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Medication In-Service:

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1 Medication In-Service:
Michigan EMS Medication In-Service: Ondansetron (Zofran) ODT

2 Course Objectives Identify the location of ondansetron (Zofran) ODT in the SEM Drug Box, as well as how it may be packaged. Describe the pharmacokinetics and pharmacodynamics of ondansetron (Zofran) ODT. List the indications and contraindications of ondansetron (Zofran) ODT. Describe how to administer ondansetron (Zofran) ODT, as well as list the applicable medication concentration, route and dose per the applicable protocols.

3 Introduction Purpose As of June 1, 2018, the following medications were added to the Southeast Michigan Regional Medication Boxes (SEM Drug Box): Ketamine Ketorolac (Toradol) Push Dose Epinephrine Ondansetron (Zofran) ODT

4 Introduction Purpose This CE will focus on: Ondansetron (Zofran) ODT
Orally Disintegrating Tablet (ODT)

5 Location in the SEM Drug Box
Two 4mg tablets will be stocked in the drug box

6 Location in the SEM Drug Box
Ondansetron ODT will NOT be found in the A-Packs

7 Location in the SEM Drug Box
Freeze dried formulation of ondansetron Disintegrates rapidly on the tongue Water is not utilized or necessary to administer

8 Location in the SEM Drug Box
Shape: plano-convex One side is flat and the other is convex

9 Location in the SEM Drug Box
Imprint: The tablets will have a “Z4” imprint Stands for Zofran 4mg

10 Pharmacokinetics and Pharmacodynamics
Class of medication Antiemetic (prevents vomiting) Serotonin receptor antagonist Blocks serotonin from binding with serotonin receptor sites Prevents vomiting impulses from being sent to the brain and suppresses nausea and vomiting

11 Pharmacokinetics and Pharmacodynamics
Mechanism of action Ondansetron (Zofran) ODT is used to prevent and/or alleviate nausea and vomiting that results from a serotonin release

12 Pharmacokinetics and Pharmacodynamics
Route of administration Ondansetron (Zofran) ODT is administered orally, but is not swallowed whole: The tablet is placed on the patient’s tongue The patient is instructed to swallow several times as the tablet rapidly dissolves The saliva transports the dissolved medication to the patient’s GI tract

13 Pharmacokinetics and Pharmacodynamics
Onset and duration of action Ondansetron (Zofran) ODT has a rapid onset. In addition: Peak antiemetic effect is observed between 15 to 30 minutes after onset Duration of action for ondansetron (Zofran) ODT is 4 to 8 hours Effects will remain the entire time the patient is being treated by EMS

14 Pharmacokinetics and Pharmacodynamics
Half-life Approximately 4 hours in the adult patient The body is able to effectively metabolize ondansetron

15 Pharmacokinetics and Pharmacodynamics
Side effects Drowsiness Headache Weakness Dry mouth A rash may occur in 1% of patients Patients receiving ondansetron (Zofran) ODT on a continued basis may report constipation

16 Pharmacokinetics and Pharmacodynamics
Side effects May cause the QT interval to lengthen slightly In rare cases, this can cause cardiac arrhythmias including torsades de pointes

17 Pharmacokinetics and Pharmacodynamics
Side effects Other cardiac side effects (rare): Hypotension Tachycardia Strong consideration should be given to monitor the patient’s heart rhythm before, during and after administration

18 Indications Ondansetron (Zofran) ODT SHOULD be administered in the following situations: Patients ≥40kg (88lbs) complaining of nausea and/or vomiting Patients experiencing nausea after receiving opioid medications for pain management

19 Indications Ondansetron (Zofran) ODT:
It will reduce nausea, prevent future vomiting and enhance patient comfort Do not administer while the patient is actively vomiting

20 Indications Ondansetron (Zofran) ODT: Keep in mind:
Vomiting can lead to serious illness Severe vomiting can lead to dehydration and electrolyte imbalances, if untreated Uncontrolled vomiting can lead to airway compromise Effective management of nausea and vomiting is safe practice for EMS Contaminated vomit increases the risk of exposure

21 Contraindications Ondansetron (Zofran) ODT should NOT be administered in the following situations: Patients that are <40kg Patients actively vomiting in the presence of EMS should receive IV/IM ondansetron (Zofran), instead

