Chapter 7 – EMT (Pharmacology)

Action
The therapeutic effect of a medication on the body

Intended effect
The effect that a medication is expected to have on the body

Medication
Chemical substance that is used to treat or prevent disease or relieve pain

Indications
Reasons/conditions for which a particular medication is given; why medication is given
E.g. nitroglycerin is _____ for chest pain associated with angina

Contraindications
When a medication would harm the patient or have no positive effect on the patient’s condition
E.g. activated charcoal would be _____ if the patient were unconscious and could not swallow

Unintended and untoward effects
Two types of side effects

Unintended effects
Effects that are undesirable but pose little risk to the patient

Untoward effects
Effects that can be harmful to the patient

Glaucoma
Eye condition causing increased fluid pressures, should avoid diphenhydramine (Benadryl) because it can cause increased pressure of the fluid within the eye

Generic name
Simple, clear, nonproprietary name; not capitalized
E.g. nitroglycerin; ibuprofen

Trade name
The brand name that a manufacturer gives to a medication; proper noun so it’s capitalized; may be designated by a raised registered symbol
E.g. Tylenol; Lasix

Enteral medications
Medications that enter the body through the digestive system; typically the form will be a pill or liquid, such as cough medicine
Tend to absorb slowly, not commonly used in an emergency setting

Parenteral medications
Medications that enter the body by a route other than the digestive tract, the skin, or the mucous membranes; often in liquid form
Generally administered using syringes or needles
Absorbed much more quickly
Offer a more predictable and measurable response

Absoprtion
The process by which medications travel through body tissues until they reach the bloodstream

Route
Often the rate at which a medication is absorbed into the bloodstream depends on its ____ of administration.

Children, for nausea or vomiting, to control seizures, when patient cannot swallow or is unconscious
Reasons to use per rectum (PR) route for medications

1 hour
Per os (PO)/oral medications often take _____ to enter the bloodstream via the digestive system (enteral medications)

Intravenous (IV)
The fastest way to deliver a chemical substance/medication

Aspirin, oxygen, and charcoal
Medications/chemicals that cannot be given by IV route

Intravenous (IV) and intraosseus (IO)
Medication routes that have immediate rates of absorption

Per rectum (PR), Inhalation, and Sublingual (SL)
Medication routes that have rapid rates of absorption

Intramuscular (IM)
Medication route that has a moderate rate of absorption

Ingestion/oral/per os (PO), Subcutaneous (SC), and Transcutaneous
Medication routes that have slow rates of absorption

Per rectum (PR) and Per os (PO)
Enteral routes of administration

IV, IO, SC, IM, inhalation, SL, transcutaneous
Parenteral routes of administration

Unconscious patients as a result of cardiac arrest or extreme shock; children who have fewer available/difficult to access IV sites
Reasons IO route is used

Because there is less blood here than in the muscles, medications that are given by this route are generally absorbed more slowly and their effect lasts longer
Why give subcutaneous (SC) injection?

Daily insulin injections; some forms of epinephrine
Examples of medications given via SC injection

Damage to muscle tissue; uneven, unreliable absorption especially in people with decreased tissue perfusion or who are in shock
Possible problems with IM injections

Auto-injector
Delivers a predetermined amount of medication into the patient when pressed firmly into the lateral thigh
E.g. EpiPen; Mark-1 auto-injector (used for managing exposure to certain chemicals)
What device is commonly used for IM injections?

Under the tongue
Sublingual means ______.

Enter via oral mucosa under the tongue and are absorbed into the bloodstream within minutes
Where do SL medications enter and how quickly/slowly do they absorb into bloodstream?

Protects medications from chemicals in the digestive system, such as acids that can weaken or inactivate them; faster absorption
Advantage of using SL route as compared to oral/PO route

Through the skin
E.g. adhesive patch containing nitroglycerin (allows it to achieve a longer-lasting effect
Transcutaneous/transdermal means _____. Give an example

Intranasal (IN)
Relatively new format for the delivery of medication

Medication is pushed through a specialized atomizer device called a mucosal atomizer device (MAD). Liquid medication is turned into a spray and is administered into a nostril; quick absorption
How are IN medications administered?

Naloxene (for overdose patients)
Give an example of a medication that is administered via IN route

Inhalation, IM, IO, IV, PO, PR, SC, SL, transcutaneous (transdermal), Intranasal (IN)
10 routes of administration

1. Tablets and capsules
2. Solutions and suspensions
3. Metered-dose inhalers
4. Topical medications
5. Transcutaneous medications
6. Gels
7. Gases for inhalation
7 forms of medications

Form
The ____ of a medication usually dictates the route of administration.

IV, IM, or SC injection
Many solutions can be given as ______ injection.

Solution
Epinephrine given via auto-injector is in the form of a _____.

