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Chapter 10
Paramedic: Principles of Pharmacology
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09/27/2012

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Term
What is the scientific study of how various substances interact with or alter the function of living organisms?
Definition
Pharmacology 423
Term
A document that gives detailed information about drugs, such as the indications an uses, dosing information, precautions, contraindications, and adverse effects.
Definition
Medication Monograph 426
Term
The biochemical and physiologic effects and mechanism of action of a medication in the body.
Definition
Pharmacodynamics 427
Term
M
A
D
E
Definition
Metabolized (Biotransformation) 427
Absorption
Distribution
Elimination
Term
The process by which the molecules of a substance are moved from the site of entry or administration into systemic circulation.
Definition
Absorbtion 427
Term
A process with four possible effects on a medication absorbed into the body;
1.An inactive substance can become active, capable of producing desired or unwanted clinical effects.
2. An active medication can be changed into another active medication.
3. An active medication may be completely or partially inactivated.
4. A medication is transformed into a substance (active or inactive) that is easier for the body to eliminate.
Definition
Biotransformation 427
Term
The movement and transportation of a medication throughout the bloodstream to tissues and cells and, ultimately, to its target receptor.
Definition
Distribution 427
Term
In a parmacologic context, the removal of a medication or its by-products from the body.
Definition
Elimination 427
Term
The fate of medications in the body, such as distribution and elimination.
Definition
Pharmacokinetics 427
Term
A specialized area in tissues that initiates certain action after specific stimulation.
Definition
Receptors 427
Term
Originating from within the organism (body).
Definition
Endogenous 427
Term
Originating from outside the organism (body).
Definition
Exogenous 427
Term
What are 2 types of medications or chemicals that directly affect cellular activity by binding with receptor sites on individual cells.
Definition
Agonist and Antagonist Medications 428
Term
____ initiate or alter a cellular activity by attaching to receptor sites, prompting a cell response.
Definition
Agonist Medications 428
Term
____ prevent endogenous or exogenous agonist chemicals from reaching cell receptor sites and initiating or altering a particular cellular activity.
Definition
Antagonist Medications 428
Term
What is the ability of a medication to bind with a particular receptor site?
Definition
Affinity 428
Term
In a pharmacologic context, the concentration of medication at which initiation or alteration of cellular activity begins.
Definition
Threshold Level 428
Term
The concentration of the medication required to initiate a cellular response.
Definition
Potency 428
Term
The ability to initiate or alter cell activity in a therapeutic or desired manner.
Definition
Efficacy 428
Term
What illustrates the relationship of medication dose (or concentration) and efficacy?
Definition
Dose-Response Curve 428-429
Term
____ temporarily bind with cellular receptor sites, displacing agonist chemicals.
Definition
Competitive Antagonists 429
Term
_____ permanently bind with receptor sites and prevent activation by agonist chemicals.
Definition
Noncompetitive Antagonists 429
Term
What binds to the receptor site but do not initiate as much cellular activity or change as do other agonists?
Definition
Partial Agonist 429
Term
What medications are used to kill or suppress the growth of microorganisms?
Definition
Antimicrobials 430
Term
The medications used to fight infection by killing the microorganisms or preventing their multiplication to allow the body's immune system to overcome them.
Definition
Antibiotics 430
Term
The medications used to treat fungal infections.
Definition
Antifungals 430
Term
Medications that bind with heavy metals in the body and create a compound that can be eliminated; used in cases of ingestion or poisioning.
Definition
Chelating Agents 430
Term
A chemical that increases urinary output.
Definition
Diuretic 430
Term
Characterized by the movement of a solvent, such as water, across a semipermeable membrane (cell wall) from an area of lower to higher concentration of solute molecules.
Definition
Osmotic 430
Term
The specified amount of a medication to be given at specific intervals.
Definition
Dosing 430
Term
A property that indicates a material can be dissolved in water.
Definition
Water-soluble 430
Term
A hemoprotein involved in the detoxification of many drugs.
Definition
Cytochrome P-450 System 430
Term
What is opposite from expected?
Definition
Paradoxical 430
Term
The percentage of red blood cells in a blood sample.
Definition
Hematocrit 431
Term
In a pharmacologic context, the positive and negative effects of an inactive medication on a person that are related to the person's expectations and other factors.
