Chapter 14

1. Chapter 14 Pharmacology And Medication Administration

2. Objectives • Administering Medications • Commonly administered medications by EMT’s • Medication Names • Routes of Administration • Medication Forms • Essential Medication Information • Key steps in administering medications • Patient reassessment after medication administration • Sources for medication information

3. Administering Medications • Medication – a drug or substance used as a remedy for illness • A chemical substance • Pharmacology – study of drugs

4. Administering Medications • EMT’s responsibility • Administer medications under physician direction • Medications identified by local protocols • Whatcom County pages 9, 17, and 26 • EMT’s Role • Will take steps necessary to give the patient a medication • EMT will prepare the medication and hand it to the patient to take themselves

5. Medications commonly administered by EMT’s • Oxygen • Odorless, Tasteless, Colorless • Makes up 21% of ambient air • Indicated for patients with medical or trauma condition and who may be hypoxic

6. Medications commonly administered by EMT’s • Oral Glucose • Simple sugar found in blood • Primary energy source for body cells • If brain cells are deprived of glucose, they die • Administered to patients with a history of diabetes who are suspected of having low blood glucose levels (glucometer)

7. Medications commonly administered by EMT’s • Activated Charcoal • A fine black powder designed to absorb an ingested poison • Poison is attached to activated charcoal will be carried through the digestive tract and eliminated • Contact Med Control for orders

8. Medications commonly administered by EMT’s • Aspirin • Administered to a patient who is having chest pains or pain related to a lack of oxygen to the heart • May keep the vessels that deliver bood to the heart from closing shut

9. Aspirin • Now a minimum standard for EMT’s in Washington State for patients who meet criteria (See Whatcom County BLS Addendum) • Indications for use: Patient exhibits any of the following signs and symptoms • Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts for more than a few minutes, or goes away and comes back

10. Aspirin • Indications – cont. • Pain spreads to shoulders, neck or arms • Chest discomfort with lightheadedness, fainting, sweating, nausea, or shortness of breath

11. Aspirin • Patient exhibits two or more of the following signs and symptoms, and you think it is of cardiac origin: • Atypical chest pain, stomach or abdominal pain. • Unexplained nausea (without vomiting) or lightheadedness (not vertigo) without chest pain • Shortness of breath and difficulty breathing (w/o chest pain) • Palpitation, cold sweat or paleness

12. Aspirin • Contraindications for use: • Patient is allergic to aspirin or ibuprofen • Patient has taken aspirin already Proper dosage: 2, 81 mg chewable aspirin

13. Medications prescribed for the patient Inhaled bronchodilator • Metered-dose inhaler (MDI) • Used by patient with a respiratory disease, such as asthma, emphysema and chronic bronchitis • Patient will experience shortness of breath, signs and symptoms of respiratory difficulties • Only MDI’s that contain beta1-agonist drug can be administered • Delivers medication with one inhalation

14. Medications prescribed for the patient Inhaled bronchodilator • Small volume nebulizer (SVN) • Uses a different route of entry than a MDI • The medication goes into a specialized chamber and pass oxygen or compressed air through it • A fine vapor that is produced is expelled through a T-tube and into a mouthpiece or mask • Creates a continuous flow of vapor containing medication

15. Medications prescribed for the patient Nitroglycerin • Used to treat cardiac patients with diseases of the coronary arteries • Vasodilator - dilates the blood vessels • Decreases the demand for oxygen by the heart muscle and increases the supply of oxygenated blood to the heart • Side effect – hypotension • Be aware of patient’s medications, do not administer if they are on other blood pressure lowering medications

16. Medications prescribed for the patient Epinephrine • Used to treat anaphylaxis • During an anaphylactic reaction, the patient’s blood vessels dilate, the bronchioles constrict, and the capillaries leak fluid • Epinephrine constricts the vessels, dilates the bronchioles, and decreases capillary permeability

17. Medication Names Chemical Name • Describes the chemical structure • Usually the first name associated with the drug Generic Name • AKA nonproprietary name • Shorter than full name • Independent of manufacturer • Listed in the U.S Pharmacopoeia Trade Name • AKA brand name • Assigned when the drug is released for commercial distribution Official Name • Assigned to drugs meeting the requirement of the U.S. Pharmacopoeia or National Formulary • Commonly, the generic name followed by the initials U.S.P. or N.F.