22 These types of meds typically end in “tron”
Contraindications Ondansetron (Zofran) ODT should NOT be administered in the following situations: Patients allergic to ondansetron or other serotonin receptor antagonists Examples: Tropisetron Palonsetron Ramosetron These types of meds typically end in “tron”

23 Contraindications Ondansetron (Zofran) ODT should NOT be administered in the following situations: Patients with phenylketonuria (PKU): Inability to metabolize phenylalanine Ondansetron ODT contains phenylalanine Administer IV/IM ondansetron instead

24 Additional information to consider
The following circumstances represent situations that require special attention: Patients with long QT syndrome May be congenital or acquired Ondansetron ODT can increase the risk of arrhythmia and sudden cardiac death Normal QT Interval Long QT Interval

25 Additional information to consider
The following circumstances represent situations that require special attention: If ondansetron (Zofran) ODT is administered put the patient on the EKG monitor if they’re experiencing: Electrolyte imbalances Bradycardia Congestive heart failure Hypomagnesemia Hypokalemia

26 Additional information to consider
The following circumstances represent situations that require special attention: Pregnant patients should avoid the use of ondansetron (Zofran) ODT unless it is clearly needed to safely manage patient care Especially in the first trimester

27 Additional information to consider
The following circumstances represent situations that require special attention: Patients taking apomorphine should avoid the use of ondansetron (Zofran) ODT Medication prescribed to treat Parkinson’s It may cause hypotension and unconsciousness

28 Applicable protocols Nausea & Vomiting (general treatment section)

29 Applicable protocols Nausea & Vomiting (general treatment section)

30 Applicable protocols Nausea & Vomiting (general treatment section)

31 Applicable protocols Nausea & Vomiting Patient must be >40kg
(general treatment section) Patient must be >40kg Administer IM/IV for patient’s <40kg Do not administer ondansetron ODT if the patient is actively vomiting Administer IM/IV instead Repeat doses require online Medical Control approval

32 Applicable protocols Pain Management (procedure section)

33 Applicable protocols Pain Management Patient must be >40kg
(procedure section) Patient must be >40kg Administer IM/IV for patient’s <40kg Do not administer ondansetron ODT if the patient is actively vomiting Administer IM/IV instead A single repeat dose DOES NOT require online medical control approval for this protocol

34 How to administer ondansetron ODT
Remove ondansetron (Zofran) ODT from the SEM Drug Box

35 How to administer ondansetron ODT
Verify the correct medication and dosage Ondansetron ODT Dose: 4mg Imprint: A “Z4” will be imprinted on the tablet

36 How to administer ondansetron ODT
Remove ondansetron (Zofran) ODT from the foil blister pack PEEL THE TAB! DON’T push out the tablet! Assure your gloved hands are dry Moisture will damage the tablet

37 How to administer ondansetron ODT
Place ondansetron (Zofran) ODT on top of the patient’s tongue Explain to the patient that the medication will dissolve within seconds Instruct the patient not to chew or swallow the medication whole while it is dissolving

38 How to administer ondansetron ODT
Instruct the patient to swallow their saliva Instruct the patient to swallow their saliva several times This will ensure the medication enters the GI tract, as intended

39 How to administer ondansetron ODT
Monitor the patient Monitor the patient for the desired effect The medication will have peak effect within minutes

40 How to administer ondansetron ODT
Monitor the patient If the patient is still experiencing nausea and/or vomiting after minutes: Nausea/Vomiting Protocol administer a second dose after obtaining approval from online Medical Control Pain Management Procedure Administer a second dose without online Medical Control

41 Medication Section 9 Every medication available in the SEM Drug Box and A-Pack is now detailed in “Section 9 Medications” of the State of Michigan EMS Protocols Click here to access the digital version of Section 9

42 Medication Section 9 Ondansetron 9-29 Applicable Protocols Indications
Contraindications Dosing: Adult Pediatrics Expected Effects Side Effects

43 Medication In-Service:
Michigan EMS Medication In-Service: Ondansetron (Zofran) ODT Thank you for utilizing this Instructor Resource Guide in preparation for delivery of continuing education. This course is intended to serve as an introduction and overview of the new protocols. LSAs will need to facilitate further education to ensure their providers are informed of changes to specific protocols. Questions???

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