Definition
Placebo Effect 432
Term
Several smaller doses of a particular medication capable of producing the same clinical effects as a single larger dose of that same medication.
Definition
Cumulative Action 432
Term
A clinical change caused by a medication that causes harm or discomfort to a patient; also known as adverse effect.
Definition
Untoward Effect 434
Term
A severe, possibly fatal reaction that mimics a burn; may be due to medication.
Definition
Stevens-Johnson Syndrome 434
Term
The destruction of red blood cells by disruption of the cell membrane.
Definition
Hemolysis 434
Term
In a pharmacologic context, abnormal susceptibility to a medication, possibly due to genetic traits or dysfunction of a metablolic enzyme, that is peculiar to an individual patient (usually unexplained).
Definition
Idiosyncratic 434
Term
The weight-based dose of a medication that was effective in 50% of the animals tested.
Definition
Median Effective Dose (ED50) 434
Term
The weight-based dose of a medication that cause death in 50% of the animals tested.
Definition
Median Lethal Dose (LD50) 434
Term
The weight-based dose of a medication that demonstrated toxicity in 50% of the animals tested.
Definition
Median Toxic Dose (TD5) 434
Term
The relationship between the medican effective dose and the median lethal dose or median toxic dose.
Definition
Theraputic Index or Therapeutic Ratio (434)
Term
A mild to severe reaction after the first exposure to a medication or other substance, often with many of the same signs and symptoms as an immune-mediated reaction.
Definition
Medication Sensitivity 434
Term
An extreme systemic form of an allergic reaction invoving 2 or more body systems.
Definition
Anaphylaxis 434
Term
A condition that develops following repeated use by a patient of a medication that results in decreased efficacy or potency.
Definition
Tolerance 435
Term
The process in which a mechanism reducing availble cell receptors for a particular medication results in tolerance.
Definition
Down-Regulation 435
Term
A condition in which repeated doses of medication within a short period rapidly cause tolerance, making the medication virtually ineffective.
Definition
Tachyphylaxis 435
Term
A process in which repeated exposure to a medication within a particular class causes tolerance that may be "transferred" to other medications in that same class.
Definition
Cross-Tolerance 435
Term
A medication or chemical that temporarily enhances central nervous system and sympathetic nervous system functioning.
Definition
Stimulant 435
Term
A chemical or medication that decreases the performance of the central nervous system or sympathetic nervous system.
Definition
Depressant 435
Term
Te unusual tolerance to the theraeutic and adverse clinical effects of a medication or chemical.
Definition
Habituation 435
Term
The physical, emotional, or behavioral need for a substance to maintain a certain level of "normal" function.
Definition
Dependence 436
Term
One medication or chemical taken by a patient that undermines the effectiveness of another medication taken by or administered to a patient.
Definition
Interference 436
Term
The time needed for the concentration of the medication at the target tissue to reach the minmum effective level.
Definition
Onset 436
Term
In a pharmacologic context, the point of maximum effect of a drug.
Definition
Peak 436
Term
The time a medication concentration can be expected to remain above the minimum level needed to provide the intended action.
Definition
Duration of Effect 436
Term
The percentage of the unchanged medication reaches systemic circulation.
Definition
Bioavailability 436
Term
Medications administered to stimulate the sympathetic nervous system.
Definition
Sympathomimetics 438
Term
The movement of a solvent, from an area of low solute concentration to one of high concentration through a selectively permeable membrane to equalize eoncentrations of a solute on both sides of the membrane.
Definition
Osmosis 441
Term
Use of hydrostatic pressure to force water or dissolved particles through a semipermeable membrane.
Definition
Filtration 441
Term
What are molecules that are uncharged?
Definition
Nonionic 441
Term
Attracted to fats and lipids.
Definition
Lipophilic 441
Term
Attracted to water molecules.
Definition
Hydrophilic 441
Term
What are charged molecules?
Definition
Ionic 441
Term
A process by which cells ingest the extracellular fluid and its contents.
Definition
Pinocytosis 441
Term
The process of medication molecules binding with carrier proteins when no energy is expended.
Definition
Facilitated Diffusion 441
Term
The process of molecules binding with carrier proteins when energy is used to move the molecules against a concentration gradient.
