Download File - Dan Shaw

NM Pharmacology for
First Responders
Lesson Goal
• Introduce drug names, forms, and
indications for use, as well as how to
assist patients with taking their
prescribed medications
Drug Names
• Generic (scientific/chemical name)
– Listed in U.S. Pharmacopeia
– Example
• Aspirin
• Trade (brand)
– Example
• Bayer, Anacin
Forms of Medication
• Oral
– Per os (PO)
– Patient must be awake
• Patient must be able to follow
commands
• Must be swallowed
– Enters bloodstream through
digestive system
• Takes effect in 30-60 min
Forms of Medication
• Inhaled
– Medication is inhaled into
the lungs
• Rapidly absorbed
• Easy to administer
– Inhaler or nebulizer
Forms of Medication
• Buccal
– Between cheek and gums
– Oral glucose
Vital Drug Information
• 6 pieces of information for every
medication
– Indications
– Dosage
– Administration
– Actions
– Side effects
– Contraindications
Vital Drug Information
• Indications
– Reason for administering medication
– Nitroglycerin
• Indicated for angina
• Dosage
– How much
Vital Drug Information
• Administration
– Route
• Actions
– Desired effects
• Nitroglycerin dilates coronary arteries to relieve
chest pain
Vital Drug Information
• Side effects
– Undesirable effects
• Contraindications
– Conditions in which medication must not
be given
• Nitroglycerin contraindicated for patients who
have recently taken drug for erectile
dysfunction
Medication Examination
• Correct medication
– Seal intact
– Color
– No precipitate (floaters)
• Correct concentration
• Check expiration date
Allowable Drugs
•
Administer the following drugs with Service
Medical Director Approval
–
–
–
–
–
–
–
Oral glucose preparations
Aspirin PO for adults with suspected cardiac chest pain
IM auto-injector of atropine and or pralidoxime for
treatment of chemical and/or nerve agent exposure
Albuterol via inhaled administration
Ipratopiem via inhaled administration, in combination with
albuterol
Epinephrine via auto-injector device
Patient’s own bronchodilator using pre-measured or MDI
device
Metered Dose Inhaler (MDI)
• You may assisted with a
patient’s own
bronchodilator using premeasured or MDI device
– Need on-line medical control
drug
• Absorbed from alveoli
into the pulmonary
capillaries
– Onset of action 1 - 3 minutes
• Patient must be awake
IM Auto-injection
•
Epinephrine
•
Nerve agent
exposure
–
–
Atropine
Pralidoxime
Acetylsalicylic Acid (ASA)
• CLASS OF DRUG
– Anti-inflammatory, analgesic, antipyretic, anticoagulant
• INDICATIONS
– Myocardial infarction patients, including suspected AMI
patients.
• CONTRAINDICATIONS
– Hypersensitivity
– Bleeding disorders
– Asthma (Relative)
• ADMINISTRATION
– Adult: [160-325 mg] orally for AMI (prefer chewable)
• SPECIAL NOTES
– All patients with suspected AMI and without
contraindications receive aspirin
Albuterol
•
CLASS OF DRUG
– Sympathomimetic, Beta 2 selective adrenergic bronchodilator
•
INDICATIONS
– Albuterol is used to treat reversible airway obstruction caused by:
• Wheezing associated with asthma, COPD (emphysema), chronic bronchitis
•
CONTRAINDICATIONS
– Hypersensitivity
•
DRUG INTERACTION
– Beta adrenergic agents - potentiates the effects
– MAO inhibitors - may lead to hypertensive crisis
– Beta adrenergic blockers - decreases the effectiveness
•
ADMINISTRATION
– Nebulizer
– Adult: [2.5-5.0 mg] (up to 10 mg) given over 5-15 minutes, may be repeated
as necessary.
– Pediatric: [1.25-2.5 mg] (up to 5 mg) given over 5-15 minutes, may be
repeated as necessary.
•
SPECIAL NOTES
– Most side effects are dosage related
Ipratropium (Atrovent)
•
CLASS OF DRUG
–
•
INDICATIONS
–
–
•
Few in the pre-hospital setting
ADMINISTRATION
–
–
•
Hypersensitivity to the drug
Acute treatment of bronchospasm where rapid response is required.
DRUG INTERACTION
–
•
Bronchial asthma
Reversible bronchospasm associated with chronic bronchitis and emphysema
CONTRAINDICATIONS
–
–
•
Anticholinergic
Should be administered in conjunction with beta agonist therapy.
Adult: 250 – 500mcg (.25 - .5 mg) via nebulization
SPECIAL NOTES
–
–
The vital signs must be monitored during therapy.
Caution should be used when administering it to elderly patients and those with
cardiovascular disease or hypertension.
Epinephrine (1:1,000)
•
CLASS OF DRUG
– Sympathomimetic
•
INDICATIONS
– Severe Bronchospasm
– Anaphylaxis
•
CONTRAINDICATIONS
– None when indicated
•
DRUG INTERACTION
– Reduced effects with Beta-adrenergic blocker
•
ADMINISTRATION
– Auto-injector
•
SPECIAL NOTES
– Increased cardiac workload can precipitate angina and/or AMI
– Use with caution on patients with peripheral vascular insufficiency
– Wheezing in the elderly is pulmonary edema or pulmonary embolus until
proven otherwise
Glucose (Dextose)
• CLASS OF DRUG
– Carbohydrate, nutrient, short acting osmotic diuretic
• INDICATIONS
– Symptomatic hypoglycemia
• Known diabetic actively seizing
• CONTRAINDICATIONS
– Intra-cranial bleeds or suspected CVA (relative)
– Unconscious (for oral glucose)
• DRUG INTERACTION
– None
• ADMINISTRATION
– Oral: [12-25 gm] of paste, may be spread with a tongue depressor.
• SPECIAL NOTES
– Attempts at documenting hypoglycemia via automatic glucometry
should be made before administration.
Oxygen
•
CLASS OF DRUG
– Gas
•
INDICATIONS
– Suspected hypoxia or respiratory distress from any cause
•
CONTRAINDICATIONS
– None
•
DRUG INTERACTION
– None
•
ADMINISTRATION
– Adult & Pediatric Dosage
• Low flow (NC 1 - 2 L/Min)
• Moderate flow (NC 4 - 6 L/Min)
• High flow (NRB 10 - 15 L/Min)
•
SPECIAL NOTES
– BE PREPARED TO ASSIST VENTILATION, IF NEEDED.
– Nasal prongs work equally well on nose and mouth breathers.
– Giving 100 % oxygen to all patients is unnecessary.
• If the patient has 96% O2 saturation and is in no acute distress, a NRB is not
necessary.
The Six Rights
•
•
•
•
•
•
Right
Right
Right
Right
Right
Right
D
R
P
A
T
S
rug
oute
atient
mount
ime
cribe
Helps prevent medication errors!
Allergies
• Always ask about
medication allergies
before administering
a medication!
Sharps Control
• Place syringe with needle
immediately into sharps
container
Do NOT recap the needle
Assessment of
Effectiveness
• After medication administration:
– Reassess early & often
• V/S
• Patient assessment
– Document findings/changes
Summary
• Many patients carry medications for
chronic medical conditions
• Know how to obtain drug information
• On-line medical direction sometimes
required
• Patients must be re-evaluated
Questions?