Pharmacology

for Paramedics

Jeremy Maddux, NREMTP, I/C

 Historical Trends
In Pharmacology
• Ancient health care
– Herbs & minerals used to treat sick & injured
– Documented use as long as 2,000 B.C.
– Ancient Egyptians, Arabs, & Greeks
• The renaissance period
– Pharmacology became a distinct and growing
discipline
– Separate from medicine
 Historical Trends
In Pharmacology
• Modern health care
– Last 50 years have seen explosion in growth of biological
sciences and associated medicine and pharmacology
• The present period of change
– Research directed to discover new treatments, cures and
prevention of disease
• New trends in health care and
pharmaceutics
– Orphan drugs developed to treat rare and chronic
diseases
 Drug Names
• Chemical Name
– Precise description of the drug’s chemical
composition and molecular structure
– 7-chloro-1, 3-dihydro-1methyl-5-phenyl-2H-1, 4-
benzodiazepin-2-one
• Generic Name (Non-proprietary Name)
– Official name approved by the FDA
– Usually suggested by the first manufacturer
– diazepam
 Drug Names

• Official Name
– The name assigned by the USP
– diazepam, USP
• Trade Name (Proprietary Name)
– The brand name registered to a specific
manufacturer or owner
– Valium ®
 Sources of Medications
• Plants
– morphine sulfate, atropine
• Animals and/or Humans
– insulin, ACTH
• Minerals
– sodium bicarb, calcium
• Synthetic (Chemical Substances)
– lidocaine, diazepam
 Drug Classification

• By Body System
– Sympathetic Agonist, Anticholinergic
• Class of Agent
– Antidysrhythmic, Analgesic
• Mechanism of Action
– Calcium Channel Blocker, Diuretic
 Sources of Drug
Information
• Physicians Desk Reference (PDR)
• Hospital Formulary (HF)
• Drug Inserts
• Other texts/sources
– Brady
– Internet
– Mosby
 Medication
Regulation & Licensing
• Pure Food & Drug Act (1906)
– Improve quality of labeling
• Harrison Narcotic Act (1914)
– Regulated importation, manufacture, sale,
& use of opium and cocaine
• Federal Food, Drug, & Cosmetic Act
(1938)
– Empowered the FDA (standards)
 Medication
Regulation & Licensing
• Durham-Humphrey Amendments
(1951)
– Required prescriptions
– New category (over-the-counter)
• Controlled Substances Act (1970)
– Replaced the Harrison Narcotic Act
– Created 5 Drug Schedules
 Drug Schedules
• Schedule I • Schedule III
– Heroin, LSD – Tylenol with Codeine
– NO accepted – Low dependence
medical use • Schedule IV
• Schedule II – Diazepam
– Opium, Cocaine – Limited dependence
– Accepted medical
• Schedule V
use
– Opiods (cough)
– Severe dependence
 Scope of Management
• You are held responsible for safe and
therapeutically effective drug
administration
• Personally responsible for each drug
you administer
– Legally
– Morally
– Ethically
 Scope of Management
• Use correct • Understand
precautions and pharmacology
techniques • Identify drug
• Observe and document indications and
effects of drugs contraindications
• Keep knowledge base • Seek drug reference
current literature
• Establish & maintain • Take a drug history
professional from patients
relationships • Consult with medical
direction
 The “Six Rights” of
Medication Administration

• Right Medication
• Right Dose
• Right Time
• Right Route
• Right Patient
• Right Documentation
Autonomic Pharmacology

• Central Nervous System (CNS)

• Peripheral Nervous System
– Somatic Nervous System
– Autonomic Nervous System (ANS)
• Sympathetic Branch
• Parasympathetic Branch
 Autonomic Nervous
System Characteristics

“Feed or Breed”
“Fight or Flight”
 ANS
Anatomy & Physiology
• The nerves of the ANS exit the CNS
and subsequently enter specialized
structures called “autonomic ganglia”
– Preganglionic fibers
• Pass between the central nervous system
and the ganglia
– Postganglionic fibers
• Pass between the ganglia and the effector
organ
 Sympathetic versus
Parasympathetic
• Sympathetic ganglia
– Located close to the spinal cord or
midway between the spinal cord and the
effector organ
• Parasympathetic ganglia
– Located close to or within the walls of the
target organs
 Cholinergic and
Adrenergic Fibers
• Cholinergic
– Fibers that release acetylcholine
– All preganglionic and postganglionic of
the parasympathetic division
• Adrenergic
– Fibers that release norepinephrine
– Most postganglionic fibers of the
sympathetic division are adrenergic, but
some are cholinergic
 Neurochemical
Transmission
• No actual physical connection exists
between two nerve cells or between a nerve
cell and the organ it innervates
– Syanpse
• Space between nerve cells
– Neruroeffector junction
• Specialized synapse between two nerve cells or a
nerve cell and an organ
– Neurotransmitter
• Chemical messenger that conducts a nervous impulse
across a synapse
Neurotransmission
 Neurotransmitters

• Acetylcholine
– Preganglionic nerves of sympathetic
nervous system
– Preganglionic and postganglionic nerves
of the parasympathetic nervous system
• Norepinephrine
– Postganglionic nerves of the sympathetic
nervous system
 Acetylcholine

• For cholinergic synapses acetylcholine

molecules combine with cholinergic
receptor molecules
– Nicotinic Receptors
• Produces an excitatory response
– Muscarinic Receptors
• Produce an excitatory or inhibition, depending
on where the target receptors are found
 Norepinephrine

• For adrenergic synapses

norepinephrine molecules combine
with adrenergic receptor molecules
– Alpha Receptors
• Blood vessels
– Beta Receptors
• Heart
• Lungs
 Catecholamines &
Related Substances
• Dopamine
– Raises pain threshold & increases
tolerances to pain
• Epinephrine
– Emergency hormone releases by the
adrenal medulla
 Catecholamines &
Related Substances
• Norepinephrine
– Important transmitter of nerve impulses
• Serotonin
– Released by injured tissues
• Enhances pain at local level
• Inhibits pain when it acts on the CNS
 Brain Peptides
• Enkephalin
– Weak analgesic effect that binds with opiate
receptors
• Endorphin
– Higher analgesic effect that’s highly
concentrated in the hypothalamus and spinal
cord
• Dynorphin
– Analgesic effects fifty times than others
 General Properties
of Drugs
• Drugs do not confer any new functions on a
tissue or organ, they only modify existing
functions
• Drugs in general exert multiple effects rather
than a single effect
• Drug action results from a physiochemical
interaction between the drug and a
functionally important molecule in the body
 Pharmokinetics

• Mechanisms that affect

pharmokinetics
– Absorption
– Distribution
– Biotransformation
– Excretion
 Absorption
• Variables • Mechanisms
– Route of – Diffusion
Administration – Osmosis
– Solubility of the – Filtration
Drug (H2O)
– Drug Concentration
(ionize)
– pH
 Distribution

• Drug reservoirs
– Plasma protein binding (molecules)
– Tissue binding (adipose or fat)
• Barriers
– Blood-brain barrier
– Placental barrier
 Biotransformation

• Also known as metabolism where a

drug is chemically converted to a
metabolite
– Active metabolites
– Inactive metabolites
 Excretion

• Organs of excretion
– Kidneys
– Intestine
– Lungs
– Sweat & salivary glands
– Mammary glands
 Drug Forms
• Liquid • Solid
– Solutions – Pills
– Tinctures – Powders
– Suspensions – Tablets
– Spirits – Suppositories
– Emulsions – Capsules
– Elixirs • Gas
– Syrups
 Routes of
Drug Administration
• Effects the rate at which the onset of
action occurs and may effect the
therapeutic response that results
– Route is crucial in determining the
suitability of a drug
• First pass metabolism
– Drugs are given for either their local or
systemic effects
 Enteral Routes

• Buccal • Nasogastric
• Oral (PO) • Rectal (PR)
• Orogastric • Sublingual (SL)
 Parenteral Routes

• Endotracheal • Intravenous (IV)

• Nasal
• Inhalation (Neb) Subcutaneous (SQ)
•
• Instillation • Transdermal
• Intradermal • Umbilical

• Intramuscular (IM)
• Intraosseous (IO)
 Mechanics of
Drug Action
• To produce optimal effect or therapeutic
effects, a drug must reach appropriate
concentrations at its site of action
• Molecules of the chemical compound must
proceed from point of entry into the body to
the tissues with which they react
• The magnitude of the response depends on
the dosage and the time course of the drug
in the body
 Mechanics of
Drug Action
Concentration of the drug at its site of action
is influenced by various processes
• Pharmaceutical • Pharmocokinetic
– Disintegration of – Absorption
dosage form – Distribution
– Dissolution of drug – Metabolism
– Excretion
• Pharmacodynamic
– Drug-receptor
interaction
 Pharmaceutical Effects

• Disintegration of dosage form

– Solid or liquid form
– Enteric coated
• Dissolution of drugs
– Rate at which a solid drug goes into a
solution after ingestion
– The faster the rate of dissolution, the
more quickly the drug is absorbed
 Pharmacodynamics

• The study of how a drug acts on a

living organism, including the
pharmacological response observed
relative to the concentration of the
drug at an active site in the organism
Drug Receptor Interaction

• Affinity
– Drug’s propensity to bind or attach itself
to a given receptor site
• Efficacy (intrinsic activity)
– Drug’s ability to initiate biological activity
as a result of binding to a receptor site
Drug Receptor Interaction

• Agonists
– Drug that binds to a receptor site and
causes a physiological response
• Antagonists
– Drug that binds to a receptor site and
prevents a physiological response or
prevents another drug from binding to a
receptor site
 Type of Receptors

• Beta 1
• Beta 2
• Alpha 1
• Alpha 2
• Dopaminergic
 Alpha Receptors
• Alpha 1 Receptors
– Postsynaptic receptors located on effector
organs
– Stimulate contraction of smooth muscle
– Results in increase in BP
• Alpha 2 Receptors
– Found on presynaptic & postsynaptic nerve
endings
– Inhibit further release of norepinephrine
– Mediate vasoconstriction
 Beta Receptors

• Beta 1 Receptors
– Located primarily in the heart
– Cause increases in inotropy & chronotopy
• Beta 2 Receptors
– Located primarily in the lungs
– Dilate bronchioles & blood vessels
– Relax smooth muscle
 Dopaminergic Receptors

• Drugs that effect dopaminergic

receptors are classified as
– Those that release dopamine
– Those that increase brain levels of
dopamine
– Dopaminergic agonists
 Plasma Level
Profile of a Drug

• Demonstrates the relationship

between the plasma concentration and
the level of therapeutic effectiveness
over time
 Factors Altering
Drug Response
• Age
– Infants – liver & kidney not fully developed
– Elderly – liver & kidney function deteriorates
• Body Mass
– More body mass = more fluid available to dilute
drug
• Gender
– Differences in the relative proportions of fat and
water
 Factors Altering
Drug Response
• Environment
– Changes in temperature or altitude
• Time of Administration
– Presence or absence of food in GI tract
– Biological rhythms
• Sleep-wake cycles

• Pathological State
– Illness or injury
– Underlying disease processes
 Factors Altering
Drug Response
• Genetic
– Lack of specific enzymes
– Lowered basal metabolic rate
• Psychological
– If the patient believes it will work it will
work
 Predictable Responses

• Desired Action
– Action or effect is seen that is consistent
with why the drug was given
• Side Effects
– Undesirable and often unavoidable
effects of a drug
– Action or effect other than those for which
the drug was given
 Unpredictable
Adverse Reactions
• Allergic Reaction
– Activates the Immune System
• Anaphylactic Reaction
– Severe allergic reaction
• Idiosyncracy
– Drug effect unique to individual
– Different than expected
 Unpredictable
Adverse Reactions
• Tolerance
– Physiologic response that requires a drug
dosage to be increased to produce the
same effect
• Cross Tolerance
– Tolerance after administration of a
different drug
• Morphine and other opiod agents
 Unpredictable
Adverse Reactions
• Tachyphylaxis
– Rapidly occurring tolerance to a drug
– Common in decongestant and
bronchodilation agents
• Cumulative Effect
– Tendency for repeated doses of a drug to
accumulate in the blood stream often
causing toxic effects
 Unpredictable
Adverse Reactions
• Drug Dependence
– State in which withdrawal of a drug
produces intense physical or emotional
disturbance
• Drug Interaction
– Beneficial or detrimental effects of one
drug by the prior or concurrent
administration of another drug
 Unpredictable
Adverse Reactions
• Drug Antagonism
– Effects of two drugs is less than the sum
of drugs acting separately
• 1+1 = 0
• Summation
– Combined effect of two drugs that the
total effect equals the sum of the
individual effects of each agent
• 1+1 = 2
 Unpredictable
Adverse Reactions
• Synergism
– The combined action of two drugs such that the
total effects exceeds the sum of the individual
effects of each agent
• 1+1 = 3

• Potentiation
– The enhancement of effect caused by the
concurrent administration of two drugs in which
one drug increases the effect of the other drug
 Drug Interactions