Definition
Active Transport 441
Term
A process in which medicatio molecules temporarily attach to proteins in the blood plasma, significantly altering mediation distribution in the body.
Definition
Plasma Protein Binding 441
Term
Describes the extent to which a medication will spread within the body.
Definition
Volume of Distribution 442
Term
What is it when a medication undergoes some degree of chemical change by the body?
Definition
Biotransformation 442
Term
A medication that has undergone biotransformation and now is no longer able to alter a cell process or body function; not pharmacologically active.
Definition
Inactive Metabolite 442
Term
A medication that has undergone biotransformation and is able to alter a cellular process or body function.
Definition
Active Metabolite 442
Term
A process in which a fixed amount of a substance is removed during a cerain period, regardless of the toatl amount in the body.
Definition
Zero-Order Elimination 442
Term
The process in which the rate of elimination is directly influenced by plasma levels of a substance.
Definition
First-Order Elimination 443
Term
The time needed in an average person for metabolism or elimination of 50% of a substance in the plasma.
Definition
Half-Life 443
Term
A term used to describe paralytic agents that act at the neuromuscular junction by binding with nicotinic receptors on muscles, causing fasciculations and preventing additional activation by acetylcholine.
Definition
Competitive Depolarizing 448
Term
Brief, uncoordinated, visible twitching of small muscle groups; may be caused by the administration of a depolarizing neuromuscular blocking agent (succinylcholine).
Definition
Fasciculation 448
Term
A term used to describe drugs that produce muscle relaxation by interfering with impulses between the nerve ending and muscle receptor.
Definition
Nondepolarizing 448
Term
Sites of generation of electrical impulses other than normal pacemaker cells.
Definition
Ectopic Foci 450
Term
A classificatin scheme based on the mechanism of action rather than on specific medication groups.
Definition
Vaughn-Williams Classification Scheme 450
Term
A state in which cardiac cells are at rest, waiting for the generation of a spontaneous impulse from within.
Definition
Automaticity 450
Term
The early phase of cardiac repolarization, wherein the heart muscle cannot be stimulated to depolarize.
Definition
Absolute Refractory Period also Effective Refractory Period 450
Term
The process of discharging resting cardiac muscle fibers by an electric impulse that causes them to contract.
Definition
Depolarization 450
Term
The period in the cell-firing cycle at which it is possible but difficult to restimulate the cell to fire another impulse.
Definition
Relative Refractory Period 450
Term
Seepage of blood and medication into the tissue surrounding the blood vessel.
Definition
Extravasation 452
Term
A tumor found in the adrenal glands.
Definition
Pheochromocytoma 452
Term
An enzyme that breaks down acetylcholine.
Definition
Acetylcholinsterase 453
Term
A term used to describe the fibers in the parasympathetic nervous system that release a chemical called acetylcholine.
Definition
Cholinergic 453
Term
Pertaining to voluntary muscle movements that are distorted or impaired because of abnormal muscle tone.
Definition
Dystonic 459
Term
___, ___, and ___ societies used chemical remedies to treat everything from pain to baldness.
Definition
Early Chinese, Mesopotamian, and Egyptian 423
Term
When did formal study of the effects of medication on the body bein to emerge?
Definition
Late 17th and 18th Centuries 423
Term
The first significant regulation was enacted with the passage of the Pure Food and Drug Act in what year?
Definition
1906 423
Term
In what year was opium prohibited from being imported under the Opium Exclusion Act?
Definition
1909 423
Term
What year did the Harrison Narcotic Act become law?
Definition
1914 423
Term
What did the Harrison Naroctic Act restrict from being used?
Definition
Opiates and Cocaine 423
Term
___ was given enforcement authority for rules requiring that new drugs were safe and pure.
Definition
US Food and Drug Administration (FDA) 423
Term
Who is responsible for enforcing the Controlled Substances Act?
Definition
US Drug Enforcement Agency 423
Term
What act classifies certain medications with the potential of abuse into 5 categories?
Definition
Controlled Substance Act 423
Term
What year was the Controlled Substance Act implemented?
Definition
1970
Term
High abuse potential; no recognized medical purpose.
Definition
Schedule I 424
Term
High abuse potential; legitimate medical purpose.
Definition
Schedule II 424
Term
Lower potential for abuse than Schedule II medications.
Definition
Schedule III 424
Term
Lower potential for abuse than Schedule III drugs.
