopranox • Tinactin

  15. Antituberculosis • Inhibits RNA synthesis in bacteria • Ethambutol • Rifampin • Isoniazid • Pyrazinamide • Streptomycin

  16. Antivirals • Affects the reproduction of the virus. • Acyclovir • Amatadine • Rimantadine • 3TC • Acyclovir • Amatadine • AZT • DDI • Quinivere • Rimatadine • Zovirax

  17. Anxiolytics • Combat anxiety by binding with receptors (GABA) in the cerebral cortex and limbic regions. • Valium • Wellbutrin • Xanax

  18. Benzodiazepines • Bind with receptors (GABA) to decrease anxiety and prevent seizures • Valium • Versed • Halcyon

  19. Beta 1 Specific Blockers • Compete for the ß-1 receptor sites • Blocadren • Corgard • Lopressor • Tenormin

  20. Bronchodilators • ß-2 agonists • Albuterol • Aminophylline • Atrovent (anti-cholinergic) • Metaproterenol • Ventolin

  21. Cardiac glycosides • Block ionic pumps in heart increasing Ca concentrations and contraction, decreasing rate and speed of conduction • Digitalis • Digitoxin • Digoxin • Lanoxin

  22. Cholesterol lowering • Prohibits the synthesis of cholesterol • Lopid • Lozol • Mevacor • Zocor

  23. Diuretics • Causes body’s water balance to shift, excreting water and some electrolytes • Loop Diuretics • inhibit reabsorption of sodium and chloride in the ascending Loop of Henle, thus excreting water and potassium. Most potent of the diuretics • Furosemide (Lasix) • Thiazide Diuretics • Affect the distal tubule blocking cotransport of Na-CL • HCTZ • Potassium-sparing Diuretics • Amiloride • Aldactone • Osmotic Diuretics • pharmacologically inert nonelectrolyte which is freely filtered by the renal glomerulus and not reabsorbed from the nephron. Osmotically pulls large amounts of water from the cells which it carries with it when it is excreted • Mannitol • D50

  24. Gastrointestinal • Chlopromazine • Dimenhydrinate • Famotidine • Loperamide • Magnesium hydroxide • Omeprazole • Prochloperazine • Scopolamine

  25. H2 blockers • Blocks H2 receptors in the stomach • Axid • Pepcid • Ranitidine • Tagamet • Cimetidine

  26. Migraine therapy • Typically decrease the vasodilatation in the cranial vascualture relieving the headache • Inderal • Ergotamine • Fiorinol • Sumatripan

  27. Narcotics • Act on the CNS to slow down all body systems and are used medically as cough suppressants or pain relievers • High potential for abuse and for dependency • Narcotics can be classified into three groups: • Natural origin • Codeine, Morphine, Fentanyl • Semi-synthetic • Heroin • Synthetic • Merperidine (Demerol), Methadone, Hydromorphone (Dilaudid)

  28. Non-Narcotic analgesics • Relieve pain without producing unconsciousness or impairing mental capacities. • Many of these drugs also have an antipyretic and/or an anti-inflammatory effect • Aspirin (ASA) • Analgesic, antipyretic, and anti-inflammatory agent used for mild to moderate pain. It is contraindicated in peptic ulcer disease. It acts as a gastric mucosal irritant and has an anticoagulant effect. • Acetaminophen (Tylenol) • Similar to aspirin, but has no anti-inflammatory action. • Ibuprofen • Ibuprofen is indicated for the relief of mild to moderate pain. Has an anti-inflammatory agent. It is not to be given to patients in the third trimester of pregnancy or anyone with a history of gastrointestinal bleeding

  29. NSAIDS • Non-Steroidal Anti-inflammatory Drug • Inhibits the cyclooxygenase enzyme from synthesizing prostaglandins • Alleve • ASA • Ibuprofen • Indomethacin • Relafen • Toradol • Voltaren

  30. Steroids • Synthetic hormones • Possess anti-inflammatory (glucocorticoid) and/or salt-retaining (mineralocorticoid) properties to varying degrees. • Glucocorticoids • Affect almost all body systems and cause varied metabolic effects • Promote gluconeogenesis • Redistribution of fat from peripheral to central areas of the body • Reduce intestinal absorption and increase renal excretion of Ca • Decrease inflammation • Stabilization of leukocyte lysosomal membranes • Inhibition of macrophage accumulation in inflamed areas • Reduction of capillary permeability. • Suppress immune responses • Reduction of activity and volume of the lymphatic system • Decreased immunoglobulin and complement concentrations • Decreased passage of immune complexes through basement membranes • Mineralocorticoids • Affect electrolyte and fluid balance by acting on the distal renal tubule to promote Na reabsorption and K and H excretion.

  31. Glucocorticoids Short Acting Cortisone Hydrocortisone Intermediate Acting Methylprednisolone Prednisolone Prednisone Triamcinolone Long Acting Betamethasone Dexamethasone Mineralocorticoids Fludrocortisone Steroids

  32. Education • Previous Training was “ see this... give this ” • Education A & P Pathophysiology Drug specifics

  33. Drug specifics • Class • Mechanism of action • Indications • Contraindications • Precautions • Side effects • Interactions • Dosage • Administration

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