Ian Peate, OBE, FRCN, Senior Lecturer, Roehampton University; Visiting Professor of Nursing, St George's University of London and Kingston University London; Visiting Professor, Northumbria University; Visiting Senior Clinical Fellow, University of Hertfordshire, and Editor-in-Chief of the British Journal of Nursing.

Suzanne Evans, PhD is Associate Professor and Director of Teaching & Learning, School of Biomedical Sciences & Pharmacy, University of Newcastle, Australia.

Lisa Clegg, PhD, MHLTHSC, BHLTHSC is an Ahpra Registered Paramedic and Senior Lecturer in Paramedicine at Charles Sturt University, Australia.

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