Fundamentals of Pharmacology for Paramedics

Ian Peate, OBE, FRCN, Senior Lecturer, Roehampton University; Visiting Professor of Nursing, St George’s University of London and Kingston University London; Visiting Professor, Northumbria University; Visiting Senior Clinical Fellow, University of Hertfordshire, and Editor-in-Chief of the British Journal of Nursing. Suzanne Evans, PhD is Associate Professor and Director of Teaching & Learning, School of Biomedical Sciences & Pharmacy, University of Newcastle, Australia.Lisa Clegg, PhD, MHLTHSC, BHLTHSC is an Ahpra Registered Paramedic and Senior Lecturer in Paramedicine at Charles Sturt University, Australia.

• Contributors xiiiPreface xxiAcknowledgements xxiiiPrefixes, suffixes and abbreviations xxivChapter 1: Introduction to pharmacology 1Suzanne Evans and Tanya SomaniAim 1Naming and classifying drugs 5How drugs bring about their actions 6How are we able to manipulate physiological function using drugs? 6Receptors as sites of drug action 7Enzymes as sites of drug action 7Ion channels 7Transport molecules 9Selectivity of binding and its effect 11The drug–body interaction is a dynamic process 11Conclusion 14Glossary 14References 15Further reading 15Multiple-choice questions 15Chapter 2: How to use pharmaceutical and prescribing reference guides 18Nigel Conway and Jennifer DodAim 18Introduction 19HCPC Standards of conduct, performance and ethics 19HCPC Standards of proficiency for paramedics 20Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Clinical Practice Guidelines 21JRCALC Update information 22How to navigate the JRCALC Guidelines 23JRCALC Pocket Book 30JRCALC Guidelines digital application (app) 31Useful additional resources 32British National Formulary (BNF) 32Monthly Index of Medical Specialities 33Electronic Medicines Compendium (EMC) 34Conclusion 34Disclaimer 35References 35Further reading 35Multiple-choice questions 35Chapter 3: Legal and ethical issues 37Claire Leader, Emma Senior, Deborah Flynn and Paul YoungerAim 37Introduction 38The law 38Ethical principles and theories 39Regulatory bodies 43Research 45Conclusion 47Glossary 47References 48Further reading 49Multiple-choice questions 50Chapter 4: Medicines management and the role of the paramedic 52Annette Hand, Carol Wills and Paul YoungerAim 52Introduction 53Medicines management 53Manufacturing, marketing, procurement and sale 54Selection 55Supply 55Patient-specific directions 56Prescriptions 56Patient Group Directions 56Exemptions 57Prescribing 59Handling and administration 60Special consideration: Controlled Drugs and critical medications 62Groups requiring special considerations 63Monitoring for side-effects 64Medicines optimisation 64Safety in medicines management 65Storage and disposal 66Conclusion 66References 66Further reading 68Multiple-choice questions 68Chapter 5: Pharmacodynamics and pharmacokinetics 70Dan DavernAim 70Introduction 70Professional regulatory council 71Programmes of education and training 71Pharmacokinetics 71The pharmacokinetic processes 71Phase 1: absorption 72Phase 2: distribution 76Phase 3: metabolism (biotransformation) 77Phase 4: elimination 79Pharmacodynamics 81Agonists and antagonists 82Drug potency and efficacy 84Therapeutic index 84Adverse drug reactions 85Conclusion 87References 87Further reading 87Multiple-choice questions 88Chapter 6: Drug formulations 90Sarah Dineen-Griffin and Barbara C. WimmerAim 90Introduction 91Routes of drug administration 91Parenteral administration 92Intravenous administration 92Subcutaneous administration 93Intramuscular administration 93Intraosseous administration 95Intrathecal administration 95Intradermal administration 95Formulations 97Localised versus long-acting injectable formulations 97Topical formulations 97Inhaled formulations 99Enteral formulations 101Rectal formulations 105Conclusion 105Glossary 106References 106Further reading 108Multiple-choice questions 108Chapter 7: Adverse drug reactions 110Matt DixonAim 110What is an adverse drug reaction? 110Classification of adverse drug reactions 111How prevalent are adverse drug reactions? 111Who is more likely to experience adverse drug reactions? 112Recognising signs and symptoms of adverse drug reactions 114Anaphylaxis 114Rashes and skin eruptions 115Serum sickness 115Renal disorders 115Geriatric syndrome 116Idiosyncratic reactions 117Preventing adverse drug reactions 117Managing adverse drug reactions 117Reporting adverse drug reactions 119Conclusion 122References 122Further reading 123Multiple-choice questions 123Chapter 8: Analgesics 125Tom MallinsonAim 125Pain and analgesia 125Understanding and assessing pain 125Why do we treat pain? 126Psychology of pain 126Physiology of pain 127Pain transmission 127Pain modulation 128Types of pain 129Assessment of pain 131Approach to analgesia 132Paracetamol 133Non-steroidal anti-inflammatory drugs 133Inhalational analgesia 136Opioids 137Antagonists 141Atypical analgesics 142Antidepressants and antiepileptics 143Adjuncts to analgesia 143Magnesium sulfate 143Local anaesthetics 143Conclusion 144Glossary 145References 146Further reading 147Multiple-choice questions 147Chapter 9: Antibacterials 149Dean Whiting, Deborah Flynn and Dawn BallAim 149Introduction 149Language and terminology 150Antibacterial mechanisms of action 150Disruption of bacterial cell wall synthesis: beta-lactams 151Interference in folate metabolism: sulfonamides, trimethoprim 151Inhibition of bacterial DNA synthesis: quinolones 151Inhibition of bacterial protein synthesis: tetracyclines, aminoglycosides, macrolides, chloramphenicol, lincosamides 151Choosing the right treatment 151Antimicrobial resistance 151Preventing antimicrobial resistance 152Antimicrobial stewardship (AMS) 153Antibacterials by clinical use 153Beta-lactams 153Tetracyclines 157Chloramphenicol 158When administered in combination with phenytoin, monitor seizure pattern. Aminoglycosides 159Macrolides 161Lincosamides 162Conclusion 163References 163Further reading 164Multiple-choice questions 164Chapter 10: Medications used in the cardiovascular system 167Lisa Clegg and Fraser RussellAim 167Cardiovascular diseases 167Hypertension and heart failure 168Management of hypertension and heart failure 168Acute coronary Syndrome (ACS) 173Management of acute coronary syndrome 173Conclusion 177Glossary 177References 178Further reading 179Multiple-choice questions 180Chapter 11: Medications used in the renal system 182Anthony KitchenerAim 182Introduction 183Acute kidney injury 183Chronic kidney disease 185Management of CKD 185Electrolyte abnormalities resulting from poor renal function 187Hyponatraemia (low serum sodium) 187Hypokalaemia (low serum potassium) and hyperkalaemia (high serum potassium) 187Urinary retention and incontinence 187Drug-induced renal damage 188Drugs that act on the renal system 188Diuretics 188Drugs used to treat urinary retention and urinary incontinence 193Conclusion 195Glossary 198References 200Further reading 201Multiple-choice questions 201Chapter 12: Medications and diabetes mellitus 203Hayley Croft and Olivia ThorntonAim 203Introduction 204Hormonal control of blood glucose 204Monitoring diabetes 205Measuring blood glucose 206Measuring ketones 207Drug use in diabetes 207Insulin replacement therapy 207Metformin 209Sulfonylureas 209Incretin mimetics 210SGLT-2 inhibitors 210Thiazolidinediones 211Alpha-glucosidase inhibitors 211Drug use in diabetic emergencies 211Hypoglycaemic emergency 211Hyperglycaemic emergency 216Management of hyperglycaemia 218Conclusion 219Glossary 219References 220Multiple-choice questions 221Chapter 13: Medications used in the respiratory system 224Jason McKennaAim 224Introduction 225Anatomy and physiology 225Nervous system control 226Common respiratory emergencies 227Asthma 227Chronic obstructive pulmonary disease 230Croup 231Pneumonia 232Pneumothorax 232Pulmonary oedema 233Classes of medications 234Bronchodilators 234Diuretics 236Nitrates 236Steroids 237Medical gases 238Oxygen devices 238Conclusion 239Find out more 239References 239Further reading 241Multiple-choice questions 241Chapter 14: Medications used in the gastrointestinal system 243George Bell-Starr and Ashley IngramAim 243Introduction 244Anatomy and physiology of the gastrointestinal system 244Nausea and vomiting 244H1 receptor antagonists (antihistamines) 246Dopamine (D2) receptor antagonists 246Serotonin (5-HT3) receptor antagonists 246Peptic ulcers 247Helicobacter pylori infections 247Non-steroidal anti-inflammatory drugs 248Symptoms of peptic ulcer 248Constipation 249Laxatives 249Gastro-oesophageal reflux disease 251Drug interventions (patients with confirmed endoscope diagnosis) 252Paramedic practice 252Antidiarrhoeals 254Inflammatory bowel disease (IBD) 255Crohn’s disease 255Ulcerative colitis 255Drug treatment for inflammatory bowel disease 255Conclusion 257References 257Multiple-choice questions 258Chapter 15: Medication and the nervous system 261Geoffrey Bench, Alastair Dolan, Lena Solanki, Paul Doherty, Charlotte White, Ricky Lawrence and Emma BeadleAim 261Introduction 261The nervous system 262Parkinson disease and parkinsonism 262Infections 264Dementia 264Drugs used in dementia 265Cautions 266Epilepsy 267Antiepileptic medication 268Psychogenic non-epileptic seizures (PNES) versus bilateral tonic clonic seizures (BTCS) 268Emergency medication in the prehospital setting 268Strokes (including transient ischaemic attacks) 270Definition of a stroke and a transient ischaemic attack 271Assessment of a stroke 271Treatment 272Conclusion 274References 274Further reading/resources 275Multiple-choice questions 276Chapter 16: Medications used in mental health 278Liam RooneyAim 278Introduction 278Neurotransmitters 279Antidepressants 280Selective serotonin reuptake inhibitors 281Monoamine oxidase inhibitors 282Serotonin and noradrenaline reuptake inhibitors 283Serotonin syndrome 283Other atypical antidepressants 284Anxiolytics 285Pregabalin 285Benzodiazepines 285Buspirone 286Beta-blockers 286Hypnotics 286Benzodiazepines 286Z-drugs 287Mood-stabilising medications 287Lithium 287Valproate 287Antipsychotics 288Antipsychotic-related side-effects 288Other side-effects 289Dementia 291Acetylcholinesterase inhibitors 291Memantine 292Attention deficit-hyperactivity disorder 292Stimulants 292Non-stimulants 292Conclusion 293Find out more about these conditions 293Glossary 293References 294Further reading 296Resources 296Multiple-choice questions 296Chapter 17: Immunisations 299Michael FannerAim 299Introduction 299Understanding the fundamental epidemiological concepts and theories in preventing infectious diseases 300Essential ways of examining infectious diseases 301Becoming familiar with vaccine design to underpin clinical practice knowledge 302Vaccine design 302Appreciating public concerns in the acceptability and uptake of immunisations 303Vaccine acceptability 307Recognising the role of the paramedic in health promotion and immunisation administration 308Immunisations as prescription-only medicines 308Embedding immunisation history taking in clinical assessment 309Conclusion 315References 316Further reading 317Multiple-choice questions 317Normal Values 319Answers 323Index 325