Download Chapter 14

MASTER TEACHING NOTES
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Detailed Lesson Plan
Chapter 14
Pharmacology and Medication Administration
200–220 minutes
Case Study Discussion
Teaching Tips
Discussion Questions
Class Activities
Media Links
Knowledge Application
Critical Thinking Discussion
Chapter 14 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
I.
5
10
Master Teaching Notes
Introduction
Case Study Discussion
A. During this lesson, students will learn about assessment and emergency
care for a patient whose condition may require administration of a
medication.
B. Case Study
1. Present The Dispatch and Upon Arrival information from the chapter.
2. Discuss with students how they would proceed.
II. Administering Medications
A. A medication is a drug or other substance used as a remedy for illness
B. A drug is a chemical substance used to treat or prevent a disease or
condition.
C. Pharmacology is the study of drugs.
1. When the correct dose of a medication is administered appropriately, the
patient’s condition may improve significantly.
2. When a medication is administered inappropriately, some drugs can
cause serious side effects and deterioration in the patient’s condition.
D. EMT’s responsibility
1. Administer medications under the direct order of a physician only.
2. Administer only medications identified in local protocols.
E. EMT’s role
1. Administration implies that the EMT will take all the steps necessary to
give the patient a medication.
2. Assisting means that the EMT will prepare the medication and then hand
it to the patient who will take the medication.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 14
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How will you know what medications a
patient needs?
 What are the safety precautions to
observe when giving medications?
Discussion Questions
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What is a drug?
What are some examples of drugs?
How can these drugs be used to treat or
prevent diseases or conditions?
Teaching Tip
Give examples of how a medication can
help if used appropriately, such as
nitroglycerin used for chest pain; also
explain how the same medication can have
detrimental effects if used inappropriately
(too much, wrong patient, and so on).
Class Activity
Have small groups of students work
together to generate a list of drugs they are
familiar with.
PAGE 1
Chapter 14 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
Critical Thinking Discussion
What are the pros and cons of the many
advertisements on television for
prescription medications?
Weblink
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access the
National Institutes of Health/National
Library of Medicine Drug Resource.
III. Medications Commonly Administered by the EMT— Medications
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Carried on the EMS Unit
A. Oxygen
1. Oxygen is an odorless, tasteless, colorless gas.
2. Makes up 21 percent of ambient air
3. Indicated for patients with medical or trauma condition and who may be
hypoxic
B. Oral glucose
1. Glucose is a simple sugar found in blood.
2. It is the primary energy source for body cells.
3. If brain cells are deprived of glucose, they die.
4. Oral glucose is administered to patients with a history of diabetes who
are suspected of having low blood glucose levels.
C. Activated charcoal
1. Activated charcoal is a fine black powder designed to absorb an
ingested poison.
2. Poison attached to activated charcoal will be carried through the
digestive tract and eliminated.
3. The use of activated charcoal has been questioned and has been
removed from many protocols.
D. Aspirin
1. Aspirin is administered to a patient who is having chest pains or pain
related to a lack of oxygen to the heart.
2. Aspirin may keep the vessels that deliver blood to the heart from closing
shut.
Discussion Questions
Why is oxygen considered a
medication?
 Under what circumstances might you
administer activated charcoal?
 Why is aspirin used in the prehospital
setting?
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Critical Thinking Discussion
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Why are there only a limited number of
drugs carried on the EMT’s ambulance?
 Why must EMTs have a physician’s
order to administer medications?
Teaching Tip
Show as many examples as possible of the
medications described. Pass the
medication containers around the
classroom so students can see and touch
them.
Weblink
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 14
PAGE 2
Chapter 14 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access a
web resource on medications that can be
administered by an EMT.
