Principles of Pharmacology - Administering part 2 Flashcards
Any medication placed in the mouth requires ___
Constant evaluation of the airway
Nitroglycerine is typically the only medication that you will help to administer ___
Sublingually
Pain in the heart from a lack of oxygen due to a blockage or narrowing of the blood vessels supplying the heart
Angina pectoris
The purpose of nitroglycerin
Increase blood flow by relieving the spasms or causing the arteries to dilate
Always do what before administering nitroglycerin?
Take the patient’s blood pressure
If the systolic BP is less than ___, the nitroglycerin may be harmful
100 mm/Hg
How to position patient before administering nitroglycerin
Sitting or laying down with the head elevated
What is a significant BP drop after administering nitroglycerin?
15 to 20 mm/Hg
If after administering nitroglycerin, the patient has a significant BP drop and suddenly feels dizzy or sick, have the patient ___
Lie down
Myocardial infarction
Heart attack
MI
Myocardial infarction
A narrowing or blockage in a coronary artery blocks the blood flow to a section of the heart muscle
Myocardial infarction
If nitroglycerin no longer brings relief to a patient in whom it has previously worked, the person may be experiencing ___
An MI instead of an angina attack
You cannot administer nitroglycerin without ___
Clearance from medical control or standing orders
Nitroglycerin when taken with ED medication can cause ___
A dramatic drop in BP
Nitroglycerin is usually taken ___
Sublingually
If the nitroglycerin does not produce the typical burning sensation, it may have ___
Lost potency because of aging or improper storage
Sublingual nitroglycerin should be stored in ___
Their original glass container with the cap screwed on tightly
Each spray of nitroglycerin is equivalent to ___
One tablet
Do not ___ the nitroglycerin canister prior to administering
Shake
When administering nitroglycerin, wait ___ for a response before repeating the dose
5 minutes
Wear ___ when administering nitroglycerin
Gloves
General steps in administering medication
- Obtain an order from medical control
- Verify the proper medication and prescription
- Verify the form, dose, and route of the medication
- Check the expiration date and condition of the medication
- Complete a cross-check procedure
- Reassess the vital signs, especially heart rate and BP, at least every 5 minutes or as the patient’s condition changes
- Document your actions and the patient’s response
___ route of administration provides quick and easy access to the circulatory system without the need for placing a needle within a vein
IM
Blood flow to the muscles is ___
Relatively stable, even during circumstances of severe illness or injury
Main hormone that controls the body’s fight or flight response and is the primary medication that you will be administering intramuscularly
Epinephrine
Mimics the effect of the sympathetic nervous system
Sympathomimetic
Epinephrine is secreted by the ___
Adrenal glands
Epinephrine is also called ___
Adrenaline
Epinephrine should not be given to patient’s who ___
Do not show signs of airway obstruction or wheezing due to an allergic reaction, patient’s with hypertension or hypothermia, or if you believe the patient may be experiencing an MI
An over-release of histamine causes ___
Lowered BP by relaxing the small blood vessels and allowing them to leak. May also cause wheezing from bronchial spasms and swelling of the airway tissues (edema)
Most prefilled naloxone IM preparations are administered in increments of ___
2 mg
Administration of naloxone to opioid-dependent patients can cause ___
Severe withdrawal symptoms, including seizures and cardiac arrest
Most common technique for naloxone administration
Intranasal
Steps to administer medication intranasally
- Obtain medical direction per local protocol
- Confirm correct medication and expiration date
- Attempt to determine if the patient is allergic to any medications
- Prepare the medication and attach the atomizer. Never use a needle
- Place the atomizer in one nostril, pointing up and slightly outward
- Administer a half-dose (1 mL maximum) into each nostril
- Reassess the patient and document appropriately
