1. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Chapter 13 General Pharmacology

2. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Administering Medications Medications Commonly Administered by the EMT-Basic Medication Names Routes of Administration Medication Forms 13Topics

3. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Essential Medication Information Key Steps in Administering Medications Reassessment Following Administration Sources of Medication Information 13Topics

4. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren As an EMT-Basic, there will be situations in which you administer, or help in the administration of, certain medications to the patient. You must be certain that you are correct regarding the decision to administer a medication. Once it is administered, you cannot extract it again from the body.Introduction13

5. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren The EMT-B must take the responsibility to administer drugs seriously. It is your responsibility to be completely familiar with the medications you will be handling during patient care as an EMT- Basic. Additionally, there are certain terms you should be familiar with. 13 Administering Medications

6. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Pharmacology –This refers to the general study of the interactions between a drug and the body. Medication –Is generally defined as a substance used as a remedy for an illness. Drug –A chemical substance used to prevent or treat an illness. –Generally, the term “medication” and “drug” are used interchangeably. 13 Administering Medications

7. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Medications have physiological effects that, when appropriately administered, may improve the patient’s condition. As an EMT-B, you will administer medications under the license of your Medical Director. You are only allowed to administer medications that are permitted by your Medical Director. 13 Administering Medications

8. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren There are three medications you carry on the ambulance with you: –Oxygen, activated charcoal, oral glucose, aspirin There are an additional three medications which you are allowed to assist in the administration of, providing the patient is prescribed one of these drugs: –Nitro, epinephrine, metered-dose inhaler 13 Medications Prescribed for the Patient

9. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Medications can have up to four names. Since they are used interchangeably, the EMT- B should be familiar with them. –Chemical Name: name describing chemical structure –Generic Name: nonproprietary name, similar to chemical name –Trade Name: brand name, for marketing purposes –Official Name: official name, followed by U.S.P. or N.F. 13 Medication Names

10. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Chemical Name: –1,2,3-propanetriol trinitrate Generic Name: –Nitroglycerin tablets Trade Name: –Nitrostat ® Official Name: –Nitroglycerin tablets, U.S.P. 13 Medication Names

11. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren The route of the medication refers to how the patient is to take it, or the EMT-B to administer it. The route chosen also influences the rate in which it is absorbed in the body, and thus, helps define the length of time needed for a change in the body to be observed clinically. 13 Routes of Administration

12. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Sublingual –The mucous membranes beneath the tongue are highly vascular, and can absorb medication readily. –Naturally, the patient must be alert for you to use this route; otherwise they may aspirate the medication. –When using this route, remind the patient not to chew or swallow the medication. 13 Routes of Administration

13. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Oral –This route allows the medication to be absorbed across the membranes of the stomach and/or the intestinal tract. –The patient must also be alert for the EMT-B to use this route so that the patient will swallow the medication rather than aspirating it should their orientation be diminished. 13 Routes of Administration

14. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Inhalation –The medication for this route is prepared as a gas or aerosol so that the patient can inhale it. –Upon inhalation, the medication is absorbed across the respiratory tract. –The key when using this route is assuring the patient has an adequate tidal volume so that they inhale the medication deep into the pulmonary tree. 13 Routes of Administration

15. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Injection –Refers to the deposition of the medication into the tissues, and for the EMT-B, this means specifically into the muscle mass. –The specific route is also known as intramuscular. –Since a needle is employed to inject the medication, the EMT-B must exercise extreme caution. –Only specific muscle groups are used by the EMT-B. 13 Routes of Administration

16. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Medications come in several different forms. The form usually limits the administration to one specific route. The form also helps define whether the drug has a local effect, or systemic effect. Common forms include: –Tablets, liquid, gels, suspensions, fine powder for inhalation, gases, sprays, and nebulized liquids 13 Medication Forms

17. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Compressed powder or tablet –A compressed powder that is formed into a small disk or elongated shape. –Nitroglycerin and aspirin tablets are good examples of this type. 13 Medication Forms

18. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Liquid for injection –A liquid substance with no particulate (undissolved) matter. –Epinephrine for intramuscular injection is an example. 13 Medication Forms

19. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Gel –A viscous substance that the patient could swallow so that the mucous membranes of the GI tract could absorb it 13 Medication Forms

20. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Suspension –Undissolved drug particles that are mixed in a liquid base. –Since the medication does not dissolve, you must thoroughly mix it prior to administration. –Activated charcoal is prepared in this fashion. 13 Medication Forms

21. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Fine powder for inhalation –A crystalline form of the medication that is mixed with a liquid to form a suspension. –Must also be shaken prior to administration. –Medication gets absorbed across the pulmonary tract. –Medications for common breathing diseases are packaged this way. 13 Medication Forms

22. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Gas –A non-liquid, non-particulate medication that is inhaled and readily absorbed across the pulmonary tract (alveoli). –Oxygen is the medication most commonly used by the EMT-B in this form. 13 Medication Forms

23. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Spray –A liquid medication can be deposited (or sprayed) under the tongue for absorption. –This is another common form that the drug nitroglycerin may come in. 13 Medication Forms

24. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Liquid/Vaporized fixed-dose inhaler –A nebulizer is a device that uses compressed gas, usually oxygen, that is forced into a small chamber containing the liquid drug. –As the gas mixes with the liquid and exits the chamber, it vaporizes the medication to allow the patient to then inhale it. –This allows deposition of the drug directly on the mucous membranes of the pulmonary system, where it is intended to exert its action. 13 Medication Forms

25. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren As stated earlier, the EMT-Basic must be intimately familiar with the drugs you will be administering. Knowing the following terms will allow you to better understand the drugs, and thus, use them appropriately. –Indications, Contraindications, Dose, Administration, Actions, Side Effects 13 Essential Medication Information

26. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Indications –This defines what clinical setting the use of the drug is intended for. –It is anticipated that the administration of the drug will improve the patient’s clinical condition. –For example, the use of oxygen for a patient complaining of respiratory distress. 13 Essential Medication Information

27. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Contraindications –This refers to specific clinical conditions in which the drug was going to be used, but cannot due to some other coexisting problem. –For example, it would be contraindicated to use nitroglycerin for cardiac chest pain, if the blood pressure was too low. –A contraindication does not apply if the drug was never appropriate. For example, a contraindication for glucose is not chest pain, because glucose was never indicated in the first place. 13 Essential Medication Information

28. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Dose –The dose refers to the amount of drug to be administered. –Adults and pediatrics may have two different doses of the same drug. –The EMT-B should know, by memory, the dosages for all the drugs which you may be responsible for administering. 13 Essential Medication Information

29. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Administration –This refers to the route in which the dose of the indicated medicine is to be given. –The EMT-B will be using the inhalation, oral, sublingual, and injection routes. –Many times the form of medication defines how it will be administered. For example, oxygen is a gas which is given via inhalation. 13 Essential Medication Information

30. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Actions –These are the effects of the drug on the body. –Medications modify what certain cells or organs of the body do, in order to correct or prevent some abnormality. –Also known as the “mechanism of action.” –If the EMT-B understands this aspect of the medication, all other aspects become very logical. 13 Essential Medication Information

31. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Side Effects –Some medications, despite their ability to correct one abnormality, may cause a disturbance elsewhere in the body. –The side effects generally are tolerated by the patient, and are predictable if you understand the drug’s actions. –For example, nitroglycerin (a vasodilator) may cause a drop in the blood pressure as a side effect. 13 Essential Medication Information

32. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Obtain an order from Medical Direction. –All medications administered by the EMT-B are done so only with permission of your Medical Director. –This order may be provided via off-line standing orders, or on-line communication with the physician. –ALWAYS be certain of the dose prior to administering it! 13 Key Steps in Administering Medications

33. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren 13 Key Steps in Administering Medications – Example of on-line medical direction for medication administration. – Be sure to reverify the drug, dose, and route when speaking to the physician.

34. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Select the proper medication. –The EMT-Basic’s responsibility next is to select the appropriate medication for the clinical situation. –If the medication belongs to the patient, and you are permitted to administer it (nitro, inhaler, or epi-pen), be certain the drug is prescribed to the patient. –Knowing the various names (trade, generic, etc.) of the medications is extremely helpful here. 13 Key Steps in Administering Medications

35. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Verify the patient’s prescription. –When administering one of the permitted medications not carried by the EMS unit, it must be obtained from the patient. –You must CLEARLY assure the medication you are about to administer is prescribed to your patient specifically (you cannot “share” medications). –Even if the patient already took a medication not prescribed to them, you cannot administer it. 13 Key Steps in Administering Medications

36. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Check the expiration date. –All medications, eventually, deteriorate to the point they are ineffective. –Because of this, there will be an expiration date printed on the drug packaging, or on the prescription label. –Obviously, you cannot administer an expired medication. –If expired, discard the medication in accordance with your state drug or pharmacy guidelines. 13 Key Steps in Administering Medications

37. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Check for discoloration or impurities. –Some medications may discolor, become cloudy, or have visible particulate matter should they become contaminated. –This may also happen if the medication has expired some time ago. –In either instance, do not administer the medication. Rather, discard of it appropriately. 13 Key Steps in Administering Medications

38. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Verify the form, route, and dose. –Be certain the drug form is appropriate for the route selected during administration. –Also verify that the prescribed dose of the drug matches the medical direction given when administering that drug. –Thoroughly inspect the drug information, do not rely on “similar packaging.” Drugs with similar packaging may still have different doses. 13 Key Steps in Administering Medications

39. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren The “Five Rights” –The five rights will help you remember what to determine prior to administering any drug: Right patient Right medication Right route Right dose Right date 13 Key Steps in Administering Medications

40. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Documentation –Once administered, document the drug given along with its dose, route, and time it was administered. –Also necessary is documentation of the patient’s response following administration (or lack thereof). 13 Key Steps in Administering Medications

41. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Following administration of a medication, perform an ongoing assessment to note any changes. Also document the absence of any specific changes anticipated by the drug administration. –For example, if chest pain subsided with nitro, document that. Also, if the chest pain did not change with nitro, that is also important to document. 13 Reassessment Following Administration

42. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Recommended reassessment parameters: –Mental status –Patency of the airway –Breathing rate and quality –Skin temp, color, and condition –Blood pressure and heart rate –Alterations in the complaint(s) of the patient –Medication side effects –General improvement or deterioration in the clinical condition of the patient following drug administration 13 Reassessment Following Administration

43. CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Where to find more information on drugs you administer, or that you commonly encounter prehospitally: American Hospital Formulary Service AMA Drug Evaluation Physicians’ Desk Reference (PDR) Drug package inserts Poison Control Centers (PCC) EMS pocket drug reference guide Epocrates for the Personal Digital Assistant (PDA) 13 Sources of Medication Information