• Intestinal absorption
• Competition for plasma protein binding
• Drug metabolism or biotransformation
• Action at the receptor site
• Renal excretion
• Alteration of electrolyte imbalance
 Drug-Drug Interactions
• The following drugs are clinically significant
for drug-drug interactions
– Blood thinners
– Tricyclic antidepressants
– Monoamine oxidase (MAO) inhibitors
– Amphetamines
– Digitalis glycosides
– Diuretics
– Antihypertensives
 Other Drug Interactions
• Drug induced malabsorption of foods
and nutrients
• Food induced malabsorption of drugs
• Alteration of enzymes
• Alcohol consumption
• Cigarette smoking
• Food initiated alteration of drug
excretion
 Drug Storage

• Drug potency can be effected by

– Temperature
– Light
– Moisture
– Shelf life
• Security of controlled medications
– Double lock & key
 Components of
a Drug Profile
• Name
– Generic, Chemical, & Trade Names
• Classification
– Broad group to which the drug belongs
• Mechanism of Action
– The way in which a drug causes it’s effects
• Indications
– Why a drug is appropriate
 Components of
a Drug Profile
• Pharmacokinetics
– How a drug enters & leaves the body
• Side Effects
– Untoward or undesired effects
• Routes of Administration
– How can the drug be given
• Contraindications
– Why a drug cannot be given
 Components of
a Drug Profile
• Dosage
– Amount of drug that should be given
• Contraindications
– Why a drug should not be given
• Special Considerations
– Pediatric patients
– Geriatric patients
– Pregnant patients
 Special Considerations
in Drug Therapy
• Pregnant Patients
– Changes in mother’s anatomy &
physiology
– Potential for drugs to harm the fetus
• Pediatric Patients
– Several physiological factors affect
pharmacokinetics in
• Newborns
• Children
 Special Considerations
in Drug Therapy

• Geriatric Patients
– Significant changes in pharmacokinetics
may occur in patients older than about 60
years
 Pregnant Patients

• A drug’s possible benefits to the

mother must clearly outweigh its
potential risks to the fetus
• Changes in heart rate, cardiac output,
and blood volume increases
– May affect the onset & duration of action
of many medications
 Pregnant Patients
• First Trimester
– Teratogenic Drugs
• Medications that may deform or kill the fetus
• Third Trimester
– Drugs may pass through the placenta to the
fetus
• FDA Categories (A, B, C, D, & X)
– Indicates drugs that may have documented
problems in animals and/or humans during
pregnancy
 Pediatrics

• Absorption of oral medications is less

due to gastric pH and emptying times
• Diminished plasma protein
concentrations
– Drugs that bind to proteins will have
higher “free drug availability”
• Proportion of drug available to to cause either
desired or undesired effects
 Neonates
• Higher percentage of extracellular fluid
(nearly 80%)
– Less expected protein binding
– May require larger doses
• Premature infants
– Susceptible to drugs penetrating the “blood-brain
barrier”
• Low metabolic rate & incompletely
developed hepatic system
– Higher risk of toxic interactions
 Length-Based
Resuscitation Tape
• Broselow Tape
– Calculations based
on height with the
assumption that
child is in the fifth
percentile for his
height
 Geriatric Patients
• May absorb oral • Fat increases &
medications slower muscle mass
due to decreased decreases
gastrointestinal • Depressed liver
motility function
• Decreased plasma • May take multiple
protein medications
concentration
• Underlying disease
 Drugs by Classification
• Analgesics and • Central nervous
antagonists system stimulants
• Anesthetics • Psychotherapeutic
• Antianxiety, drugs
sedative, and • Antidepressant
hypnotic drugs therapy
• Anticonvulsants
 Narcotic Analgesics
• Pain has two categories
– Sensation of pain (nerve pathways)
– Emotional response (anxiety)
• Most block pain at the CNS level
• Opiates are drugs that contain opium
– Morphine
– Demerol
– Darvon
 Narcotic Analgesics

• Undesired effects
– Nausea and/or vomiting
– Constipation
– Orthostatic hypotension
– Respiratory depression
– CNS depression
 Narcotic Antagonists

• Block the effects of “opiod” narcotics

and their undesired effects
– Respiratory depression
– CNS depression
• Displace analgesics from their receptor
sites
– Examples: Naloxone (Narcan) &
Nalmefene (Revex)
 Nonnarcotic Analgesics

• Act by a peripheral mechanism that

interferes with local mediators
released when tissue damage occurs
– Damaged nerve endings are stimulated
less often
• Example: Ketorolac (Toradol)
 Anesthetics

• CNS depressants that have a

reversible action on nervous tissue
• Three general categories
– General
– Regional
– Local
 Stages and Signs
of General Anesthesia
 Antianxiety, Sedative,
& Hypnotic Drugs

• Used to reduce the feelings of

apprehension, nervousness, worry,
and/or fearfulness
• Depress the CNS, produce a calming
effect, and help induce sleep
 Sedatives
versus Hypnotics

• Sedative
– A small dose of an agent administered to
calm a patient
• Hypnotic
– A larger dose of the same agent sufficient
to induce sleep
 Benzodiazepines
• Thought to work by binding to specific
receptors in the cerebral cortex and limbic
system
• Have four actions
– Anxiety reduction
– Sedative-hypnotic
– Muscle relaxing
– Anticonvulsant
• Common Benzodiazepines
– Ativan, Valium, Versed
 Benzodiazepine Antidote

• Flumazenil (Romazicon)
– Benzodiazepine receptor antagonist
– Effective in reversing benzodiazepine
induced sedation
 Barbiturates

• Divided into four classes according to

their duration of action
– Ultra short acting
• Within a few seconds
– Short acting
• Onset 10 to 15 minutes
• Peak in 3 to 4 hours
 Barbiturates

• Divided into four classes according to

their duration of action
– Intermediate acting
• Onset 45 to 60 minutes
• Peak in 6 to 8 hours
– Long acting
• Requires over 60 minutes for onset
• Peak in 10 to 12 hours
 Miscellaneous
Sedatives & Hypnotics
• Number of antianxiety and sedative-
hypnotic drugs that occasionally are used
do not fall into the previously discussed drug
classes
• More similar to barbiturates than
benzodiazepines
• Examples
– Chloral Hydrate (Noctec)
– Antihistamines such as hydroxyzine (Vistaril,
Atarax)
 Anticonvulsants

• Used to treat seizure disorders, mainly

epilepsy
• Exact mode and site of action of these
drugs are not understood
• In general these drugs depress the
excitability of of neurons that fire to
initiate seizure activity
 Anticonvulsants

