New Hampshire AEMT Pharmacology

New Hampshire AEMT Pharmacology
Division of Fire Standards & Training and Emergency Medical Services Intermediate Pharmacology January 2006

Special Thank you! Jeanne Erickson, NREMT-I
Christopher Rousseau, NREMT-I Intermediate Pharmacology January 2006

AEMT Medications Activated Charcoal Epinephrine – cardiac
Epinephrine – anaphylaxis Dextrose Atropine Narcan Ipratropium Albuterol Aspirin Nitroglycerin Glucagon Oral Glucose Nitrous Oxide Oxygen Intermediate Pharmacology January 2006

Objectives Understand basic pharmacological definitions
Understand the normal actions of the body Look at the forms in which the medications may be found Know how to calculate drug dosages Become competent in methods of drug administration State which medications are approved for Intermediate use Know the dosages, uses, side effects, contraindications of approved meds Intermediate Pharmacology January 2006

Objectives Review the specific anatomy and physiology pertinent to pharmacology. Discuss the standardization of drugs. Differentiate among the chemical, generic (nonproprietary), and trade (proprietary) names of a drug. List the four main sources of drug products. Describe how drugs are classified. List the authoritative sources for drug information. Discuss special consideration in drug treatment with regard to pregnant, pediatric and geriatric patients. Discuss the AEMT responsibilities and scope of management pertinent to the administration of medications. List and describe general properties of drugs. List and describe liquid, solid, and gas drug forms. List and differentiate routes of drug administration. Intermediate Pharmacology January 2006

Objectives Differentiate between enteral and parenteral routes of drug administration. Describe mechanisms of drug action. List and differentiate the phases of drug activity, including the pharmaceutical, pharmacokinetic, and pharmacodynamic phases. Describe pharmacokinetics, pharmacodynamics, theories of drug action, drug-response relationship, factors altering drug responses, predictable drug responses, iatrogenic drug responses, and unpredictable adverse drug responses. Discuss considerations for storing drugs. List the components of a drug profile. List and describe drugs which the AEMT may administer in a pharmacological management plan according to local protocol. Discuss procedures and measures to ensure security of controlled substances the AEMT may administer. Intermediate Pharmacology January 2006

Objectives Review of the following medical emergencies and the related NH Patient Care Protocols Intermediate Pharmacology January 2006

Drug Chemical agents used in the diagnosis, treatment, or prevention of disease. Intermediate Pharmacology January 2006

Pharmacology The study of drugs and their interactions with the body.
Drugs are NOT magical. They cannot alter the body systems qualitatively, only quantitatively Intermediate Pharmacology January 2006

Names Chemical Name Generic Name Official Name Brand Name
Most detailed, chemical description Generic Name A name suggested by the manufacture and confirmed by the U.S. Adopted Name Council Official Name FDA’s official name Brand Name A manufacturer’s trade name or proprietary name To study and converse about pharmacology, the health-care professional must have a systematic method for naming drugs Chemical Name: Generic Name: Suggested by the manufacture & confirmed by the U.S. Adopted Name Council. Official Name: FDA’s official name when listed in the Untied States Pharmacopeia (USP) USP: the official standard for information about pharmaceuticals in the United States. Brand Name: to foster brand loyalty the manufacturer gives the drug its “own” name. Intermediate Pharmacology January 2006

As an example: Epinephrine
Chemical Name: 4-(1-hydroxy-2-methylamino-ethyl)benzene-1,2-diol Generic name: epinephrine Official name: Brand name: Adrenalin, EpiPen® Epinephrine for example Intermediate Pharmacology January 2006

Source Plants Animal Mineral Laboratory (synthetic)
Purple foxglove = digitalis Deadly nightshade Atrope belladonna plant = Atropine Animal Insulin (bovine & porcine) Mineral Calcium Chloride, magnesium sulfate Laboratory (synthetic) Fentanyl Intermediate Pharmacology January 2006

Reference Materials USP (United States Pharmacopoeia)
PDR (Physician’s Desk Reference) Drug Information Monthly Prescribing Reference AMA (American Medical Association) Drug Evaluation Using multiple sources is “GOOD MEDICINE” as it can be difficult obtaining information about a medication. USP: United States Pharmacopoeia: the official standard for information about pharmaceuticals in the U.S. PDR: Physician’s Desk Reference, compilation of drug inserts from the U.S. FDA, includes 3 indexes & a section w/ photos. Contains facts only and must be interpreted by informed readers. Drug Information (Nurse’s Drug Books): A service to the American Society of Health System Pharmacist, contains authoritative listing of monographs on virtually every drug used in the USA, less bulky… Monthly Prescribing Reference: Designed to assist MD’s in prescribing meds. AMA Drug Evaluation: American Medical Asso. publishes this. Intermediate Pharmacology January 2006

