Download TEMSIS

New Hampshire
AEMT Pharmacology
New Hampshire
Division of Fire Standards & Training and
Emergency Medical Services
Special Thank you!
Jeanne Erickson, NREMT-I
 Christopher Rousseau, NREMT-I

AEMT Medications










Activated Charcoal
Epinephrine – cardiac
Epinephrine –
anaphylaxis
Dextrose
Atropine
Narcan
Ipratropium
Albuterol
Aspirin
Nitroglycerin




Glucagon
Oral Glucose
Nitrous Oxide
Oxygen
Objectives

Understand basic pharmacological definitions

Understand the normal actions of the body

Look at the forms in which the medications may
be found

Know how to calculate drug dosages

Become competent in methods of drug
administration

State which medications are approved for
Intermediate use

Know the dosages, uses, side effects,
contraindications of approved meds
Objectives

Review the specific anatomy and physiology pertinent to
pharmacology.
Discuss the standardization of drugs.
Differentiate among the chemical, generic (nonproprietary),
and trade (proprietary) names of a drug.
List the four main sources of drug products.
Describe how drugs are classified.
List the authoritative sources for drug information.
Discuss special consideration in drug treatment with regard to
pregnant, pediatric and geriatric patients.
Discuss the AEMT responsibilities and scope of management
pertinent to the administration of medications.
List and describe general properties of drugs.
List and describe liquid, solid, and gas drug forms.

List and differentiate routes of drug administration.









Objectives








Differentiate between enteral and parenteral routes of drug
administration.
Describe mechanisms of drug action.
List and differentiate the phases of drug activity, including the
pharmaceutical, pharmacokinetic, and pharmacodynamic
phases.
Describe pharmacokinetics, pharmacodynamics, theories of
drug action, drug-response relationship, factors altering drug
responses, predictable drug responses, iatrogenic drug
responses, and unpredictable adverse drug responses.
Discuss considerations for storing drugs.
List the components of a drug profile.
List and describe drugs which the AEMT may administer in a
pharmacological management plan according to local protocol.
Discuss procedures and measures to ensure security of
controlled substances the AEMT may administer.
Objectives

Review of the following medical
emergencies and the related NH Patient
Care Protocols
Drug

Chemical agents used in the diagnosis,
treatment, or prevention of disease.
Pharmacology

The study of drugs and their
interactions with the body.

Drugs are NOT magical.

They cannot alter the body
systems qualitatively, only
quantitatively
Names

Chemical Name


Generic Name


A name suggested by the manufacture and confirmed by
the U.S. Adopted Name Council
Official Name


Most detailed, chemical description
FDA’s official name
Brand Name

A manufacturer’s trade name or proprietary name
As an example: Epinephrine

Chemical Name:


Generic name:


epinephrine
Official name:


4-(1-hydroxy-2-methylamino-ethyl)benzene1,2-diol
epinephrine
Brand name:

Adrenalin, EpiPen®
Source

Plants



Animal


Insulin (bovine & porcine)
Mineral


Purple foxglove = digitalis
Deadly nightshade Atrope belladonna plant = Atropine
Calcium Chloride, magnesium sulfate
Laboratory (synthetic)

Fentanyl
Reference Materials

USP (United States Pharmacopoeia)

PDR (Physician’s Desk Reference) Drug
Information

Monthly Prescribing Reference

AMA (American Medical Association) Drug
Evaluation
Drug Profile

Names

Classifications

Mechanism of action

Indications

Pharmacokinetics

Side effects/adverse reactions

Contraindications

Dosages

How supplied

Special considerations
Drugs and the Law

Pure Food & Drug Act of 1906

Harrison Narcotic Act of 1914

Federal Food, Drug & Cosmetic Act of 1938

Durham-Humphrey Amendments

Comprehensive Drug Abuse Prevention & Control Act
of 1970

Over-the-counter (OTC) medication

State laws

Local

Standards
Drug Schedules

Schedule I: No acceptable medical indications

Schedule ll: Accepted medical indication, but
high abuse potential, may lead to severe
dependence

Schedule lll: Less abuse potential, may lead
to moderate or low physical dependence

Schedule lV: Less abuse potential then lll,
limited psychological and/or physical
dependence

Schedule V: Even lower abuse potential
Special considerations in drug therapy

Pregnant patients

Before using any drug during pregnancy, the expected
benefits should be considered against the possible risks
to the fetus

The FDA has established a scale (Categories A, B, C, D,
and X) to indicate drugs that may have documented
problems in animals and/ or humans during pregnancy

Many drugs are unknown to cause problems in animals
and/ or humans during pregnancy

Pregnancy causes a number of anatomical and
physiological changes

Drugs may cross the placenta or through lactation
Special considerations in drug therapy
Pediatric patients

