Paramedic Pocketbook of Prescription Medications - 1st
Edition
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iii
Contents
Foreword ix
Acknowledgements xi
List of Abbreviations xii
Introduction xiv
Drug Legislation and Paramedic Practice 1
Schedule 19 of the Human Medicines Regulations 2012 1
Schedule 17 of the Human Medicines Act (Part 3.8) 2
Patient Group Directives 3
Associate of Ambulance Chief Executives Protocols 4
Prescribing 4
Controlled Drugs 5
References 7
Special Circumstances 8
Paediatrics 8
The Older Person 13
Kidney Injury and Disease 15
Hepatic Failure 19
Pregnancy and Breastfeeding 20
Palliative Care and Those at the End of Life 24
References 27
Medication Groups 28
An Example Table 32
iv Contents
A 33
Aciclovir 33
Acetylcysteine 34
Alendronic acid 35
Alginates 36
Allopurinol 37
Amitriptyline 38
Amlodipine 39
Amoxicillin 40
Anakinra 41
Apixaban 42
Aripiprazole 43
Aspirin 44
Atenolol 45
Atorvastatin 46
Atovaquone/Proguanil (hydrochloride) 47
Azathioprine 48
Azithromycin 49
References for A 50
B 51
Beclometasone (dipropionate) 51
Bendroflumethiazide 52
Bisacodyl 53
Bisoprolol (fumarate) 54
Budesonide 55
Bumetanide 56
Buprenorphine 57
References for B 58
C 59
Candesartan (cilexetil) 59
Carbamazepine 60
Carbocisteine 61
Cefalexin 62
Ceftriaxone 63
Cetirizine (hydrochloride) 64
Chloramphenicol 65
Chlorphenamine 66
Ciprofloxacin 67
Citalopram 68
Clarithromycin 69
Clotrimazole 70
Clozapine 71
Co-Amoxiclav 72
Co-codamol 73
Codeine (phosphate) 74
Contents v
Colchicine 75
Colecalciferol (with calcium carbonate) 76
Co-trimoxazole 77
Cyanocoalbumin 78
Cyclizine 79
References for C 80
D 81
Dabigatran (etexilate) 81
Desogestrel (+/− ethinylestradiol) 82
Digoxin 83
Dihydrocodeine (tartate) 84
Diltiazem (hydrochloride) 85
Diazepam 86
Docusate (sodium) 87
Domperidone 88
Donepezil (hydrochloride) 89
Doxazosin 90
Doxycycline 91
References for D 92
E 93
Enoxaparin (sodium) 93
Erythromycin 94
Estradiol 95
Ethinylestradiol 96
References for E 96
F 97
Felodipine 97
Fentanyl 98
Fexofenadine 99
Ferrous (fumarate/sulphate) 100
Finasteride 101
Flucloxacillin 102
Fluoxetine 103
Fluconazole 104
Fludrocortisone (acetate) 105
Folic Acid 106
Furosemide 107
References for F 108
G 109
Gabapentin 109
Gentamicin 110
Gliclazide 111
References for G 111
vi Contents
H 112
Haloperidol 112
Hyoscine Butylbromide 113
Hyoscine hydrobromide 114
Hydroxocobalamin 115
Hypromellose 116
References for H 116
I 117
Indapamide 117
Infliximab 118
Insulin 119
Irbesartan 120
Isosorbide mononitrate 121
Isotretinoin 122
References for I 123
K 124
Ketoconazole 124
Ketamine 125
References for K 126
L 127
Lactulose 127
Lamotrigine 128
Lansoprazole 129
Latanoprost 130
Lercanidipine (hydrochloride) 131
Levetiracetam 132
Levothyroxine 133
Levodopa 134
Lidocaine 135
Linagliptin 136
Lisinopril 137
Lithium 138
Loperamide 139
Loratadine 140
Lorazepam 141
Losartan (potassium) 142
Lymecycline 143
References for L 144
M 145
Macrogol 145
Mefloquine 146
Mesalazine 147
Metformin (hydrochloride) 148
Contents vii
Methadone (hydrochloride) 149
Methotrexate 150
Metronidazole 151
Mirtazapine 152
Montelukast 153
Morphine (sulphate) 154
Moxifloxacin 155
References for M 156
N 157
Naproxen 157
Nicotine 158
Nifedipine 159
Nitrofurantoin 160
Nystatin 161
References for N 161
O 162
Olanzapine 162
Omeprazole 163
Oxybutynin (hydrochloride) 164