• Classifications
– The choice of drug depends on the type
of seizure disorder (generalized, partial,
or status)
• Hydantoins
• Barbiturates
• Succinimides
• Benzodiazepines
 Central Nervous
System Stimulants
• Classified by where they exert their
major effects in the nervous system
– Cerebrum
– Medulla and brain stem
– Hypothalamic limbic regions
• Work to increase excitability by
blocking activity of inhibitory neurons
or their respective neurotransmitters
 Anorexiant Drugs

• Appetite suppressants used to treat

obesity
• Produce a direct effect on the
hypothalmic and limbic regions
• Examples
– Phendimetrazine (Plegine)
– Mazindol (Mazanor, Sonorex)
 Amphetamines
• Stimulate the cerebral cortex and
reticular activating system
• Primarily used to treat attention deficit
disorder (ADD) with hyperactivity and
narcolepsy
• Examples
– Methamphetamine (Desoxyn)
– Methylphenidate (Ritalin)
 Psychotherapeutic Drugs

• Include antipsychotic agents,

antidepressants, and lithium
• Used to treat psychoses and affective
disorders, especially schizophrenia,
depression, and mania
 Antipsychotic Agents

• Primarily used to treat schizophrenia

• May be used to treat
– Tourette’s Syndrome
– Alzheimer’s Disease
• Effective antipsychotic (neuroleptic)
drugs block dopamine receptors in the
CNS
 Antidepressants

• Used to treat affective disorders

(mood disturbances), including
depression, mania, and elation
– Depression
• Tricyclic antidepressants
• Monoamine Oxidase (MAO) Inhibitors
– Mania
• Lithium
Tricyclic Antidepressants
• Thought to treat depression by increasing
levels (blocking reuptake) of the
neurotransmitters norepinephrine and
serotonin
• Examples
– Imipramine (Tofranil)
– Amitriptyline (Elavil)
• Overdoses can be reversed with Sodium
Bicarbonate administration
 MAO Inhibitors
• Central acting monoamines, especially
norepinephrine and serotonin, are thought
to cause depression and mania
• MAO inhibitors block monoamine enzymes
which stop the metabolism of
norepinephrine
• Examples
– Isocarboxazid (Marplan)
– Phenelzine (Nardil)
 Lithium
• Monovalent cation that is closely related to
sodium
• Thought to work by remaining in the
intracellular fluid thereby reducing the
amount of sodium within the cells and
improving the manic state
• In addition lithium enhances some of the
actions of serotonin and may decrease
levels of norepinephrine and dopamine
 Drugs for Specific CNS-
Peripheral Dysfunctions

• Several movement disorders result

from an imbalance of dopamine and
acetylcholine.
• Two most common
– Parkinson’s Disease
– Huntington’s Disease
 Parkinson’s Disease
• Characterized by
– Rigidity of voluntary muscles
– Tremor of fingers and extremities
• Most often affects people over 60
• May occur in younger people, especially
after
– Acute encephalitis
– Cases of carbon monoxide poisoning
– Use of illicit drugs
 Huntington’s Disease

• An inherited disorder characterized by

– Progressive dimentia
– Involuntary muscle twitching
• Thought to be related to an imbalance
between dopamine, acetylcholine, and
other neurotransmitters
 Drugs with Central
Anticholinergic Activity

• Anticholinergic
– Drugs that block or inhibit acetylcholine
• Work to restore the normal dopamine-
acetylcholine balance in the brain
 Drugs that Affect
Brain Dopamine

• Three classifications
– Those that release dopamine
– Those that increase brain levels of
dopamine
– Dopaminergic agonists
 Drugs that Affect
Brain Dopamine
• Levodopa (L-Dopa)
– Increases brain levels of dopamine
– Drug of choice in movement disorders
associated with dopamine-acetylcholine
imbalance
• Two types of MAO Inhibitors
– Monoamine Oxidase A
• Metabolizes norepinephrine & serotonin
– Monoamine Oxidase B
• Metabolizes dopamine
 Drugs that Affect the
Parasympathetic Nervous System

• Four Classifications
– Cholinergic Drugs
– Cholinergic Blocking Drugs
– Ganglionic Stimulating Drugs
– Ganglionic Blocking Drugs
 Cholinergic Drugs
(Parasympathomimetic)
• Act directly (choline esters) by combining
with cholinergic receptors in postsynaptic
membranes and indirectly by inhibiting the
enzyme that degrades acetylcholine
• Result in accumulation of acetylcholine,
which causes a prolonged and intensified
response at various effector sites
• Generally not considered emergency
medications
Cholinergic Drugs
 Cholinergic Blocking
Drugs (Anticholinergic)

• Types of anticholinergic receptors

– Muscarinic
– Nicotinic
• Nicotinic N (neuron)
• Nicotinic M (muscle)
 Cholinergic Blocking
Drugs (Anticholinergic)
• Also known as parasympatholytics
• Block the muscarinic effects of
acetylcholine reducing acetylcholine’s
actions at effector sites
• Atropine
– Functions as a competitive antagonist
– Occupies muscarinic receptor sites
 Cholinergic Blocking
Drugs (Anticholinergic)
• Scopolamine (belladonna
anticholinergic)
– Similar to atropine but also causes
sedation and antiemesis
– Used to treat motion sickness
• Ipratropium Bromide (Atrovent)
– Inhaled anticholinergic used to treat
asthma
 Cholinergic Blocking
Drugs (Anticholinergic)
• Nicotinic Cholinergic Antagonists
– Block acetylcholine at nicotinic sites
– Include ganglionic blocking agents that
block the nicotinic (neuro) receptors in the
autonomic ganglia
– Neuromuscular blocking agents that block
nicotinic (muscle) receptors at the
neuromuscular junction
 Cholinergic Blocking
Drugs (Anticholinergic)
• Ganglionic Blocking Agents
– Competitive antagonism with acetylcholine at the
nicotinic (neuro) receptors in the autonomic
ganglia
– Can turn off the entire Autonomic Nervous
System
– Side effects include those similar to atropine
overdose
• Dry mouth, blurred vision, urinary retention, and
tachycardia
Drugs Affecting the Sympathetic
Nervous System

• Adrenergic Drugs
– Direct acting
– Indirect acting
– Dual acting (direct and indirect)
 Direct Acting

• Mimic the effects of the three naturally

occurring catecholamines in the body
– Epinephrine
– Norepinephrine
– Dopamine
• Stimulate the effects of alpha and beta
sites within the ANS
 Alpha Effects