Drug Profile Names Classifications Mechanism of action Indications
Pharmacokinetics Side effects/adverse reactions Contraindications Dosages How supplied Special considerations Name: frequently generic or brand Classification: Broad group to which the drug belongs. Classifications is essential to understanding the drugs properties Mech. Of Action: The way in which a drug causes its effects, its pharmacodynamics. Indications: Conditions that make administration of the drug appropriate. (as approved by the FDA) Pharmacokinetics: How the drug is absorbed, distributed and eliminated; typically the onset & duration of its action. Side effects/adverse reactions: untoward or undesired effects. Contraindications: conditions that make it inappropriate to give the drug. A predictable harmful event occurs if the drug is given in this situation. Dosages: amount of the drug that should be given. How supplied: typically includes the common concentration of the available preparations. Special considerations: how the drug may affect pediatrics, geriatric or pg pts. Intermediate Pharmacology January 2006

Drugs and the Law Pure Food & Drug Act of 1906
Harrison Narcotic Act of 1914 Federal Food, Drug & Cosmetic Act of 1938 Durham-Humphrey Amendments Comprehensive Drug Abuse Prevention & Control Act of 1970 Over-the-counter (OTC) medication State laws Local Standards Pure Food & Drug Act of 1906: Enacted to improve the quality and labeling of drugs. Harrison Narcotic Act of 1914: Limited the indiscriminate use of addicting drugs by regulating the importation, manufacture, sale and use of opium, cocaine, and their compounds or derivatives. Federal Food, Drug & Cosmetic Act of 1938: Empowered the FDA to endorse and set pre-market safety standards for drugs. Durham-Humphrey Amendments: A 1951 amendment to the 1938 act, required pharmacists to have either a written or verbal prescription from a physician to dispense certain drugs. Comprehensive Drug Abuse Prevention & Control Act of 1970: AKA Controlled substance act: most recent major federal legislation affecting drug sales & use. The feds. strictly regulate controlled substance because of their high potential for abuse… this produced the Drug Schedule Over-the-counter (OTC) medication: Present low risk, generally available in small doses State laws: Varies. Some state have legislated which meds are appropriate for an intermediate to administer. Local: Local procedure protecting the pt. ie: pulse ox. Mandated on sedated pts. Standards Intermediate Pharmacology January 2006

Drug Schedules Schedule I: No acceptable medical indications
Schedule ll: Accepted medical indication, but high abuse potential, may lead to severe dependence Schedule lll: Less abuse potential, may lead to moderate or low physical dependence Schedule lV: Less abuse potential then lll, limited psychological and/or physical dependence Schedule V: Even lower abuse potential Schedule l: Heroin, LSD, Mescaline Schedule ll: Opium, cocaine, morphine, codeine, oxycodone, methadone, Schedule lll: opioids combined with other no controlled substance: Vicodin, Tylenol III Schedule IV: Diazepam, lorzepam, phenobarbital Schedule V: limited opioids often for cough or diarrhea. Intermediate Pharmacology January 2006

Special considerations in drug therapy
Pregnant patients Before using any drug during pregnancy, the expected benefits should be considered against the possible risks to the fetus The FDA has established a scale (Categories A, B, C, D, and X) to indicate drugs that may have documented problems in animals and/ or humans during pregnancy Many drugs are unknown to cause problems in animals and/ or humans during pregnancy Pregnancy causes a number of anatomical and physiological changes Drugs may cross the placenta or through lactation Intermediate Pharmacology January 2006

Special considerations in drug therapy
Pediatric patients Based on the child's weight or body surface area Special concerns for neonates Length-based resuscitation tape Geriatric patients The physiological effects of aging can lead to altered pharmacodynamics and pharmacokinetics

Scope of Management AEMT’s are held responsible for safe and therapeutically effective drug administration AEMT’s are personally responsible - legally, morally, and ethically - for each drug they administer

Scope of Management-continued
AEMT’s are responsible for: Use correct precautions and techniques Observe and document the effects of drugs Keep their knowledge base current to changes and trends in pharmacology Establish and maintain professional relationships Understand the pharmacology of their approved drugs Perform evaluation to identify drug indications and contraindications Seek drug reference literature Take a drug history from their patients including OTC

Review of the Nervous System
A.Nervous system components 1. Central nervous system 2. Peripheral nervous system a.Peripheral nervous system characteristics 3. Somatic system 4. Autonomic nervous system (ANS) a. Autonomic nervous system characteristics i) Parasympathetic and sympathetic characteristics ii) Autonomic antagonists iii) Physiological antagonism between sympathetic and parasympathetic discharge - organ responses 5. Sympathetic branch of ANS 6. Parasympathetic branch of ANS 7. Direction of sympathetic influences 8. Altering neurotransmission with drugs a. Modification of chemical transmission by drugs 9. Receptor location and selective drug action a. Autonomic neurotransmitters b. Acetylcholine (cholinergic) receptor locations c .Norepinephrine (adrenergic) receptor locations 10. Biological model systems and receptor characterization 11. Receptor structure 12. Synaptic control mechanisms Intermediate Pharmacology January 2006