Reference for O 164
P 165
Paroxetine 165
Perindopril (arginine) 166
Phenoxymethylpenicillin 167
Phenobarbital 168
Phenytoin 169
Pravastatin (sodium) 170
Prednisolone 171
Pregabalin 172
Propranolol (hydrochloride) 173
Permethrin 174
References for P 175
Q 176
Quetiapine 176
Quinine (sulphate) 177
Reference for Q 177
R 178
Ramipril 178
Ranitidine 179
Repaglinide 180
Rehydration Salts 181
Risperidone 182
viii Contents
Rituximab 183
Rivaroxaban 184
References for R 185
S 186
Salbutamol 186
Salmeterol 187
Semaglutide 188
Senna 189
Sertraline 190
Sildenafil 191
Simvastatin 192
Sitagliptin 193
Sodium Valproate 194
Solifenacin (succinate) 195
Spironolactone 196
Sumatriptan 197
References for S 198
T 199
Tamoxifen 199
Tamsulosin (hydrochloride) 200
Temazepam 201
Tetracycline 202
Thiamine 203
Tiotropium (bromide) 204
Tolterodine (tartate) 205
Tramadol (hydrochloride) 206
Trimethoprim 207
References for T 208
V 209
Vancomycin 209
Venlafaxine 210
Reference for V 211
W 212
Warfarin (sodium) 212
Reference for W 212
Z 213
Zoledronic Acid 213
Zopiclone 214
Brand Names Index 215
Glossary 222
ix
Foreword
As paramedics, we are entrusted with the immense responsibility of
caring for the health and well-being of those in need. Every day, we
face countless challenges, potentially making split-second decisions
that can have long-lasting effects.
The world of paramedicine continues to evolve at pace, one area
that has changed beyond recognition in the last couple of decades is
the paramedic’s knowledge of pharmacology; no longer is a protocol
approach sufficient. The modern paramedic is expected to under-
stand and navigate the complexities presented by medications
and drugs.
This remarkable book presents a treasure trove of easily accessible
content offering a comprehensive guide to common prescription
medications for paramedics working in a variety of environments.
Within these pages you will find a wealth of information that will
enhance your understanding of prescription medications and
empower you to make informed decisions in this field. This book is a
testament to the author in ensuring that paramedics have access to up
to date and relevant information in this critical aspect of our practice.
What truly sets this book apart is its commitment to accessibility. A
talented artist, Rose has presented the information in a visually
engaging manner, using graphics to enhance comprehension. This
practical approach is suited fabulously to the pragmatic people that
we paramedics tend to be; each medication is presented in a concise
and easily understandable manner, making it accessible even to those
with a limited pharmacological background.
I would like to express my deepest gratitude to Rose, for her dedi-
cation and expertise in compiling this essential resource. Her
x Foreword
commitment to excellence is evident in every page, and her passion for
advancing knowledge and understanding of pharmacology shines
through.
To my fellow paramedics, I encourage you to embrace this text as a
companion on your journey to providing the highest standard of
care. May this book serve as a trusted ally in navigating the complex
arena of medications.
Kirsty Lowery-Richardson, Head of
Education – College of Paramedics
xi
Acknowledgements
Thanks to the team at Wiley for helping me write my first book!
