How much emphasis on pharmacology during medic school?

[Chief Complaint]

Just curious how much time you spent learning your medications in your respective programs. I feel like my program spent virtually no time on medications outside of ACLS drugs and a handful of others. We had drug quizzes but they were only for extra credit, and were unbelievably easy to pass.

It was basically up to us to learn on our own time, which doesnt seem to make sense at all. Its a degree program and i expected more. I still have another year of medic school, im currently an Intermediate, but since VA is still on the I-99 standard we have the same scope as a Paramedic. I feel like there should have been MUCH more emphasis on learning our meds as Intermediate students.

How did your programs go about teaching the drugs? Do you feel like you were adequately prepared when you finished school?

 

[Lifeguards For Life]

Just curious how much time you spent learning your medications in your respective programs. I feel like my program spent virtually no time on medications outside of ACLS drugs and a handful of others. We had drug quizzes but they were only for extra credit, and were unbelievably easy to pass.

It was basically up to us to learn on our own time, which doesnt seem to make sense at all. Its a degree program and i expected more. I still have another year of medic school, im currently an Intermediate, but since VA is still on the I-99 standard we have the same scope as a Paramedic. I feel like there should have been MUCH more emphasis on learning our meds as Intermediate students.

How did your programs go about teaching the drugs? Do you feel like you were adequately prepared when you finished school?

We were expected to know everything for every drug used in our county, and some that were not. However, you could memorize these for the test, and if you forgot them no one would ever be the wiser.

With that being said, we were responsible for knowing the indication, dose, side effects, mechanism etc. of all of the cardiac related drugs at all times.

But even then, memorizing mechanisms is not hard, our program placed no importance on actually understanding the mechanisms.

 

[Handsome Robb]

We have quizzes every day on the subject that was covered the day before as well as pharmacology. To start out it was blatant memorization, now were are expected to know, understand and retain said understanding of the mechanism of medications that were covered in the lecture.

 

[STXmedic]

Our "pharmacology class" was a joke. We learned the basics of neurology, then they said, "Here, learn these." Never even tested on them. The only ones that we really learned were the cardiac drugs, and that was learned in cardiology. Self-study is where it's at

 

[Iceman26]

The first four months of my medic program were A&P and pharmacology. We didn't even touch our paramedic text book. We had quizzes every week on the drugs up until we were almost done with the entire program.

They had a really effective system in place to learn the drugs, I'll explain the best I can. It's a simple system but hard to explain.

In Arizona we had 36 drugs to learn, and they were divided into six groups of six by our school. The AZ Dept of Health Drug Profiles were given to us which included every characteristic in detail; generic name, brand name, class, mechanism of action, indications, contraindications, adverse effects/reactions, adult dosage, ped dosage, how it's carried i.e. what kind of vials and how much volume/dosage in total, etc, and there are some others I'm not thinking of right now.

The six groups of six drugs were named in category. The first six were 1, the second six were 2, third six 3, etc. up to 6.

All the drug characteristics were divided into four groups, so each group had three to four characteristics. Group 1 was generic name, brand name, and class. Group 2 was adult dosage, ped dosage, indications, contraindications. Group 3 had three others, and Group 4 had the rest.

So your first quiz was 1-1. Group 1 of the drugs, Group 1 of the characteristics. The next week was 2-1. Group 2 of the drugs, Group 1 of the char's. The next week was 3-1 and so on and so on until you get through 6-1.

AFTER 6-1, now you move on to 1-2. Group 1 of drugs, Group 2 of the char's. Except you also had to do Group 1 of the char's again in addition to Group 2. You keep doing this system until you complete 6-4. Group 6 of the Drugs, Group 4 of the characteristics, but you repeat the other Characteristic group's you've already done in addition to the new ones.

It was a great system because you gradually learned little bits at a time, but then had to remember what you already learned in addition to the new stuff. And the quizzes were all written out long hand. You got handed a sheet of paper and had to write everything out long hand and then we'd grade them after the time was up/everyone finished. These were for grades...not extra credit.

