Pharmacology

[Lithium]

Alright, my question for the week ...

How in-depth is your knowledge of pharmacology? Is it where you'd like to be, or would you like more, or less?

For instance, which one of these statements would apply to you best?

A) Nitroglycerin is a drug we give to people experiencing suspected ischemic chest pain and pulmonary edema.

Nitroglycerin is a vasodilator, which in turn will reduce preload, which is WHY we give it to persons with suspected ischemic chest pain and probable pulmonary edema.

C) Nitroglycerin releases nitric oxide in vascular endothelial cells. Nitric oxide is a gas, which when released in vascular smooth muscle, results in the formation of cyclic guanosine monophosphate (cGMP). cGMP relaxes vascular smooth muscle by inactivating myosin light-chain kinase or by stimulating dephosphorylation of myosin phosphate. (Copyright Rob Theriault, from Drug Guide for Paramedics, 2003)

What do you believe should be the minimum amount of knowledge for pharmacology for EMTs and Paramedics?

peace

edit: spell check

[Ridryder 911]

I personally believe the Paramedic should have a very thorough understanding of C however; even physicians when discussing the application and use of NTG are not that anal. But one should have a through bio-chemical and pathophysiological understanding.

Be safe,

R/r 911

[vs-eh?]

Most PCP and ACP programs teach at the "B" level, with maybe some elements of "C". I believe that is a good instructional level, with room for people to study more in depth on their own.

[Dustdevil]

I agree that the "B" level is what is taught in most paramedic schools, and it is probably the minimally adequate level of understanding for the practising professional. But remember, nobody remembers everything from school. Your knowledge decreases after graduation and continues to do so unless you are very conscientious about your continuing education. Therefore, I believe that the "C" level is what should be taught in initial education. It is indeed important that you understand pharmacology in much greater detail before beginning to practise it. Maintaining that depth of understanding isn't quite as important, simply because it is that greater understanding that prepares you to practise comfortably and intelligently. If you forget some of your cellular physiology after a year or three of practise, that is understandable, and as much as I hate to say it, probably even acceptable to a great extent. However, it is unfortunately too easy to sink to this lowest level of acceptability and stay there. Then you begin to take things for granted and start practising at level "A", and don't bother to learn your new drugs in depth when they come out.

You have to figure that a great many medics will regress at least one level soon after beginning practise. If you teach them at the "C" level, then you can count on keeping most of your people at the "B" level of understanding. But when you start at the "B" level, then you can count on most of your people eventually practising with "A" level understanding at best. We have a term for those medics here in the U.S. Firemen.

I'd be comfortable allowing a medic with "B" level understanding to practise in my system. But I would strongly encourage and even mandate that all my personnel continuously improve their understanding. And those who didn't would find themselves unemployed.

I would not allow anybody to graduate from my school with less than "A" level understanding.

[AZCEP]

If they forget things after they graduate, why would you feel safe knowing that they were at the lowest level when they left class? I think I misunderstood your position, Dust.

It is my feeling that the "C" level needs to be the requirement. If we allow anything less, knowing that the problem listed above will happen, how could we feel comfortable allowing these people to practice.

If demanding students to have a thorough understanding of what they are doing to people is anal, then so be it. It won't be the first time that description has been sent my way.

[Dustdevil]

If they forget things after they graduate, why would you feel safe knowing that they were at the lowest level when they left class? I think I misunderstood your position, Dust.

Sorry. My position is that I feel safe with them knowing the "B" level in practise IF they were at least educated and comfortable with "C" level understanding when they graduated. In other words, I don't think it is unacceptably risky to expect that "C" level understanding will eventually digress to "B" level in practise.

I am not at all comfortable with the "A" level of understanding in the field, or in education. And I'm not exactly happy with the "B" level either. But I am comfortable with the "B" level being the rock bottom level of understanding for the practising field provider. And again, I must emphasise that educational programs and incentives must constantly work to improve that level so that the providers knowledge does not degenerate.

Sorry... I am having a hard time explaining this for some reason. :?

[chbare]

What about splitting the difference? I could accept a base level of knowledge somewhere between B and C for entry into practice.

Take care,

chbare.

[AZCEP]

I had a feeling that was where you were headed Dust. I just wanted to be sure.

I would tend to think that to start on the street the B/C level would be acceptable. This would show that somewhere along the line, the individual was instructed about how the given medication acts, and was able to understand a good portion of it. Going further would be nice, but as an entry point, it might be excessive.

[JPINFV]

C shouldn't too hard to acheive for the entry level, but it all depends on how well the course is taught. I can't speak to how much physiology there is in paramedic school, but learning how nitro works is going to be tough if its the first time the student has heard about MLCK. On the other hand, if the student gets any where close to a decent course (come on now, we talked about MLCK in a 10 week, 2.5 hr/week course at my university. I hope that paramedics get more then 25 hours of physio), then learning how their interventions work should be a lot easier. Without decent A&P, a simple fluid bolus to induce a Starling's effect becomes complicated (more fluid=more end diastolic volume[EDV]=muscle is stretched further=higher tension=higher stroke volume=higher MAP [if no change to peripheral resistance]). If a student has a good education in physio, the simple fluid bolus becomes more fluid=more EDV. Lidocaine just blocks Sodium channels and Narcan competes for receptor spots. Physio should fill in the rest.

[craig]

Where is the "D" .........all of the above?

stay safe