Ch. 16: General Pharmacology Flashcards
pharmacology
the study of drugs, their sources, their characteristics, and their effects.
Six medication you can administer or assist with
aspirin, oral glucose, oxygen, activated charcoal, bronchodilator inhalers, nitroglycerin, epinephrine auto-injectors, naloxone, force protection medications
Asprin
Indications:
-Relieve headache or treat a fever
-Chest pain of a suspected cardiac origin
□ Reduces the blood’s ability to clot and works to prevent clot formation that causes damage to the heart
§ Since no water, EMS carry chewable children’s aspirin (oral)
Contradictions: Allergy & Gastrointestinal bleeding
Oral Glucose
§ Sugar than can be taken by mouth by a conscious person with the ability to swallow
§ Tube of gel that you can apply to a tongue depressor and place between the patient’s cheek and gum or under the tongue. This allows the patient to swallow the glucose so it can be easily absorbed into the digestive tract and bloodstream, which carries it to the brain
Oxygen
§ Gas
§ a drug to treat any patient whose medical or traumatic condition causes him to be hypoxic (low in oxygen) or in danger of becoming hypoxic
activated charcoal
§ powder prepared from charred wood, usually premixed with water to form a slurry for use in the field
§ treat a poisoning or overdose when a substance is swallowed and is in the patient’s digestive tract. Activated charcoal will absorb some poisons (bind them to the surfaces of the charcoal) and help prevent them from being absorbed by the body
Bronchodilator Inhalers
§ Asthma, emphysema, or chronic bronchitis
§ a medication designed to enlarge constricted bronchial tubes, making breathing easier
§ Carried in an inhaler
§ have an effect on the heart, an increased heart rate and patient jitteriness are common side effects of treatment.
You may need to have permission from medical direction to help a patient self-administer a prescribed inhaler. This permission from medical direction may come by phone or radio, or there may be a standing medical order that permits you to assist a patient with this kind of medication
Nitroglycerin
§ a drug that helps to dilate the coronary vessels, which supply the heart muscle with blood. It is often called just “nitro.” A common trade name is Nitrostat.
§ People with problems such as recurrent chest pain or a history of heart attack carry
§ Pill or spray
§ Many patients are instructed by their physician to take up to three nitroglycerin pills for their chest pain and, if the chest pain persists, to call EMS.
§ Sometimes patients forget about them
§ Must be patients not family or friends
§ determine whether the patient has recently taken anything to treat erectile dysfunction, such as sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), or similar medication. If so, he should not take nitroglycerin because of the possibility of serious negative interaction with these drugs
Epinephrine Auto-Injectors
§ For allergies such as shellfish, penicillin, or a bee sting, he may have a very severe reaction that may cause life-threatening changes in the airway and circulation
§ Epinephrine helps constrict the blood vessels and relax airway passages reversing the allergic reaction
§ increased heart rate and blood pressure commonly occur after its administration to the patient
§ Life-threatening in short periods of time
§ Brands
□ Epi-Pen® is the trade name of a commonly carried epinephrine auto-injector.
□ Auvi-QTM is the trade name of an epinephrine auto-injector that gives voice instructions for its use.
□ Twinject® is the trade name of an auto-injector that contains two doses of epinephrine.
If you need to assist a patient with the use of an epinephrine auto-injector, be sure to determine that the auto-injector is actually the patient’s and not that of someone else.
Naloxone
§ When someone takes too much of a narcotic, the person can lose consciousness, become unable to protect the airway and, most important of all, go into respiratory failure with slow, shallow breathing leading to respiratory arrest
§ Naloxone = Narcan reverses the effects of narcotics very quickly
§ Usually injected also very effective as fine nasal spray
§ Will have no effect on someone just in respiratory distress
Even if a patient has taken a narcotic, if the mucous membranes are damaged or blocked, intranasal administration will not work and you will need to use your airway management skills
Atropine
autoinjectors to treat responders in the event of a chemical weapons attack such as nerve gas
§ Be administered to yourself and your partner
Three names of drugs
the generic name, chemical name, trade/brand name
indications
specific signs, symptoms, or circumstances under which it is appropriate to administer the drug to a patient
contraindications
specific signs, symptoms, or circumstances under which it is not appropriate and may be harmful to administer the drug to the patient
Side effects
any action of a drug other than the desired action
□ Some wide side effects are predictable.
unintended effects
effects that occur in addition to the specific reason the drug was administered
untoward effects
not only unexpected but also potentially harmful to the patients (a type of unintended effect)
Routes of administrations
oral, sublingual inhaled or breathed into lungs intranasal or sprayed into the nostrils intravenous or injected into the vein intramuscular or injected into a muscle subcutaneous or injected under the skin intraosseous or injected into the bone marrow cavity endotracheal or sprayed directly into a tube inserted into the trachea
The five rights of medication administration
- right patient
- right time
- right medication
- right dose
- route of administration
pharmacodynamics
the study of the effects of medications on the body.