Definition
Schedule IV 424
Term
Lower potential for abuse than Schedule IV drugs.
Definition
Schedule V 424
Term
Heroin, marijuana, and LSD are examples of what schedule?
Definition
Schedule I 424
Term
Fentanyl (Sublimaze), methylphenidate (Ritalin), and Cocaine are examples of what schedule?
Definition
Schedule II 424
Term
Hydrocodone (Vicodin), acetaminophen with codeine, and ketamine are examples of what schedule?
Definition
Schedule III 424
Term
Diazepam (Valium) and lorazepam (Ativan) are examples of what schedule?
Definition
Schedule IV 424
Term
Narcotic cough medicines are an example of what schedule?
Definition
Schedule V 424
Term
Medications made completely in a laboratory setting.
Definition
Synthetic 424
Term
Medications made from chemicals derived from plant, animal, or mineral sources that have been chemically modified in a laboratory setting.
Definition
Semisynthetic 424
Term
___ is also used to manufacture certain medications that cannot be obtained from natural sources.
Definition
Genetic Engineering 424
Term
____ is a great source of information regarding the manufacturing details of a particular medication.
Definition
The USP-NF 424
Term
What are the sources of medication?
Definition
Plant, Animal, Microorganism, and Minerals 424
Term
Atrophine, aspirin, digoxin, and morphine come from what source?
Definition
Plant 424
Term
Heparin, antivenom, thyroid preparations, and insulin come from what source?
Definition
Animal 424
Term
Streptokinase and numerous antibiotics come from what source?
Definition
Microorganisms 424
Term
Iron, magnesium sulfate, lithium, phosphorus, and calcium come from what source?
Definition
Minerals 424
Term
What are the 3 type of medication names?
Definition
Chemical, Generic, and Brand 425
Term
Who approves the generic name for a medication?
Definition
US Adopted Names Council and World Health Organization 435
Term
Generic names typically include what that links them to other medications in the same class?
Definition
A Stem 425
Term
What is the stem that benzodiazepine medications have?
Definition
"am" 425
Term
What is the stem for Angiotensin-Converting Enzymes (ACE) inhibitor medications?
Definition
"pril" 425
Term
Who approves the brand name of a medication given by the manufacturer?
Definition
FDA 425
Term
What is the most basic concern regarding medication storage?
Definition
Integrity of Medication Container 427
Term
What is the USP recommended temperature range for the storage of most medications used in the prehospital setting?
Definition
15-30 C / 55-85 F
Term
When a medication binds with a receptor site, one of four possible actions will occur.
Definition
1. Channels permitting the passage of ions in cell walls may be opened or closed.
2. A biochemical messenger becomes activated, initiating other chemical reactions within the cell.
3. A normal cell function is prevented.
4. A normal or abnormal function of the cell begins.
Term
____ is demonstrated when the dose-response curves of two different medications causing the same effect are compared.
Definition
Relative Potency 429
Term
Vasoconstriction of arteries and veins.
Definition
Alpha-1 429
Term
Insulin restriction, glucagon secretion, and inhibition of norepinephrine release.
Definition
Alpha-2 429
Term
Increased heart rate, increased myocardial contractility, increased myocardial conduction, and renin secretion for urinary retentio.
Definition
Beta-1 429
Term
Bronchus and bronchiole relaxation, insulin secretion, uterine relaxation, and arterial dilation in certain key organs.
Definition
Beta-2 429
Term
Vasodilation of renal and mesenteric arteries (Numerous receptor subtypes exist.)
Definition
Dopaminergic 429
Term
Present at neuromuscular junction, allowing acetylcholine (ACh) to stimulate muscle contraction.
Definition
Nicotinic 429
Term
Present in the heart; activated by ACh to offset sympathetic stimulation, decreasing heart rate, contractility, and electrical conduction velocity.
Definition
Muscarinic-2 429
Term
Medications distribute into 3 primary types of boy substances.
Definition
Water, Lipids or Fats, and Protein 430
Term
In a recent study, how much were health care providers' estimates off of a patient's weight?
Definition
10-15% 431
Term
With a preganant patient, how much does her cardiac output and intravascular volume increase?
Definition
About 40% Above Baseline 431
Term
What are the 6 rights of medication administration?
