1. Unit 3 Lesson 5 General Pharmacology for ALS

2. No cells, ear buds, or I-pads!

3. Needle and syringe

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Pharmacology can be defined as the science of how drugs are used to prevent, diagnose, and treat disease. It deals with the interactions between living systems and chemical molecules.

6. Angles of insertion

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A drug’s administration route influences the quantity given and the rate at which the drug is absorbed and distributed. Routes of administration include: Orally (PO) – the safest and most convenient administration route Sublingual – under the tongue Respiratory – drugs are administered as gases by inhalation

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Intradermal (ID) – substances are injected into the skin (dermis) Subcutaneous (SC) – substances are injected under the dermis Intramuscular (IM) – drugs are injected directly into the various muscle groups Intravenous (IV) – allows injection of substances directly into the bloodstream through a vein. Bolus – refers to a relatively large dose of a drug injected rapidly as a single unit into a vein.

9. Intradermal (ID)

10. Intramuscular routes (IM)

11. Intramuscular routes (IM)

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Every drug has indications, or specific signs, symptoms, or circumstances under which it is appropriate to administer the drug to a patient. For example, nitroglycerin is indicated when a patient has chest pain or squeezing, dull pressure.

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Each drug also has contraindications, under which it is not appropriate, and may be harmful, to administer the drug to the patient. For example, nitroglycerin is contraindicated (should not be given) if the patient has low blood pressure, because nitroglycerin, in dilating the arteries, causes a slight drop in the systolic blood pressure.

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A side effect is any action of a drug other than the desired actions. Some side effects are predictable, like the drop in blood pressure from nitroglycerin. If you were not aware of this side effect and gave the drug to a patient who already had low blood pressure, the results could be devastating. The patient’s blood pressure would “bottom out” resulting in the possible death of the patient.

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Pharmacological science and an overview of the indications and contraindications of even a limited listing of medications could easily encompass an entire master’s level course. From an ALS perspective; however, a small listing of emergency drugs are as follows (adult doses):

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Adenosine – initial dose 6mg rapid IV bolus used to suppress supraventricular tachycardia restores normal sinus rhythm. Epinephrine – 1 mg every 3-5 min as needed (q3-5 min prn) IV for sinus node dysfunction during CPR, bradycardia, or asystole that is induced by drugs or toxic substances. Restores cardiac rhythm in cardiac arrest.

17. Adenosine

18. Epinephrine

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Morphine – initial dose 1-3 mg PO, mg p4h or mg/h by continuous infusion IV; for relief of severe acute and chronic pain also used to relieve dyspnea and acute left ventricle failure, pulmonary edema, and pain due to MI. Naloxone hydrochloride (narcan) – mg q2-3 min up to 10 mg if necessary; complete or partial reversal of respiratory depression induced by opiate overdose.

20. Lidocaine and morphine

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Naloxone hydrochloride (narcan) – mg q2-3 min up to 10 mg if necessary; complete or partial reversal of respiratory depression induced by opiate overdose.

22. Narcan = for opiate overdose

23. Romero footnote*
IV bolus = intravenous rapid injection mg (migs) = milligrams mg/hr = milligrams per hour (mg/m = milligrams per minute) prn = “as needed” q = “every”

24. Pharmacology Drug Order Interpretation
6mg rapid IV bolus .5-1 mg IM/IV 1 mg q3-5 min prn IV mg IV bolus q5-10 min; maximum of 300 mg 1-3 mg PO mg p4h or mg/h mg q2-3 min up to 10 mg

25. Pharmacology Drug Order Interpretation
6mg rapid IV bolus
“six milligrams rapid intravenous injection”
.5-1 mg IM/IV
“point five to one milligram intramuscular or intravenous”
1 mg every 3-5 min as needed (q3-5 min prn) IV
“One milligram every three to five minutes as needed intravenous”

26. Pharmacology Drug Order Interpretation
mg IV bolus q5-10 min; maximum of 300 mg
“Fifty to one hundred milligrams intravenous rapid injection every five to ten minutes; maximum dose of three hundred milligrams”
1-3 mg PO
“One to three milligrams orally”
mg p4h or mg/h
“Two point five to fifteen milligrams every four hours or zero point eight to ten milligrams per hour”
.02-2 mg q2-3 min up to 10 mg
“Point zero two to two milligrams every two to three minutes up to a maximum of ten milligrams”