• Vasoconstriction of arterioles, resulting

in an increase in blood pressure and a
shunting of blood from the periphery to
the brain and heart
• Pupil dilation
• Relaxation of the gut
 Beta Effects

• Cardiac acceleration and increased

contractility
• Vasodilation of arterioles supplying the
skeletal muscle
• Bronchial relaxation
• Uterine relaxation
 Indirect Acting &
Dual Acting Drugs
• Act indirectly on receptors by
triggering the release of the
catecholamines norepinephrine and
epinephrine which then activates the
alpha and beta receptors
• Example
– Ephedrine Sulfate
 Adrenergic
Blocking Drugs

• Classified into two categories

– Alpha Blocking Drugs
– Beta Blocking Drugs
• Selective Blocking Drugs
• Nonselective Blocking Drugs
 Alpha Blocking Drugs

• Block the vasoconstricting effects of

catecholamines
• Used in
– Cases of hypertension
– Prevent tissue necrosis when
norepinephrine (Levophed) and
dopamine (Intropin) have extravasated
into the tissues
 Beta Blocking Drugs

• Selective Blocking Drugs

– Block Beta1 or Beta2 receptors
– Also known as “cardioselective blockers”
because they block the Beta1 receptors
in the heart
• Metoprolol (Lopressor)
– Selectivity may not be 100% and may
affect the lungs and vise versa
 Beta Blocking Drugs

• Nonselective Blocking Drugs

– Block both Beta1 and Beta2 receptor
sites
• Beta1 receptors in the heart
• Beta2 receptors in the lungs
– Propranolol (Inderal)
– Labetalol (Trandate)
• Also has some alpha-blocking activity
 Skeletal
Muscle Relaxants
• Skeletal muscle contraction is evoked
by a nicotinic cholinergic transmission
process
• Classified as
– Central-Acting Muscle Relaxants
– Direct-Acting Muscle Relaxants
 Central-Acting
Muscle Relaxants
• Used to treat muscle spasms
• Thought to work by producing CNS
depression in the brain and spinal cord
• Antispastic Agents
– Baclofen (Lioresal)
– Cyclobenzaprine (Flexeril)
– Diazepam (Valium)
 Direct-Acting
Muscle Relaxants

• Work directly on the skeletal muscle

• Produce muscle relaxation, resulting in
a decrease in muscle contraction
– Dantrolene (Dantrium)
 Neuromuscular Blockers
• Produce complete muscle relaxation
and paralysis by binding to the
nicotinic receptor for acetylcholine at
the neuromuscular junction
• Used for
– Endotracheal Intubation
– Muscle spasms of the larynx
– Breathing control by a respirator
 Neuromuscular Blockers
• Produce complete paralysis
– Ventilatory support must be provided
– Efficacy of ventilation and oxygenation closely
monitored
• Do not inhibit pain or seizure activity
• Examples
– Pancuronium (Pavulon)
– Vecuronium (Norcuron)
– Succinylcholine (Anectine)
 Drugs that Affect the
Cardiovascular System

• Antidysrhythmics
• Antihypertensives
• Cardiac Glycosides
• Vasodilators
• Antihemorrheologic Agents
 Antidysrhythmics
• Used to treat and prevent disorders of
cardiac rhythm
• May suppress dysrhythmias by direct
action on the cardiac cell membrane
– Lidocaine
• May suppress dysrhythmias by
indirect action that affects the cell
– Propranolol
 Antidysrhythmic
Classifications
• Class I
– Sodium channel blockers that work to
slow conduction
– Further divided into
• Class Ia
• Class Ib – decrease or have no effect on
conduction
• Class Ic – profoundly slow conduction and are
indicated only for life-threatening dysrhythmia
 Antidysrhythmic
Classifications

• Class II
– Beta blocking agents which reduce
adrenergic stimulation of the heart
• Propranolol (Inderal)
 Antidysrhythmic
Classifications
• Class III
– Produce potassium channel blockade,
which increases contractility
– Do not suppress automaticity and have
no effect on conduction velocity
– Thought to terminate dysrhythmias that
result from reentry of blocked impulses
• Bretylium (Bretylol)
• Amiodarone (Cordarone)
 Antidysrhythmic
Classifications
• Class IV
– Calcium channel blockers
– Block the inflow of calcium through the
cell membranes of cardiac and smooth
muscle cells
– Depress muscle contraction, automaticity,
and in some cases conduction velocity
• Verapamil (Isoptin)
• Diltiazem (Cardizem)
 Antihypertensives
• Exact mechanism of action of many of these
drugs is unknown
• The ideal antihypertensive drug should
– Maintain BP within normal limits
– Maintain or improve blood flow
– Reduce workload of the heart
– Have no undesirable effects
– Permit long-term administration without
intorlerance
 Antihypertensives

• Diuretics
• Sympathetic Blocking Agents
• Vasodilators
• Angiotensin-Converting Enzyme
(ACE) Inhibitors
• Calcium Channel Blockers
 Diuretics

• Use of these drugs results in a loss of

sodium and water by renal excretion
– Decrease in plasma and extracellular fluid
volume (decreases preload and stroke
volume)
– Direct effect on arterioles
• Result in a lowered blood pressure
 Diuretics

• Thiazides
– Moderately effective in lowering BP
– Help prevent side effects of hypertensive
agents that retain sodium and water
• Hydrochlorothiazide (HCTZ)
 Diuretics

• Loop Diuretics
– Powerful and short acting
– Inhibit sodium and chloride reabsorption
in the Loop of Henle
– Cause excessive loss of potassium
– Increase in excretion of sodium and water
• Furosemide (Lasix)
 Diuretics
• Potassium-sparing Agents
– Promote sodium and water loss without
an accompanying loss of potassium
– Used to treat hypertensive patients that
become hypokalemic with other diuretics
– May be used to treat some edematous
states such as cirrhosis of the liver with
ascites
• Spironolactone (Aldactone)
 Sympathetic
Blocking Agents

