Download November 2016 Instructor`s Guide (MS Word format)

Instructor Guide
Session Reference: 1
Title: BLS Pharmacology
Level of Instruction: Cognitive
Time Required: 3 hours
Materials:
 White Board
 Dry Erase Markers
 Eraser
Reference:
The Maryland Medical Protocols for Emergency Medical Services Providers
Effective July 1, 2016
PREPARATION:
Motivation:
Once a medication is given, it can’t be taken back. EMS personnel need to be sure they
recognize when a medication is indicated, possible adverse effects to watch for, precautions
when administering a medication, contraindications, and proper dosage. Failure to administer
medications in accordance with Maryland protocols can result in harm to the patient and
charges of negligence.
Objective (SPO): 1-1
The student will be able to identify indications, adverse effects, precautions, contraindications,
and correct dosages for the 9 BLS medications included in the Maryland protocols.
Overview:
Set up a Jeopardy game board on a white board. Refer to the Attachment 1 (spreadsheet) for
an overview of what the game board should look like. Review Attachment 2 for the questions
that go with each Jeopardy square. There is a separate sheet for each medication, listing the
following categories: indications, adverse effects, precautions, contraindications, dosage and
miscellaneous. The points assigned to each category depends on the complexity for each drug.
For example, the contraindications of Acetaminophen are extensive so the category for that
drug is assigned a high point value. Conversely, the contraindications for Albuterol are limited
so the point value for that drug category is low. When participants select a point value under a
certain drug, they won’t know what information they will be asked to provide.
Session 1 BLS Pharmacology
Student Performance Objective (SPO) 1-1:
The student will be able to identify indications, adverse effects, precautions, contraindications,
and correct dosages for the 9 BLS medications included in the Maryland protocols.
Enabling Objectives:
EO-1 Identify indications for administration of all 9 BLS drugs
EO-2 Identify adverse effects for all 9 BLS drugs.
EO-3 Identify precautions related to all 9 BLS drugs.
EO-4 Identify contraindications for all 9 BLS drugs.
EO-5 Identify correct adult and pediatric doses for all 9 BLS drugs.
I. Prior to participants arriving:
a. Set up the game board (See Attachment 1)
b. Review points system and how they are assigned to each drug category (See
Attachment 2)
c. Note: It is at the discretion of the instructor how much of an answer must be
given to earn points. For example, if there are a list of adverse effects or
contraindications, the instructor may choose to ask for all of them or a specific
number of them to award points; OR they can choose to award partial points
based on the amount of answers given.
II. At the start of the drill, read the following directions to participants:
a. Tonight we will be playing Jeopardy to review the Maryland protocols on BLS
Pharmacology. You will be divided into teams. When it is your turn, you will
select a drug and point value. Once the question is asked, whoever stands first
will be given the chance to answer. If the answer is correct, they will be awarded
the points. If the answer is incorrect, the points will be deducted and someone
from another team will have the chance to answer.
b. At the end, once all the squares have been chosen, there will be a final Jeopardy
question. Each team will decide how much they will wager prior to hearing the
question. If the question is answered correctly, they will get the points they
wager. If they answer incorrectly, they will lose the points they wager.
c. The team with the most points wins.
d. Allow time for questions to clarify any rules.
III. Divide participants into teams. They can be any size necessary to accommodate the
number of participants.
IV. Play Jeopardy utilizing the following questions:
a. Acetaminophen
 Answer: The indication for Acetaminophen (100 pts)
o Question: What is patients 3 years and above judged to be in mild to
moderate discomfort?
 Answer: The adverse effects of Acetaminophen (200 pts)
o Question: What is not clinically significant?
 Answer: The dose for a 6-12 year old patient. (400 pts)
o Question: What is TWO unit doses of 160mg/5ml (total of
320mg/10ml) ?
 Answer: The dose for a patient 13 years and above. (600 pts)
o Question: What is FOUR unit doses of 160mg/5ml (total of
640mg/20ml) OR TWO 325mg pills/tablets (total of 650mg) with sips
of water as tolerated by the patient?
 Answer: The precaution for Acetaminophen. (800 pts)
o Question: Administration does not eliminate the need for transport?
 Answer: 5 contraindications of Acetaminophen (1000 pts)
o Question: What are Head Injury, Hypotension, Administration of
acetaminophen (or medications containing acetaminophen) in the
last 4 hours, Inability to swallow or take medications by mouth,
Respiratory distress, Persistent vomiting, Known or suspected liver
disease, Allergy to acetaminophen, Patients less than 3 years of age?
(ANSWER SHOULD INLCUDE ANY OF THE 5)
b. Activated Charcoal
 Answer: The indication for Activated Charcoal. (100 pts)
o Question: What is poisoning by mouth?