My school was very particular about us knowing the drugs in and out and knowing everything about them while in school. Obviously once in the field you forget particular details about some things, but you know what you need to know. Even once the quizzes were done, we then got put on "the hot seat" in front of the class and our instructor would give us scenarios and we had to come up with the correct drugs to use, the dose, why we were using it,etc. Needless to say, we were pretty well versed in our drugs! It was mind-numbing at times (like trying to remember every single mech of action word for word) but it definitely worked out great and I'm glad they did it that way.

Now, I hope I didn't give anyone a seizure from confusing while reading this.

 

[MrBrown]

Paramedic and Intensive Care Paramedic cover pharmacology to the molecular level including cAMP and cellular messaging

Volunteer EMTs cover a more macro-level introduction to the drugs they use eg GTN, ASA, salbutamol

 

[Chief Complaint]

Interesting to see such varying responses, thanks for the replies. Looks like I'm not the only one who has been forced to result to self study. I assumed that they would have done a better job since its a degree program, oh well.

 

[systemet]

I think you always need to self-study anyway. Once you get out of paramedic school, if you want to be more than a protocol-monkey you have to find some sort of way of maintaining that knowledge. It's inevitable that you're also going to find gaps in your training, no matter how good a reputation your program has.

It's not like the field stays the same either. There's always going to be some new intervention or change in the standard of care. Most medic programs are so short that it's really hard to prepare someone at an acceptable theoretical level, anyway.

Sometimes the understand a student can get of pharmacology is also limited by their background in physiology. For example, if someone really wants to understand how nitroglycerin works, they need to have an appreciation for how the endothelium synthesises nitric oxide, how the smooth muscle cell handles calcium at the membrane and sarcoplasmic reticulum, how cGMP is synthesised, and broken down (sidebar to phosphodiesterase inhibitors, like viagra), how myosin light chain phosphorylation is regulation, and how this affects contraction and how cGMP-dependent protein kinase modulates these processes. Then you also need some understanding of hemodynamics, understanding of the Frank Starling law, an appreciation for coronary circulation, collateral flow, autoregulation, coronary steal, preload, afterload, myocardial oxygen consumption, and tachyphylaxis. Add to that an ability to interpret the 12/15/whatever-lead ECG, identify and manage RVI, etc.

Depending on the program some, or all, of that information may be covered -- but in most programs at least some of that's going to be lacking. Unfortunately most medic programs follow a process of rote memorisation of standard drug classes and dosages, without attempting to explain how the inividual medications work. Let alone trying to really survey the field of pharmacology and explain how common prescription and nonprescription drugs act.

I remember taking university pharmacology courses and being suprised at how uneven my knowledge of pharmacology was. I had a pretty good understanding of antiarrhythmics -- we'd even talked about cardiac action potentials, pacemaker potentials, Vaughan-Williams classification, and just touched on beta-1 mediated cAMP-dependent second messaging (just enough to understand glucagon as an inotrope). I was ok with neuromuscular blockers, had some understanding of autonomic nervous system pharmacology, etc. But I knew virtually nothing about chemotherapy agents, antibiotics, endocrine system pharmacology, etc. I think we don't tend to get either a deep enough or a well-rounded education in pharmacology as a science.

 

[phideux]

For 1 semester we were given 3 new drugs every week, times 16 weeks, 48 drugs total. We had drug test twice a week. Each test was on 3 drugs chosen at random. We had to know:
Indications
Administration route
Adult dose
Peds Dose
Effect
Contraindications
Side Effects

That same semester we also did Cardiology/EKG

 

[Frozennoodle]

Paramedic and Intensive Care Paramedic cover pharmacology to the molecular level including cAMP and cellular messaging

Volunteer EMTs cover a more macro-level introduction to the drugs they use eg GTN, ASA, salbutamol

When you discussed cAMP did you go into Funny Current and it's role in regulating heart rate? How in depth did you get into the physiology of the ion channels?

 

[Sodapop]

Weekly tests

The program I am in has all of the drugs in the national scope split into 8 groups. Initially we had one group a week to study and would be tested on 2 random drugs from that group. Once we went through all 8 groups we started over and had 2 groups per week with one drug from each group that would be tested. the tests are random so we do not know which of the 10 - 12 drugs it will be.