Definition
1. Right Patient 444
2. Right Medication
3. Right Dose
4. Right Route
5. Right Time
6. Right Documentation and Reporting
Term
What is a rare, but immediately life-threatening, adverse reaction to succinylcholine?
Definition
Malignant Hyperthermia 448
Term
What are symptoms of malignant hyperthermia?
Definition
Severe Hyperthermia, Muscle Rigidity, and Metabolic Acidosis 448
Term
Two medications with a similar effect combine, and the resulting effect is greater than the sum of the effects of the medications.
Definition
Synergism 437
Term
The effect of one medication is greatly enhanced by the presence of another medication, which does not have the ability to produce the same effect.
Definition
Potentiation 437
Term
Two medications, each producing opposite effects, are present simultaneously, resulting in minimal or no clinical changes.
Definition
Physiologic (drug) antagonism 437
Term
Abiltiy of medication to pass through the GI tract into the bloodstream.
Definition
GI Motility 438
Term
Perfusion of the GI system (may be decreased during systemic trauma or shock).
Definition
GI pH 438
Term
Injury or bleeding in the GI system (both can alter GI motility, decreaing the time that oral medications can be absorbed).
Definition
Presence of food, liquids, or chemicals in the stomach 438
Term
What was the first significant regulation that was enacted in 1906?
Definition
Pure Food and Drug Act 423
Term
What act prohibited altering or mislabeling medications?
Definition
Pure Food and Drug Act 423
Term
In 1909, opium was prohibited from being imported under the _____.
Definition
Opium Exclusion Act 423
Term
What became law in 1914 and restricted the used of various opiates and cocaine?
Definition
Harrison Narcotic Act 423
Term
Under the Food, Drug, and Cosmetic Act in 1938, the ______ was given enforcement authority for rules requiring that new drugs were safe and pure.
Definition
United States Food and Drug Administration (FDA) 423
Term
What are schedule I drugs?
Definition
Heroin, marijuana, and LSD 424
Term
What are schedule II drugs?
Definition
Fentanyl (Sublimaze), methylpheidate (Ritalin), morphine sulfate, and cocaine 424
Term
What are schedule III drugs?
Definition
Hydrocodone (Vicodin), acetaminophen with codeine, and ketamine 424
Term
What are schedule IV drugs?
Definition
Diazepam (Valium), midazolam (Versed), lorazepam (Ativan) 424
Term
What are schedule V drugs?
Definition
Narcotic cough medicines 424
Term
What are the sources of medications?
Definition
Plant, Animal, Microorganism, and Minerals 424
Term
What type of source does atropine, aspirin, digoxin, and morphine come from?
Definition
Plant 424
Term
What type of source does heparin, antivenom, thyroid preparations, and insulin come from?
Definition
Animal 424
Term
What type of source does streptokinase and numerous antibiotics come from?
Definition
Microorganism 424
Term
What type of source does iron, magnesium sulfate, lithium, phosphorus, and calcium come from?
Definition
Mineral 424
Term
What is made completely in a laboratory setting?
Definition
Synthetic 424
Term
What is made from chemicals derived from plant, animal, or mineral sources that have been chemically modified in a laboratory setting?
Definition
Semisynthetic 424
Term
What is a great source of information regarding the manufacturing details of a particular medication?
Definition
USP-NF 424
Term
Who has to approve the generic name of a medication?
Definition
US Adopted Names Council and World Health Organization 425
Term
Who approves the brand name of medications?
Definition
FDA 425
Term
What provides a wealth of reliable, detailed information about thousands of medications?
Definition
United States Pharmacopiea-National Formulary (USP-NF) and Physicians Desk Reference (PDR) 426
Term
Why should paramedics be careful when referencing the AMA publication?
Definition
Not every medication has FDA approvl 426
Term
What is the most basic concern regarding medication storage?
Definition
Integrity of Container 427
Term
What is the USP recommended temperature range for the storage of most medications used in the prehospital setting?
Definition
15-30 C (55-86 F) 427
Term
What should you suspect in situations in which appropriate doses of analgesic or sedative medications seem ineffective, especially when patient tolerance is unlikely?
Definition
Tampering 427
Term
Vasoconstriction of arteries and veins.
Definition
Alpha 1 429
Term
Insulin restriction, glucagon secretion, and inhibition of norepinephrine release.