• Classified as:
– Beta Blocking Agents
– Adrenergic Inhibiting Agents
• Result in a lowered blood pressure
 Sympathetic
Blocking Agents
• Beta Blocking Agents
– Decrease cardiac output
– Inhibit the secretion of renin by the
kidneys
• Result in a lowered blood pressure
– Compete with epinephrine for available
beta receptor sites
• Inhibits tissue and organ response to beta
stimulation
 Beta Blocking Agents
• Beta1 Blocking • Beta1 and Beta2
Agents Blocking Agents
(Cardioselective) (Nonselective)
– Acebutolol (Sectral) – Labetalol (Trandate)
– Atenolol (Tenormin) – Nadolol (Corgard)
– Metoprolol – Propranolol
(Lopressor) (Inderal)
 Sympathetic
Blocking Agents
• Adrenergic Inhibiting Agents
– Sympathetic stimulation results in
• An increase in heart rate and myocardial
contraction
• Constriction of arterioles and venules
• A release of renin by the kidneys
– Blocking this sympathetic stimulation can
reduce blood pressure
 Adrenergic
Inhibiting Agents
• Centrally Acting • Peripheral
Adrenergic Adrenergic
Inhibitors Inhibitors
– Clonidine – Guanethidine
(Catapres) Sulfate (Ismelin)
– Methyldopa – Reserpine (Sandril,
(Aldomet) Serpasil)
 Vasodilator Drugs
• Act directly on the smooth muscle walls of
the arterioles, veins, or both
– Lowering peripheral resistance and BP
• Stimulate the sympathetic nervous system
resulting in an increase in
– Heart rate
– Cardiac output
– Renin release
• Combined therapy is usually prescribed to
inhibit the sympathetic response
 Vasodilator Drugs
• Arteriolar Dilator • Arteriolar and
Drugs Venous Dilator
– Diazoxide Drugs
(Hyperstat IV) – Sodium
– Hydralazine Nitroprusside
(Apresoline) (Nipride)
– Minoxidil (Loniten) – Nitro SL (Nitrostat)
– Nitro IV (Tridil)
 Angiotensin-Converting
Enzyme (ACE) Inhibitors
• Angiotensin II is a powerful vasocontrictor
– Raises blood pressure and causes a release of
aldosterone, which contributes to sodium and
water retention
• ACE Inhibitors prevent the conversion of
Angiotensin I to Angiotensin II which results
in a lowered blood pressure
– Catopril (Capoten)
– Enalapril (Vasotec)
Calcium Channel Blockers
• Reduce peripheral vascular resistance by
inhibiting the contractility of smooth
muscle
– Dilate coronary arteries (increase oxygen
supply to the heart)
– Decrease afterload (myocardial oxygen
demands of the heart)
• Verapamil (Isoptin)
• Diltiazem (Cardizem)
 Cardiac Glycosides

• Naturally occurring plant substances

that have characteristic effects on the
heart
• Work by blocking ionic pumps in the
cellular membrane, which indirectly
increases the calcium concentration to
the contractile proteins
– Digoxin (Lanoxin)
 Digitalis Glycosides

• Affect the heart in two ways

– Increase the strength of contraction
(positive inotropic effect)
– Dual effect on the electrophysiological
properties of the heart
• Modest negative chronotropic effect (slowing
of heart rate)
• Profound negative dromotropic effect
(decreasing conduction velocity)
 Digitalis Glycosides
Side Effects
• May be neurological, visual,
gastrointestinal, cardiac, or psychiatric
• Often vague and and easily attributed
to a viral syndrome
– Anorexia
– Nausea and vomiting
– Visual disturbances
– Cardiac rhythm disturbances
 Digitalis Glycosides
Toxic Effects
• Dose related and increased by presence of
other drugs, such as diuretics
• Dysrhythmias may include
– Bradycardia
– Tachycardia
– Ventricular Fibrillatin
• Treatment aimed at correction of electrolyte
imbalance, neutralization of the free drug,
and use of antidysrhythmics
 Antihemorrheologic
Agents
• Used to treat peripheral vascular
disorders caused by pathological or
physiological obstruction
(arteriosclerosis)
• Improve blood flow and delivery of
oxygen to ischemic tissues
– Pentoxifylline (Trental)
 Drugs that
Affect the Blood

• Anticoagulants
• Thrombolytics
• Blood Components
 Anticoagulants

• Drugs that interfere with platelet

aggregation
• Also known as anitplatelet or
antithrombic drugs
– Aspirin
– Dipyridamole (Persantine)
– Clopidrogrel (Plavix)
 Thrombolytics

• Dissolve clots after their formation by

promoting the digestion of fibrin
• Used for reestablish blood flow, acute
pulmonary embolism, and DVT
– Streptokinase (Streptase)
– Tissue Plasminogen Activator (t-PA)
– Retivase (Retavase)
 Antihemophilic Agents
• Hemophilia A (classic hemophilia)
– Results from a deficiency of factor VIII
• Hemophilia B (Christmas Disease)
– Results from a deficiency of factor IX
• Therapy aimed at replacement of the
missing clotting factor
– Factor VIII (Factorate)
– Factor IX (Konyne)
 Hemostatic Agents

• Hasten clot formation to reduce

bleeding
– Systemic Hemostatic Agents
• Amicar
• Cyklocapron
– Topical Hemostatic Agents
• Gelfoam
• Novacell
 Blood & Blood
Components (Replacement)
• Replacement of the blood component that is
deficient
– Whole blood (rarely used)
– Packed red blood cells
– Fresh-frozen plasma
– Platelets
– Coagulation factors
– Albumin
– Fibrinogen
 Antihyperlipidemic Drugs

• Hyperlipidemia refers to the excess of

lipids in the plasma
• Several types associated with elevated
levels of cholesterol and triglycerides
– Atorvastatin (Lipitor)
– Niacin (Nicobid)
– Simvastatin (Zocor)
 Drugs that Affect the
Respiratory System