IV. Medications Commonly Administered by the EMT— Medications
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Prescribed for the Patient
A. Inhaled bronchodilator
1. Metered-dose inhaler (MDI)
a. Used by a patient with a respiratory disease, such as asthma,
emphysema, and chronic bronchitis
b. Patient will experience shortness of breath and signs and symptoms
of respiratory difficulty.
c. Only MDIs that contain a beta2-agonist drug can be administered.
d. Delivers medication with one inhalation
2. Small-volume nebulizer (SVN)
a. Uses a different route of delivery than an MDI
b. Place the medication into a specialized chamber and pass oxygen
or compressed air through it.
c. The fine vapor that is produced is expelled through a T-tube and into
a mouthpiece or mask.
d. Creates a continuous flow of vapor containing medication
B. Nitroglycerin
1. Nitroglycerin is a medication used to treat cardiac patients with diseases
of the coronary arteries.
2. This medication is a vasodilator, which dilates the blood vessels.
3. It decreases the demand for oxygen by the heart muscle and increases
the supply of oxygenated blood to the heart.
4. The major side effect of this medication is hypotension.
5. It should not be administered to patients taking other medications known
to lower blood pressure.
C. Epinephrine
1. Epinephrine is a drug used to treat patients suffering from anaphylaxis.
2. During an anaphylactic reaction, a patient’s blood vessels dilate, the
bronchioles constrict, and the capillaries leak fluid.
3. Epinephrine constricts the vessels, dilates the bronchioles, and
decreases capillary permeability.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 14
Class Activity
Instead of lecturing on this section, assign
each of the drugs listed to a group of
students and provide them with several
resources in addition to their texts. Each
group should take about 15 minutes to
research their assigned drug, and then
present their findings to the rest of the
class. Be sure to emphasize key points and
fill in any gaps.
Knowledge Application
Give several examples of patient problems
(asthma, chest pain, anaphylactic reaction,
or poisoning) and ask students what drug
used by EMTs may be indicated for the
patient.
Discussion Questions
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What are the consequences of
administering nitroglycerin to a patient
who has recently taken a drug for
erectile dysfunction?
 Why is epinephrine used for severe
allergic reactions?
Video Clip
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access a
video clip describing the actions and use of
an epinephrine auto-injector.
PAGE 3
Chapter 14 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
15
Content Outline
Master Teaching Notes
V. Medication Names
A. Chemical name
1. Describes the chemical structure of the drug
2. Is usually the first name associated with the drug
B. Generic name
1. Also known as nonproprietary name
2. Shorter than full chemical name
3. Independent of manufacturer
4. Listed in the U.S. Pharmacopoeia
C. Trade name
1. Also known as brand name
2. Assigned when drug is released for commercial distribution
D. Official name
1. Assigned to drugs meeting the requirement of the U.S. Pharmacopoeia
or National Formulary
2. Is commonly the generic name followed by the initials U.S.P. or N.F.
Teaching Tip
Give examples of a generic drug name,
such as ibuprofen, and several of the trade
names it is marketed under.
Discussion Questions
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What is the generic name of a drug?
How is the generic name of a drug
different from the official name?
Critical Thinking Discussion
Why must EMTs know both generic and
trade names for drugs?
Knowledge Application
List examples of the generic names of
drugs commonly administered by the EMT
and have students match it with trade
names, and vice versa.
Class Activity
Give over-the-counter medication
containers to small groups of students.
Have them search for the generic and trade
names and report them to the class.
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VI. Routes of Administration
A. The route describes how a medication is given to or taken by a patient.
B. The route controls how fast the medication is absorbed by the body.
C. The EMT prepares the medication in a form that allows the quickest and
safest absorption by the body.
1. Sublingual—Under the tongue
a. Nitroglycerin tablets
b. Nitroglycerin spray
2. Oral—Swallowed
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 14
Discussion Questions
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How does the absorption of drugs
administered into the muscle compare
with the absorption of drugs
administered orally?
 What is the difference between oral
administration and sublingual
administration routes?
PAGE 4
Chapter 14 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
a. Aspirin
b. Oral glucose
c. Activated charcoal
3. Inhalation—Breathed in by the patient
a. Oxygen
b. Metered-dose inhaler
c. Small-volume nebulizer
4. Intramuscular injection—Injected into muscle mass
a. Epinephrine with auto-injector
Teaching Tip
Reinforce learning by naming drugs
administered by EMTs and having students
state the route by which it is administered.