Definition
Alpha 2 429
Term
Increased heart rate (chronotropic), Increased myocardial contractility (inotropic), Increase myocardial conduction (dromotropic), and renin secretion for urinary retention.
Definition
Beta 1 429
Term
Bronchus and bronchiole relaxtion, insulin secretion, uterine relaxtion, and arteral dilation in certian key organs.
Definition
Beta 2 429
Term
Vasodilation of renal and mesenteric atreries.
Definition
Dopaminergic 429
Term
Present at neuromuscular junction, allowing acetylcholine to stimulate muscle contraction.
Definition
Nicotinic 429
Term
Present in the heart; activated by ACh to offset sympathetic stimulation, decreasing heart rate, contractility, and electrical conduction velocity.
Definition
Muscarinic 2 429
Term
What happens when there is a large difference between the median effective dose and the median toxic dose or median lethal dose?
Definition
Considered safe and possibly nontoxic 434
Term
What is medication and substances present in the environment that have the potential to trigger and exaggerated response from the body's immune system?
Definition
Allergic Reaction 434
Term
What chemicals cause a transient increase in physical, mental, or emotional performance?
Definition
Stimulants 435
Term
What are examples of stimulants?
Definition
Caffine, cocaine, and amphetamines 435
Term
What medications and chemicals reduce CNS and sympathetic nervous system functioning, causing sedation, anxiolysis, respiratory depression, bradycardia, hypotension, and a variety of similar clinical symptoms?
Definition
Depressants 435
Term
What are some common depressants?
Definition
Benzodiazepines, alcohol, and opioid chemicals 435
Term
What medicine can be giving intranasal?
Definition
fentanyl (Sublimaze), midazolam (Versed), and naloxone (Narcan) 438
Term
What is given for cyanide exposure?
Definition
Amyl Nitrate 440
Term
What may be nebulized following inhalation exposure to hydrofluoric acid?
Definition
Calcium Gluconate 440
Term
What are 3 anatomic barriers that prevent various medication molecules from reaching underlying tissues?
Definition
Blood-Brain barrier, blood-placenta barrier, and blood-testes barrier 441
Term
What is a the chemical produced following biotransformation?
Definition
Metabolite 442
Term
What does most biotransformation occur?
Definition
Liver 442
Term
What are two ultra short-acting sedative medications used to facilitate airway placement?
Definition
etomidate (Amidate) and ketamine (Ketalar) 445
Term
What is a competitve benzodiazepine antagonist?
Definition
flumazenil (Romazicon) 448
Term
What is a rare, but immediately life-threatening, adverse reaction to succinylcholine?
Definition
Malignant Hyperthermia 448
Term
What can promote cellular uptake of potassium, making it a potential temporary treatment for hyperkalemia until definitive potassium removal occurs?
Definition
albuterol (Ventolin and Proventil) 449
Term
What medications slow the movement of sodium through channels in certain cardiac cells?
Definition
Class I Antidysrhythmic 451
Term
What constitutes the second major class of antidysrhythmic agents?
Definition
Beta-Adrenergic Blocking Agents 451
Term
What is a beta-blocking agent used to reduce the heart rate during myocardial ischemia and in certain artrial tachycardias?
Definition
metoprolol (Lopressor) 451
Term
What medications increase the duration of phases 1, 2, and 3 of the cardiac cycle?
Definition
Class III antidysrhythmic 451
Term
What is peripheal vascular resistance?
Definition
Afterload 451
Term
What is hypotension related to sudden position change?
Definition
Postural Hypotension 452
Term
What is elevated concentration of glucose and plasma proteins?
Definition
Plasma Hyperosmolality 454
Term
What is the preferred IV fluid for Y-site tubing administration during blood product transfusion?
Definition
Normal Saline 456
Term
What is a blood product that contains a concentrated assortment of blood clotting factors, without the additional volume present in FFP?
Definition
Cryoprecipitate 457
Term
What is a low platelet level in the blood?
Definition
Thrombocytopenia 457
Term
What is the treatment of pain?
Definition
Analgesia 458
Term
What is pruritus?
Definition
Itching 458
Term
What is a tear in the mucous membrane of the lower part of the esophagus or the upper part of the stomach?
Definition
Mallory-Weiss Tear 459
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