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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

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