19. Routes of Administrations (1 of 3) • Intravenous (IV) injection • Injected directly into the vein • Oral • Taken by mouth; enters body through digestive system • Aspirin, oral glucose, activated charcoal • Sublingual • Placed under the tongue; absorbed by mucous membranes • Nitroglycerin tablet or spray

20. Routes of Administrations (2 of 3) • Intramuscular (IM) injection • Injection into the muscle • Epinephrine • Intraosseous (IO) • Injection into the bone marrow • Subcutaneous (SC) injection • Injection into tissue between skin and muscle

21. Routes of Administration (3 of 3) • Transcutaneous • Medications absorbed through the skin • Inhalation • Medications inhaled into the lungs • Oxygen, MDI, SVN • Per rectum (PR) • Administration by rectum

22. Tablets Materials mixed with medication and compressed under pressure Capsules Gelatin shells filled with powdered or liquid medication Dosage Forms (1 of 4)

23. Dosage Forms (2 of 4) • Solutions • Liquid mixture of one or more substances • Suspensions • Mixture of fine particles distributed throughout a liquid by shaking

24. Dosage Forms (3 of 4) • Metered-dose inhaler • Miniature spray canister, used to direct medication through the mouth into the lungs • Topical medications • Lotions, creams, and ointments applied to skin

25. Dosage Forms (4 of 4) • Transcutaneous medications • Designed to be absorbed through the skin • Gels • Semi-liquid substances administered orally • Gases for inhalation • Oxygen

26. Essential Information • Indications • Includes most common uses for the drug • Geared toward the relief of signs, symptoms, or specific condition • Contraindications • Situations in which the drug should not be administered due to potential harm to the patient. • The drug may not have any benefit to the patient

27. Essential Information • Dose • How much should be taken • Important to distinguish between adult, children and infants • Administration • Route and form in which the drug is given • EMT’s will administer either sublingually, orally, by inhalation, or by injection

28. Essential Information • Actions • The effect the drug has on the body • Therapeutic effect is the intended responses by the body • Mechanism of action is how the drug works to create its effect on the body • Side Effects • Actions that are not desired and that occur in addition to the therapeutic effects • Are not allergic reactions • EMT must be prepared to manage expected and unexpected side effects

29. Key steps in Administering Medications Obtain Medical Direction • An order can be obtained on-line by direct communication with med control or off-line through protocols • Verify an on-line order by restating the drug, dose, and route • Make a judgment as to the patient’s tolerance of the administration

30. Key steps in Administering Medications Select the proper medication • Read the label to check that the medication is consistent with the order Verify the patient’s prescription • Do not administer medication that is not prescribed for the patient unless ordered by med control • If the label is on separate packaging, determine that the prescription belongs to the patient

31. Key steps in Administering Medications Check the Expiration Date • Do not administer expired medication • Dispose medications according to your state drug or pharmacy guidelines Check for discoloration or impurities • Inspect for discoloration or cloudiness • Do not administer and dispose medication immediately Verify form, route and dose • Match the label to the drug order

32. Key steps in Administering Medications Medication Administration: The Five “Rights” • Right Patient • Right medication • Right route • Right dose • Right date (time) Documentation • Document drug, dose, route, and time the medication was administered • Report any changes in patient condition

33. Reassessment following administration • Repeat vital signs • Assess for any changes in the patient’s condition • Mental status • Patency of airway • Breathing rate and quality • Pulse rate and quality • Skin color, temperature and condition • Blood pressure • Change or relief of complaints • Relief of signs and symptoms • Medication side effects • Improvement or deterioration in patient’s condition • Confirm adequacy of oxygen administration • Document your reassessment

34. Sources of Medication Information • American Hospital Formulary Service • AMA Drug Evaluation • Physician’s Desk Reference (PDR) • Package inserts • Poison control centers • EMS pocket drug reference guide • ePocrates for the PDA • On-line sources approved by your medical direction • “We’ve got an app for that”

35. Any Questions?