In continuing the Prescribing Paramedic series, this article explores the nature of drug actions that occur within the body. An understanding of these principles allows the paramedic to make an informed decision on the medicines that may be offered, the likely outcomes and possible risks. Often considered a complex subject, this article aims to present a set of principles that the reader can apply to almost all drugs that one may encounter. Where appropriate, relevant case studies have been included to support theory and provide contextual examples.