Chapter 12

1. Chapter 12 General Pharmacology Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

2. Topics 12 • Administering medications • Medications carried on the EMS unit • Medications prescribed by a physician • Medication names • Routes of administration Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

3. Topics 12 • Medication forms • Essential medication information • Key steps in administration • Reassessment strategies • Sources of medication information Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

4. Introduction 12 • As an EMT, there will be situations in which you administer, or help in the administration of, certain medications to the patient Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

5. Administering Medications 12 • Pharmacology • This refers to the general study of the interactions between a drug and the body • Medication • Is generally defined as a substance used as a remedy for an illness • Generally, the term “medication” and “drug” are used interchangeably Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

6. Medications Carried on the EMS Unit 12 • Medications you carry on the ambulance with you: • Activated charcoal • Oral glucose • Oxygen • Aspirin Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

7. Medications Prescribed by a Physician 12 • Medications prescribed by a physician, that the EMT may help in the administration of: • Prescription inhaler • Nitroglycerin • Epinephrine Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

8. Medication Names 12 • Medications can have up to four names. • Chemical name: name describing chemical structure • Generic name: nonproprietary name, similar to chemical name • Trade name: brand name, for marketing purposes • Official name: official name, followed by U.S.P. or N.F. http://www.usp.org/ Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

9. Medication Names 12 • Chemical name: • 1,2,3-propanetriol trinitrate • Generic name: • Nitroglycerin tablets • Trade name: • Nitrostat® • Official name: • Nitroglycerin tablets, U.S.P. Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

10. Routes of Administration 12 • The route of the medication refers to how the patient is to take it, or the EMT to administer it Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

11. Routes of Administration 12 • Oral • This route allows the medication to be absorbed across the membranes of the stomach and/or the intestinal tract Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

12. Routes of Administration 12 • Sublingual • The mucous membranes beneath the tongue are highly vascular, and can absorb medication readily • When using this route, remind the patient not to chew or swallow the medication Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

13. Routes of Administration 12 • Inhalation • Upon inhalation, the medication is absorbed across the respiratory tract • The key when using this route is assuring the patient has an adequate tidal volume so that they inhale the medication deep into the pulmonary tree Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

14. Routes of Administration 12 • Injection • Refers to the deposition of the medication into the tissues • Since a needle is employed to inject the medication, the EMT must exercise extreme caution Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

15. Medication Forms 12 • Medications come in several different forms • Common forms include: • Tablets, liquid, gels, suspensions, fine powder for inhalation, gases, sprays, and nebulized liquids Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

16. Medication Forms 12 • Compressed powder or tablet • A compressed powder that is formed into a small disk or elongated shape Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

17. Medication Forms 12 • Liquid for injection • A liquid substance with no particulate (undissolved) matter The epinephrine auto-injector may be prescribed for patients with a history of severe allergic reaction. Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

18. Medication Forms 12 • Gel • A viscous substance that the patient could swallow so that the mucous membranes of the GI tract could absorb it Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

19. Medication Forms 12 • Suspension • Undissolved drug particles that are mixed in a liquid base • Since the medication does not dissolve, you must thoroughly mix it prior to administration Activated charcoal comes in suspension form and is carried on the EMS unit. It is used in poisoning and overdose emergencies. Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

20. Medication Forms 12 • Fine powder for inhalation • A crystalline form of the medication that is mixed with a liquid to form a suspension • Medication gets absorbed across the pulmonary tract A metered-dose inhaler with a spacer may be prescribed for respiratory conditions. Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

21. Medication Forms 12 • Gas • A non-liquid, non-particulate medication that is inhaled and readily absorbed across the pulmonary tract (alveoli) Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

22. Medication Forms 12 • Spray • A liquid medication can be deposited (or sprayed) under the tongue for absorption. Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

23. Medication Forms 12 • Liquid/vaporized fixed-dose inhaler • A nebulizer is a device that uses compressed gas, usually oxygen, that is forced into a small chamber containing the liquid drug • As the gas mixes with the liquid and exits the chamber, it vaporizes the medication to allow the patient to then inhale it Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

24. Essential Medication Information 12 • As stated earlier, the EMT must be intimately familiar with the drugs you will be administering • Knowing certain terms will allow you to better understand the drugs, and thus, use them appropriately Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

25. Essential Medication Information 12 • Indications • This defines what clinical setting the use of the drug is intended for • It is anticipated that the administration of the drug will improve the patient’s clinical condition Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

26. Essential Medication Information 12 • Contraindications • This refers to specific clinical conditions in which the drug was going to be used, but cannot due to some other coexisting problem • The term contraindication does not apply if the drug was never appropriate Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

27. Essential Medication Information 12 • Dose • The dose refers to the amount of drug to be administered • Adults and pediatrics may have two different doses of the same drug Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

28. Essential Medication Information 12 • Administration • This refers to the route in which the dose of the indicated medicine is to be given • The EMT will be using the inhalation, oral, sublingual, and injection routes Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

29. Essential Medication Information 12 • Actions • These are the effects of the drug on the body • Medications modify what certain cells or organs of the body do, in order to correct or prevent some abnormality • Also known as the “mechanism of action” Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

30. Essential Medication Information 12 • Side effects • Some medications, despite their ability to correct one abnormality, may cause a disturbance elsewhere in the body • The side effects generally are tolerated by the patient, and are predictable if you understand the drug’s actions Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

31. Key Steps in Administering Medications 12 • Obtain an order from medical direction • All medications administered by the EMT are done so only with permission of your medical director Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

32. Key Steps in Administering Medications 12 – Example of on-line medical direction for medication administration Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

33. Key Steps in Administering Medications 12 • Select the proper medication • The EMT’s responsibility next is to select the appropriate medication for the clinical situation • If the medication belongs to the patient, and you are permitted to administer it, be certain the drug is prescribed to the patient Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

34. Key Steps in Administering Medications 12 • Verify the patient’s prescription • You must CLEARLY assure the medication you are about to administer is prescribed to your patient specifically Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

35. Key Steps in Administering Medications 12 • Check the expiration date • All medications, eventually, deteriorate to the point they are ineffective • Because of this, there will be an expiration date printed on the drug packaging, or on the prescription label Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

36. Key Steps in Administering Medications 12 • Check for discoloration or impurities • Some medications may discolor, become cloudy, or have visible particulate matter should they become contaminated Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

37. Key Steps in Administering Medications 12 • Verify the form, route, and dose • Be certain the drug form is appropriate for the route selected during administration • Also verify that the prescribed dose of the drug matches the medical direction given when administering that drug Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

38. Key Steps in Administering Medications 12 • The “Five Rights” • Right patient • Right medication • Right route • Right dose • Right date Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

39. Key Steps in Administering Medications 12 • Documentation • Once administered, document the drug given along with its dose, route, and time it was administered Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

40. Reassessment Strategies 12 • Following administration of a medication, perform an ongoing assessment to note any changes • Airway, breathing, and circulation • Repeat vital signs • Document response to interventions Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

41. Sources of Medication Information 12 • Where to find more information: • American Hospital Formulary Service • AMA Drug Evaluation • Physicians’ Desk Reference • Drug package inserts • Poison Control Centers • EMS pocket drug reference guide • ePocrates for the PDA http://www.fda.gov/ http://www.aapcc.org/ http://www.pdr.net/ http://www.epocrates.com/ Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen