1. Chapter 16
General Pharmacology

2. Drugs are chemicals used to diagnose, treat, and prevent disease.

3. Medication Forms Used by the EMT-Basic
Compressed powders or tablets (e.g., nitroglycerin)
Liquids for injection (e.g., epinephrine)
Gels (e.g., glucose)
Suspensions (e.g., activated charcoal)
Fine powder for inhalation
Gases (e.g., oxygen)
Aerosol or spray (e.g., nitroglycerin)

4. Names of Drugs Chemical Generic Official Brand
States its chemical composition and molecular structure
Generic
Usually suggested by the manufacturer
Official
As listed in the U.S. Pharmacopeia
Brand
The trade or proprietary name

5. Medication Names Generic Trade Name listed in the U.S. Pharmacopoeia
Name assigned to drug before it becomes officially listed
Usually a simple form of the chemical name
Trade
Brand name manufacturer uses in marketing the drug

6. Medication Terms Indications Contraindications
Most common uses of the drug
Contraindications
Situations in which a drug should not be used
May cause harm to the patient
May have no effect in improving the patient's condition

7. Medication Terms Dose Administration Actions
How much of the drug should be given
Administration
Route by which the medication is administered
Actions
Desired effects a drug has on the patient/body systems

8. Medication Terms Side effects
Actions of a drug other than those desired

9. Dose Metric Conversions
Kilograms Grams Milligrams Micrograms
1 kg 1000 g
1 g mg
1 mg g

10. Dose Metric Conversions
Liters Milliliters
1 L mL
0.5 L mL
0.1 L mL
0.01 L mL
0.001 L mL
1000 mL
1 L

12. Legal
Knowing and obeying the laws and regulations governing medications and their administration is an important part of an EMT’s career.
These include federal, state, and agency regulations.

13. Federal Pure Food & Drug Act of 1906 Harrison Narcotic Act of 1914
Federal Food, Drug, & Cosmetic Act of 1938
Comprehensive Drug Abuse Prevention & Control Act of 1970

14. State vs. Local Standards
They vary widely.
Always consult local protocols and with medical direction for guidance in securing and distributing controlled substances.

15. New Drug Development

17. Components of a Drug Profile
Name
Generic, trade
Classification
Mechanism of Action
Indications
Pharmacokinetics
Side Effects/adverse reactions
Routes of Administration
Contraindications
Dosage
How Supplied
Special Considerations

18. Providing Patient Care Using Medications
Have current medication references available.
Take careful drug histories including:
Name, strength, dose of prescribed medications
Over-the-counter drugs
Vitamins
Herbal medications
Allergies

19. Providing Patient Care Using Medications
Evaluate the patient’s compliance, dosage, and adverse reactions.
Consult with medical direction as needed.

20. Seven “Rights” of Medication Administration
Right medication
Right dosage
Right time
Right route
Right patient
Right documentation
Right to refuse

21. De-Mystifying Pharmacology
Drugs do not do anything new.
They can only alter functions that are already occurring in the body.
Replace a function, enhance a function or interrupt a function
Drugs will always leave residual effects.
Even selective-site drugs!
Albuterol and muscle tremors
The next 2 slides are part of the motivation of the lesson. These slides will assist in taking out the fear/unknowns regarding pharmacology. This should also lead to the responsibilities of the EMT-I in drug administration.

22. De-mystifying Pharmacology
Drugs usually have to bind to something before anything can occur.
Antacids bind to receptors in the stomach
Morphine binds to euphoria receptors, nausea and vessel control receptors in the brain

23. Pediatric Considerations
Dosages must be administered based on body weight.
Patient may have difficulty with inhalation.
Consider spacer or extension tubing
Patient may be reluctant to take medication.
Enlist patient/parent cooperation

24. Geriatric Considerations
Patient may take several medications.
Prone to adverse effects, drug interactions, inadvertent overdose
When possible, transport all medications to hospital with patient.
May help hospital staff diagnose and manage patient condition

25. Absorption Rates Oral Subcutaneous Topical Intramuscular Sublingual
Rectal
Endotracheal, Inhalation, IO, IV
Intracardiac
This covers section #13 in Venous Access and Medication Administration as well as section #10 in Pharmacology.

