1. EMT Basic Pharmacology EMT 151 Spring 2006

2. Basic Pharmacology Medications that the EMT Basic is allowed to administer by Oregon statute: Epinephrine 1:1,000 Activated charcoal Oxygen Aspirin Glucose

3. Pharmacology Medications that the EMT Basic is allowed to assist a patient with administration: Nitroglycerin Inhaler/Bronchodilator

4. Pharmacology Basic drug information Chemical- 1, 2, 3- propanetriol trinitrate Generic-nitroglycerin tablets Trade-Nitrostat Official – nitroglycerin tablets, U.S.P.

5. Pharmacology Routes of medications : PO (by mouth) IV (intravenous) IM (intramuscularly) SQ (subcutaneous) SL (sub-lingual) IO (intraosseous) Inhalation

6. Pharmacology Forms Solution Topical Tablet Capsule Suspension Transdermal Inhalation

7. Pharmacology Indications Contraindications Dose Route Action Side effects

8. Pharmacology Nitroglycerin – suspected MI Epinephrine - anaphylaxis Oxygen – medical/trauma conditions Activated Charcoal – poisoning/OD Inhalers – asthma, emphysema Glucose - hypoglycemia

9. Case #1 You are dispatched to a report of a 52 y/o male c/o sudden onset chest pain while at rest. You arrive to find this anxious patient sitting on his couch. He is CAO PPTE, skin is pale and diaphoretic, B/P 152/94, HR 76, RR 30. PMH: AMI in 1995; NIDDM, HTN. Meds: NTG, Glucaphage,

10. Case #1, cont. What is your DDX? What is your immediate tx? Which of his medications can you assist him in taking? Any other concerns?

11. Patients Medication Physician order Read the Label CAREFULLY Patients Name Name of Drug Medication Strength Number of Pills Route and Directions Record this Information Clearly Write carefully and neatly

12. Allergies To Medications ALWAYS ASK “Are you allergic to any medications?” Remember this – Once you give a medication, it may be impossible to get it out of the patient. So it better not be one they are allergic to! Always ask BEFORE giving a drug.

13. 5 “rights” of medication administration (or is it 6?) Right patient Right medication Right route Right dose Right date Right to refuse

14. Now, reassess the pt. Mentation Airway patency Respiratory rate, quality Pulse rate, quality Skin color, temperature, condition B/P Change in patient complaint & s/s Side effects

15. Oxygen Basic need by all cells Inhaled, absorbed through lungs Needs red blood cells to carry to body Careful around flames May reduce HYPOXIC drive in COPD 2-15 lpm via mask or n/c

16. Glucose Basic need by all cells Good at proper levels (80-110) Too High is bad Too Low is bad Not for those with compromised Gag Not good in the lungs Oral intake (25 grams) Paste or in drink

17. Activated Charcoal Binds chemicals to it Don’t use in patients with compromised gag reflex Good in stomach Bad in lungs Yucky Black Stuff Challenge to get kids to drink it 25-100 grams in suspension

18. Nitroglycerine Dilates Veins and coronary arteries Causes hypotension and a headache (migraine like) Don’t give if already hypotensive Sublingual spray or tablets Don’t shake the bottle (Boom!) Just kidding, but don’t shake the bottle

19. Administ. Of NTG, cont. Assess vitals B/P >90 systolic PMH – ulcers, GI bleed, Alcohol abuse Meds – Viagra? Have pt. Sit or lie down Sl spray or tablet – just one spray Wait 5 min. consider another spray Wait 5 min., consider another spray

20. Epinephrine Constricts arteries Dilates Bronchioles Increases Heart Rate Increases Blood Pressure Use with caution Always useful in True Anaphylaxis Sub-Q 0.3-0.5 ml 1:1000 dilution

21. So what is true anaphylaxis? An Extreme Allergic Reaction Symptoms of Flushing, swelling of tongue, lips, extremities Wheezing, SOB, Coughing, Hoarseness Headache Nausea, Vomiting, abdominal cramps Sense of Impending Doom, decreased mentation

22. Ouch! 22g

23. Inhalers Albuterol, Proventil, Terbutaline, etc. Open up the airways Inhaled by puffer or nebulizer Similar effects to body as epi. Safer than epi, multiple dosing with less side effects Use of conserving devices common Remember this “They have to be breathing well enough to get the meds into lungs!”

