EHS 202 Week 1 Introduction to Pharmacology 2023-2024 PDF

EHS 202 Pharmacology for EMS Introduction to Pharmacology Week 1 2 PRINCIPLES OF PHARMACOLOGY Course Learning Outcomes: 1. Describe the basic concepts and principles of pharmacokinetics; pharmacodynamics; drug metabolism; drug-drug interactions; a...

EHS 202 Pharmacology for EMS Introduction to Pharmacology Week 1 2 PRINCIPLES OF PHARMACOLOGY Course Learning Outcomes: 1. Describe the basic concepts and principles of pharmacokinetics; pharmacodynamics; drug metabolism; drug-drug interactions; and explain how they can influence route of administration; drug action; drug efficacy and potency; potential for drug interactions; and drug toxicity; 2. List the major drugs and drug classes currently used in prehospital practice; 3. Describe the specific pharmacology of the major drugs and drug classes currently used in prehospital practice including their indications, contraindications, mechanisms of action, physiological effects, major adverse effects and clinically significant drug interactions; 4. Describe the specific pharmacology of the major drugs and drug classes currently used in prehospital practice including their indications, contraindications, mechanisms of action, physiological effects, major adverse effects and clinically significant drug interactions; 8/30/2022 2 4. Apply understanding of pharmacology along with disease-specific and patient-specific factors to select the most appropriate medication(s) for the effective pharmacotherapy of a given disease or condition in a specific patient; 5. Evaluate the effectiveness of interventions and modify treatment plan accordingly; 6. Discuss the basic principles of toxicology; the mechanisms by which excess exposure to certain drugs can lead to adverse effects; and the basic principles of managing the overdose patient; 7. Explain the physiological, pharmacological, and psychological effects of acute and chronic exposure of individuals to prescribed medications and describe the consequences of sudden withdrawal of such a drug from a drug-dependent individual. 8/30/2022 3  What is Pharmacology? ‘Pharmacology is the study of the effects of drugs on the function of living systems’.1  Why do we want to learn about pharmacology? As a paramedic you will encounter a wide variety of medications. Including those you will administer and those prescribed for or taken by your patients. Having a detailed understanding of pharmacology is vitally important to effectively manage your patients and deliver the highest standards of care. A source of education and advice to the public. Responsible for the initiation, monitoring and adjustment of drug treatment strategies. Informed clinical decision making. Why do we want to learn about pharmacology? ‘why does that happen?’, ‘how does that work?’ and ‘what are we trying to achieve?’ So what is a drug? Discuss …..  What is a drug? ‘A chemical substance of know structure, other than a nutrient or an essential ingredient, which, when administered to a living organism produces a biological effect’.1 ‘Any substance or product that is used to modify of explore physiological systems or pathological states for the benefit of the recipient’. 2 Drugs may be synthetic chemicals, chemicals obtained from plants or animals, or products of genetic engineering.  Is the route of administration important? What if the sodium chloride solution for injection was ingested orally, would it still be a drug?  Is the route of administration important? The difference between what is considered a drug and what is not can sometimes be confusing. Many substances considered as drugs are also produced endogenously by the body. In such circumstances to be counted as a drug the substance must be administered (exogenous) rather than released from physiological mechanisms. Can you think of an example?– Discuss with your neighbor (1 minute)  What is a medication or medicine? ‘A chemical preparation, which usually but not necessarily contains one or more drugs, administered with the intention of producing a therapeutic effect ’.1 ‘Drugs mixed in a formulation with other ingredients to improve the stability, taste or physical form, in order to allow appropriate administration of the active drug’. 2 For a drug to be clinically useful, it should have the attributes of potency, biological selectivity and chemical specificity.  Is the source of the chemical important? Codeine Morphine Some of the drugs Heroin derived from plants have clinically useful properties as well as abuse potential.  Sources of Medication Synthetic Made completely in a laboratory Semisynthetic Made from chemicals derived from plant, animal, or mineral sources https://dribbble.com/shots/3818573-Chemistry-lab 13  Is the intention of administration important? Whether a drug is deliberately consumed or not does not change it’s action and interaction within the body. The various routes of administration must also be considered.  Drug Controls in the UAE The UAE are is aligned with several international agreements in relation to narcotic and psychotropic drugs to ensure such drugs are not freely available to the public. These conventions are designed to minimise the risk of abuse and avoid drug trafficking. Federal Law No. 4 of 1983 describes the basic requirements for prescribing and supplying prescription medicines Federal Law No 14 of 1995 describes how these conventions are applied in the UAE. Why is this important? 15 Drug Controls in the UAE Federal Decree Law no 30 of 2021 relates to changes and the legalization surrounding the use of narcotics and psychotropic medications. There is now a focus on rehabilitation rather than punishment in the case of first offenders. The abuse of such drugs remains illegal, however, there are changes in the legal response to some cases. 