Based on the child's weight or body surface area

Special concerns for neonates

Length-based resuscitation tape
Geriatric patients

The physiological effects of aging can lead to altered
pharmacodynamics and pharmacokinetics
Scope of Management
 AEMT’s
are held responsible for safe and
therapeutically effective drug administration
 AEMT’s are personally responsible - legally,
morally, and ethically - for each drug they
administer
Scope of Management-continued

AEMT’s are responsible for:

Use correct precautions and techniques

Observe and document the effects of drugs

Keep their knowledge base current to changes and
trends in pharmacology

Establish and maintain professional relationships

Understand the pharmacology of their approved drugs

Perform evaluation to identify drug indications and
contraindications

Seek drug reference literature

Take a drug history from their patients including OTC
Review of the Nervous System
Patient’s Rights
Right
 Right
 Right
 Right
 Right
 Right

medication
dose
time
route
patient
documentation
Actions of Drugs
 Pharmacokinetics – study of how drugs
enter the body, reach their site of action
& are eliminated
 Pharmacodynamics – study of drug’s
action on a body




Can act by binding to a receptor site
Can act by changing physical properties
Can act by chemically combining with other
substances
Can act by altering a normal metabolic
pathway
Pharmacokinetics

Absorption

Distribution

Biotransformation

Elimination
Absorption
 Liberation - Release of drug from
pill, tablet, capsule
 Dissolving of active drug in GI fluids
 Absorption – the process by which
drug enters the blood stream; is
influenced by several factors:
 Route of administration
 Circulatory status
Absorption
 Speed of absorption (in order)
 Intravenous / Intraosseous
 Transtracheal (ETT)
 Sublingual
 Rectal
 Intramuscular
 Subcutaneous
 Oral
Distribution
 Distribution – once in circulatory
system, the drug is distributed to
body’s tissues
 From intravascular to interstitial
spaces
 Some drugs bind to serum proteins &
have a delayed onset & longer duration
 Dependent on circulatory status
 Brain is protected from most drugs by
blood brain barrier
Biotransformation
 Biotransformation (AKA Metabolism)–
many drugs are inactive when given &
have to be converted to active form
 Done in the blood or by the target
tissue
 Results in chemical variations called
metabolites
 Some drugs are active on
administration, are utilized, then
biotransformed into an inactive
metabolite for excretion
Elimination
 Elimination – either in its original form or
as a metabolite, excreted by:
 The kidneys, liver, intestines and the lungs
 Varies with the drug & general health:
 Adversely affected by shock, poor renal,
hepatic or respiratory status
 The slower the rate of elimination, the longer
the drug stays in the body
Actions of Drugs
 Drug Receptors – proteins on surface of
cells that, when activated, cause cell to
behave in desired manner
 ie. Epinephrine effect on target cells in
lungs
 Agonists are drugs that bind to receptor to
cause desired response
 Antagonists are substances that bind to
same receptor & block the desired
biochemical response
Pharmacodynamics

Drug Receptor Interactions





Agonist
Antagonist
Affinity
Efficacy
Types of receptors


Beta
Alpha
Other definitions you need to know
Agonist: drug that binds to a receptor
and causes it to initiate the expected
response
 Antagonist: drug that binds to a receptor
but does not cause it to initiate the
expected response

Receptor Sites
Factors altering drug responses
Age
 Body mass
 Sex
 Environmental milieu
 Time of administration
 Pathologic state
 Genetic factors
 Psychological factors

Drug Routes

Enteral





PO
Orogastric/naogastric
SL
Buccal
Rectal

Parenteral












IV
ET
IO
Umbilical
IM
SQ
Inhalation/nebulized
Topical
Transdermal
Nasal
Instillation
Intradermal
Drug Forms

Pills/tablets: compressed

Powders:

Suppositories: drug mix with wax-like base (melts)

Capsules: gelatin container, dissolves in GI

Solutions: generally water based

Tinctures: an alcohol solution w/ non-volatile drug

Suspensions: solid does not dissolve


Emulsions: suspension w/ oily substance in solvent
Spirits: Volatile drug in alcohol

Elixirs: alcohol & water, often flavored

Syrups: sugar, water & drug

Gas:
Action of Drugs

Bind to a receptor site

Change the physical properties of cells

Chemically combine with other chemical

Alter the normal metabolic pathway
Responses to Drug Administration


Allergic reaction: hypersensitivity
Idiosyncrasy: unique to the individual; different than
seen or expected in the general population

Cross tolerance: tolerance of a drug after admin of a
different drug. Morphine & other opioids