• Mucokinetic Drugs
• Bronchodilator Drugs
• Xanthine Derivatives
• Prophylactic Asthmatic Drugs
 Mucokinetic Drugs
• Used to move respiratory secretions,
excessive mucus, and sputum along
the tracheobronchial tree
• Alter the consistency of secretions
– Dilutents (water, saline solution)
– Aerosols
– Mucolytic Drugs
– Expectorants (Mucomyst)
 Bronchodilators
• Administered via inhalation via a nebulizer
or a pressurized cartridge
• Sympathomimetics categorized by receptor
action
– Nonselective adrenergic drugs
– Nonselective beta adrenergic drugs
– Selective beta2 receptor drugs
– Catecholamine beta2 receptor drugs
– Noncatecholamine beta2 receptor drugs
 Bronchodilators
• Nonselective • Nonselective Beta
Adrenergic Drugs Adrenergic Drugs
– Epinephrine – Adrenalin
inhalation aerosol – Isuprel
(Bronkaid Mist,
Primatene Mist) • Selective Beta2
– Racemic Epi Drugs
– Albuterol (Proventil)
– Isoetharine
(Bronkosol)
 Xanthine Derivatives
• Include caffeine, theophylline, and
theobromine
• Relax smooth muscle, stimulate cardiac
muscle and the CNS, increase
diaphragmatic contractility, and promote
diuresis
– Amoline
– Sompophyllin
– Bronkodyl
 Prophylactic
Asthmatic Drugs
• Reduce allergic or inflammatory
response to stimuli and have a effect
on bronchial smooth muscle
– Beclomethasone Dipropionate (Vanceril)
– Dexamethasone (Decadron)
– Ipratropium (Atrovent)
 Drugs that Affect the
Respiratory Center
• Oxygen Therapy
– Use to treat hypoxia and hypoxemia
– Essential for sustaining life
• Direct Respiratory Stimulants
– Also known as analeptics
– Act directly on the medullary center of the
brain to increase the rate and depth of
respiration
• Doxapram (Dopram)
 Drugs that Affect the
Respiratory Center
• Reflex Respiratory Stimulants
– Spirits of Ammonia
– Noxious odor stimulates respirations
through afferent messages to the brain
• Respiratory Depressants
– Include opium and barbiturate drugs
– Seldom given to intentionally inhibit rate
and depth of respiration
 Drugs that Affect the
Respiratory Center
• Cough Suppressants
– Prescribed for nonproductive cough or
prolonged coughing
– Coughing is a protective reflex
– Opiod Antitussive Drugs
• Codeine
– Nonopiod Antitussive Drugs
• Benzonatate (Tessalon)
• Diphenhydramine (Benadryl)
 Drugs that Affect the
Respiratory Center
• Nasal Decongestants
– Constrict nasal capillaries
– Alpha1 agonists
• Phenylephrine
• Pseudoephedrine
– Topical administration reduces systemic
effects
– Rebound congestion with prolonged use
 Drugs that Affect the
Respiratory Center
• Antihistamines
– Compete with histamines for receptor
sites, thereby preventing the physiological
action of histamine
• H1 Receptors (blood vessels & bronchioles)
• H2 Receptors (gastrointestinal tract)
– Also have anticholinergic or atropine-like
action
 Drugs that Affect the
Respiratory Center
• Antihistamines
– Used for allergic reactions, motion
sickness, or as a sedative or antiemetic
• Dimenhydrinate (Dramamine)
• Diphenhydramine (Benadryl)
• Promethazine (Phenegran)
• Loratadine (Claritin)
• Fexofenadine (Allegra)
 Drugs that Affect the
Respiratory Center
• Serotonin
– Naturally occurring vasoconstrictor found
in platelets and cells of the brain
– Not administered as a drug but as a
major influence on other drugs and some
disease states
• Helpful in repairing blood vessels
• Stimulate smooth muscle contraction
• Acts as a neurotransmitter in the CNS
 Drugs that Affect the
Respiratory Center
• Antiserotonins (serotonin antagonists)
– Inhibit responses to serotonin and its
influence on other drugs & disease states
• Block smooth muscle contraction and
vasoconstriction
• Inhibit the action of serotonin in the brain
– May be used to treat vascular headaches
and allergic disorders
• Lysergic Acid Diethylamide (LSD)
 Drugs that Affect the
Gastrointestinal System

• Categorized into
– Drugs that affect the stomach
– Drugs affecting the lower gastrointestinal
tract
 Drugs that Affect
the Stomach
• Antacid Combinations
– Buffer or neutralize hydrochloric acid
– Peptic ulcer, gastritis, and heartburn
• Alka-Seltzer, Gaviscon, Rolaids

• Antiflatulents
– Prevent the formation of gas
– Common condition in diverticulitis, ulcer disease,
and irritable colon
• Simethicon (Mylicon)
 Drugs that Affect
the Stomach
• Digestants
– Promote digestion
– Release small amounts of digestive enzymes
• Pancrelipase (Pancrease)

• Cytoprotective Agents
– Protect cells from damage
– Peptic ulcer disease (protect mucosa)
• Sucralfate (Carafate)
• Misprostol (Cytotec)
 Drugs that Affect
the Stomach
• Emetics
– Used to induce vomiting for overdose or
poisonings
• Syrup of Ipecac
• Antiemetics
– Treat nausea and vomiting
• Promethazine (Phenegran)
• Prochlorperazine (Compazine)
 Drugs that Affect
the Stomach
• H2 Receptor Antagonists
– Block H2 receptors and reduce the
volume of gastric acid secretion
– Examples
• Cimetidine (Tagament)
• Ranitidine (Zantac)
• Famotidine (Pepcid)
Drugs Affecting the Lower
Gastrointestinal Tract
• Laxatives
– Produce defecation
– Used to evacuate the bowel and to soften
hardened stool
– Examples
• Saline Laxatives (Milk of Magnesia)
• Stimulant Laxatives (Dulcolax, Ex-Lax)
• Lubricant Laxatives (Metamucil)
• Fecal Moistening Agents (Colace)
Drugs Affecting the Lower
Gastrointestinal Tract
• Antidiarrheals
– Reduce an abnormal frequency of bowel
evacuation
– Including bacterial or viral invasion and
irritable bowel syndrome
• Adsorbents (Pepto-Bismol)
• Anticholinergics (Donnatal)
• Other Agents (Lomotil and Imodium)
 Opthalmic Drugs
• Antiglaucoma Agents
– Pressure of the fluid in the eye causes
compression on the eye’s blood vessels
– Drugs that dilate the pupil
• Pilocarpine
– Drugs that constrict the pupil
– Drugs that slow the secretion of aqueous
fluid
• Acetazolamide
 Mydriatic and
Cycloplegic Agents
• Applied topically to cause dilation of
the pupils and paralysis of
accommodation of light
• Used routinely during eye exam or for
ocular surgery
– Atropine Ophthalmic Solution
– Oxymetazoline (OcuClear)
 Antiinfective and/or
Antiinflammatory Agents
• Use to treat conjunctivitis, sty, and
keratitis (corneal inflammation caused
by bacteria)
– Bacitracin (Baciguent)
– Chloramphenicol (Chloroptic)
– Erythromycin (Ilotycin)
– Natamycin (Natacyn)
Topical Anesthetic Agents

• Prevent pain during surgical

procedures and eye examinations
• Have rapid onset (within 20 seconds)
and last 15 to 20 minutes
– Proparacaine HCl (Opthaine)
– Tetracaine HCl (Pontocaine)
 Drugs Affecting the Ear
• Antibiotics
– Used to treat infections
• Chloramphenicol (Chloromycetin Otic)

• Steroid / Antibiotic Combinations

– Used to treat superficial bacterial infections
• Hydrocortisone (Cortisporin Otic)

