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
