Fundamentals of Pharmacology for Paramedics

The range of drugs covered within these additional resources is far broader than the JRCALC Guidelines and may therefore be used by paramedics to develop their knowledge and understanding in relation to broader medications, a patient’s medical history, other uses of drugs, drug interactions and contraindications as well as cost. Postqualified paramedics going on to undertake non‐medical prescribing courses and clinical roles will need to be more familiar with these additional resources, which include the following.

British National Formulary (BNF)

Children’s British National Formulary (CBNF)

Monthly Index of Medical Specialities (MIMS)

Electronic Medicines Compendium

For an excellent guide to the British National Formulary and other resources, we recommend you refer to Pryor and Hand (2021).

Assembled by the Joint Formulary Committee, this is a reliable resource of information on medication. It includes drug information covering individual medication, groups of medication, uses, side‐effects and interactions (Young and Pitcher, 2016). The information provided is evidence informed from drug manufacturer/supplier datasheets, literature, consensus guidelines and peer review. The BNF makes use of a grading system of A–E and levels of evidence to help understand the strength of evidence underpinning the associated recommendations given (Joint Formulary Committee, 2019). The BNF is available in hard copy for both the Adult (BNF 2020a) and Children’s (BNF 2020b) versions. The resources can also be accessed as a mobile app or online (bnf.nice.org.uk/).

Medication listed within pharmaceutical and prescribing guidance documents can be presented with a generic and brand or trade name. The generic name is used to define:

The chemical name of a medication

A term referring to the chemical make‐up of a medication rather than to the advertised brand name under which the medication is sold

A term referring to any medication marketed under its chemical name without advertising

The medication’s active ingredient.

The brand or trade name of a medication is the name given by the pharmaceutical company that manufactures it. It is usually easy to write and say for sales and marketing purposes. An example of this is paracetamol (generic name) which can have the following brand or trade names: Panadol, Calpol.

The brand or trade name is often written more clearly on a medicine’s packaging; the generic name will also be written somewhere on the packaging but often in small print. It is also not uncommon to find that some packaging only has the generic name on it.

The production of a given generic medication by individual manufacturers using a different brand or trade name can also result in a medication being presented differently. Examples of this can include a variation in the colour, size and shape of a given medication depending on which company makes it. The paramedic needs to be vigilant and aware of this potentially dangerous issue. It may be that the pharmacist supplying an ambulance service or the patient with a given drug is getting it from a different company, or the prescription has been written in a generic way rather than using a brand name. Paramedics must take great care to check and ensure that any medication to be administered is the correct medication.

As you progress through your clinical experience and paramedic career, especially within the primary care setting, you may also come across the MIMS prescribing guide ( www.mims.co.uk/). This is an up‐to‐date prescribing reference for healthcare professionals. MIMS is updated constantly online, to reflect the latest approved prescribing information, along with the addition of new drugs and formulations, and also removes products that are no longer available. MIMS is primarily intended for use by GPs and healthcare professionals undertaking advanced roles working within primary care. All prescribing healthcare professionals wishing to access this resource, including paramedics, will need to subscribe to MIMS to access either the online version or the quarterly print edition.

MIMS is a helpful prescribing resource and provides:

News on changes that affect medicines and prescribing

Drug information for branded and generic products, updated daily

At‐a‐glance drug comparison tables including dosing and monitoring regimens, available presentations, prices, potential sensitisers and compatible devices

Quick‐reference summaries of key clinical guidance from authoritative national bodies including NICE and the Scottish Intercollegiate Guidelines Network (SIGN)

Online drugs shortages tracker showing branded and generic medicines that are out of stock

Online visual guides to help you identify, compare and recommend diabetes and respiratory administration devices.

The EMC contains up‐to‐date, easily accessible information about medicines licensed for use in the UK. It can be found at: www.medicines.org.uk/emc. The EMC contains more than 14 000 documents, which have been checked and approved by either the UK or European government agencies which license medicines. These agencies are the UK Medicines and Healthcare Products Regulatory Agency (MHRA) and the European Medicines Agency (EMA). The EMC is updated continually and you can browse for medicines or active ingredients using the A–Z buttons. The EMC contains regulated and approved information on medicines available in the UK including the following.

Summaries of Product Characteristics (known as SPCs or SmPCs) : an SmPC informs healthcare professionals how to prescribe and use a medicine correctly. It is based on clinical trials that a pharmaceutical company has carried out and gives information about dose, use and possible side‐effects. A SmPC is always written in a standard format.

Patient Information Leaflets (PILs, Package Leaflets or PLs) : a PIL is the leaflet included in the pack with any medicine. The PIL is a summary of the SmPC and is written for patients.

Risk Minimisation Materials (RMMs) : RMMs are resources for healthcare professionals which aim to optimise the safe and effective use of a medicine. RMMs can come in a number of forms, such as educational programmes, prescribing or dispensing guides, patient brochures or alert cards.

Safety Alerts : these are issued by the regulator and/or marketing authorisation holder and contain important public health messages or safety‐critical information about a medicine.

Product Information : this is any additional information about a product. It may include important information such as change of packaging or issues related to stock levels.

Within the EMC there are audio and video resources that provide additional information in a user‐friendly format, promoting the safe and effective use of a medicine. For example, a video clip may demonstrate how to administer a certain medicine correctly.

This chapter has provided an overview of the main pharmaceutical and prescribing reference guides used within paramedic practice. Guidance has been given to encourage you to start to navigate the JRCALC Guidelines in hard‐copy, digital and app format. This guidance will help to ensure you know where to find all the information needed about a medicinal product or device to guide safe and effective paramedic practice. The differences between paper‐based and online versions have been highlighted to ensure you are aware where to access the most up‐to‐date and accurate drug information. An introduction to additional resources has also been given.