Class Activity
Pass out small tablet-shaped candies. Tell
students not to eat them until you explain
the instructions to them. First instruct
students as if you were instructing a patient
to take an oral medication. Then instruct
students as if you were instructing a patient
to take a sublingual medication.
Video Clips
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access
video clips describing oral glucose
administration, nitroglycerin administration,
activated charcoal administration, and MDI
administration.
Critical Thinking Discussion
How do you think poor perfusion might
affect drug absorption?
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VII. Medication Forms
A. Medications come in different forms.
B. The form limits administration to one specific route.
C. The form determines the effects of the drug.
D. Common forms of medications administered by the EMT
1. Compressed powder or tablet
2. Liquid for injection
3. Gel
4. Suspension
5. Fine powder for inhalation
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 14
Discussion Questions
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What form of medication is used in a
small-volume nebulizer?
 What medication can be administered
as a spray?
Teaching Tip
Refer to the equipment and medications
you brought in as you discuss each form.
PAGE 5
Chapter 14 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
6.
7.
8.
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3
Master Teaching Notes
Small-volume nebulizer
Gas
Spray
VIII. Essential Medication Information—Indications
A. Indications include the most common uses of the drug in treating a specific
condition.
B. Indications are geared toward the relief of signs, symptoms, or specific
conditions.
Discussion Question
IX. Essential Medication Information—Contraindications
Discussion Question
A. Contraindications are situations in which the drug should not be
administered because of potential harm to the patient.
B. In some cases, the drug may not have any benefit to the patient.
X. Essential Medication Information—Dose
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A. Administration refers to the route and form in which the drug is given.
B. The EMT will administer medications sublingually, orally, by inhalation, or by
injection.
XII. Essential Medication Information—Actions
3
A. The action is the effect the drug has on the body.
B. The therapeutic effect is the intended positive response by the body.
C. The mechanism of action is how the drug works to create its effect on the
body.
XIII. Essential Medication Information—Side Effects
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What is a contraindication for nitroglycerin?
Teaching Tip
A. The does indicates how much of the drug should be given to the patient.
B. It is important to distinguish between dosages for adults, children, and
infants.
XI. Essential Medication Information—Administration
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What is an indication for nitroglycerin?
A. Side effects are actions that are not desired and that occur in addition to the
desired therapeutic effects.
B. Side effects are not allergic reactions.
C. The EMT must be prepared to manage expected and unexpected side
effects.
Explain the essential information of several
drugs to illustrate the concepts in this
section.
Critical Thinking Discussion
How does the SAMPLE history assist you
with considering whether or not to give a
patient a medication?
Knowledge Application
Hand out several over-the-counter
medication containers. Have students apply
the information from this section to describe
the indications, contraindications, dosage,
and side effects for the medications.
Discussion Question
What is a side effect of nitroglycerin?
XIV. Key Steps in Administering Medications—Obtain an Order from
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 14
PAGE 6
Chapter 14 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
5
Content Outline
Master Teaching Notes
Medical Direction
A. A medical order can be obtained on-line by direct communication with
medical direction or off-line through protocols or standing orders.
B. It is important to know and understand local protocols prior to an emergency
call.
C. Verify an on-line order by restating the drug, dose, and route.
D. Make judgments as to whether the patient can tolerate the administration of
a medication.
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XV.Key Steps in Administering Medications—Select the Proper
Medication
A. EMT must ensure that the proper medication is selected.
B. Read the label to check that the medication is consistent with the order.
5
XVI. Key Steps in Administering Medications—Verify the Patient’s
Prescription
A. Verify that the medication is prescribed for the patient.
B. The EMT should not administer medication that is not prescribed for the
patient unless ordered to do so by medical direction.
C. If the label is on separate packaging, determine through careful questing if
the prescription belongs to the patient.
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XVII. Key Steps in Administering Medications—Check the Expiration
Date
A. Check the expiration date of the medication.
B. Do not administer expired medication.
C. Dispose of medications according to your state drug or pharmacy guidelines.
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Discussion Question
Why is it important to verify a patient’s
prescription before assisting with
medication administration?