Patient’s Rights Right medication Right dose Right time Right route
Right patient Right documentation Right Patient: Not usually a problem in the prehospital setting unless involved with more then one patient. Right Drug: One of the most common drug errors is administration of the wrong drug. Check then double check. Right Dose: The other most common drug error is dose error. Right Route: IV, IN, PO, ETT, SQ, IM Right Time: The time in which the medication was administered and the rate. Some medications require a rapid IV push while other need a slow IV push over a couple of minutes Right Documentation: Patient’s indications, the time the medication was given, what medication, what dose, what route, what rate it was administered, who gave the medication, the patient’s response. Intermediate Pharmacology January 2006

Actions of Drugs Pharmacokinetics – study of how drugs enter the body, reach their site of action & are eliminated Pharmacodynamics – study of drug’s action on a body Can act by binding to a receptor site Can act by changing physical properties Can act by chemically combining with other substances Can act by altering a normal metabolic pathway Intermediate Pharmacology January 2006

Pharmacokinetics Absorption Distribution Biotransformation Elimination
A. Pharmacokinetics 1. Passive transport 2. Active transport 3. Absorption a. Variables that affect drug absorption i) Nature of the absorbing surface ii) Blood flow to the site of administration iii) Solubility of the drug iv) pH v) Drug concentration vi) Dosage form vii) Routes of drug viii) Bioavailability 4. Mechanisms involved in absorption a. Diffusion b. Osmosis c. Filtration 5. Distribution a. Drug reservoirs i) Plasma protein binding ii) Tissue binding b. Barriers to drug distribution i) Blood-brain barrier ii) Placental barrier 6. Biotransformation a. Active metabolites b. Inactive metabolites 7. Excretion a. Organs of excretion i) Kidneys ii) Intestine iii) Lungs iv) Sweat and salivary glands v) Mammary glands Intermediate Pharmacology January 2006

Absorption Liberation - Release of drug from pill, tablet, capsule
Dissolving of active drug in GI fluids Absorption – the process by which drug enters the blood stream; is influenced by several factors: Route of administration Circulatory status CIRCULATORY STATUS, I.E. SHOCK, HYPO/HYPER THERMIA. Intermediate Pharmacology January 2006

Absorption Speed of absorption (in order) Intravenous / Intraosseous
Transtracheal (ETT) Sublingual Rectal Intramuscular Subcutaneous Oral Intermediate Pharmacology January 2006

Distribution Distribution – once in circulatory system, the drug is distributed to body’s tissues From intravascular to interstitial spaces Some drugs bind to serum proteins & have a delayed onset & longer duration Dependent on circulatory status Brain is protected from most drugs by blood brain barrier CIRCULATORY FACTORS LIKE HYPOTENSION & PERIPHERAL VASOCONSTRICTION. Intermediate Pharmacology January 2006

Biotransformation Biotransformation (AKA Metabolism)– many drugs are inactive when given & have to be converted to active form Done in the blood or by the target tissue Results in chemical variations called metabolites Some drugs are active on administration, are utilized, then biotransformed into an inactive metabolite for excretion SOME METABOLITES ARE HARMFUL & TOXIC IF NOT TRANSFORMED INTO THE FINAL USABLE FORM. DEMEROL HAS MANY HARMFUL METABOLITES. EPINEPHRINE IS AN EXAMPLE OF A DRUG THAT HAS A RAPID BIOTRANSFORMATION, REQUIRING REPEAT DOSES. Intermediate Pharmacology January 2006

Elimination Elimination – either in its original form or as a metabolite, excreted by: The kidneys, liver, intestines and the lungs Varies with the drug & general health: Adversely affected by shock, poor renal, hepatic or respiratory status The slower the rate of elimination, the longer the drug stays in the body THE KIDNEY IN URINE. THE LIVER IN BILE. THE INTESTINES IN STOOL. THE LUNGS IN EXPIRED AIR. Intermediate Pharmacology January 2006

Actions of Drugs Drug Receptors – proteins on surface of cells that, when activated, cause cell to behave in desired manner ie. Epinephrine effect on target cells in lungs Agonists are drugs that bind to receptor to cause desired response Antagonists are substances that bind to same receptor & block the desired biochemical response AGONIST = EPINEPHRINE, INSULIN ANTAGONIST = CALCIUM CHANNEL BLOCKERS, BETA BLOCKERS, ACE INHIBITORS Intermediate Pharmacology January 2006

Pharmacodynamics Drug Receptor Interactions Types of receptors Agonist
Antagonist Affinity Efficacy Types of receptors Beta Alpha Intermediate Pharmacology January 2006

Other definitions you need to know
Agonist: drug that binds to a receptor and causes it to initiate the expected response Antagonist: drug that binds to a receptor but does not cause it to initiate the expected response Intermediate Pharmacology January 2006

