Pharmacology Flashcards by Melissa Berech

What are the BLS medications that are carried on an ambulance?

Oxygen, oral glucose, narcan, api-pen or SEK, albuterol, and aspirin (baby)

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What are the medications an EMT is able to assist a patient with?

Nitroglycerin, albuterol inhaler, rectal valium (diazepam or diastat), api-pen auto injectors, narcan, and other medications may be considered with consolation with MedCon

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Prescribed or assisted medications

These are medications that the patient has at home prescribed by their doctor. You assist the patient in taking these.

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Administered medications

These are medications that you have with you on your ambulance. You _______ these.

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True or false: Is a patient who is alert and oriented allowed to refuse a medication that is recommended?

True; make sure to explain all the risk factors, have them sign an RMA for refusing the medication, and still transport to hospital even thought the patient refused the medication.

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Indication

When you WOULD use a medication

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Contraindication

When you WOULD NOT use a medication

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Desired effect

The effect that you WANT the medicine to have

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Side effect

Any effects that you DO NOT WANT the medicine to have

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Standing Order

A procedure you can do IF the patient meets the requirements WITHOUT contacting Medical Control (MedCon) first- this is also called OFF Line Medical Control

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Medical Control Option

A procedure you must first contact Medical Control (MedCon) for- this is also called ON Line Medical Control

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What is MedCon?

Medical Control located at Stony Brook University Hospital ER where a paramedic answers the phone and will relay info/orders from a doctor in the ER.

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What is MedCom?

Medical Communication which handles answering 911 call and dispatching ambulance

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What are the 5 Rights of Medication Administration?

Right patient, right medication, right dose, right route, and right date

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What are some general guidelines for medication usage?

-ALWAYS take vitals BEFORE & AFTER medication administration as well as a complete patient history

-WHEN IN DOUBT CALL MEDICAL CONTROL BEFORE ADMINISTERING ANY MEDICATIONS!!

-MedCon can be reach by phone or via the 800MHz radio

-Many “WHAT IT” situations can occur, there is no way for anyone to answer these for every situation. You will HAVE to call Medical Control for help.

-Always consider calling for ALS in any medication administration situation, DO NOT DELAY TRANSPORT!!

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What is MedCon’s phone number?

631-689-1430

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Oxygen

-Considered a medication in NYS and you need to be a CFR or higher to administer.

-Is usually limited to patients with dyspnea, respiratory arrest or failure, significant trauma, or those with a pulse ox less than 94%

-Can be given either NRB 10-15 LPM or NC 2-6 LPM.

-Patients who are suspected to have Carbon Monoxide Poisoning should ALWAYS get high flow oxygen via NRB at 10-15 LPM

-Anyone receiving assisted ventilations with a BMV should get oxygen at 15-25 LP

Oral Glucose

-Used to raise the blood sugar of patients that are hypoglycemic

-if patient is “AMS”: protocol is to check a blood sugar, and make sure to rule out trauma, opiate overdose, or other cause of AMS

-if patient is NOT “AMS: and blood sugar is less than 60 mg/gl and patient has an intact gage reflex (ex. they can swallow on their own), you can administer 1 tube of OG which is ingested.

-NEVER administer to someone who is unresponsive

What are some reasons to not give an unresponsive patient Oral Glucose?

Can easily obstruct the airway

-It is VERY thick and sticky

-NO suction pump will be able to clear this out of an airway

Narcan

-Used to block the effects of opiate drugs (ex. morphine, oxycodone, heroin, fentanyl, etc.). Blocks the opiate receptor sites in the cells in the brain so that the opiate can’t activate the receptor site. Does NOT work on any other class of drug other than opiates.

-If opiate overdose is suspected of causing hypoventilation with other signs such as pinpoint pupils and AMS, then ______ is indicated under the “Opiate Overdose” protocol.

-NOT to be used unless the patient is suffering from hypoventilation.

-Can use the patient’s Narcan or the Narcan that is carried onboard the ambulance.

What are some side effects of narcan?

Nausea, vomiting, agitation (can become combative), withdrawal symptoms, high or low blood pressure & pulmonary edema ( if present be prepared for rapid onset and severe be ready to ventilate the patient with a BVM.

True of False: Narcan can be given to someone who is unresponsive, but is breathing adequately?

False; Narcan is only given to someone if they are suffering from hypoventilation

Narcan Dose

-FIRST: assist patient ventilation w/ a BVM attached to Oxygen

-Administer Narcan intranasal either with a 2mg prefilled syringed with a mucosal atomizer device (MAD)- 1mg in each nostril OR 4mg in a prepared metered dose

-May repeat a second dose (either method) after 5 minutes if the patient is still not breathing adequately

-If patient becomes alert and breathing adequately ALS may transfer care back to BLS is the BLS provider is comfortable

What are the two ways Narcan is given through IN?