 Answer: The contraindications of Activated Charcoal. (200 pts)
o Question: What are altered mental status and patients who have
received an emetic?
 Answer: The precaution for Activated Charcoal. (400 pts)
o Question: What is does not absorb all drugs and toxic substances?
 Answer: The adverse effect of Activated Charcoal. (600 pts)
o Question: What is it may indirectly cause vomiting and nausea?
 Answer: The dosage of Activated Charcoal. (800 pts)
o Question: What is Administer 1gram/kg for adults and pediatrics?
 Answer: The reason we don’t want Sorbitol in Activated Charcoal. (1000 pts)
o Question: What is because its side effects are nausea and diarrhea?
c. Albuterol
 Answer: The contraindication for Albuterol. (100 pts)
o Question: What is the inhaler is not prescribed for the patient?
 Answer: The dosage for Albuterol. (200 pts)
o Question: What is a maximum of 2 doses (4 puffs) over a 30minute period for adults and pediatrics?
 Answer: The indications for Albuterol. (400 pts)
o Question: What are Signs and symptoms of respiratory distress
OR bronchospasms/wheezing associated with Asthma, Chronic
bronchitis, Emphysema, or Allergic Reactions (anaphylaxis)?
 Answer: Additional doses can be administered. (600 pts)
o Question: What is with medical consultation?
 Answer: The precautions of Albuterol. (800 pts)
o Question: What are it may cause severe bronchospasm from
repeated excessive use and Patient must have his/her own
physician-prescribed hand-held aerosol inhaler?
 Answer: 5 adverse effects of Albuterol. (1000 pts)
o Question: What are tachycardia/palpations, hypertension,
angina, nervousness/anxiety, tremors, dizziness, headache,
sweating, nausea/vomiting, and sore throat? (ANSWER SHOULD
INCLUDE ANY OF THE 5)
d. Aspirin
 Answer: The indication for Aspirin. (100 pts)
o Question: What is chest pain when acute myocardial infarction is
suspected?
 Answer: The contraindication for Aspirin. (200 pts)
o Question: What is known hypersensitivity?
 Answer: The dosage of Aspirin. (400 pts)
o Question: What is 324 mg or 325 mg CHEWED? (adults only, no
pediatric dose)
 Answer: The precautions for Aspirin. (600 pts)
o Question: What are GI bleeding and upset?
 Answer: The pharmacology of Aspirin. (800 pts)
o Question: What is platelet inhibitor and anti-inflammatory?
 Answer: The adverse effects of Aspirin. (1000 pts)
o Question: What are heartburn, nausea and vomiting, and
wheezing?
e. Epinephrine
 Answer: The contraindications of Epinephrine. (100 pts)
o Question: What are none in the presence of anaphylaxis?
 Answer: The dosage of Epinephrine Auto-injector. (200 pts)
o Question: What is 5 years and greater 0.5mg in 0.5mL IM and
patients less than 5 years 0.15mg in 0.15mL IM?
 Answer: The indications for Epinephrine. (400 pts)
o Question: What are moderate to severe allergic reaction with
reparatory distress or mild allergic reaction with a history of life-
threatening allergic reaction OR pediatric patients with severe
asthma?
 Answer: The precaution for Epinephrine. (600 pts)
o Question: What is unless in severe allergic reaction or severe
asthma, medical consultation must be obtained before
administering to pregnant, cardiac, or adult asthma patients?
 Answer: The 2 reasons you MUST consult relating to Epinephrine.
o Question: What are administration of additional doses and
administration to adult asthma patients?
 Answer: 5 adverse effects of Epinephrine. (1000 pts)
o Question: What are tachycardia/palpitations, angina, headache,
nausea/vomiting, dizziness, hypertension, nervousness/anxiety,
and tremors? (ANSWER SHOULD INCLUDE ANY OF THE 5)
f. Naloxone
 Answer: The indication for Naloxone. (100 pts)
o Question: What is to reverse respiratory depression induced by
opioid/narcotic agent?
 Answer: The adverse effect of Naloxone. (200 pts)
o Question: What is opioid withdrawal?
 Answer: How often you can repeat administration. (400 pts)
o Question: What is as necessary to maintain respiratory activity?
 Answer: The dosage for Naloxone. (600 pts)
o Question: What is 28 days to 4 years old get 0.8-1mg IN; 5 years
to adult 2mg IN?
 Answer: The contraindication for Naloxone. (800 pts)
o Question: What is a patient under 28 days old?