26. Reassessment Strategies
After drug administration, reassess patient for:
Therapeutic effects
Side effects
Noticeable changes in patient condition
Document time of administration
Document times of ongoing assessments
Vital signs
Changes in patient condition
Therapeutic or side effects

28. Cells talk to each other
Three distinct languages
Nervous system
neurotransmitters
Endocrine system
hormones
Immune system
cytokines

29. In disease, all systems are affected
The three systems can’t exist without each other
The actions of one impact the actions of the others
I.e., stress (nervous system) disrupts endocrine system which may respond with glucocorticoid production = suppressed immune response

30. Drug Classifications Drugs are classified 3 different ways:
By body system
By the action of the agents
By the drug’s mechanism of action
#3c in the pharmacology declarative

31. Drug Class Examples Nitroglycerin Indications for nitroglycerin
Body system: “Cardiac drug”
Action of the agent: “Anti-anginal”
Mechanism of action: “Vasodilator”
Indications for nitroglycerin
Cardiac chest pain
Pulmonary edema
Hypertensive crisis
Which drug class best describes this drug?
The purpose for this slide is to expand the student’s thoughts about how they view medications, and that 1 description of the medication in a field guide may not accurately represent it’s effects (and side effects)

32. Medications Carried on the EMS Unit Activated Charcoal
Used for toxic ingestion
Binds to certain poisons
Prevents absorption
Not all brands are the same.
Some bind much more poison.
Consult medical direction about the brand to use

33. Medications Carried on the EMS Unit Oral Glucose
Used for altered mental status, suspected hypoglycemia
Absorbed in the oral mucosa
Provides needed glucose for patient with low blood sugar

34. Medications Carried on the EMS Unit Oxygen
Increases oxygen delivery to blood
Essential treatment for hypoxia and hypoperfusion
% of delivered oxygen (dose) determined by flow rates and delivery device

35. Medications carried on the EMS unit Epinephrine
Used to treat severe allergic reaction
Blocks release of histamine
Increases vascular resistance to maintain blood pressure

36. Epinephrine Absorption
What is the concentration and dosing time for subcutaneous and IV epinephrine?
SQ - 1:1000 with repeat doses every 3-5 minutes
Why is there a need for 2 different concentrations?
Epinephrine is a short-lived drug and will break down quickly
SQ absorption is significantly slower than IV
A higher concentration of the drug will assure that enough of the active drug will still be available after it is absorbed
**Enhancement – this discussion can also expand to include ET administration of epinephrine. Although the concentration here is the same as IV (1:10,000), more of the drug is needed to assure that “just enough” makes it into the circulation. The alveoli have a ton of blood vessels ready to absorb the drug (no need for a higher concentration), but the surface area of the bronchi and bronchioles may not deliver as much to the alveoli as a regular IV dose.

37. Medications carried on the EMS unit Aspirin
Action
Produces analgesia
Reduces inflammation and fever by inhibiting the production of prostoglandins
Decreases platelet aggregation

38. Aspirin For cardiac chest pain Usual dose
81 mg x 3 or 4 (243 – 324 mg) po
chewable

39. New Info! New England Journal of Medicine, 3/05
Men 50 y/o or more (no clinical evidence of coronary disease).
ASA - Risk of MI 44% less
No significant effect on risk of stroke and no effect on mortality from cardiovascular causes
Women 65 y/o or more (no history of cardiovascular disease)
ASA - No significant effect on risk of MI or risk of death from cardiovascular causes
BUT 24% reduction in risk of ischemic stroke and 17% reduction in stroke risk overall

41. Drugs carried on the EMS unit Activated Charcoal
To treat poison ingestion
Acts externally to the surface of the bowel to adsorb toxins from the mucosa
Increases drug diffusion rate from plasma into GI tract for absorption

42. Medications EMT-Basic May Assist Prescribed Inhalers
Used to treat bronchoconstriction
Prescribed by patient’s physician
Administration is approved by medical direction and/or by local protocol.
May be carried in the ambulance in some EMS systems

43. Atrovent (Ipratroprium)
Albuterol
Causes bronchodilation by acting on B-2 receptors (B-agonist)
Atrovent (Ipratroprium)
Causes bronchodilation by inhibiting acetylcholine at receptor sites on bronchial smooth muscle

44. Medications EMT-Basic May Assist Nitroglycerin
Used to treat ischemic chest pain
Dilates vessels to improve circulation through the coronary arteries
Decreases the workload of the heart by dilating peripheral vessels
Administered under the tongue by tablet or spray

45. Nitroglycerin How does the drug come packaged?
As a tablet, spray, ointment, liquid (IV)
Nitroglycerin forms and absorption rates
SL: 1-3 minutes
Ointment/transdermal: 30 minutes
IV: immediate!
Source: Pharmacology for Health Professionals, p.374; E.Salerno, Mosby Publishers
The oral form of the drug is actually isosorbide dinitrate

47. Summary Medications play a critical role in EMS.
Care must be taken to assess patients to identify the need for medication.
Be familiar with the indications, contraindications, and side effects of administered medications.
Always contact medical direction and/or follow local protocols.
Remember the “rights” of medication administration.