Receptor Sites SO, WHAT DO YOU THINK ARE THE IMPLICATIONS OF EPI & ITs EFFECTIVENESS IN A PT WHO IS TAKING A BETA BLOCKER? HOW IMPORTANT IS YOUR HISTORY TAKING, ESP. MEDS TAKEN? Intermediate Pharmacology January 2006

Factors altering drug responses
Age Body mass Sex Environmental milieu Time of administration Pathologic state Genetic factors Psychological factors Intermediate Pharmacology January 2006

Drug Routes Enteral Parenteral PO IV ET Orogastric/naogastric IO SL
Buccal Rectal Parenteral IV ET IO Umbilical IM SQ Inhalation/nebulized Topical Transdermal Nasal Instillation Intradermal ENTERAL: Absorption through the GI tract PO: Oral Orogastric/naogastric : oral meds when tube in place anyways SL: good route for self admin. Very vascular Buccal absorbed between cheek & gum Rectal for unconscious or vomiting pts.or cannot get an IV. Very vascular PARENTERAL ROUTES delivery of meds, outside of the GI tract. IV rapid onset, preferred in most emergencies ET Alternative, especially while waiting IV access IO: Alternative to IV in pedi emergencies Umbilical Alternative for neonates IM route w/ slower absorption, as drug passes into capillaries SQ slower then IM because subcutaneous tissue less vascular than muscle Inhalation/nebulized very rapid absorption, especially for drugs whose target tissue are in the lungs Topical delivers drug directly to the skin Transdermal absorbed through the skin, allows slow, continuous release. Nasal for drugs directly to the nasal mucosa Instillation similar to topical, but places the drug directly into a wound or an eye Intradermal Administration. Delivery of drug or biologic agent between the dermal layers. Tb test, allergy testing Intermediate Pharmacology January 2006

Drug Forms Pills/tablets: compressed Powders:
Suppositories: drug mix with wax-like base (melts) Capsules: gelatin container, dissolves in GI Solutions: generally water based Tinctures: an alcohol solution w/ non-volatile drug Suspensions: solid does not dissolve Emulsions: suspension w/ oily substance in solvent Spirits: Volatile drug in alcohol Elixirs: alcohol & water, often flavored Syrups: sugar, water & drug Gas: Volatile drug is one that evaporates easily. Elixirs:A sweetened aromatic solution of alcohol and water, serving as a vehicle for medicine Intermediate Pharmacology January 2006

Action of Drugs Bind to a receptor site
Change the physical properties of cells Chemically combine with other chemical Alter the normal metabolic pathway Binding: Most drugs act by binding to a receptor. Almost all drug receptors are protein molecules on cell surface. Part of the normal stimulation/inhibition function and can be stimulated or inhibited by chemicals. Affinity: the force of attraction between a drug and a receptor. Physical change to cell properties: like change in the osmotic balance across the cell membrane Chemically combine with other chemical: antacids & hydrochloric acid in the stomach is an example Alter normal metabolic pathway: Cancer meds and some antiviral drugs changes the normal metabolic substrates Intermediate Pharmacology January 2006

Responses to Drug Administration
Allergic reaction: hypersensitivity Idiosyncrasy: unique to the individual; different than seen or expected in the general population Cross tolerance: tolerance of a drug after admin of a different drug. Morphine & other opioids Tachyphylaxis: rapid tolerance. Typically w/ sympathetic agonists (decongestant & bronchodilation agents) Cumulative Effects: increased effects with several doses Drug interaction: one drug alters the response to another Synergism: 2 drugs given give greater response than their sum. 1+1=3 Intermediate Pharmacology January 2006

Unpredictable adverse responses
Anaphylaxis Delayed reaction Tolerance Drug dependence Summation (addition or additive effect) Potentiation Interference Potentiation: to make potent or powerful. To enhance or increase the effects of a drug Interference: The direct biochemical interaction between two drugs; one drug affects the pharmacology of another drug Intermediate Pharmacology January 2006

Predictable Responses
Desired action Side effects Intermediate Pharmacology January 2006

Body Substance Isolation Equipment
Always take appropriate body substance isolation measures to reduce your risk of exposure during medication administration Intermediate Pharmacology January 2006

Drug Storage Storage considerations Security Accountability
Temperature Light Moisture Shelf Life Security Accountability Logs Intermediate Pharmacology January 2006

Needle Handling Precautions
Minimize the tasks performed in a moving ambulance Balance the safety needs with the need to transport in a timely manner Immediately dispose of used sharps in a sharps container Recap needles only as a last resort Learn the one-handed recapping maneuver CAN BE A TRICKY CALL IF YOUR DEPARTMENT LOOKS STRICTLY AT ON-SCENE TIME WITHOUT CONSIDERATION OF PATIENT CARE ISSUES & PROVIDER SAFETY ISSUES. Intermediate Pharmacology January 2006