- Pediatric patient will require less medication
- geriatric patients will have difficulty eliminating medications and therefore feel the effects of medications longer
Physician’s Desk Reference (PDR)
additional information about a patient’s medication
○ remember that your main purpose in finding out what medications the patient is taking is not to make a field diagnosis but to report this information to the medical direction and hospital personnel
Maintaining an IV
§ The constricting band used to raise the vein for insertion of the needle may have been mistakenly left on the patient’s arm, perhaps covered by a sleeve.
§ The flow regulator may be closed.
§ The clamp may be closed on the tubing.
§ The tubing may kink.
§ The tubing may get caught under the patient or the backboard.
○ Adjusting, or even splinting, the arm may be helpful as long as the splint is not too tight. Since the IV flow usually depends on gravity, be sure that the bag is held well above the IV site and the patient’s heart.
○ Insufficient flow can cause blood to clot in the catheter. This can be prevented by adjust- ing the flow to an adequate “keep the vein open,” or KVO, rate.
§ KVO varies
□ 30 drops per min. for a micro drip
□ 10 drops per min. for a macro drip
○ If the drip chamber is overfilled, clamp the tubing, invert the drip chamber, and pump some fluid back into the bag.
An infiltrated IV is one where the needle has either punctured the vein and exited the other side or has pulled out of the vein. In either case, the fluid is flowing into the sur- rounding tissues instead of into the vein. An unnoticed infiltrated IV can be very dangerous
6 rights of Oxygen
indication: Shortness of breath, hypoxia, signs of ischemia secondary to hypoxia, SpO2 < 94% contraindication: none action: Increases SpO2 by increasing FiO2 dose: depends on device route: inhaled/gas side effects: Can dry the mouth and mucus membranes special consideration: If not needed do not give oxygen just to do something, can cause harm in the setting of MI or CVA Med Control: standing order
Dose: Nasal Cannula
2-6 liter per minute (~4)
dose: simple facemask
6-10 liter per minute
dose: nebulizer
6-8 l/min (8 for albuteral)
dose: non-rebreather
10-15 l/min (15)
dose: bag valve mask
15-25 l/min
6 rights of albuterol (MDI)
indications: Wheezing or
Respiratory Distress due to Reactive Airway Disease
contradictions: Unable to use,
maximum dose reached, no Rx
actions: Bronchodilation as a beta-2-agonist leading to smooth muscle relaxation
dose: Number of puffs as
described in patient’s
prescription (usually
one to two puffs)
route: inhaled aerosol
side effects: tachycardia, tremors, anxiety
Special consideration:
medical control: 1st standing order; subsequent are online
6 rights of albuterol (nebulizer)
indications: Respiratory Distress due to RAD and Rx for
medications
contradictions: Age <6 months,
cardiac disease history
actions: Bronchodilation as a beta-2-agonist leading to smooth muscle relaxation
dose: 2.5mg in 3mL of saline
(adult), 1.25mg in 3mL of saline (pediatric)
route: inhaled/mist
side effects: tachycardia, tremors, anxiety
Special consideration: Contact ALS for intercept, Pediatric
for this medication is considered < 2 years old
medical control: standing order
6 rights of Atrovent (nebulizer)
indications: Respiratory Distress due to RAD and Rx for
medications
contradictions: Age <6 months,
cardiac disease history
actions: Nonselective muscarinic antagonist, works as a parasympatholytic on the smooth bronchial muscles preventing further bronchospasm
dose: 0.5 mg in 3 mL of saline (adult), 0.25 mg in 3 mL of saline (pediatric)
route: inhaled/mist
side effects: Dizziness, headache, and palpitations
Special consideration: Contact ALS for the intercept, pediatric patients are considered < 2 years old, has a synergistic effect with albuterol when paired
medical control: Standing order
6 rights of epinephrine auto-injector
indications: Primary treatment for anaphylaxis, secondary treatment for severe respiratory distress
contradictions: none
actions: Effects all adrenergic receptors to increase HR,
bronchodilation, and vasoconstriction
