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Fundamentals of Pharmacology for Paramedics. Edition No. 1

  • Book

  • 368 Pages
  • March 2022
  • John Wiley and Sons Ltd
  • ID: 5836467

Fundamentals of Pharmacology for Paramedics provides students with the insight and understanding of pharmacological essentials needed to respond effectively to the patients' needs. This textbook will help students improve, expand, and enhance their expertise and the overall health and wellbeing of their patients, while boosting their self-confidence as paramedics in the process. This textbook integrates the extensive knowledge of pharmacology into a workable and accessible plan of care that will help to improve patient care. The book also includes:

  • Thorough introductions to pharmacology and how to use pharmaceutical, and prescribing reference guides
  • Comprehensive explorations of the legal and ethical issues of pharmacology within paramedicine and the role of the paramedic in medicines management
  • Practical discussions of pharmacodynamics, pharmacokinetics, drug formulations, and adverse drug reactions
  • In-depth examinations of a wide variety of medicines, including analgesics, antibacterials, and medications used in the cardiovascular, renal, respiratory, gastrointestinal, and nervous systems

Written for students of paramedicine, Fundamentals of Pharmacology for Paramedics would also prove an indispensable resource for practicing paramedics seeking a practical, one-stop reference on a challenging subject.

Table of Contents

Contributors xiii

Preface xxi

Acknowledgements xxiii

Prefixes, suffixes and abbreviations xxiv

Chapter 1: Introduction to pharmacology 1

Suzanne Evans and Tanya Somani

Aim 1

Naming and classifying drugs 5

How drugs bring about their actions 6

How are we able to manipulate physiological function using drugs? 6

Receptors as sites of drug action 7

Enzymes as sites of drug action 7

Ion channels 7

Transport molecules 9

Selectivity of binding and its effect 11

The drug-body interaction is a dynamic process 11

Conclusion 14

Glossary 14

References 15

Further reading 15

Multiple-choice questions 15

Chapter 2: How to use pharmaceutical and prescribing reference guides 18

Nigel Conway and Jennifer Dod

Aim 18

Introduction 19

HCPC Standards of conduct, performance and ethics 19

HCPC Standards of proficiency for paramedics 20

Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Clinical Practice Guidelines 21

JRCALC Update information 22

How to navigate the JRCALC Guidelines 23

JRCALC Pocket Book 30

JRCALC Guidelines digital application (app) 31

Useful additional resources 32

British National Formulary (BNF) 32

Monthly Index of Medical Specialities 33

Electronic Medicines Compendium (EMC) 34

Conclusion 34

Disclaimer 35

References 35

Further reading 35

Multiple-choice questions 35

Chapter 3: Legal and ethical issues 37

Claire Leader, Emma Senior, Deborah Flynn and Paul Younger

Aim 37

Introduction 38

The law 38

Ethical principles and theories 39

Regulatory bodies 43

Research 45

Conclusion 47

Glossary 47

References 48

Further reading 49

Multiple-choice questions 50

Chapter 4: Medicines management and the role of the paramedic 52

Annette Hand, Carol Wills and Paul Younger

Aim 52

Introduction 53

Medicines management 53

Manufacturing, marketing, procurement and sale 54

Selection 55

Supply 55

Patient-specific directions 56

Prescriptions 56

Patient Group Directions 56

Exemptions 57

Prescribing 59

Handling and administration 60

Special consideration: Controlled Drugs and critical medications 62

Groups requiring special considerations 63

Monitoring for side-effects 64

Medicines optimisation 64

Safety in medicines management 65

Storage and disposal 66

Conclusion 66

References 66

Further reading 68

Multiple-choice questions 68

Chapter 5: Pharmacodynamics and pharmacokinetics 70

Dan Davern

Aim 70

Introduction 70

Professional regulatory council 71

Programmes of education and training 71

Pharmacokinetics 71

The pharmacokinetic processes 71

Phase 1: absorption 72

Phase 2: distribution 76

Phase 3: metabolism (biotransformation) 77

Phase 4: elimination 79

Pharmacodynamics 81

Agonists and antagonists 82

Drug potency and efficacy 84

Therapeutic index 84

Adverse drug reactions 85

Conclusion 87

References 87

Further reading 87

Multiple-choice questions 88

Chapter 6: Drug formulations 90

Sarah Dineen-Griffin and Barbara C. Wimmer

Aim 90

Introduction 91

Routes of drug administration 91

Parenteral administration 92

Intravenous administration 92

Subcutaneous administration 93

Intramuscular administration 93

Intraosseous administration 95

Intrathecal administration 95

Intradermal administration 95

Formulations 97

Localised versus long-acting injectable formulations 97

Topical formulations 97

Inhaled formulations 99

Enteral formulations 101

Rectal formulations 105

Conclusion 105

Glossary 106

References 106

Further reading 108

Multiple-choice questions 108

Chapter 7: Adverse drug reactions 110

Matt Dixon

Aim 110

What is an adverse drug reaction? 110

Classification of adverse drug reactions 111

How prevalent are adverse drug reactions? 111

Who is more likely to experience adverse drug reactions? 112

Recognising signs and symptoms of adverse drug reactions 114

Anaphylaxis 114

Rashes and skin eruptions 115

Serum sickness 115

Renal disorders 115

Geriatric syndrome 116

Idiosyncratic reactions 117

Preventing adverse drug reactions 117

Managing adverse drug reactions 117

Reporting adverse drug reactions 119

Conclusion 122

References 122

Further reading 123

Multiple-choice questions 123

Chapter 8: Analgesics 125

Tom Mallinson

Aim 125

Pain and analgesia 125

Understanding and assessing pain 125

Why do we treat pain? 126

Psychology of pain 126

Physiology of pain 127

Pain transmission 127

Pain modulation 128

Types of pain 129

Assessment of pain 131

Approach to analgesia 132

Paracetamol 133

Non-steroidal anti-inflammatory drugs 133

Inhalational analgesia 136

Opioids 137

Antagonists 141

Atypical analgesics 142

Antidepressants and antiepileptics 143

Adjuncts to analgesia 143

Magnesium sulfate 143

Local anaesthetics 143

Conclusion 144

Glossary 145

References 146

Further reading 147

Multiple-choice questions 147

Chapter 9: Antibacterials 149

Dean Whiting, Deborah Flynn and Dawn Ball

Aim 149

Introduction 149

Language and terminology 150

Antibacterial mechanisms of action 150

Disruption of bacterial cell wall synthesis: beta-lactams 151

Interference in folate metabolism: sulfonamides, trimethoprim 151

Inhibition of bacterial DNA synthesis: quinolones 151

Inhibition of bacterial protein synthesis: tetracyclines, aminoglycosides, macrolides, chloramphenicol, lincosamides 151

Choosing the right treatment 151

Antimicrobial resistance 151

Preventing antimicrobial resistance 152

Antimicrobial stewardship (AMS) 153

Antibacterials by clinical use 153

Beta-lactams 153

Tetracyclines 157

Chloramphenicol 158

When administered in combination with phenytoin, monitor seizure pattern. Aminoglycosides 159