Specifically, I would like to thank Tom Marriott at Wiley for initially
reaching out to me with his idea for this book and Christabel and
Valli for their support during the writing stages. Equally I would like
to thank my partner Harry and loyal wire-haired pointer Marsco for
their pastoral support! Thanks to my mum Fiona Matheson for read-
ing through early drafts for spelling errors just as she used to do for
my school essays and Maya Walker who also lent me sharp eye! Most
importantly, thank you to my students who have helped me get rid of
my imposter syndrome (a bit) and to the students who are reading
this book to try and learn more to support the people they treat.
xii
List of Abbreviations
5HT – Serotonin
ACE – Angiotensin Converting Enzyme
AF – Atrial Fibrillation
AIDS – Acquired Immune Deficiency Syndrome
AKI – Acute Kidney Injury
BPH – Benign Prostate Hyperplasia
CCB – Calcium Channel Blocker
CK – Creatine Kinase
CKD – Chronic Kidney Disease
CKD-EPI – Chronic Kidney Disease Epidemiology Collaboration
CNS – Central Nervous System
COPD – Chronic Obstructive Pulmonary Disease
COX – Cyclo-oxygenase
D2 – Dopamine
DIC – Disseminated Intravascular Coagulation
DMARDs – Disease Modifying Anti-Rheumatic Drugs
DOAC – Direct Oral Anti-Coagulant
DPP-4 – Dipeptidyl Peptidase 4
DRESS – Drug Reaction with Eosinophilia and Systemic Symptoms
DVLA – Driving and Vehicle Licensing Agency
DVT – Deep Vein Thrombosis
ECG – Electrocardiogram
FBC – Full Blood Count
GERD – Gastro-oesophageal Reflux Disease
GSL – General Sales List
H@H – Hospital at Home
INR – International Normalised Ratio
JIC – Just In Case
List of Abbreviations xiii
LDL – Low Density Lipoproteins
LFT – Liver Function Tests
MHRA – Medicines and Healthcare Products Regulatory Agency
NG – Nasogastric (tube)
NJ – Nasojejunal (tube)
NSAID – Non-steroidal Anti-inflammatory Drug
OCD – Obsessive Compulsive Disorder
P – Pharmacy
PC – Palliative Care
PCOS – Polycystic Ovary Syndrome
PE – Pulmonary Embolism
PEG – Percutaneous Endoscopic Gastrostomy (tube)
PGD – Patient Group Directive
POM – Prescription Only Medicine
PPCI – Primary Percutaneous Coronary Intervention
PRN – ‘pro re nata’ (take as required)
QRS – QRS Complex of Electrocardiogram
RAAS – Renin Angiotensin Aldosterone System
RIG – Radiologically inserted gastrostomy (tube)
SCARs – Severe Cutaneous Adverse Reactions
SLE – Systemic Lupus Erythematosus
SNRI – Serotonin and Noradrenaline reuptake inhibitor
STEMI – ST-Elevation Myocardial Infarction
T2DM – Type 2 Diabetes Mellitus
TIA – Transient Ischaemic Attack
URTI – Upper Respiratory Tract Infection
VT – Ventricular Tachycardia
xiv
Introduction
‘Have You Recently had a Change in Your
Medications?’
This is one of my favourite questions to ask a patient. Mainly in the
hope that I can use some pharmacological detective skills to find a
medication that is causing their symptoms (Figure 1). Maybe their
new blood pressure medication is the reason they are feeling dizzy
when they stand up? Maybe their insulin dose is causing them to suf-
fer regular hypoglycaemic events? Has their steroid inhaler caused
their oral thrush? Has their lidocaine patch sent them into an
arrhythmia?
As paramedics, we have a unique knowledge of medications. We
have the medications that we are privileged to provide people in an
emergency through Schedule 17 and 19 of the Human Medicines
Regulation 2012 and then some more that are mutually agreed to be
beneficial and included in guidelines from the JRCALC or as a
Patient Group Directive. As the role of the paramedic has devel-
oped from primarily a transport service to a mobile medical centre,
we have developed into expert generalists in urgent and emer-
gency medicine. The role of the paramedic has been less of an
emerging profession but an exploding one with a dramatic change
in the demands on the profession over the last few decades.