dose: 0.3mg for >25kg (55lbs), 0.15mg for <25kg
route: Intramuscular/Liquid/Auto-Injector
side effects: Tachycardia, anxiety,
hypertension, site pain
Special consideration:
medical control: Second pediatric dose is online, doses for bronchospasm are online as well
6 rights of aspirin
indications: Chest Pain or other
symptoms indicative of Acute Coronary Syndrome
contradictions: Hypersensitivity,
Active GI Bleed
actions: Cox-1 / Cox-2 Inhibitor leading to the decreased platelet aggregation and inflammation
dose: 162 - 324mg (2 or 4 x
81mg), if patient on daily aspirin bring dose to 324 mg
route: PO (Oral) / Pill
side effects: nausea, heartburn
Special consideration: Make sure the patient chews
medical control: standing order (will never exceed 324 mg)
6 right of nitroglycerin
indications: Chest Pain or other symptoms indicative
of Acute Coronary Syndrome
contradictions: SBP<120, PDE-5 taken in the last 48 hours
actions: Converted to nitrous oxide leading to vasodilation and decreased preload
dose: 0.4mg (1 tab or spray)
max. of three doses 5 minutes apart
route: Sublingual / Pill or Spray
side effects: Hypotension, headache, turning flush, syncope
Special consideration: Ask both men and women about
PDE-5 meds (viagra)
medical control: Standing Order
6 rights of oral glucose
indications: Altered mental status with BGL < 70 mg/dL
contradictions: Patient cannot
swallow
actions: Increases available blood glucose for cells to uptake
dose: One tube, may repeat
after 10 minutes Pedi dose 0.5mg/kg to max of 1 tube
route: Buccal / Tab or Gel
side effects: hyperglycemia
Special consideration: Hypoglycemia can present with
seizures, contact medical control if patient is suspected to have a CVA
medical control: Standing Order, may repeat after 10
minutes if symptoms persist
6 rights of glucagon
indications: Altered mental status with BGL < 70 mg/dL,
patient unable to swallow
contradictions: none
actions: Promotes the breakdown of glycogen from the liver to allow for more glucose molecules to circulation in the blood
dose: 1 mg
route: intramuscular/liquid
side effects: hyperglycemia
Special consideration: Not going to be effective in patients
with depleted glycogen stores such as chronic alcoholics
medical control: Standing Order
6 rights of Naloxone
indications: Respiratory depression with decreased LOC
contradictions: none
actions: Competitively binds to mu receptors removing opioid from receptors
dose: 0.4 mg IM & 2-4mg IN depending on delivery system,
may repeat once
route: Intranasal or
Intermuscular
side effects: Vomiting,
weakness, combative behavior
Special consideration: Use in conjunction with airway
management/ allow medication time to work before redosing, consider police presence for when patient awakes
medical control: Standing Order
6 rights of activated charcoal
indications: Poisoning via ingestion with confirmed < 4
hrs. since ingestion
contradictions: Unable to swallow, poisoning was done
with caustic substance, heavy
metal, or hydrocarbon
actions: Adsorbs the poisons when it comes in contact with it
dose: 1g/kg, if patient vomits dose may be repeated once
route: Oral / Slurry
side effects: Vomiting, upset
stomach, black tarry stool
Special consideration: Not used in MA anymore, Online
med control when available in most states. Many patients will not tolerate full weight-based dose, do not force them to.
medical control:
6 rights of Mark I Kit /
DuoDote /Atropine and
Pralidoxime (2-PAM)
indications: Exposure to organophosphates leading to poisoning contradictions: none actions: Atropine will prevent the poison from slowing the heart down too much, 2-Pam Chloride restores function to acetylcholinesterase allowing the breakdown of ACh and the relief of parasympathetic overload dose: One Auto-Injector (2 mg of Atropine and 600 mg of 2-PAM) route: Intramuscular / Liquid / Auto-Injector side effects: Tachycardia, Seizures Special consideration: These are force protection medications, meaning that if you carry them they are meant for you and your partner, one dose is not going to be enough you will need to go to the hospital for further treatment medical control: Standing Order