For these drugs we have to know the classification, pharmacology and actions, Indications, 2 contraindications, 2 side effects, doses and route. When we reach the pedi section will will also have to know the pedi dose.

In addition to this we have 12 groups of "home meds" which are drugs that are commonly seen in a patients home. Each group has 12-16 medications listed and we are tested on 6 of them randomly. After one time through we get 2 weeks worth to be responsible for. Again they select the ones to test randomly so we have to know them all or lose points on the tests. For these we only have to know the classification and what it is used for.

And these tests are not matching or multiple choice they are handwritten all we get is a page with the drug name on it and a section for each thing we have to write it. At the beginning these are worth 30 points and at about mid way through they switch to be worth 18 points, one point for each section. So if you list 4 indications for a drug and forget one you get it wrong and no point for that section. If a drug has several routes/doses and you forget to list one or do not specify IV, IM, etc another lost point.

It can be very frustrating but it also makes us study our medications every week and we have that test even if there is a major exam or ACLS or another class going at the same time.

(we also got medical math quizzes, & ECG quizzes weekly when doing those areas and many times we get one as a pop quiz along with a drug quiz or other exam. It is rare that we ever have just one test if we are taking one we usually expect something else to be dropped on us too)

 

[FreezerStL]

My program's pharmacology portion was split into four tests covering 48 medications.

Each test was a blank sheet of paper with either a trade name or generic name listed at the top.

From there we had to complete:

Trade name
Generic names
Dosage
Class
Action
Indications
Contraindications
Adverse effects
Onset
Duration
Half life
Preg. Class

Worst thing was, If you got below a 75% on any test you were dropped from the program.

 

[Iceman26]

The program I am in has all of the drugs in the national scope split into 8 groups. Initially we had one group a week to study and would be tested on 2 random drugs from that group. Once we went through all 8 groups we started over and had 2 groups per week with one drug from each group that would be tested. the tests are random so we do not know which of the 10 - 12 drugs it will be.

For these drugs we have to know the classification, pharmacology and actions, Indications, 2 contraindications, 2 side effects, doses and route. When we reach the pedi section will will also have to know the pedi dose.

In addition to this we have 12 groups of "home meds" which are drugs that are commonly seen in a patients home. Each group has 12-16 medications listed and we are tested on 6 of them randomly. After one time through we get 2 weeks worth to be responsible for. Again they select the ones to test randomly so we have to know them all or lose points on the tests. For these we only have to know the classification and what it is used for.

And these tests are not matching or multiple choice they are handwritten all we get is a page with the drug name on it and a section for each thing we have to write it. At the beginning these are worth 30 points and at about mid way through they switch to be worth 18 points, one point for each section. So if you list 4 indications for a drug and forget one you get it wrong and no point for that section. If a drug has several routes/doses and you forget to list one or do not specify IV, IM, etc another lost point.

It can be very frustrating but it also makes us study our medications every week and we have that test even if there is a major exam or ACLS or another class going at the same time.

(we also got medical math quizzes, & ECG quizzes weekly when doing those areas and many times we get one as a pop quiz along with a drug quiz or other exam. It is rare that we ever have just one test if we are taking one we usually expect something else to be dropped on us too)

I think that's a really good idea. I obviously learned quickly in my ride-time what a lot of the more common prescription meds are and what they are for and have continued to learn, but I don't think it would've hurt to get a head start on them in school like that. Though that's easy to say now that I'm done. The last thing I wanted back then was MORE drugs to learn! Ha. In the meantime I have the Epocrates app on my phone which is great. You can type in the name of any drug out there and it'll tell you what it's for.

 

[RealMedic]

Pharmacology

A great reference and study guide for Pharmacology is :
Goodman & Gilman's The Pharmacological Basis of Therapeutics
The new 12th edition is out but a 10th edition will do fine.(& it's cheaper) This is a must have for all medical folks I think no matter what your training/background.
RM