Activated charcoal, given by mouth or rectally, applied directed to skin as in calamine lotion, via IM or SC injection (NOT IV because suspended particles do not remain dissolved), e.g. hormone shots and vaccinations
Examples of suspensions in medications/routes

Metered-dose inhaler (MDI)
Often used for patients with respiratory illnesses such as asthma or emphysema
A miniature spray canister used to direct such substances through the mouth and into the lungs; delivers same amount of medication each time it is used

An inhaled medication is usually suspended in a propellant
Why must the MDI be shaken vigorously before it’s administered?

Lotions, creams, and ointments
Applied to surface of skin and affect ONLY that area
Topical medications include…

Lotions contain the most water and are absorbed the most rapidly (e.g. calamine lotion)
Ointments contain the least water and are absorbed the most slowly (e.g. neosporin)
Lotions vs. ointments

Transcutaneous/transdermal medications (absorbed through skin, e.g. nitroglycerin paste) are intended for systemic (whole-body) effects whereas topical medications work directly at application site (local effects)
Transcutaneous medications vs. topical medications

Adhesive patch; allow even absorption of a medication for many hours
E.g. nitroglycerin, nicotine, some pain medications, oral contraceptives
Newer delivery system for transcutaneous medications

Gel
usually transparent (clear) but have the consistency of pastes or creams
May give oral glucose in gel form to a patient with diabetes (apply to mucous membranes between cheek and gum)
Semiliquid substance that is administered orally in capsule form or through plastic tubes

Oxygen
Gas medication most commonly used outside the operating room

Liter flow rate, time oxygen was delivered in military time, and the type of device used
E.g. “09:15 Nonrebreathing mask at 15 L/min. Patient states shortness of breath is better.”
Also document the patient’s response to oxygen administration
When you document the use of oxygen, you should include….

Order from medical control
As an EMT, you may only administer medications for which you have a/an _______.

1. Right patient
2. Right medication
3. Right dose
4. Right route
5. Right time
6. Right documentation
6 rights of medication administration

Reassess
After documentation, you will need to _____ the patient to see if it worked.

Echo technique
E.g. “Dr. Huffman, I copy one nitroglycerin tablet administered under the tongue. I will contact you in 3 minutes for additional orders.”
When you receive orders from medical control for the administration of a medication and you repeat the order back to the physician, this is called _____.

Expiration date on the medication (5. right time) to make sure it has not passed.
The last step before administering a medication is to check the ____.

Reassess vital signs, especially HR and BP at least every 5 minutes after administration of medication
When/what should you reassess patient?

Online/direct orders via telephone or radio or via offline/indirect control via standing orders in protocols
When can you give a medication to patient?

Peer-assisted medication (typically in auto-injector format to yourself and/or your partner)
Patient-assisted medication (e.g. nitroglycerin to relieve pain of angina, EpiPen for allergic reaction, MDI bronchodilator for asthma)
EMT-administered medication (such as oxygen, oral glucose, activated charcoal, aspirin)
Three circumstances when an EMT can assist/administer medications

Local standards
Refer to your _____ to obtain a listing of how and when EMTs can administer medications

Oxygen
Activated charcoal
Oral glucose
Aspirin
Epinephrine auto-injector
Metered-dose inhaler medications (MDI)
Nitroglycerin

^^^Determined/set by state

List of medications that, depending on local protocol, may be administered by EMTs

State, department, and medical director
Your ______ will ultimately define what medications are carried on your ambulance.

Acetaminophen, ibuprofen, diphenhydramine (Benadryl)
Three common medications that are used daily by millions of Americans and have been deemed by the FDA to be safe for consumer use without medical supervision.

Speed of movement of food through the digestive track dramatically changes the speed of absorption
Serious limitation for oral medications

Altered level of consciousness; aspiration
Acid, alkali, or a petroleum product
Activated charcoal should not be given to any one with a/an ______ because of the risk of ______.
It’s also not indicated for patients who have ingested ______.

Excess of insulin
Hypoglycemia can be caused by _____.

IV line; mouth; gel designed to be spread on the mucous membranes between the cheek and gum
Hospital personnel and AEMTs/paramedics can give glucose through _____, but EMTs can only give glucose by _____ in the form of a ____.

Documented hypersensitivity to aspirin, pre-existent liver damage, bleeding disorders, and asthma
Also should NOT be given to children during episodes of fever-causing illnesses due to its association with Reye syndrome (causes swelling of brain and liver)
Contraindications for aspirin

Nitroglycerin
______ is typically the only medication that EMTs will help to administer sublingually.