28th February 2011 Presentation title 16  A drug, food or nutritional supplement? Concentrated and refined compounds derived from natural sources still have an effect on the body. Despite a beneficial intent, excess quantities that would not naturally be possible can be beneficial or detrimental. Alternate therapies? Aroma therapy Chinese medicines Compounds and chemicals used in ‘alternate therapy’ often have active ingredients that are absorbed into the Organic compounds body and can stimulate changes as any other drugs or chemical do. Scented lotion may initiate an immune response and various teas and supplements interact with other drugs or physiological processes. Poisons and other chemicals? The same compound may be toxic in one setting and therapeutic in another. By controlling and varying the dose, a poison in one setting can be changed into a valuable treatment regime in another setting. Poisons and other chemicals? All drugs are chemicals, regardless of whether they originate from plants, animals, microorganisms, minerals or are synthesised. Context and application of drugs and chemicals is important.  Drug Name Most drugs have at least 3 different names: Tofranil - Chemical name; - Generic (non-proprietary) name; - Trade (proprietary) name. Endep Deptran Chemical Name 1-(4-hydroxy- 3 -hydroxymethylphenyl)- 2 -(tert-butylamino) ethanol sulfate. Molecular formula: (C13H21NO3)2.H2SO4. Chemical names are rarely used except by chemists, biochemists and pharmacologists. The chemical name describes the chemical structure of the compound including location and type of chemical side-chains. Generic (non-proprietary) name Generic names are usually derived from part of the chemical name in order to make a simplified name that is easier to remember. Generally one generic name for a drug. Health professionals generally use the generic name when discussing a drug. The generic name salbutamol is derived from the salicylyl, butyl, amine and alcohol groups. Generic (non-proprietary) name Not all generic names are as obvious and some are derived from the Latin name, a derivative of the source compound or could include a suffix to indicate the drug group. atenolol propanolol Adrenoceptor β-Antagonists. sotalol These drugs have different structures and properties however, they are structurally similar and belong to the same functional group of drugs. Generic (non-proprietary) name Some drugs have several therapeutic uses. Some generic names of drugs within the same group may differ due to their significant structural differences or source. The different forms of a generic drug may also be described in the name: Morphine Hydrochloride, Morphine Sulphate, Morphine Tartrate This is due to the insolubility of some drugs in water and changed into organic salts or esters that are more dissolved, absorbed and distributed throughout the body. Trade (proprietary) name The proprietary or trade name is the name given to a drug and by which the drug is normally marketed and sold.  Trade (proprietary) name This name is the property of the company and is trademarked. When a drug is first discovered it is patented so that other companies can not produce or sell it and usually has only one trade name. After the patent for a particular drug expires other companies can market and sell the same drug under a different trade name. There are often multiple trade names for one drug. Trade (proprietary) name Company: Generic name: Trade names: GlaxoSmithKline Paracetamol Panadol Panadol (Childrens) Panadol Back and Neck Panadol Extend Panadol Rapid Panadol Osteo (665mg) + Caffeine Panadol Extra + Codeine Panadeine (500mg/8mg) Panadeine Extra (500mg/15mg) Panadeine Forte (500mg/30mg) The additional suffix of Forte, Extra, HCT etc. at the end of a drug trade name indicates a change in medication. This may be dose or the addition of another drug. Grouping of drugs by function Antihypertensive Drugs used to treat or prevent a specific E.g. Labetolol disease processes can be classed together generically. Antidepressant E.g. Amitriptyline Doing this can allow for discussion about treatment strategies and goals without knowing Anticonvulsant intimate details about the drug or dosing E.g. Diazepam regime. Analgesic E.g. Panadol Grouping of drugs by mechanism of action B blockers ACE Inhibitors Anti-hypertensive AT 2 Receptor Antagonists Diuretics Most functional groups (E.g., antihypertensives or anticonvulsants) contain multiple drugs with different mechanisms of action. Prescribed medication can give an excellent insight into conditions that they are likely to be diagnosed and treated for - if you know what you are looking for!  A note on Americanism.... Generic (non-proprietary) name adrenaline v epinephrine noradrenaline v norepinephrine salbutamol v albuterol paracetamol v acetaminophen frusemide v furosemide lignocaine v lidocaine As discussed most drugs have a single generic name however there are exceptions predominantly associated with the difference between British and American nomenclature.  Weekly Learning Task Pick a drug each and for next week prepare a unique presentation for your peers about this drug. Your presentation must Include the following information: Presentations Indications Actions Dose and administration Contraindications Caution Side effects 32 References 1.‘Rang and Dale’s Pharmacology’, 6t h Edition. (Rang et al.) 2.‘Pharmacology for Health Professionals’, 2nd Edition. (Bryant & Knights) 3.‘Fundamentals of Pharmacology’, 5th Edition. (Bullock et al.) 4.Pollak,A.N., Elling,B., & Smith,M.( 2013). Nancy Caroline’s Emergency Care in the Streets (7th ed.) Burlington, MA : Jones and Bartlett Learning.