-2mg of Narcan in a prefilled syringe used with a mucosal atomizer device (MAD)- for adults 1mg (1mL) of Narcan is administered into each nostril for a total of 2mg (2mL) or for pediatrics 0.5mg (0.5mL) of Narcan is administered into each nostril for a total of 1mg (1mL).

-4mg of Narcan in a commercially prepared metered dose. It’s in just 0.1mL of fluid so it is administered all into 1 nostril, the dose is the same for adults or children

What is the starting dose of Narcan for adults?

2mg (2mL)

What is the starting does of Narcan for pediatrics?

0.5mg (0.5mL)

Epinephrine

-Used to counteract the effects of a severe allergic reaction, anaphylaxis, with either respiratory distress or hypo perfusion (low BP) -Will cause dilation of the airways (decrease respiratory distress) and constriction of the blood vessels (increase BP) -Should NEVER be used for a simple localized allergic reaction, api is very effective, but can increase cardiac workload which can lead to cardiac arrest, rare- but still possible -With orders from Medical Control is can used for asthma

What are some side effects of epinephrine?

-Increased heart rate, dizziness, chest pain, sudden death, headache, nausea, vomiting, and excitability

When is epinephrine used?

-During a severe allergic reaction known as anaphylaxis or if given orders from Medical Control can be used to help with asthma

Epi Administration

-Administer in either one of two situations: SEVERE respiratory distress, facial, or oral edema, and/or hypoperfusion; if the patient has a history of anaphylaxis and has an exposure to an allergen developing respiratory distress and/or hypo perfusion and/or rash -Administer as an intramuscular (IM) injection in the lateral thigh -A second dose may be administered after 5 minutes if patient's symptoms persist or reoccur -Albuterol, up to 3 doses may be considered if the patient is continuing to experience wheezing

Epi Dose

-Weight based -Adult Epi-Pen (auto injector) or SEK 0.3 mg for patients equal or greater than 66 lbs (30kg) -Pediatric Epi-Pen (auto injector) or SEK 0.15mg for patients less than 66 lbs (30kg)

Albuterol

-For asthma or COPD -A bronchodilator, it makes the bronchial airways increase in diameter (dilate) to counteract the symptoms of asthmas -Administered via nebulizer connected to oxygen at 6LPM and is inhaled -Used under the "Difficulty Breathing: Asthma/Wheezing" Protocol -Administer up to 3 doses, contact medical control if more is needed -May be used if the patient is wheezing due to anaphylaxis, no orders needed to be given -Epinephrine may be used as well, but under the discretion of Medical Control, MUST call MedCon for orders

What are some side effects of albuterol?

-Increased pulse rate, tremors, nervousness, and nausea

Aspirin

-Used in the "Cardiac Related Problem" Protocol when the patient has chest pain believed to be related to a cardiac issue (ADULTS ONLY) -Dosage is 324mg which is 4 baby aspirin tablets (81mg each) CHEWED NOT SWALLOWED. Do not administer to any patient not capable of chewing. -If the patient is prescribed nitroglycerin consider assisting the patient with the medication -If trained, obtain and transmit to MedCon a 12 lead EKG and contact MedCon!

What is the dosage of aspirin given to a cardiac related patient?

324mg, 4 baby aspirin tablets each 81mg

How is aspirin given to cardiac patients?

CHEWED!!

If a patient swallows aspirin prior to EMS arrival, does the patient still need to be given the 4 baby aspiring once EMS arrives?

Yes, because the aspirin has not yet been absorbed through the mucus membrane and does not act as fast as chewing.

Nitroglycerin

-An assisted patient medication -For cardiac related chest pain -Can give up to 3 doses -Patients systolic BP MUST BE ABOVE 120 mm/Hg prior to EACH dose. -If you are trained perform a BLS 12 lead EKG that you MUST transmit to MedCon and contact them PRIOR to administration of Nitro

Albuterol Metered Dose Inhaler (MDI)

-An assisted patient medication -Used for asthma or COPD

Rectal Valium (diazepam or Diastat)

-An assisted patient medication -For seizure patients -Typically for children but can be for adults as well, ONLY if they are still actively seizing

Eip-Pen Auto Injectors

-An assisted patient medication -For anaphylaxis -Can used the patient's or the supply you carry onboard the ambulance which is usually a SEK kit. -MAKE SURE THUMB IS HELD AROUND SHAFT OF EPI-PEN AND NOT ON EITHER END OF THE EPI-PEN!!!!!!