Not enough oxygen because of a blockage or narrowing in the blood vessels (coronary arteries) that supply the heart; occasionally caused by a spasm in these blood vessels
Angina pectoris (pain) is caused by…

arteries to dilate by relaxing the muscular walls of the coronary arteries and veins
Also relaxes veins throughout the body so less blood is returned to the heart and heart does not have to work as hard each time it contracts –> Blood pressure decreases
Relaxes arteries throughout the body
Often causes mild headache after administration
Nitroglycerin causes ______. (effects)

Blood pressure
You should always take the patient’s _____ before administering nitroglycerin.

100 mmHg
If systolic blood pressure is less than _____, nitroglycerin may lower blood flow to the heart’s own blood vessels (harmful)

15-20 mmHg; raise the legs
Nitroglycerin administration: If a significant drop in patient’s blood pressure occurs (______ mmHg) and patient suddenly feels dizzy or sick, lay person down and ______.

slight tingling or burning sensation
Nitroglycerin tablet (SL) should cause ______.

5 minutes
Nitroglycerin administration (tablet or spray): Wait _______ for a response before repeating the dose. Give repeated doses per medical control/local protocol.

Sympathomimetic
Epinephrine is a _____.

Increase HR and BP (constricts blood vessels)
Dilate passages in lungs (reduces swelling and dilates airways so flow of air is less restricted)
*May also help to maintain someone’s blood pressure who is close to anaphylactic shock
Epinephrine effects

Hypertension
Hypothermia
Myocardial Infarction
Patients who are NOT wheezing or have NO signs of respiratory compromise or hypotension
Patients should NOT be given epinephrine is they have…..

Histamine
Release of ____ lowers blood pressure 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) making it difficult to breathe (occurs during allergic reaction)

Histamine
Epinephrine acts as a specific antidote to _____, countering its harmful effects.

0.3 mg
Amount of epinephrine usually injected via auto-injector (EpiPen)

burning sensation; heart rate
Epinephrine causes a _______ after it is injected and patient’s ____ will increase after injection.

not breathing; getting air into the lungs
If a patient is _____ or is having trouble ________, you should administer supplemental oxygen. (if patient is experiencing significant respiratory difficulties or shock)

Nonrebreathing mask at 10-15 L/min (preferred method)
Nasal cannula at 2-6 L/min
*If patient is NOT breathing, you must also provide artificial ventilations so you will need to use a bag-mask device, delivers oxygen at 15 L/min
Methods for administering oxygen and their rates

90%; 44%
Nonrebreathing mask can provide up to ___% inspired oxygen; nasal cannula at 6 L/min can provide up to ___% inspired oxygen.

beta-2 agonists
beta-1 agonist
Metaproterenol and albuterol are ____; they act more specifically than epinephrine on the bronchi or the lungs causing dilation with a lesser effect on the heart (______).

short-action bronchodilators
Albuterol (Proventil or Ventolin)
The ONLY medication that will be effective during an acute attack of shortness of breath will be ______. A popular and effective one is ______.

liquid medications that have been turned into a fine mist by a flow of air or oxygen
atomize
Metered-dose inhalers (MDIs) and nebulizers are used to administer _______. They _____ the medication, allowing it to be breathed into the lungs and delivered to the alveoli, allowing for rapid absorption.

patient needs to be cooperative and control his/her breathing
if patient is unconscious, can’t use MDI but nebulizer can be used
Major disadvantage of an MDI

start to inhale
“spacer” (adapter)
When using an MDI, patients must aim properly and spray just as they ______. Use a ____ to avoid misdirecting the spray on the roof of the mouth.

Patient inhales all the medication in a single-sprayed dose
Most important thing when using MDI for asthma (reactive airway disease)/COPD is to ensure that ______.

Anterior or lateral
EpiPen can be administered to ____ or ______ part of thigh in children.

1) Oxygen 2) Oral Glucose 3) Activated Charcoal 4) Aspirin What are the 4 medications carried on the EMS Unit? chemical name describes the drug’s chemical structure WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU …

Absorption Process by which medications travel through body tissue Contradiction Situation in which a drug should not be given WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample Side Effect …

Specific signs, symptoms, or circumstances under which it is appropriate to administer a drug to a patient Indications Spray device with a mouthpiece that contains an aerosol form of a medication that a patient can spray directly into his airway …

A 31-year-old female is experiencing an acute asthma attack. She is conscious and alert, but in obvious respiratory distress. After assisting her with her prescribed MDI, you should: Select one: A. administer another treatment in 30 seconds if she is …

What is the reason for giving an epinephrine​ auto-injector in a​ life-threatening allergic​ reaction? It will help constrict the​ patient’s blood vessels and relax the airway passages. Your patient is a​ 59-year-old woman with a history of emphysema. Per​ protocol, …

What marked the beginning of modern pharmacology? During the 1800s chemists were able to isolate the pure chemicals from plants. When did mass production of medicine begin? In the World War II era (1939-1945) WE WILL WRITE A CUSTOM ESSAY …

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