However, a lot of this learning is done post-qualification. Education
can still be focused on trauma and life-threatening calls of which the
latter is now well expected to make up only 10% of our workload [1].
The other 90% of calls we attend don’t always align to our training.
This can leave both new and experienced clinicians to suffer from
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Figure 1 Ambulance call-outs due to medicines can be grouped into different categories which can hide behind
common presentations that we might not consider to be related to a person’s medication.
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xvi Introduction
regular bouts of uncertainty which when repeated can contribute to
burnout [2]. The role of the paramedic involves attending more and
more people with urgent presentations and chronic disease which
has resulted in paramedics needing a more rounded knowledge of
prescription medicines despite this not classically being part of the
curriculum for paramedics. That is where I am hoping this book
comes in useful, as an easy-to-use resource to familiarise ambulance
clinicians with commonly prescribed medications. The list of medica-
tions used includes the top prescribed medications in England [3] but
with a greater focus on medications in a primary care setting as these
are more commonly encountered by ambulance clinicians in the pre-
hospital environment.
Due to my location and training, this book focuses on UK-based
practice and legislation. However, in the main list, the drug names
have been used rather than brand names and many of the uses, side
effects and data will still be applicable elsewhere in the world. This
pocketbook aims to provide an additional reference for ambulance
staff and other non-prescribers in order to familiarise themselves
with commonly prescribed medications. It is not meant to be used as
an alternative to the British National Formulary (BNF) or a discus-
sion with a prescriber.
References
1 The Nuffield Trust. Ambulance Response Times [internet]. 2023. The Nuffield Trust:
London. [cited 2023 08 29]. Available at: https://www.nuffieldtrust.org.uk/
resource/ambulance-response-times
2 Alzahrani, A., Keyworth, C., Wilson, C. and Johnson, J. Causes of stress and poor
mental wellbieng among paramedic students in Saudi Arabia and the
United Kingdom: a cross-cultural qualitative study BMC Health Serv Res 2023 5
(23). [cited 2024 03 15]. Available at: https://doi.org/10.1186/s12913-023-09374-y
3 Audi, S., Burrage, DR., Lonsdale, DO., Pontefract, S. Coleman, JJ., Hitchings,
AW. and Baker, EH. The ‘top 100’ drugs and classes in England: an updates ‘starter
formulary’ for trainee prescribers Br J Clin Pharm 2018 84 (11) p2562–2571. [cited
2023 06 01]. Available at: https://doi.org/10.1111/bcp.13709
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1
Drug Legislation and Paramedic Practice
Paramedics are able to administer several medications to patients
autonomously, meaning without a discussion with a prescriber, but
these medications do not all fall under the same legislation.
Schedule 19 of the Human Medicines
Regulations 2012
These are medications that anyone can administer in an emer-
gency [1]. This is why anyone can give an EpiPen® to someone suf-
fering from suspected anaphylaxis and there is increasing training in
‘Take Home Naloxone’ for opiate overdoses. Medications under
this legislation include:
● Adrenaline 1:1000 up to 1 mg for intramuscular use in anaphylaxis
● Atropine sulphate and obidoxime chloride injection
● Atropine sulphate and pralidoxime chloride injection
● Atropine sulphate injection
● Atropine sulphate, pralidoxime mesylate and avizafone injection
● Chlorphenamine injection
● Dicobalt edetate injection
● Glucagon injection
● Glucose injection
● Hydrocortisone injection
● Naloxone hydrochloride
● Pralidoxime chloride injection
● Pralidoxime mesylate injection
● Promethazine hydrochloride injection
Paramedic Pocketbook of Prescription Medications, First Edition. Rose Matheson.
© 2024 John Wiley & Sons Ltd. Published 2024 by John Wiley & Sons Ltd.