Discussion Question
What things should you be looking for as
you inspect a container of medication?
XVIII. Key Steps in Administering Medications—Check for
Discoloration or Impurities
A. Inspect liquid medications for discoloration or cloudiness.
B. Do not administer cloudy or discolored medication.
C. Discard cloudy or discolored medication appropriately.
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XIX. Key Steps in Administering Medications—Verify the Form, Route,
and Dose
A. Be sure the proper drug form is used for the route selected.
B. Verify the dose is correct.
C. Match the medication label to the drug order.
XX. Key Steps in Administering Medications—Medication
PREHOSPITAL EMERGENCY CARE,
9TH EDITION
DETAILED LESSON PLAN 14
Critical Thinking Discussion
How do you think medication errors can
occur?
Discussion Question
PAGE 7
Chapter 14 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Administration: The Five “Rights”
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A.
B.
C.
D.
E.
XXI.
5
What are the “rights” of medication
administration?
Right patient
Right medication
Right route
Right dose
Right date (time)
Weblink
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access a
web resource on the “rights” of medication
administration.
Key Steps in Administering Medications—Documentation
A. Document the drug, does, route, and time the medication was administered.
B. Report any changes in the patient’s condition.
XXII.
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Master Teaching Notes
Reassessment Following Administration
A. Repeat measurement of vital signs.
B. Assess for any changes in the patient’s condition.
1. Mental status
2. Patency of airway
3. Breathing rate and quality
4. Pulse rate and quality
5. Skin color, temperature, and condition
6. Blood pressure
7. Change or relief of complaints
8. Relief of signs and symptoms associated with complaints
9. Medication side effects
10. Improvement or deterioration in the patient’s condition
C. Check the adequacy of oxygen administration.
D. Document your reassessment.
XXIII. Sources of Medication Information
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A.
B.
C.
D.
E.
F.
G.
Demonstrate the steps in the medication
administration process, explaining each
step and verbalizing your actions.
Teaching Tip
To review what was learned about the
drugs administered by EMTs, list each drug
and ask students what changes they should
be looking for in the reassessment.
Discussion Question
What are some specific things you should
reassess after giving a medication?
Critical Thinking Discussion
Why is it important to document any
changes, or lack of changes, in the
reassessment?
Teaching Tip
American Hospital Formulary Service
AMA Drug Evaluation
Physicians’ Desk Reference (PDR)
Package inserts
Poison control centers
EMS pocket drug reference guide
ePocrates for the PDA
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
Teaching Tip
Demonstrate the use of several drug
reference resources.
Critical Thinking Discussion
How soon do you think sources of drug
information are outdated?
DETAILED LESSON PLAN 14
PAGE 8
Chapter 14 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
H. On-line sources approved by your medical direction
Class Activity
Provide small groups of students with drug
reference material. Have students look up
essential information about the drugs
discussed.
XXIV. Follow-Up
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Case Study Follow-Up Discussion
A. Answer student questions.
B. Case Study Follow-Up
1. Review the case study from the beginning of the chapter.
2. Remind students of some of the answers that were given to the
discussion questions.
3. Ask students if they would respond the same way after discussing the
chapter material. Follow up with questions to determine why students
would or would not change their answers.
C. Follow-Up Assignments
1. Review Chapter 14 Summary.
2. Complete Chapter 14 In Review questions.
3. Complete Chapter 14 Critical Thinking.
D. Assessments
1. Handouts
2. Chapter 14 quiz
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 14
Why is oxygen the first drug used for
this patient?
 Why is aspirin given to this patient?
 What side effects should you anticipate
from administering nitroglycerin?
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Class Activity
Alternatively, assign each question to a
group of students and give them several
minutes to generate answers to present to
the rest of the class for discussion.
Teaching Tips

Answers to In Review and Critical
Thinking questions are in the appendix
to the Instructor’s Wraparound Edition.
Advise students to review the questions
again as they study the chapter.
 The Instructor’s Resource Package
contains handouts that assess student
learning and reinforce important
information in each chapter. This can be
found under mykit at
www.bradybooks.com.
PAGE 9