 Answer: The precautions for Naloxone. (1000 pts)
o Question: What are may induce opiate withdrawal in patients
who are physically dependent on opioids; certain drugs may
require much higher doses of Naloxone for reversal than are
currently used; should be titrated so respiratory efforts return,
but not intended to restore full consciousness; Intranasal
Naloxone must be administered via nasal atomizer; and duration
of action of 40 minutes- the effect to the opioid/narcotic may last
longer than 5Naloxone (patients should be encouraged to be
transported)?
g. Nitroglycerin
 Answer: The indications for Nitroglycerin. (100 pts)
o Question: What are patients must have their own prescribed
sublingual nitroglycerin and have chest pain?
 Answer: The dosage for Nitroglycerin. (200 pts)
o Question: What is one tablet or spray sublingually, repeated in 3
to 5 minutes if chest pain persists up to a maximum of 3 doses?
(contraindicated under the age of 12)
 Answer: The adverse effects of Nitroglycerin. (400 pts)
o Question: What are hypotension, headache, dizziness, and
tachycardia?
 Answer: The precautions of Nitroglycerin. (600 pts)
o Question: What are reassess BP before and after administration
and if the systolic BP drops more than 20 mmHg, obtain medical
consultation before further administration?
 Answer: The contraindications of Nitroglycerin. (800 pts)
o Question: What are BP below 90 mmHg systolic; heart rate less
than 60; medication not prescribed for the patient; pediatric
patient under age 12; any patient having taken medication for
Pulmonary Hypertension or erectile dysfunction within the past
48 hours?
 Answer: The dose of each tablet or spray in mg. (1000 pts)
o Question: What is 0.4 mg?
h. Oral Glucose
 Answer: The adverse effect of Oral Glucose. (100 pts)
o Question: What is not clinically significant?
 Answer: The contraindication of Oral Glucose. (200 pts)
o Question: What is not clinically significant?
 Answer: The indications for Oral Glucose. (400 pts)
o Question: What are altered mental status with known diabetic
history and unconscious for an unknown reason?
 Answer: The precaution for Oral Glucose. (600 pts)
o Question: What is patient without a gag reflex?
 Answer: The dosage of Oral Glucose. (800 pts)
o Question: What is 10-15 grams between the cheek and gum?
 Answer: The difference between tube net weight and actual dosage.
(1000 pts)
o Question: What is the dosage is not based on net weight of the
tube, but the amount of glucose or sugar/carbohydrates
contained in the tube?
i. Oxygen
 Answer: The dosage of oxygen for the 2 most common face masks. (100
pts)
o Question: What is 12-15 lpm via Non-rebreather mask and 2-6
lpm via a nasal canula?
 Answer: The adverse effect of oxygen. (200 pts)
o Question: What is high concentrations of oxygen will reduce the
respiratory drive in some COPD patients?
 Answer: The indication for oxygen. (400 pts)
o Question: What is all medical and trauma patients?
 Answer: The contraindication of oxygen. (600 pts)
o Question: What is none?
 Answer: The precautions of oxygen. (800 pts)
o Question: What are never withhold oxygen from those who need
it, oxygen should be given with caution to patients with COPD,
simple or partial rebreather face masks must be supplied with a
minimum of 6 lpm, and non-rebreather face masks must be
supplied with a minimum of 12 lpm?
 Answer: The concentration of oxygen in percentages for nasal canula,
non-rebreather, and bag-valve mask. (1000 pts)
o Question: What are 24-44% for nasal canula, 80-100% for nonrebreather, and 90-100% for bag-valve mask?
j. Final Jeopardy
 Answer: The 2 drugs listed in the protocol under nitroglycerin for
pulmonary hypertension and the 3 drugs under nitroglycerin for erectile
dysfunction.
o Question: What are Adcirca™ and Revatio™ for pulmonary
hypertension and Viagra™, Levitra™, and Cialis™ for erectile
dysfunction?
V. Allow time at the end to discuss any parts of the protocols that proved difficult for
participants.
Summary:
It is important to regularly review BLS Pharmacology to ensure you are familiar with when and
how to give drugs.
Review:
Review areas that seemed difficult for participants to recall automatically. Discuss strategies
for remembering.
Remotivation:
Administering drugs is a serious responsibility. Making a mistake can be harmful to our patients
and may bring charges of negligence.
Sample Game Board
Acetminophen
1,000
800
600
400
200
100
Activated
Charcoal
1,000
800
600
400
200
100
Albuterol Aspirin Epinephrine Naloxone Nitroglycerin
1,000
1,000
1,000
1,000
1,000
800
800
800
800
800
600
600
600
600
600
400
400
400
400
400
200
200
200
200
200
100
100
100
100
100
Oral Glucose
1,000
800
600
400
200
100
Oxygen
1,000
800
600
400
200
100