Definitions Metric System – system of weights & measures widely used in science & medicine Based on units of 10 Apothecary System – antiquated system of measures & weights used in early medicine Intermediate Pharmacology January 2006

All metric units are derived from these
Weights & Measures Metric System has 3 basic units of measurements For Mass: the gram (G) For Length: the meter (M) For Volume: the liter (L) All metric units are derived from these 3 base units Intermediate Pharmacology January 2006

Conversion between Prefixes
Intermediate Pharmacology January 2006

Weights & Measures – Metric
Kilogram(kg)= 1,000 grams Gram (gm) = 1,000 milligrams Decigram (dl)= 100 mg or 0.1 gm Milligram (mg)= 1,000 micrograms or gm Microgram (mcg or μg)= 1/1,000,000 or 1 Liter (l)= 1,000 milliliters (ml) ml = cc Intermediate Pharmacology January 2006

Weights & Measures – Apothecary 1 grain = 60 milligrams
Household 1 teaspoon = 5 ml 1 tablespoon = 15 ml 1 ounce = 30 ml 8 ounces = 240 ml 1 quart = 946 ml

Weights & Measures You need to know how to
Add, subtract, multiply & divide decimals Convert from liters <-> milliliters, etc. Calculate dosages If in doubt, carry a calculator, find a chart Have your partner double check you It’s better to double check than to make a mistake!!! Buy & use medication math calculation books MATH FOR MEDS IS A GOOD BOOK, BUT EXPENSIVE. HERE ARE OTHER ALTERNATIVES. Intermediate Pharmacology January 2006

Drug Calculations Desired Dose – quantity of medication that the physician wants administered Usually expressed in mg, gm or gr. Concentration of Drug on Hand – amount of drug present in the vial or ampoule or syringe Expressed in mg., gm. Or gr. Per volume unit i.e. 10 mg / 2 ml Volume of Drug on Hand – the amount of fluid within the vial or ampoule Expressed in ml or cc Intermediate Pharmacology January 2006

Or use the fraction / ratio format
Drug Calculations Medication Dose Volume administered = Volume on hand x Desired Dose Concentration on Hand Or use the fraction / ratio format Concentration on hand expressed as a fraction Desired dose expressed as a fraction 100 mg = 75 mg x = x = 75 1 ml x ml x = x = 0.75 ml 100 Intermediate Pharmacology January 2006

Drug Calculations Converting Pounds to Kilograms: 2.2
Weight in Pounds = Weight in Kilograms 2.2 OR 3 a.m. rule: Divide wt in pounds by 2 and subtract 10% of the result = Weight in Kilograms 182 lbs/2.2 = 82.7 KGS 182 lbs DIVIDED BY 2 = 91 MINUS 10% = 82 KGS MANY MEDS ARE DOSED BASED ON WEIGHT. ESPECIALLY PEDIATRIC MEDS. Intermediate Pharmacology January 2006

Medications via Inhalation Route
Broncholdiator (beta angonist) Equipment oxygen nebulizer adapters Administering Indications Techniques Precautions General principals Intermediate Pharmacology January 2006

Parenteral Administration
Subcutaneous Intramuscular Intravenous bolus Intraosseous Sublingual Equipment: syringes, needles, ampules, vials, prefilled syringes, others Intermediate Pharmacology January 2006

Subcutaneous Injection
In general, EMS providers administer subq epinephrine 1:1,000 in the upper arm. You can have your students practice on an orange. 1. Administration of medication by the subcutaneous route a. Subcutaneous route - injections are made into the loose connective tissue between the dermis and muscle layer b. Equipment needed for administration of a medication by the subcutaneous route c. Locate anatomical sites i) Upper arms d. Technique for administration of medication by the subcutaneous route e. Precautions Intermediate Pharmacology January 2006

Intramuscular Injection

Sublingual Route Administering medications by the sublingual route
1. Places where medications are commonly applied a. Under the tongue (sublingual) b. Against the cheek (buccal) 2. Dosage forms a.Tablets b. Liquid/Spray Intermediate Pharmacology January 2006

Intravenous Bolus 1. Preparation of parenteral medication
a. Equipment needed for preparing a parenteral medication b.Standard procedures for preparing all parenteral medications c. Guidelines for preparing medications i) Prefilled syringes ii)To prepare a medication from an ampule iii)Removal of a volume of liquid from a vial iv)Preparing a drug from a mix-o-vial Intermediate Pharmacology January 2006

Prefilled / Preloaded Syringes

Intravenous Med Administration
Pt’s Rights Right medication Right dose Right time Right route Right patient Right documentation Prepare the equipment Check the label Check the expiration date Intermediate Pharmacology January 2006

Prefilled / Preloaded Syringes
Confirm prefilled syringe label (name, dose, and expiration date) Assemble the prefilled syringe Remove the pop-off caps and screw together Reconfirm indication, drug, dose, and route of administration Administer appropriately via the indicated route Properly dispose of the needle and syringe Intermediate Pharmacology January 2006