24. So, when do I administer an Inhaler? Obvious respiratory distress S/s Audible wheezing Wheezing on auscultation Previously used inhaler? What if it doesn’t work?

25. Aspirin – Special circumstances Pathophysiology of acute myocardial infarction Occurs when blood supply to the myocardium (heart muscle) is interrupted long enough that the muscle dies Coronary artery disease (CAD), Angina pectoris, AMI

26. Pharmacology Administration AHA ACLS guidelines indicate that aspirin should be given immediately for the general treatment of chest pain suggestive of ischemia. The action of ASA when given in AMI has shown to decrease mortality.

27. Aspirin – Actions Inhibits platelet aggregation Mild analgesic and anti- inflammatory agent

28. Aspirin Contraindications Known allergy or ASA induced asthma Hx of active bleeding disorder Current ulcer or GI bleed Taking ASA within last 24 hours Check local protocol Receiving anticoagulation therapy Possibility of aortic dissection

29. Aspirin Side effects GI distress (cramping, heartburn, mild nausea) May exacerbate bleeding disorders GI bleeding – signs and symptoms Low grade toxicity may cause; ringing in the ears, headache, dizziness, flushing, tachycardia

30. Aspirin Precautions – use with caution in patients with renal failure or vitamin K deficiency Dose/route – 162-324 mg (2-4) chewable baby aspirin Quickest route vs swallowing

31. So, when do I give Aspirin? Signs and symptoms – AMI Pain/pressure - Angina vs. AMI Silent AMI Indicated in unstable angina and AMI Chest pain not relieved by NTG or lasting more than 15 minutes

32. S/S AMI, cont. Diaphoresis (profuse sweating) Dyspnea (difficulty breathing) Nausea/vomiting Weakness Dizziness Palpitations Feeling of impending doom Denial

33. S/S, cont. General appearance Anxious Frightened In pain Poor color (gray, pale, cyanosis)

34. Assessment Vital signs Respirations Level of consciousness Pulse Blood pressure Pulse oximetry

35. Tx General approach to the patient ABC’s Oxygen therapy Vital signs Prepare for immediate transport Nitroglycerin Aspirin Prepare for the worst! Extra hands for CPR maybe?

36. Scenario 1 45 yo male, sitting in truck on side of road. Truck parked the wrong way on a small side street. Man is confused and tired looking. He repeatedly refuses any care. His speech is slurred and you notice nothing else remarkable about his appearance. When asked about where he is headed, he asks directions to Turner, over and over again. He cannot get his cigarette lighter to work and is frustrated. What do you do?

37. Scenario 2 You arrive at a home with an elderly woman who called you because she is having chest pain and is short of breath. She has no medication in the house and is otherwise very healthy. This has been going on for 30 minutes and is getting more uncomfortable. What drugs may be useful for her?

38. Scenario 3 Elderly man complaining of SOB. He has a history of COPD. All he wants is some oxygen and he will be fine. You give him some oxygen and he gets better. He assures you that if you leave the tank of oxygen, he will see his doctor tomorrow. Do you see anything wrong with this?

39. Scenario 4 Your neighbor has eaten some lima beans by mistake. She is allergic to them and is now having hives all over her. She is very uncomfortable and itches badly. She asks you to help her with her epinephrine shot. Are you comfortable with helping her with the shot?

40. Scenario 5 A child at a T-ball game becomes Short of Breath after running the bases during a home run hit. He is wheezing terribly and laboring to breath. He has a proventil puffer and wishes help to use it. Mother is anxious and hands you the puffer. What is the next course of action?

41. Scenario 6 Little LeRoy has done it again. This time he has eaten all of Grandpa’s percocet tablets. Mom caught him doing it just minutes ago and called you. Mom has Poison Control on the phone as you arrive. What is Poison Control going to want to know about the child? What do you suppose they will suggest doing?

42. Scenario 7 Mr. Jones is feeling great. He is returning from a jog and has become SOB and has Chest Pain at 8/10 scale. He doesn’t understand this, he had a pre-marriage physical exam last month and at 84 years of age, he is “fit as a fiddle”. What might you ask Mr. Jones before giving him any medication?