• Drugs used to treat ear wax accumulation,

inflammation pain, and other conditions
– Boric Acid in Isopropyl Alcohol (Aurocaine 2)
 Drugs Affecting
the Pituitary Gland
• Anterior Pituitary Gland Drugs
– Used to treat growth failure in children
caused by growth hormone deficiency
• Somatrem (Protropin)
• Somatropin (Humatrope)
• Posterior Pituitary Gland Drugs
– Used to treat symptoms of diabetes
insipidus resulting from ADH deficiency
• Vasopressin (Pitressin)
 Drugs Affecting the
Parathyroid & Thyroid
• Thyroid Drugs
– Used to treat hypothyroidism and prevent
goiters
• Thyroid
• Iodine Products
• Parathyroid Drugs
– Used to treat hyperparathyroidism
• Vitamin D
• Calcium Supplements
 Drugs that Affect
the Adrenal Cortex
• Glucocorticoids
– Raise blood glucose and suppress
inflammatory reaction
• Mineralocorticoids
– Regulate electrolyte and water balance
• Adrenal Steroid Inhibitors
 Drugs Affecting
the Pancreas
• Insulin Preparations • Oral Hypoglycemic
– Humulin 70/30 Agents
– Lente Insulin – Dymelor
– Ultralente – Diabinese
• Hyperglycemic – Glucophage
Agents – Glucotrol
– Glucagon – Micronase
– Dextrose – Tolinase
– Orinase
 Drugs Affecting the Female
Reproductive System
• Female Sex • Oral Contraceptives
Hormones – “The pill”
– Supplemental – Combination of
Estrogen estrogen and
– Progesterone progesterone
(synthetic progestin) • Ovulatory
Stimulants
– Gonatropins
– Clomid
 Drugs for Labor
and Delivery
• Oxytocics
– Drugs that increase uterine contraction
• Pitocin
• Syntocinon
• Tocolytics
– Drugs that inhibit uterine contractions
• Terbutaline (Brethine)
• Ritodrine (Yutopar)
 Drugs Affecting the Male
Reproductive System
• Testosterone
– Used for the treatment of hormone
deficiency
• Testicular Failure
• Impotence
• Delayed Puberty
• Female Breast Cancer
– Methyltestoserone (Metandren)
 Drugs that Affect
Sexual Behavior
• Drugs used to impair libido and sexual
gratification
– Interfere with sympathetic nervous stimulation
• Antihypertensives
• Antidepressants

• Drugs used to enhance libido and sexual

gratification
– Levodopa (L-Dopa)
– Sildenafil Citrate (Viagra)
 Antineoplastic Agents
• Used in cancer chemotherapy to prevent
proliferation of malignant cells
• Nonselective and are injurious to all cells in the
body
• Side effects include infection, nausea and
vomiting, and hemorrhage
• Toxicity may affect the pulmonary,
cardiovascular, and renal systems
• Prehospital care is aimed at providing
comfortable measures & emotional support
 Drugs Used in Infectious
Disease & Inflammation
• Antibiotics
– Penicillins
• Most effective and least toxic
• Effective against gram-positive and some
gram-negative bacteria
– Cephalosporins and related products
• Active against both gram-positive and gram-
negative bacteria
• Widely used to treat ear, throat, and
respiratory infections
 Drugs Used in Infectious
Disease & Inflammation
• Antibiotics
– Macrolide Antibiotics
• Used to treat infections of the skin, chest,
throat, and ears
• Useful in the treatment of pertussis
– Tetracyclines
• Active against many gram-negative and
gram-positive organisms
• Commonly used to treat acne, bronchitis,
syphilis, and gonorrhea
 Antibiotics
• Penicillins • Macrolides
– Amoxicillin (Amoxil) – Erythromycin (E-
Mycin)
– Ampicillin (Amcil) – Azithromycin
• Cephalosporins (Zithromax)

– Cefazolin (Ancef) • Tetracyclines

– Doxcyline (Vibramycin)
– Cephalothin (Keflin)
– Tetracycline
(Achromycin)
 Drugs Used in Infectious
Disease & Inflammation
• Antifungal Drugs
– Broadly classified into superficial
infections, subcutaneous infections, and
immunosuppressant
• Antiviral Drugs
– Many agents have been tested but few
have proven effective without toxic effects
 Antifungal and
Antiviral Drugs
• Antifungal • Antiviral
– Tolnaftate (Tinactin) – Acyclovir (Zovirax)
– Fluconazole – Zidovudine
(Diflucan) (Retrovir, AZT)
– Nystatin – Lamivudine (Epivir)
(Mycostatin)
 Other Antimicrobal and
Antiparasitic Drugs

• Antimalarial Medications
• Antituberculous Agents
• Antiamebiasis Agents
• Anthelmintic Agents
• Leprostatic Agents
 Nonsteroidal
Antiinflammatory Drugs
• Analgesic-Antipyretic Drugs
– Drugs that reduce fever or mild pain
• Acetylsalicylic Acid (Aspirin)
• Acetaminophin (Tylenol)

• Nonsteroidal Antiinflammatory Drugs

– Prescribed for various inflammatory conditions
• Acetylsalicylic Acid (Aspirin)
• Naproxen (Naprosyn)
• Ketorolac (Toradol)
 Serums, Vaccines, and
Immunizing Agents
• Serums
– Clear fluid that separates from blood
when it clots
– Contain salts, glucose, and other proteins
(including antibodies formed by the
body’s immune system to protect against
infection)
– Prepared from the blood of a person (or
in rare cases an animal)
 Serums, Vaccines, and
Immunizing Agents
• Vaccines
– Contain killed or modified microorganisms
(“live attenuated organisms”) that usually
do not cause disease
– Produce specific immunity to a disease
causing bacterial toxin, virus, or
bacterium
– Examples include vaccines for measles,
mumps, rubella, yellow fever, and polio
 Drugs Affecting the
Immunologic System
• Immunosuppressants
– Reduce the activity of the body’s immune system
and activity of lymphocytes
– Usually prescribed to prevent rejection of foreign
tissues after transplant surgery
• Immunodulating Agents
– Increase the efficiency of the immune system
– Some enhance the ability of a vaccine to
stimulate the immune system
 Dermatologic Drugs

• Used to treat skin irritations

• Common over-the-counter
medications
• Include baths, soaps, solutions,
cleansers, emollients, and skin
protectants
• Sunscreen is included in this category
Vitamins & Minerals
 Antidotes & Overdoses

• Treatment of poisoning and overdose

aimed at
– Eliminating the substance by emptying
the gastric contents
– Increasing gastric motility
– Alkalinizing the urine
– Filtering the substance from the blood
 QUESTIONS?

Jeremy Maddux
ncmedix@msn.com