Select administration port Port closest to the patient Cleanse Pinch the tubing upstream from the port Medical Asepsis Clean technique versus sterile technique Sterilization Antiseptics Disinfectants Intermediate Pharmacology January 2006

Administer the medication Flush the line Re-assess the patient Re-adjust the rate Intermediate Pharmacology January 2006

Epinephrine

Epinephrine Class Description Epinephrine 1:10,000 (Cardiac)
Adrenergic agent; Sympathomimetic Description Causes marked stimulation of alpha, beta-1, and beta-2 receptors, causing sympathomimetic stimulation, pressor effects, cardiac stimulation, bronchodilation, and decongestion. Epinephrine 1:10,000 (Cardiac) Epinephrine 1:1,000 (Anaphylaxis) Intermediate Pharmacology January 2006

Epinephrine 1:10,000 Indications for the EMT-Intermediate:
Cardiac Arrest with pulseless Vtach, Vfib, asystole (flat line on the monitor) or PEA Asystole needs to be confirmed. Look at your patient!! Unresponsive, no pulse, no respiration, leads are attached properly, monitor is on, check in all 3 leads. Intermediate Pharmacology January 2006

Epinephrine 1:10,000 Contraindications Side effects
Epi 1:10,000 is contraindicated in patients not in full asystole cardiac arrest. Side effects Epinephrine can cause palpitations, anxiety, headache, dizziness, nausea and vomiting. Because of its strong inotropic and chronotropic properties, epinephrine increases myocardial oxygen demand. Even in low doses it can cause myocardial ischemia. When administering epi in the emergency setting, these effects should be kept in mind. Intermediate Pharmacology January 2006

Epinephrine 1:10,000 How Supplied 1mg in 10 cc prefilled syringe:
Dosage 1 mg of a 1:10,000 solution IV Push. Repeat q 3-5 minutes Special Considerations Should be protected from light. Do not administer with alkaline solutions for it can be deactivated. Flush all lines before and after administration. Intermediate Pharmacology January 2006

Anaphylaxis Review Intermediate Pharmacology January 2006
Review cardiovascular system Review of respiratory system Terminology a. Allergic reaction b Anaphylaxis c. Allergen B. Pathophysiology 1. Routes of entry 2. Common allergens 3. Allergic response a. Histamine or histamine-like substance release b. Biphasic response i) Acute reaction ii) Delayed reaction c. Immunity d. Sensitivity e. Hypersensitivity f. Redness of skin g.Swelling/ edema of the skin h.Anaphylactic shock i) Cardiovascular system ii)Respiratory system Intermediate Pharmacology January 2006

Intermediate Pharmacology January 2006

Epinephrine 1:1,000 Indications Contraindications Anaphylaxis
is suspected exposure to an allergen AND one or more of the following: severe respiratory distress; airway compromise / impending airway compromise (wheezing, swelling of the lips / tongue, throat tightness); signs of shock (including systolic BP <90). . Contraindications None in a LIFE THREATENING emergency Intermediate Pharmacology January 2006

Epinephrine 1:1,000 Alpha and beta effects Bronchodilator
Decreases vascular permeability Vasoconstriction Intermediate Pharmacology January 2006

Epinephrine 1:1,000 Side effects
Epinephrine can cause palpitations, anxiety, headache, dizziness, nausea and vomiting. Because of its strong inotropic and chronotropic properties, epinephrine increases myocardial oxygen demand. Even in low doses it can cause myocardial ischemia. When administering epi in the emergency setting, these effects should be kept in mind. How Supplied 1mg in 1 cc ampoule or prefilled syringe Dosage 0.3mg of a 1:1,000 solution SQ. Consider repeating q 3-5 minutes Intermediate Pharmacology January 2006

Epinephrine 1:1,000 Onset SQ 5-10 min Duration SQ 4-6 hrs
Special Considerations Should be protected from light. Do not administer with alkaline solutions for is can be deactivated. Flush all lines before and after administration Fatal ventricular fibrillation, cerebral or subarachnoid hemorrhage obstruction of central retinal artery. A rapid and large increase in BP may cause aortic rupture, cerebral hemorrhage, or angina pectoris Intermediate Pharmacology January 2006

Ampules Intermediate Pharmacology January 2006

Ampules Hold the ampule upright & tap the top to dislodge any trapped solution. Place gauze around the thin neck. Wear proper PPE. Intermediate Pharmacology January 2006

Ampules Snap top off with your thumb. Draw up the medication.
Use a filtered needle to draw up Change to proper sized needle Dispose of in sharps container Intermediate Pharmacology January 2006

45º Intermediate Pharmacology January 2006

In general, EMS providers administer subq epinephrine 1:1,000 in the upper arm. You can have your students practice on an orange. Intermediate Pharmacology January 2006

Localized Reaction This is an example of a localized reaction, that DOES NOT warrant epinephrine. Intermediate Pharmacology January 2006