Tachyphylaxis: rapid tolerance. Typically w/
sympathetic agonists (decongestant &
bronchodilation agents)

Cumulative Effects: increased effects with several
doses

Drug interaction: one drug alters the response to
another

Synergism: 2 drugs given give greater response
than their sum. 1+1=3
Unpredictable adverse responses

Anaphylaxis

Delayed reaction

Tolerance

Drug dependence

Summation (addition or additive
effect)

Potentiation

Interference
Predictable Responses
Desired action
 Side effects

Body Substance Isolation Equipment
Always take appropriate body substance
isolation measures to reduce your risk of
exposure during medication
administration
Drug Storage

Storage considerations




Temperature
Light
Moisture
Shelf Life
Security
 Accountability


Logs
Needle Handling Precautions
 Minimize the tasks performed in a
moving ambulance
 Balance the safety needs with the need
to transport in a timely manner
 Immediately dispose of used sharps
in a sharps container
 Recap needles only as a last resort
 Learn the one-handed recapping
maneuver
Definitions
 Metric System – system of weights &
measures widely used in science &
medicine
 Based on units of 10
 Apothecary System – antiquated
system of measures & weights used
in early medicine
Weights & Measures
Metric System has 3 basic units of
measurements
 For Mass: the gram (G)
 For Length: the meter (M)
 For Volume: the liter (L)
All metric units are derived from these
3 base units
Conversion between Prefixes
Weights & Measures – Metric
 Kilogram(kg)= 1,000 grams
 Gram (gm) = 1,000 milligrams
 Decigram (dl)= 100 mg or 0.1 gm
 Milligram (mg)= 1,000 micrograms or
0.001 gm
 Microgram (mcg or μg)= 1/1,000,000 or
0.000001
 1 Liter (l)= 1,000 milliliters (ml)
 ml = cc
Weights & Measures –
Apothecary
 1 grain = 60 milligrams
 ¼ grain = 15 milligrams
Household
 1 teaspoon = 5 ml
 1 tablespoon = 15 ml
 1 ounce = 30 ml
 8 ounces = 240 ml
 1 quart = 946 ml
Weights & Measures
You need to know how to
 Add, subtract, multiply & divide decimals
 Convert from liters <-> milliliters, etc.
 Calculate dosages
 If in doubt, carry a calculator, find a chart
 Have your partner double check you
It’s better to double check than to
make a mistake!!!
 Buy & use medication math calculation
books
Drug Calculations
 Desired Dose – quantity of medication that
the physician wants administered
 Usually expressed in mg, gm or gr.
 Concentration of Drug on Hand – amount
of drug present in the vial or ampoule or
syringe
 Expressed in mg., gm. Or gr. Per volume unit
 i.e. 10 mg / 2 ml
 Volume of Drug on Hand – the amount of
fluid within the vial or ampoule
 Expressed in ml or cc
Drug Calculations
Medication Dose
Volume administered = Volume on hand x Desired Dose
Concentration on Hand
Or use the fraction / ratio format
 Concentration on hand expressed as a fraction
 Desired dose expressed as a fraction
100 mg
1 ml
= 75 mg
x ml
x = 75
100
100x = 75
100
x = 0.75 ml
100x = 75
100
Drug Calculations
Converting Pounds to Kilograms:
Weight in Pounds
Kilograms
2.2
= Weight in
OR 3 a.m. rule: Divide wt in pounds by 2
and subtract 10% of the result = Weight
in Kilograms
Medications via Inhalation Route

Broncholdiator (beta angonist)

Equipment




oxygen
nebulizer
adapters
Administering




Indications
Techniques
Precautions
General principals
Parenteral Administration

Subcutaneous

Intramuscular

Intravenous bolus

Intraosseous

Sublingual

Equipment: syringes, needles, ampules,
vials, prefilled syringes, others
Subcutaneous Injection
Intramuscular Injection
Sublingual Route
Intravenous Bolus
Prefilled / Preloaded Syringes
Intravenous Med Administration
 Pt’s Rights






Right medication
Right dose
Right time
Right route
Right patient
Right
documentation
 Prepare the
equipment
 Check the label
 Check the
expiration date
Prefilled / Preloaded Syringes
 Confirm prefilled syringe label (name, dose,
and expiration date)
 Assemble the prefilled syringe
 Remove the pop-off caps and screw
together
 Reconfirm indication, drug, dose, and route of
administration
 Administer appropriately via the indicated
route
 Properly dispose of the needle and syringe
Intravenous Med Administration
 Select administration port
 Port closest to the
patient
 Cleanse
 Pinch the tubing upstream
from the port
Intravenous Med Administration
 Administer the
medication
 Flush the line
 Re-assess the patient
 Re-adjust the rate
QUESTIONS