If you do not have naloxone available, ___ provide necessary treatment to opioid overdose patients until definitive treatment can be reached
Bag-mask ventilations
When documenting a medication, include the ___
- Name of the medication
- Dose & route
- Vital signs before and after administration
SVNs
Small-volume nebulizers
Used to administer liquid medications that have been turned into a fine mist by flow of air or oxygen
MDIs and SVNs
When medication is atomized, it is ___
Breathed into the lungs and delivered to the alveoli, where blood flow is very high and absorption rates are close to that found with IV medications
Disadvantage of an MDI
Patient must be cooperative and control their breathing
Adapter that fits over the inhaler like a sleeve
Spacer
If an inhaler is administered improperly, most of the medication ___
Ends up on the roof of the patient’s mouth
Steps to administer an SVN
- Obtain medical direction per local protocol
- Confirm correct medication and expiration date
- Confirm that the patient is not allergic to the medication
- Add the appropriate medication and dose to the nebulizer reservoir and assemble according to the manufacturer’s directions
- Perform the medication cross-check
- Connect to the nebulizer machine or oxygen tank at 6 to 8 L/min
- Place the nebulizer in the patient’s mouth and instruct the patient to breath until the medication is gone (usually about 5 minutes)
- Reassess the patient and document appropriately
If relief is not achieved with and SVN, wait ___ and repeat
3 to 5 minutes
Reactive airway disease
Asthma
Common OTC MDIs for asthma
Primatene Mist, Bronitin Mist, and Bronkaid Mist
OTC MDIs for asthma contain ___ and can cause ___
- Epinephrine
- Tachycardia, hypertension, and restlessness
Most patients with asthma use certain ___
Chemical cousins of epinephrine that produce fewer adverse effects and act more specifically on the bronchi of the lungs
Common prescription MDIs for asthma
Albuterol (ProAir, Proventil, and Ventolin), ipratropium bromide (Atrovent), and levalbuterol (Xopenex)
Often albuterol and ipratropium are ___
Combined in one inhaler (Combivent, DuoNeb)
Two types of inhalers for asthma
- Rescue
- Maintenance
Common maintenance inhalers for asthma
Fluticasone propionate (Flovent Diskus), budesonide (Pulmicort), mometasone furoate (Asmanex Twisthaler), beclomethasone dipropionate (Qvar), and ciclesonide (Alvesco)
The use of multiple medications by one person
Polypharmacy
In addition to prescription medications, patient’s often take ___
Nonprescription OTC medications, herbal medications, or other supplements
When possible, EMS providers should verbally verify which medications are ___, even when presented with a printed medication list
Actually being taken
Beta adrenergic blocking agents and calcium channel blocking agents can prevent the patient’s heart rate from increasing in ___
Sepsis, trauma, hemorrhage, and other conditions that normally would present with tachycardia
Beta adrenergic blocking agents
Metoprolol (Lopressor) and atenolol (Tenormin)
Calcium channel blocking agents
Amlodipine (Norvasc) and diltiazem (Cardizem)
Decrease the ability of blood platelets to aggregate
Antiplatelet medications
Antiplatelet medications
Aspirin and clopidogrel (Plavix)
Interfere with other blood clotting mechanisms in the body
Anticoagulant medications
Anticoagulant medications
Warfarin (Coumadin), apixaban (Eliquis), and rivaroxaban (Xarelto)
Antiplatelet and anticoagulant medications are prescribed to patients who ___
Are susceptible to dysfunctional blood clotting conditions, including acute coronary syndrome, ischemic cerebrovascular accident (stroke), peripheral or pulmonary blood clots, and similar conditions
An inappropriate use of a medication that could lead to patient harm
Medication error
Before administering a medication, stop to ask yourself, ___
Why am I doing this?
Steps if a medication error takes place
- Rapidly provide any appropriate patient care that is required
- Notify medical control as quickly as possible
- Follow your local protocols and document the incident thoroughly, accurately, and honestly
EMS providers should strongly suspect ___ in patients who present with an altered mental status or other neurologic symptoms
Intracranial hemorrhage