Example of Anaphylaxis

Dextrose 50 % (D50)

Diabetes Overview Dysfunction of endocrine glands of Pancreas
Islets of Langerhans which secrete the beta hormone, Insulin & the alpha hormone, glucagon Insulin facilitates the use of glucose by the cells, secretion is stimulated by high blood sugar Function of insulin - increase glucose transport into cells, increase glucose metabolism by cells, decrease blood glucose concentrations to normal levels Intermediate Pharmacology January 2006

Diabetes Overview Type 1 , Insulin dependent
Can occur anytime in life, juvenile is common & more serious Requires administration of Insulin Type 2, Non-Insulin dependent Normally adult onset Some Insulin is produced, so oral meds possible Classic signs/symptoms of HYPERglycemia: polydipsia, polyphagia, polyuria Intermediate Pharmacology January 2006

Diabetes Overview Effects of untreated Diabetes:
Osmotic diuresis: elevated glucose in blood spills over into the urine. This concentrated urine pulls water to dilute the glucose Ketone body formation: fat breaks down to provide energy, by-product of fat metabolism are ketoacids Renal excretion of ketoacids: elevated levels too much for kidneys to excrete, leading to accumulation of ketones & hence acidosis Intermediate Pharmacology January 2006

Diabetes Overview HYPERGLYCEMIA HYPOGLYCEMIA Too little Insulin
Too much food Infection, alcohol Pregnancy, stress Slow onset > 14 hrs 3 Ps, N/V, tachycardia, deep resp. (Kussmaul), warm, dry skin, fruity breath LOC but rare coma HYPOGLYCEMIA Too much Insulin Too little food Excessive exercise Pancreatic tumor Rapid onset < 1 hr Weak rapid pulse, cool clammy skin, fidgety, uncoordinated, appears drunk, non-cooperative LOC to coma & seizures Intermediate Pharmacology January 2006

Dextrose – D50 Class Description Carbohydrate, hypertonic solution
the principal form of carbohydrate utilized by the body. D50 is used in emergency care to treat hypoglycemia and in the management of coma of unknown origin. Intermediate Pharmacology January 2006

Dextrose – D50 Indications Contraindications
Hypoglycemia, blood glucose <80mg/dl Altered level or consciousness, coma of unknown etiology, seizure of unknown etiology. Contraindications Intracranial hemorrhage, increased ICP, Known or suspected CVA. Intermediate Pharmacology January 2006

Dextrose – D50 How supplied Dose Onset Duration
25 gm in 50cc prefilled syringe Dose 25 gm slow IV push Onset < 1 minute Duration Depends on degree of hypoglycemia Intermediate Pharmacology January 2006

Dextrose – D50 Special Considerations Adverse reaction
Extravasations may cause tissue necrosis (use large vein and ensure patency of IV) Rebound hypoglycemia D50 may sometimes precipitate severe neurological symptoms (Wernicke's encephalopathy) in thiamine deficient patients, for example, alcoholic. (Administering 100 mg of thiamine, IV can prevent this.) Adverse reaction Warmth, pain, burning from medication infusion, thrombophlebitis. Intermediate Pharmacology January 2006

Thiamine (B1)

Thiamine (B1) Class Description Water-soluble vitamin
Required for the synthesis of thiamine pyrophosphate, a coenzyme required in carbohydrate metabolism. Aids in energy (carbohydrate) metabolism Enables normal functioning of the nervous system Necessary for proper functioning of the heart Intermediate Pharmacology January 2006

Thiamine (B1) Indications Contraindications
Hypoglycemia, in the presence of chronic alcoholism, alcohol intoxication, or malnourishment, administer Contraindications do not use with substances that yield alkaline solutions, such as citrates, barbiturates, carbonates, or erythromycin lactobionate IV Intermediate Pharmacology January 2006

Thiamine (B1) How Supplied Dose Onset Duration 100 mg vial 100 mg IVP
varies Duration Intermediate Pharmacology January 2006

Thiamine (B1) Side Effects Special Consideration
Serious hypersensitivity reactions, including anaphylaxis Special Consideration Use with caution during lactation. Intermediate Pharmacology January 2006

Vials Intermediate Pharmacology January 2006

Vials Remove the plastic cap. Cleanse the vial’s rubber top.

Vials Prepare the syringe and needle
Insert the needle into the rubber top and inject the air from the syringe into the vial Draw desired dose into syringe & administer Intermediate Pharmacology January 2006

Naloxone (Narcan)

Naloxone (Narcan) Class Description Synthetic opioid antagonist
is a competitive narcotic antagonist used in the management and reversal of overdoses caused by narcotics and synthetic narcotic agents. Unlike other narcotic antagonists, which do not completely inhibit the analgesic properties of opiates, naloxone antagonizes all actions of morphine Intermediate Pharmacology January 2006

These pictures show signs or evidence for suspicion of narcotic use.