Macrolides 161

Lincosamides 162

Conclusion 163

References 163

Further reading 164

Multiple-choice questions 164

Chapter 10: Medications used in the cardiovascular system 167

Lisa Clegg and Fraser Russell

Aim 167

Cardiovascular diseases 167

Hypertension and heart failure 168

Management of hypertension and heart failure 168

Acute coronary Syndrome (ACS) 173

Management of acute coronary syndrome 173

Conclusion 177

Glossary 177

References 178

Further reading 179

Multiple-choice questions 180

Chapter 11: Medications used in the renal system 182

Anthony Kitchener

Aim 182

Introduction 183

Acute kidney injury 183

Chronic kidney disease 185

Management of CKD 185

Electrolyte abnormalities resulting from poor renal function 187

Hyponatraemia (low serum sodium) 187

Hypokalaemia (low serum potassium) and hyperkalaemia (high serum potassium) 187

Urinary retention and incontinence 187

Drug-induced renal damage 188

Drugs that act on the renal system 188

Diuretics 188

Drugs used to treat urinary retention and urinary incontinence 193

Conclusion 195

Glossary 198

References 200

Further reading 201

Multiple-choice questions 201

Chapter 12: Medications and diabetes mellitus 203

Hayley Croft and Olivia Thornton

Aim 203

Introduction 204

Hormonal control of blood glucose 204

Monitoring diabetes 205

Measuring blood glucose 206

Measuring ketones 207

Drug use in diabetes 207

Insulin replacement therapy 207

Metformin 209

Sulfonylureas 209

Incretin mimetics 210

SGLT-2 inhibitors 210

Thiazolidinediones 211

Alpha-glucosidase inhibitors 211

Drug use in diabetic emergencies 211

Hypoglycaemic emergency 211

Hyperglycaemic emergency 216

Management of hyperglycaemia 218

Conclusion 219

Glossary 219

References 220

Multiple-choice questions 221

Chapter 13: Medications used in the respiratory system 224

Jason McKenna

Aim 224

Introduction 225

Anatomy and physiology 225

Nervous system control 226

Common respiratory emergencies 227

Asthma 227

Chronic obstructive pulmonary disease 230

Croup 231

Pneumonia 232

Pneumothorax 232

Pulmonary oedema 233

Classes of medications 234

Bronchodilators 234

Diuretics 236

Nitrates 236

Steroids 237

Medical gases 238

Oxygen devices 238

Conclusion 239

Find out more 239

References 239

Further reading 241

Multiple-choice questions 241

Chapter 14: Medications used in the gastrointestinal system 243

George Bell-Starr and Ashley Ingram

Aim 243

Introduction 244

Anatomy and physiology of the gastrointestinal system 244

Nausea and vomiting 244

H1 receptor antagonists (antihistamines) 246

Dopamine (D2) receptor antagonists 246

Serotonin (5-HT3) receptor antagonists 246

Peptic ulcers 247

Helicobacter pylori infections 247

Non-steroidal anti-inflammatory drugs 248

Symptoms of peptic ulcer 248

Constipation 249

Laxatives 249

Gastro-oesophageal reflux disease 251

Drug interventions (patients with confirmed endoscope diagnosis) 252

Paramedic practice 252

Antidiarrhoeals 254

Inflammatory bowel disease (IBD) 255

Crohn’s disease 255

Ulcerative colitis 255

Drug treatment for inflammatory bowel disease 255

Conclusion 257

References 257

Multiple-choice questions 258

Chapter 15: Medication and the nervous system 261

Geoffrey Bench, Alastair Dolan, Lena Solanki, Paul Doherty, Charlotte White, Ricky Lawrence and Emma Beadle

Aim 261

Introduction 261

The nervous system 262

Parkinson disease and parkinsonism 262

Infections 264

Dementia 264

Drugs used in dementia 265

Cautions 266

Epilepsy 267

Antiepileptic medication 268

Psychogenic non-epileptic seizures (PNES) versus bilateral tonic clonic seizures (BTCS) 268

Emergency medication in the prehospital setting 268

Strokes (including transient ischaemic attacks) 270

Definition of a stroke and a transient ischaemic attack 271

Assessment of a stroke 271

Treatment 272

Conclusion 274

References 274

Further reading/resources 275

Multiple-choice questions 276

Chapter 16: Medications used in mental health 278

Liam Rooney

Aim 278

Introduction 278

Neurotransmitters 279

Antidepressants 280

Selective serotonin reuptake inhibitors 281

Monoamine oxidase inhibitors 282

Serotonin and noradrenaline reuptake inhibitors 283

Serotonin syndrome 283

Other atypical antidepressants 284

Anxiolytics 285

Pregabalin 285

Benzodiazepines 285

Buspirone 286

Beta-blockers 286

Hypnotics 286

Benzodiazepines 286

Z-drugs 287

Mood-stabilising medications 287

Lithium 287

Valproate 287

Antipsychotics 288

Antipsychotic-related side-effects 288

Other side-effects 289

Dementia 291

Acetylcholinesterase inhibitors 291

Memantine 292

Attention deficit-hyperactivity disorder 292

Stimulants 292

Non-stimulants 292

Conclusion 293

Find out more about these conditions 293

Glossary 293

References 294

Further reading 296

Resources 296

Multiple-choice questions 296

Chapter 17: Immunisations 299

Michael Fanner

Aim 299

Introduction 299

Understanding the fundamental epidemiological concepts and theories in preventing infectious diseases 300

Essential ways of examining infectious diseases 301

Becoming familiar with vaccine design to underpin clinical practice knowledge 302

Vaccine design 302

Appreciating public concerns in the acceptability and uptake of immunisations 303

Vaccine acceptability 307

Recognising the role of the paramedic in health promotion and immunisation administration 308

Immunisations as prescription-only medicines 308

Embedding immunisation history taking in clinical assessment 309

Conclusion 315

References 316

Further reading 317

Multiple-choice questions 317

Normal Values 319

Answers 323

Index 325

Authors

Ian Peate University of Hertfordshire, UK. Suzanne Evans University of Newcastle, Australia. Lisa Clegg Charles Sturt University, Australia.