Naloxone (Narcan) Indications
For the complete or partial reversal of narcotic depression, including respiratory depression, induced by opioids including natural and synthetic narcotics. Narcan is also indicated for the diagnosis of suspected acute opioid overdoses. Contraindications Known hypersensitivity Use with caution in narcotic-dependent patients who may experience withdrawal syndrome Intermediate Pharmacology January 2006

Naloxone (Narcan) How supplied
Multidose vials, prefilled syringes, ampules Dosage 0.4mg - 2.0mg IVP SLOWLY, Titrate to respirations 0.4 mg – 2.0 mg IN Onset Within 2 minutes Duration 30 – 60 minutes Intermediate Pharmacology January 2006

Naloxone (Narcan) Side Effects Special Considerations
Tachycardia Hypertension Dysrhythmias Nausea and vomiting Diaphoresis Special Considerations Caution should be exercised when administering naloxone to narcotic addicts (may precipitate withdrawal with hypertension, tachycardia, and violent behavior). Intermediate Pharmacology January 2006

Intranasal Administration

Atropine

Atropine Class Description Cholenergic blocking agent
parasympatholytic Description Atropine is a parasympatholytic that is derived from parts of the Aropa belladonna plant Atropine acts by blocking acetylcholine receptors (Vagus nerve) thus inhibiting parasympathetic stimulation. Atropine has been shown to be of some use in asystole, presumably because some cases of asystole may be caused by a sudden and tremendous increase in parasympathetic tone. Intermediate Pharmacology January 2006

Atropine Indications Cardiac arrest with asystole (flat line on the monitor) Asystole needs to be confirmed. Look at your patient!! Unresponsive, no pulse, no respiration, leads are attached properly, monitor is on, check in all 3 leads. Slow PEA Intermediate Pharmacology January 2006

Examples of asystole and slow PEA

Atropine Contraindications
None in an emergency asystole cardiac arrest. In bradycardia: Tachycardia Hypersensitivity Unstable cardiovascular status in acute hemorrhage and myocardial ischemia Narrow-angle glaucoma Intermediate Pharmacology January 2006

Atropine How supplied Dose Onset Duration
1 mg in 10 cc prefilled syringe Dose 1 mg IV push every 3-5 minutes not to exceed 0.04mg/kg. Onset rapid Duration 2 - 6 hours Intermediate Pharmacology January 2006

Atropine Side effects: blurred vision, dilated pupils, dry mouth, tachycardia, drowsiness and confusion. Special Considerations Heart transplant patient, vagus nerve has been severed. The effects of atropine may be enhanced by antihistamines, procainamide, quinidine, antipsychotics, antidepressants, and benzodiazepines Intermediate Pharmacology January 2006

Albuterol

Albuterol Class Description Sympathomimetic
Beta 2 -selective sympathomimetic. Relaxes smooth muscle of the bronchial tree and peripheral vasculature. Inhaled beta-adrenergic agonists Intermediate Pharmacology January 2006

Point out this COPD’r anatomy, with barreled chest, intercostal retractions and subclavical retractions. Intermediate Pharmacology January 2006

Nebulizer Intermediate Pharmacology January 2006

Drug – Albuterol (Proventil, Ventolin)
Explain each step. Intermediate Pharmacology January 2006

Albuterol Indications
relief of bronchospasm in patients with reversible obstructive airway disease and acute attacks of bronchospasm Contraindications Prior hypersensitivity reaction to albuterol Cardiac dyshythmias associated with tachycardia Intermediate Pharmacology January 2006

Albuterol How supplied Dose Onset Duration
Multidose vial, prefilled “bullets” also called “fishes” Dose 2.5 mg (0.5 ml of 0.5% solution) diluted to 3 ml with 0.9% saline solution. Administer of 5-15 minutes by nebulizer. Onset 5-15 minutes after inhalation Duration 3-4 hours after inhalation Intermediate Pharmacology January 2006

Albuterol Side Effects
Restlessness, apprehension, dizziness, palpitations, increase in BP, dysrhythmias, increased hypoxemia Intermediate Pharmacology January 2006

Albuterol Special Considerations
As with all sympathomimetics, may exacerbate adverse cardiovascular effects. May precipitate angina pectoris and dysthythmias, MI, cardiac arrest. Albuterol should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, since the action of albuterol on the vascular system may be potentiated. Beta-receptor blocking agents and albuterol inhibit the effect of each other. Since albuterol may lower serum potassium, care should be taken in patients also using other drugs which lower serum potassium as the effects may be additive Intermediate Pharmacology January 2006

QUESTIONS

New Hampshire AEMT Pharmacology

Similar presentations

Presentation on theme: "New Hampshire AEMT Pharmacology"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

New Hampshire AEMT Pharmacology

Similar presentations

Presentation on theme: "New Hampshire AEMT Pharmacology"— Presentation transcript:

Similar presentations

About project

Feedback